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NATIONAL LIBRARY OF MEDICINE
        Bethesda, Maryland
 
 
 
TREATISE
INSANITY
AFFECTING   THE   MIND
BY  JAMES  COWLES  PRICHARD,  M.D.  F.41.S.

        CORRESPONDING MEMBER OF THE INSTITUTE OF FRANCE ;
  MEMBER OF THE ROYAL ACADEMY OF MEDICINE OF PARIS, AND OF THE
               PHILOSOPHICAL SOCIETY OF SIENNA ;
           SENIOR PHYSICIAN TO THE BRISTOL INFIRMARY.
" TJsqueadeo res humanas vis abdita quaedam
 Obterit------
 Quid mirum si se teranant mortalia ssecla !"
               PHILADELPHIA:
HASWELL,  BARRINGTON, AND HASWELL.
                     1837. 
®> 
                        TO

            MONSIEUR  ESQUIROL,
      PHYSICIAN IN CHIEF TO THE ROYAL HOSPITAL OF CHABENTON,
MEMBER OF THE " CONSEIL DE SALTTBRITE," CHEVALIER OF THE LEGION OF HONOR,
                       ETC. ETC.


  Dear Sir,
      Permit me to dedicate to you the result of many
years' observation and study in researches to which you
have devoted a great part of your life—to express, at the
same time, a grateful  sense of your personal kindness to
me, and to pay that  homage  which is  due  to  the most
distinguished writer of his age on the subjects which  I
have endeavoured to investigate.

  May I thus be allowed to  connect with  my work  a
name which will be handed down to posterity as that of
one who, by elucidating  the causes of the most severe of
temporal calamities, and the means of its alleviation, has
deserved the gratitude of mankind.
          I remain,
               Dear Sir,
                    Your obliged and faithful servant,
                           J. C. PRICHARD. 
PREFATORY  OBSERVATIONS.
   Although the subject  of mental  derangement is one to which
 for more than twenty years I have  been led to devote much study
 and reflection, I should probably never have undertaken the work
 now laid before the public, if I had not been requested to contribute
 to  the  Cyclopaedia of Practical Medicine.   While  employed  in
 preparing for that compilation an  article  on  Insanity, and some
 others more  or  less  connected with it, I  became more fully con-
 vinced than I had before been, that, although many excellent trea-
 tises exist on various matters connected with mental  derangement
 in the English, French, and German languages, there is yet not one
 work extant in either of them which exhibits the present state of
 knowledge and opinion on the  whole subject of  diseases  affecting
 the mind.  To supply this  want was  found not to be within the
 limits which propriety seemed to mark out for an  article in the
 Cyclopaedia, but  having become fully interested in the undertaking,
 I felt desirous, after the publication of  my papers in  that work,  of
 finishing what I had begun, and  of drawing up, in  a deliberate
 manner and with unconfined space, a more complete treatise on the
 same subject.  In  this design  I was  greatly encouraged  by the
 spontaneous and  kind advice of some of my friends, and  particu-
 larly by that of Dr. Tweedie, one of the editors of the Cyclopaedia.
 The task was further recommended to me by the opportunity which
 it offered of stating in a more convincing manner my opinions on
 some important questions connected  with the nature  of Insanity,
 with respect to which  I believe the notions generally prevalent, and
 sanctioned by the highest medical and legal authorities in this coun-
 try, to be not only erroneous, but the sources of great practical evils.
 On this subject I have no need to explain myself  at present more
 fully than by referring my readers to the first and second  sections
of the second chapter, and  to the  third and following  sections of
the eleventh chapter, in the  following treatise. 
ANALYSIS OF  THE  CONTENTS.
              INTRODUCTORY CHAPTER—I.

PRELIMINARY REMARKS ON THE DEFINITION OF INSANITY : NOSOGRAPHY
            OF THE DISEASE AND OF ITS VARIOUS FORMS.

Difficulty of the definition.   Method attempted by Heinroth, Fodere,
  Georget, Guislain, Broussais, and Jacobi, 13.
Nosography, including  description  of the various forms of madness.
  Limited notion of Locke and Cullen, 14.
Different forms of insanity.  Partial Insanity, or Monomania, Raving
  Madness or Mania,  and  Incoherence,  included under  Intellectual
  Insanity, or derangement of the understanding,  15.
Moral Insanity, 16.
      Moral insanity imperfectly described by nosologists.
      Pinel's  description.
      His examples not sufficiently characteristic.
Nosography of the four forms of insanity, 16.
      1.  Moral insanity.
      2.  Monomania,  or partial derangement of the understanding.
      3.  Mania or raving madness.
      4.  Incoherence or dementia.
General nosography of insanity, including a description of the  four
  forms.
                 Notes on the preceding Chapter.
Professor  Heinroth's  distribution of the forms of insanity.
      ,Three departments of mental disorder distinguished by Hein-
         roth.  Insanity of the affection (des gemiiths)—of the under-
         standing—and of the will  or voluntary powers, 18.
      Reasons for preferring the arrangement before adopted, 19.

                        CHAPTER II.

 PHENOMENA OF INSANITY DESCRIBED AS THEY ARE MANIFESTED IN THE
                DIFFERENT FORMS OF THE DISEASE.

Sect. I.—Moral insanity.
 ' Description of moral insanity.
         State of the temper and affections, 21.
         State of the understanding, 21.
         Examples given by M. Pinel, 22.
                                1* 
6
ANALYSIS OF THE CONTENTS.
         Remarks on this disease by M. Esquirol, 22.
         Remarks of M. Georget, 23.
         Varieties of moral insanity, 24.
         Melancholy and dejection,  24.
         Morbid excitement, 25.
         Disorder connected  with religious  feelings, whether of de-
           jection or excitement, 26,
         Malicious propensity—morbid irascibility, 26.
         Eeine Tollheit; insane propensities, 27.
         Destructive propensity, 27.
         Propensity to theft, 28.
         Erotomania, satyriasis, &c, 28.
         Senile insanity, 29.
         Prognosis in moral insanity, 29.
Sect. II.—Monomania or partial insanity of the  understanding.
  Character of this disease ; denominations, 30.
  Monomania and melancholia, 30.
  Common notion erroneous,  31.
  State of the affections in monomania,  31.
  Succession of phenomena in the development of this disease, 32.
  Different forms of monomania.  Demonomania—misanthropical and
    melancholy illusions, 33.
Sect. III.—Cases exemplifying the  description of moral insanity and
              that of monomania, and illustrating the relation between
              these  forms of  disease and  the transition from one to
              another.
  First case of moral  insanity, terminating  in  monomania  and sui-
    cide, 36.
  Second case—of moral insanity degenerating into monomania, 37.
  Third case—of moral insanity, 38.
  Fourth case—of moral insanity with excitement, 41.
  Fifth case—moral insanity displaying eccentricity of conduct, 42.
  Sixth case—of moral insanity degenerating into monomania, 43.
  Seventh case—of moral insanity, 44.
  Communications from several physicians, 45.
  Case of moral insanity, communicated by Dr. Symonds,  45.
  Cases and Commentaries upon them, communicated by Mr.  Hitch,
    47.
Sect, IV.—Mania or raving madness.
  Characteristic of the disease, 61.
  Description of mania, 61.
  State of highest excitement described by Pinel, 63.
  Graphical description by Chiaruggi, 64.
Sect. V.—Of the phenomena of protracted insanity, or of the advanced
           and chronic stage  of the disease.
  Ultimate tendency, 66.
  Opinion of M. Bayle, 67.
  State of chronic disease in maniacs and monomaniacs, 67.
  Observations of M. Calmeil, 68.
Sect. VI.—Of incoherence, or dementia.
  Incoherence, primary and secondary, 69.
  Opinions of Pinel, Esquirol, and Calmeil, 70.
  Essential character of this disease, 71. 
                ANALYSIS OF THE CONTENTS.               7

  Description by Esquirol, 72.
  Several degrees of incoherence, 72.
  First degree of incoherence or dementia.  Impaired memory—stage
    of forgetfulness, 73.
         Cases exemplifying this stage, 74.
  Second degree of incoherence—Loss of the reasoning power, 76.
  Third degree of incoherence—Incomprehension, 78.
  Fourth and last degree of  incoherence—Loss of the  instinctive fa-
    culties—Inappetency, 79.
Sect. VII.—Of general paralysis complicated with insanity.
  Account of this disease first given by M. Esquirol, 80.
  M.  Calmeil's description,  82.
  Paralysis in the first degree, 82.
  Second degree of general paralysis, 82.
  Third degree of general paralysis, 83.
  Accessory diseases complicated with general paralysis, 84.
          1. Congestions in the brain, 84.
         2.  Hemorrhages in the cerebral substance, 84.
         3.  Simple hemorrhages between the laminae of the arach-
            noid, 85.
         4. Ramollissement, 85.
         5.  Erosions of the cerebral surfaces, 85.
  Duration of general paralysis.
  Opinion of M.  Royer Collard and  M. Esquirol as to the ultimate
    prognosis, 85.
  Occurrence of this disease in English lunatic hospitals, 86.
  Modification of paralysis more frequent in England, 88.
Sect. VIII___Observations on the state of the sensorial and intellectual
               functions in  cases of insanity.
  Conditions of the mind and the nervous system in moral insanity, 88.
  Opinion of Broussais, 89.
  State of the mental and sensorial faculties in other varieties of in-
     sanity, 89.
  State of consciousness—Of sensation and perception, 90.
  Observations of Cullen, of Jacobi, Guislain, Esquirol, 91.
  Hallucinations—Hypochondriacal illusions,  91.
   Disturbance of the Understanding—Opinions of La Ronuguiere and
     Guislain, on the judgment and reasoning  power, 92.
  Observations on the influence of the will in intellectual processes, 94.
   Of attention—Opinion of Hoffbauer, 95.
Sect. IX.—Disorders in the state of the physical functions attendant
              upon madness.
  Questions  which is the primary disorder, 96.
   State of the physical functions, 96.
   State in chronic cases, 96.
   State in acute cases,  97.

                         CHAPTER  III.
                OF THE TERMINATIONS  OF INSANITY.
Sect. I.—General remarks on  the duration  and terminations of in-
     sanity. 
8                ANALYSIS OF THE CONTENTS.

  Various periods of duration, 98.
  Three terminations, 98.
Sect. II.—-Of recoveries from insanity, and, first, of  the various cir-
           cumstances which have an influence on their proportional
           number.
  Article 1. Of the complication of insanity with other cerebral dis-
              orders, 99.
            Complication with general paralysis, 99.
            ------    ■ with epilepsy, 99.
         2. Of the forms of the disease—What varieties of madness
             are most curable, 100.
         3. The period of the disease, 100.
            Great probability of cure in the early periods—Fact from
             Willis, Tuke, Pinel, Esquirol—Instances of recovery
             after long duration of insanity—Facts, 101.
         4. Age, 105.
         5. Sex, 106.
         6. Season, 106.
         7. Circumstances of the  constitution, 106.
Sect. III.—Of the proportional number of recoveries which take place
           in insanity generally.
  Report of Dr. Burrows, 107.
  ------of Dr. Maximilian Jacobi, 107.
  Researches of M. Esquirol at Bicetre, the Salpetriere, and at  Cha-
    renton, 108.
  English lunatic asylums, 108.
  Report of Bethlem hospital, 110.
  Of  provincial  hospitals, 111.
  Of  Lancaster County Asylum, 111.
  Of Gloucester County Asylum, 112.
  Of the Retreat near York, 113.
  General Conclusion, 113.
Sect. IV.—Of  the termination of insanity in death.
  Modes by which insanity induces death, 114.
  Mortality in different forms of derangement, 117.
Sect. V.—Of Relapses, and of recurrent insanity.
  Liability to relapses—Proportion in  which madness is  recurrent,
    118.

                        CHAPTER IV.

                  OF  THE  CAUSES OF  INSANITY.
Sect. I.—Nature of the causes of insanity.
  Distribution under different heads, 120.
Sect. II.—Predisposing causes of  insanity.
    Article 1. Of constitutional predisposition, whether hereditary or
                 original, 121.
           2. Of sex:  Facts collected  from various countries as to
                 the different proportions  of lunatics in the two sexes
                 124.
           3. Of age: Facts illustrative of the difference  of  predis-
                 position in different  ages, 126. 
ANALYSIS OF  THE CONTENTS.
9
           4. Of temperament:  Peculiarities of complexion and  of
                 form which are  supposed to denote predisposition to
                 insanity in general, or to  particular forms  of the
                 disease, 129.
            5. Previous attacks of insanity and other diseases  ot  the
                 brain, 130.
            6. Of education, 131.                              .
Sect. III.—Of the productive causes of  insanity—Moral and physical
           causes, 132.
  Opinions of Heinroth, Guislain, Georget,  133.
  Statements of  Pinel, 135.
  Several statements by Esquirol, 137.
Sect. IV.—Of particular moral causes.
     Article 1. Care and anxiety, 139.
            2. Passions and emotions, 140.
              Different proportions of unmarried and married persons
                 —Jacobi's statement,  141.
            3 Apprehensions relating to a future state, 142.
              Of insanity connected  with  religious  impressions-
                 Facts relating  to religious madness, so termed, m
                 general,  143.                               .
               Comparison of Catholics and Protestants in this  re-
                 spect—Statements of  Hallaran, Guislain, and Jaco-
                 bi, 146.                          ■  , .  ,
               Observations by Mr. Tuke on cases of this description
                 and on the causes of  insanity in general, 151.
 Sect. V.—Physical causes of insanity, 153.
             1.  Injuries of the head, 153.
               Singular phenomena reported to  be the remote  conse-
                  quences of  injuries of the head, 153.
            2. Insolations and exposure to heat,  154.
            3. Metastasis,  154.
            4. Intoxicating liquors and other stimulants, 154.
             5.  Sensuality, 155.
             6.  Intestinal irritation, 156.
             7.  Causes depending on states  of the uterine system, 15b.
                Dysmenorrhceal affections, 156.
                Suppressions  of the catamenia, 157.
                Puerperal madness, 157.

                           CHAPTER V.

 RESULTS  OF  NECROSCOPICAL RESEARCHES INTO THE CHANGES OF STRUC-
                  TURE  CONNECTED WITH INSANITY.
 Sect I —Morbid phenomena discovered in the head: Researches of
      " '   Morgagni,  Greding, Haslam,  Pinel, Esquirol, Georget,
            Bavle, Calmeil, Foville.
    Observations of Morgagni, 158.
    ___________of Greding, 158.
    ____________of Haslam, 159.
                 of Georget, 159.
                 of Pinel,  160. 
10              ANALYSIS OF THE CONTENTS.
  Observations of Esquirol, 160.
  -----------of Bayle, 161.
  Abstract of M. CalmeiPs observations, 162.
  Abstract of M. Foville's observations, 164.
Sect. II.—Of morbid appearances in the thoracic viscera.
  1. Diseasesin the lungs, 170.
  2. ------in the heart, 190.
     Observations of Nasse, Romberg, and  Foville,  170.
Sect. III.—Of diseasesin the abdomen discovered incases of insanity.
  Observations of MM. Scipion, Pinel and Esquirol, on disorders of
       the intestinal canal in madness, 172.

                         CHAPTER VI.

         THEORY OR  PATHOLOGY  OF MENTAL DERANGEMENT.
Sect. I—General remarks on opinions maintained by different writers—
         Opinions of Heinroth and others that insanity is a disease of
         the mind properly so termed, 174.
  Jacobi's refutation of the opinion of Professor Heinroth, 176.
Sect. II.—Of the opinions of MM.  Georget, Foville, and others that
         Insanity is an idiopathic disease of the brain, 177.
Sect. HI.—Of the opinion of Pinel, that the cerebral disease is sym-
         pathetic, 178.
Sect. IV.—Survey of the preceding theories, and general conclusions
         as to the nature of insanity, 180.

                        CHAPTER  VII.

                      TREATMENT OF INSANITY.
Sect. I.—Therapeutical treatment of insanity, 185.
     Article 1. First  practical indication in the medical treatment of
                     insanity, 185.
              Of the propriety of bleeding.
              Opinions of Cullen, 186.
                          Pinel, 187.
                          Esquirol, 187.
                          Haslam,  188.
                          Rush, 188.
              Arguments of Foville on this subject, 189.
              Concluding observations, 190.
              Of abstraction of heat from the  head—regulation  of
                     temperature—bathing, 193.
              Of counter-irritation,  194.
              Of purgatives, 195.
              Of emetics, 195.
              Of digitalis, 197.
              Of the use of opium, 197.
              ——■--------hyoscyamus, 199.
              -------------camphor,  199.
              -------------mercury, 200.
              -------------rotatory motion, 200.
            2. Second practical indication in the  medical treatment of
                   insanity, 201. 
ANALYSIS OF THE  CONTENTS.
11
Sect. II.—Moral treatment of insanity, 204.
    Article 1.  Of the propriety of secluding the insane, and separating
                    them from their friends and society, 205.
             Opinions of  MM. Esquirol, Pinel, and others on this
                    subject, and general conclusions, 205.
            2.  Of other means of abstracting lunatics from the morbid
                    impressions and associations which  foster their
                    mental diseases, 213.
            3.  Of the  moral discipline  and  personal control under
                    which lunatics ought to be  placed, 217.
            4.  Of the  treatment of the  understanding of lunatics,  in
                    relation to their illusions and the morbid impres-
                    sions on their minds, 219.
            5.  On the arrangement and management of lunatic asylums,
                    220.

                        CHAPTER Vfll.

                     OF PUERPERAL MADNESS.
 Sect. I. Description and general account of the disease, 222.
 Sect. II.  Terminations of puerperal madness, 224.
 Sect. III. Causes and pathology of puerperal madness, 225.
 Sect. IV.  Treatment of puerperal madness, 227.

                         CHAPTER IX.

               OF IDIOTISM AND  MENTAL  DEFICIENCY.
 Sect. I. General description of idiotism and mental  deficiency, 230.
   Of  cretinism, 230.
   Of  ordinary idiotism, 232.
   Of  imbecility, 234.
 Sect. II.  Causes of idiotism, 235.

                          CHAPTER X.

                      STATISTICS OF INSANITY.
 Sect. I.  Statistical  history of insanity in Britain, 236.
 Sect. II.  Statistical history of insanity in France, 242.
 Sect. HI. Statistics of insanity in other countries:  General observa-
        tions, 246.
   Number and condition of lunatics in Belgium  and Holland, 246.
   In the Prussian states, 247.
   In Norway and other countries in the north, 248.
   In the United States of America, 249.
   In Italy and the South of Europe, 250.
   In  barbarous countries, 250.

                          CHAPTER XI.

       OF UNSOUNDNESS OF  MIND IN RELATION TO JURISPRUDENCE.
 Sect. I.  General observations: Three sources of Unsoundness, 252
   Different course pursued in the English and Roman law, 253. 
12
ANALYSIS OF THE CONTENTS.
 Sect. II. Of mental deficiency in its different modifications and degrees:
       Hoffbauer's stages of silliness and stupidity, 256.
 Sect. III.  Of disorders of the mind considered in relation to jurispru-
       dence, 264.
 Sect. IV.  Of moral insanity, in its relation to criminal and civil law ;
       Observations on the  criterion of insanity according to English
       physicians and lawyers.  Statement of a different opinion, 271.
 Sect. V.  General  observations on homicidal madness, 273.
 Sect. VI.  Continuation of the same subject. Allusion to some remark-
       able cases exemplifying homicidal madness and the character of
       moral insanity, 279.
 Sect. VII. Of suicide, 284.
 Sect. VIII. Of other modifications of moral insanity, 285.

                        CHAPTER XII.

                    OF ECSTATIC AFFECTIONS.
 Sect. I. General account:  Ordinary phenomena, 287.
  Of dreaming and somnambulism, 288.
 Sect. II. Of artificial somnambulism.
  History of animal magnetism, 290.
 Sect. III.  Of the phenomena of animal magnetism, 298.
  Kluge's account  of the six stages of animal magnetism, 299.
 Sect. IV.  Theory of animal magnetism, 303.
  Dr. Stieglitz's account of  the different theories of animal  magnetism,
       305.
 Sect. V. Phenomena of real somnambulism.   Ordinary and cataleptic
       somnambulism, or ecstasis.  Comparison of  the phenomena of
       somnambulism with  those of  the state induced by animal mag-
       netism, 306.
     Article 2. Ecstasis, of  cataleptic somnambulism, 314.
 Sect. VI.  Of maniacal ecstasy, or ecstatic madness, 319.
 Sect. VII. Of ecstatic visions, or traces, 320.
  Remarkable case communicated by Dr. Arnould, 321.
 Sect. VIII. Further observations on the pathology of ecstatic  affec-
      tions, 323.

Supplementary note on peculiar  configurations of the skull connected
      with mental derangement, with observations on the evidence of
      phrenology  and  on opinions respecting the functions of  the
      brain, 325.
  Of the form  of the skull in lunatics, 325.
  Of the form  of the skull in idiots, 326.
  Survey of the doctrine of the phrenologists, 326.
  Later researches  into the functions of the brain, 334.
  Opinions of Dr. Foville, 336. 
A
TREATISE   ON   INSANITY
                   AND


OTHER DISORDERS OF THE MIND.
                INTRODUCTORY CHAPTER.

 PRELIMINARY REMARKS ON THE DEFINITION OF  INSANITY: NO-
      SOGRAPHY OF THE DISEASE: ITS DIFFERENT FORMS.

   Writers on disorders of the mind have frequently remarked that
 it is difficult to furnish a definition  of insanity, which may enable
 us at once to recognise it when it exists, and to distinguish it from all
 other conditions  whether of  health or disease.  So great, indeed,
 has this difficulty appeared to some authors, that by them it has been
 thought better to lay aside such an attempt.  It is, however, requi-
 site, at the commencement of a treatise on any subject of extensive
 relations, that the writer  should make known to his readers in  as
 clear and definite a manner as possible what is the precise nature  of
 the objects to which their attention is to be directed.  On this con-
 sideration I find it to be incumbent upon me to take some notice  of
 the attempts  which have been made to define  or  characterise in-
 sanity ; and if these attempts should be found, on examination, un-
 successful,  to supply the defect if not by a new definition, at least
 by some brief description that  may answer the same purpose.
   It has been said, with perfect accuracy, that insanity is  a disorder
of the system by which the sound and healthy exercise of the men-
tal faculties is impeded or  disturbed.  The definitions adopted by
several modern writers have nearly this meaning, though  expressed
in various terms.* Yet this statement cannot be considered as a

     * See MM. Heinroth, Fodere, Georget, Guislain, Broussais, Jacobi.
  April, 1837.                2 
11
DEFINITIONS OF INSANITY.
 sufficient definition of insanity, for while it probably comprises every
 form of that disorder, it includes also many other morbid affections.
 Among the latter may be mentioned the varieties of delirium which
 occur in phrenitis, typhus, and other febrile and inflammatory dis-
 eases, and which  ought not to be confounded  with  insanity, though
 they are comprehended within the definition above proposed.   On
 this account it becomes necessary to introduce some express  limita-
 tions.  For a similar reason it appears requisite to  exclude the dis-
 ordered state of the mental faculties,  consisting chiefly in  stupor
 and diminished capability of sensation and perception, which accom-
 panies lethargy, apoplexy, and other comatose diseases.   There are
 some other morbid conditions of the brain  and of  the faculties de-
 pendent for their exercise on the functions  of that organ, which
 must in like manner be excluded  by particular restrictions.   Such
 are congenital idiotism and the mental weakness of old age.   Now
 it is obvious that a definition  loses all  its utility, when it is found
 necessary to encumber it  with so  many additional circumstances.
 Thus the endeavour to define  insanity in the most simple and obvi-
 ous terms which suggest themselves, is found to afford no satisfactory
 result, and a like  disappointment has ensued on every similar at-
 tempt.
   It  appears that the practical advantages of a definition can, in this
 instance, only be  attained  by stating what are in reality those dis-
 turbances which the mental operations sustain in cases of insanity.
 These  disturbances, however, present very  different phenomena in
 different forms of the disease, and we cannot attempt to enumerate
 them or describe them in a collective statement, till we have taken
 notice of their principal varieties.
   It has generally been supposed that the chief, if not the sole dis-
 order of persons labouring under insanity consists in some particular
 false  conviction, or in some erroneous  notion  indelibly impressed
 upon the belief.  Mr. Locke made  a remark which has often been
 cited, that " madmen do not appear to have lost the faculty of rea-
 soning ; but having joined  together  some ideas very wrongly, they
 mistake them for truths, and  they err, as men do that argue right
 from  wrong principles."   From Mr. Locke's time  it has been cus-
 tomary to observe that insane  persons  reason  correctly from erro-
 neous premises; and some instance of illusion, or some  particular
 erroneous impression has been looked for as the characteristic of the
 disease, or an essential circumstance  in  it.   Dr.  Cullen  seems to
 have had Mr. Locke's observation in his mind when  he laid  down
 the definition of insanity, which occurs in his ' First Lines.'   He
 describes this disease to be," in a person awake, a false or  mistaken
judgment of those  relations of things which, as occurring most fre-
 quently in life, are those about which the generality of  men form
 the same judgment, and particularly when  the judgment is very
 different from what the person himself had before usually formed."
 Cullen  attempted  to draw even this description  within narrower
 limits, by observing that " there is  generally some false perception 
DIFFERENT FORMS OF INSANITY.
15
of external objects, and that such false perception  necessarily occa-
sions a delirium or erroneous judgment, which is to be considered
as the disease."   That this is by far too  limited an account of in-
sanity, and only comprises one among  various forms of mental
derangement, every person must be aware who has had opportuni-
ties of extensive observation.
   An attentive consideration of the phenomena which present them-
selves in different cases of insanity, enables  us to observe <everal
forms of varieties, which are distinguishable from each other by well-
marked lines.  To one division  of  cases,—namely, to those which
are referrible to the form of madness termed melancholia,  mono-
mania, ov partial insanity,—the preceding remarks of Mr. Locke
and Dr. Cullen are alone applicable.   These are instances in which
the illusion of the understanding is connected with some particular
subject, and leaves the judgment comparatively clear in  other re-
spects.  The phenomena of such cases are very different from those
of mania  or raving madness, in which the  mind is totally de-
ranged, and the individual affected talks nonsense, or expresses him-
self wildly and absurdly on every subject.  There is, in  the third
place,  a class  of persons  generally reckoned  among lunatics, but
consisting chiefly, though not entirely, of  individuals whose disor-
der has already reached an advanced or protracted stage.   In these
the condition of the faculties is such  as to preclude  the possibility
of any mental effort or voluntary direction of thought.  The most
striking characteristics in this state are the rapid succession of ideas,
and the unconnected manner in  which they enter into the mind,
without order or  coherence, or, at least, without following their or-
dinary and natural arrangement and association.   Incoherence is
the characteristic of this morbid  condition.
  The modifications of insanity  already mentioned are affections of
the understanding or rational powers, but there is likewise a form
of mental derangement in which the intellectual faculties appear to
have  sustained little or no injury, while the disorder is manifested
principally or alone, in the  state of the feelings, temper, or  habits.
In cases of this description the moral  and active principles of the
mind are strangely perverted and  depraved ;  the power of  self-
government is lost or greatly impaired; and the individual is found
to be incapable, not of talking or reasoning upon any subject pro-
posed to him, for  this he will often do with great shrewdness and
volubility, but of  conducting himself with decency  and  propriety
in the business of  life.   His wishes and inclinations, his attachments,
his likings and dislikings, have all undergone a  morbid change, and
this change appears to be the originating cause, or to  lie at the
foundation of  any disturbance which  the understanding itself  may
seem to have sustained, and  even in some instances to form through-
out the sole  manifestation of the disease.  The older nosologists,
Sauvages, Sagar,  and Linnaeus, were not  wholly unaware of these
distinctions, for in their distributions of mental disorders, we  find,
besides an order of Vesanide or Hallucinationes, in which errone- 
16
NOSOGRAPHY OF INSANITY.
 ous impressions were supposed to  affect the understanding, another*
 department, styled Morositates, or Morbi Pathetici, consisting of
 depraved appetites and other morbid changes in the feelings and
 propensities.  The disordered states, however, which are classed
 under these heads, are not, all of them at least, strictly (orms of in-
 sanity ; and Pinel appears to have been the first writer  who, with
 a clear  conception of the subject, distinguished a class  of mental
 disorders under the term of " madness without delirium."  Pinel,
 who was an acute and original observer, and whose  opinions carry
 much weight on  account of his  extensive opportunities  of investi-
 gating the history of madness, has made  the  following  remark in
 reference to the  sentiments of Mr. Locke:—" We may justly ad-
 mire," he says, " the writings of this philosopher, without admitting
 his authority upon subjects not necessarily connected  with his  in-
 quiries.  On resuming, at Bicetre, my researches into this disorder,
 I thought, with  the above author, that  it was  inseparable from
 delirium or delusion, and I was not a little  surprised to  find many
 maniacs who at no period gave evidence of any lesion of the under-
 standing,  but who  were  under the dominion of instinctive and
 abstract fury, as if the active faculties alone had sustained injury."
   The examples given by Pinel in illustration of this remark were
 not fortunately chosen, and they are all of one kind, namely, of that
 in which the principal manifestations of insanity were violent fits
 of anger or rage.   The general observation which the author has so
 clearly expressed, that insanity consists, in certain cases, in a morbid
 perversion  of the affections  and moral feelings exclusively, and
 without any perceptible lesion of the intellectual faculties, is a fact
 of the  highest  importance, pathologically and  practically, and the
 opinion  of the author above cited, in this particular, deserves the
 most attentive  consideration.   In the following pages I hope  to
 confirm  this opinion, and to show that the facts which I shall adduce
 are sufficient to authorise a more general statement than  the parti-
 cular instances hitherto related would lead us to adopt.
   If the preceding observations are well founded, we shall be enabled
 to distinguish the principal forms or varieties of insanity  under the
 following terms:—
   1.  Moral Insanity, or madness consisting in a morbid perversion
 of the natural feelings, affections, inclinations, temper, habits, moral
 dispositions, and natural impulses, without any remarkable disorder
 or defect of the intellect or knowing  and reasoning faculties, and
 particularly without any insane illusion or hallucination.
   The three following modifications of the disease may be termed
 Intellectual Insanity in contradistinction to the preceding form.
 They are severally :—
   2. Monomania, or partial  insanity, in which the understanding
 is partially disordered or under the  influence  of some  particular
 illusion, referring to one  subject, and  involving one train of ideas,
 while the intellectual powers appear, when exercised  on other sub-
jects,  to be in a great measure unimpaired. 
NOSOGRAPHY OF INSANITY.
17
  3. Mania,  or raving madness, in which  the  understanding  is
generally deranged  ; the reasoning faculty, if not lost, is confused
and disturbed  in its exercise ;  the  mind  is  in a state of morbid
excitement, and the individual talks  absurdly on every subject  to
which  his thoughts  are momentarily  directed.
  4. Incoherence, or dementia.   By  some persons it may be thought
scarcely correct to term this a form of insanity, as it has been gener-
ally considered as a result and sequel of  that disease.   In some
instances, however,  mental derangement has  nearly this character
from the commencement, or at least assumes  it at a very early
period. I  am therefore justified in  stating it, after Pinel, to be a
fourth  and  distinct  form of madness.  It is thus characterised  by
that justly celebrated writer :—" Rapid succession or uninterrupted
alternation  of  insulated ideas,  and evanescent and  unconnected
emotions ;  continually  repeated acts  of extravagance ;  complete
forgetfulness of  every  previous state ; diminished sensibility  to
external impressions ;  abolition  of the  faculty  of judgment; per-
petual  activity."
  If I am  correet in assuming that all the varieties of  madness may
find their place under one of the descriptions  thus marked out, a
short nosography of the  disease, which will answer  many of the
purposes of a  definition, will  be furnished  by summing up the
characteristics  of the  different forms.   We may,  then,  describe
insanity as a  chronic disease, manifested by deviations from the
healthy and natural state of the mind, such  deviations consisting
either  in a  moral perversion, or a  disorder of the feelings, affec-
tions, and habits of the  individual, or in intellectual derangement,
which last is sometimes  partial, namely, in monomania, affecting
the understanding only in particular trains  of thought; or general,
and accompanied with  excitement,  namely,  in  mania, or raving
madness; or,  lastly, confounding  or destroying the connections
or associations  of ideas, and producing a state of incoherence.
  I shall now endeavour to draw an  accurate and tolerably complete
description of  the  phenomena  of insanity, containing a statement
generalized from a multitude  of   particular  examples.   In this
description, while I avail  myself of the aid afforded by the best
practical writers of different countries, it will be my aim to avoid
the admission of any circumstance  or  feature  of disease  which I
have not in more or fewer instances actually observed.   The reader
will find, if I am not  mistaken in the evidence of facts which I
shall lay before him, enough to confirm and illustrate the preceding
remarks, and to show how far the distinctions laid down  are suffi-
cient and complete.


        NOTES ON THE PRECEDING  CHAPTER.

  The division  of the forms of insanity pointed out  in the prece-
ding chapter is the most simple that  is admissible, or adapted to the
  April, 1837.                3 
18
PROFESSOR HEINROTH'S FORMS OF INSANITY.
existing varieties of the disease ; it is entirely practical, and founded
on observation.  A more extensive arrangement has been laid down
by Professor Heinroth, in his celebrated Treatise  on Derangement
of the Mental Faculties, a work which, though singular and absurd
in some of its fundamental principles, is, perhaps, of all treatises on
disorders  of the  mind,  the  most  elaborate  and  comprehensive.
Heinroth's distribution is rather theoretical or speculative  than the
result of actual observation and experience ;  yet it  will be  found
worthy of consideration.
  The disorders  of the  mind, according to this  writer, are  only
limited in number and in kind by the diversities which exist in the
operations of the mental faculties.  The mental operations are of
three distinct kinds, and are referred on the testimony of conscious-
ness to three different departments in our  inward  nature, viz. to
those of the feeling or sentiment (des gemiifhs), the understanding,
and  the will.   The emotions of joy, grief, pleasure and pain, the
mental processes of reflection and contemplation, and the voluntary
act of self-determination, are three kinds of mental phenomena,
which, as they present themselves to our inward consciousness, are
so clearly and strongly  distinguished from each  other, that it is
impossible to confound them.   " If the cause of derangement is in
relation to one of these manifestations of mental existence—and to
one or another it must belong, since the mind is ever occupied with
phenomena related to one out of the three classes—we have only to
inquire to which  modification the disorder actually refers  itself, or
whether it affects the feelings, the understanding, or the will.  Since
one  of these  has  possession  of our consciousness,  or is  at  least
predominant at every point of time, whichever function of  the mind
happens to be that which is falling into disorder, by it the form of
insanity is determined."  Thus we have, continues Heinroth, three
classes of mental diseases  corresponding to the three departments
of our minds.  A second distinction is founded  on the character of
the disturbance which is experienced ;  whether it is of the nature
of exaltation or depression, of increased or diminished excitement.
   It would be superfluous to follow Herr Heinroth closely through
the particulars  with which  he has filled up the  preceding outline.
It appears, indeed, to me that he has inadvertently lost sight of his
original principle of discrimination, and has confounded essentially
separate forms of mental disorder, for which he had provided dis-
tinct places in his system.   I  shall simply enumerate the  principal
modifications  of derangement of the mind,  or of its diseases and
defects, according to the principles of Heinroth's method.
   First kind of mental disorder.—Disorders of the moral disposi-
tions.
   The first division consists, as above stated, in disorders of passion,
feeling, or affection, of the gemiith, or moral disposition.  This has
two forms.
   First form :—Exaltation or excessive intensity.
                Undue vehemence of feeling.
                Morbid violence of passions  and emotions. 
         PROFESSOR HEINROTH'S FORMS OF INSANITY.       19

  Second form :—Depression.
               Simple melancholy, dejection without  illusion of
                 the understanding.
  Second kind of mental disorders.
  The second division consists of disorders affecting the understand-
ing or the intellectual faculties.
  First form :—Exaltation.
               Undue intensity of the imagination, producing men-
                 tal illusions.
       To  this head belong all the varieties of monomania.
  Second form :—Depression.
               Feebleness of conception ; of ideas.  Imbecility of
                 the understanding.
  Third kind of mental disorders.
  The third division comprises disorders of the voluntary powers,
or of propensities, and of will.
  First form :—Exaltation.
               Violence of will and of propensities.
               Tollheit, or madness without lesion of  the  under-
                 standing.
  Second form :—Depression.
               Weakness or incapacity of willing.
               Moral imbecility.
  To these annexed forms others are added under  each  division,
displaying  combinations of  several simple varieties.  Thus, exalta-
tion of feeling with an exalted state of the  imagination constitutes
derangement of the understanding with violent excitement or raving
madness.  Delusion with depression of feeling or melancholy con-
stitutes insanity with sorrowful dejection. In one of  these divisions
every variety of mental disorder finds its appropriate place.
  No systematic arrangement of mental disorders can be contrived
more complete than that of Professor Heinroth. Although founded
on  abstract views rather  than on observation, it may furnish some
useful suggestions.   Instances of mental derangement really exist
of  which  the  characteristic is  a morbid state of the feelings and
affections.   Nor is there any uncertainty as to the existence of dis-
orders which refer themselves to Heinroth's  third division:  in this
the voluntary powers and propensities  are the department  of our
mental constitution which  betrays the  symptoms of a disordered
state.   Propensities, however, are so nearly allied to passions and
emotions, that they are generally referred to  the  same division of
the faculties or of mental phenomena :  both are included by meta-
physicians in the ethical or moral department of the mind,  as con-
tradistinguished from  the intellectual.   A multiplicity of subdivi-
sions is inconvenient and burdensome, and it appears, on the whole,
better to adhere, in describing mental disorders, to the more simple
classification adopted in  the preceding  section.   In  this, the disor-
ders of affection or feeling, as well as those of the active powers or
propensities, are comprehended under one head, to which the desig- 
20
MORAL INSANITY.
nation of Moral Insanity is given.  If it  were desirable to affix  a
single compound epithet to this class of mental disorders, the most
appropriate would be Parapathia, or, perhaps, Pathomania, in coin-
cidence with the Monomania of M. Esquirol.   The subdivisions of
this department may comprise all the modifications  or  disordered
feeling or affection which belong to the fiist division of Heinroth,
as well as the disorders  of will or propensity, which constitute the
third department  of that writer.  The second division, that of disor-
ders of the intellectual faculties, are, in the arrangement which I have
selected, distributed into general and  partial,  termed Mania and
Monomania, to which Incoherency or Dementia is  added in the
third place : and this division is more in accordance with actual
phenomena than that of exaltation and depression  adopted by Hein-
roth.   On the whole, I do not discover any reason for changing the
distribution  already selected, and which, in fact, I had adopted be-
fore the work of Professor Heinroth came into my hands.  His
scheme is, however, the most complete system  that can  be formed,
and I  have laid the outline of it before my readers, as it may tend
to render more distinct  their  conception of the relations of the dif-
ferent forms of insanity  to each other.
                       CHAPTER II.

PHENOMENA OF INSANITY DESCRIBED AS THEY ARE MANIFESTED
          IN THE DIFFERENT FORMS OF THE DISEASE.

                 Section I.—Moral Insanity.

  This form of mental derangement has been described as consist-
ing in a morbid  perversion of  the  feelings, affections, and active
powers, without any illusion or eroneous conviction impressed upon
the understanding : it sometimes co-exists with an  apparently unim-
paired state  of the intellectual faculties.
  There are many individuals living at large, and not entirely sepa-
rated  from society,  who  are affected in a certain  degree with this
modification of insanity.   They  are reputed persons  of a singular,
wayward, and eccentric character. An attentive observer  will often
recognize something remarkable in their manners and habits, which
may lead him to entertain  doubts  as to their entire sanity ; and
circumstances are sometimes discovered, on inquiry,  which add
strength  to his suspicion.  In many instances it has been found that
an hereditary tendency to madness has existed in the family, or that
several relatives of the person affected have laboured  under other
diseases of the brain.   The  individual himself has been  discovered
to have suffered, in  a former period of life,  an attack of madness of 
MORAL INSANITY.
21
a decided character. His temper and dispositions are found to have
undergone a change ; to be not what they were previously to a cer-
tain time : he has  become an altered man, and the difference has,
perhaps, been noted from  the period when  he sustained some re-
verse of fortune, which deeply affected him, or the loss of some
beloved relative.  In other instances, an alteration in  the  character
of  the individual  has  ensued immediately on some severe shock
which his bodily constitution has undergone.   This has been either
a disorder affecting the head, a slight attack  of paralysis, a fit of
epilepsy,  or some febrile or inflammatory disorder, which has pro-
duced a perceptible change in the habitual state of the constitution.
In some cases the alteration in temper and habits has  been gradual
and imperceptible, and it seems only to  have  consisted in an exalta-
tion and increase of peculiarities, which were always  more  or less
natural and habitual.
   In a state like that above described, many persons have continued
for years to be the  sources of apprehension and solicitude to their
friends and relatives.   The latter, in many instances, cannot bring
themselves to admit the real  nature of the case.   The individual
follows the bent of his  inclinations ; he is continually engaging in
new pursuits, and soon relinquishing them without any other induce-
ment than mere caprice and fickleness.   At length the total perver-
sion of his affections, the dislike, and perhaps even enmity,manifested
towards his dearest friends, excite  greater alarm.  When it happens
that the head of a family labours under  this ambiguous modification
of  insanity, it  is sometimes thought  necessary, from prudential
motives, and to  prevent absolute ruin from  thoughtless and absurd
extravagance,  or from the results of wild projects and speculations,
in the pursuit of which the individual has always a  plausible reason
to offer for his conduct, to  make some attempt with a  view  to take
the management of his  affairs out of his  hands.  The laws have
made inadequate provision  for such contingencies, and the endeavor
is often unsuccessful.   If the  matter is  brought before  a  jury, and
the individual gives pertinent replies to the  questions that  are put
to him, and displays no particular  mental illusion,—a  feature which
is commonly looked upon as essential to madness,—it is most prob-
able that the suit will be rejected.
   Persons labouring  under this disorder are capable of  reasoning
or supporting  an argument upon any subject  within their  sphere of
knowledge that  may be presented to them ; and they often display
great ingenuity in giving reasons for  the  eccentricities of their
conduct, and in  accounting for  and justifying the state  of moral
feeling under which they appear to exist.   In one sense, indeed,
their  intellectual faculties may be termed unsound ;  they think and
act under the influence of strongly excited  feelings, and persons
accounted sane are, under such circumstances, proverbially liable to
error both  in judgment and conduct.
   I have already had occasion to observe that the existence of moral
insanity as a distinct form  of derangement has been recognized by
                               3* 
22
MORAL INSANITY.
Pinel ; the following example recorded by that writer is a charac-
teristic one.  Pinel terms  this affection " emportement maniaque
sans delire."*
  " An only son of a weak and indulgent mother gave himself up
habitually to the gratification of every caprice and passion of which
aji untutored and violent temper was susceptible.   The impetuosity
of his disposition  increased  with  his years.  The money with
which he was lavishly  supplied removed every obstacle to the
indulgence of his wild  desires.   Every instance  of opposition or
resistance roused  him to acts of fury.   He assaulted his adversary
with  the audacity of a savage; sought to reign by  force, and was
perpetually embroiled in disputes and quarrels.  If a dog, a horse,
or any other animal offended him, he instantly put it to death.   If
ever he went to a fete or any  other public meeting,  he was sure to
excite such tumults and quarrels  as terminated in actual pugilistic
rencontres, and he generally  left the scene with a bloody  nose.
This wayward youth, however, when unmoved by passion, posses-
sed  a perfectly sound  judgment.  When he became  of age, he
succeeded to the possession of an extensive  domain.  He proved
himself fully competent to the management of his estate, as well as
the discharge of his relative duties, and he ever distinguished himself
by  acts of  beneficence and  compassion.  Wounds, lawsuits, and
pecuniary compensations,  were generally the consequences of his
unhappy  propensity to quarrel.  But an act of notoriety put an end
to his career  of violence.   Enraged with a woman  who had used
offensive language  to him, he  threw her into a well.   Prosecution
was  commenced against him  ; and on the deposition  of a  great
many witnesses, who  gave evidence to his furious deportment, he
was condemned to perpetual confinement in Bicetre."
  Several other practical writers  have given a testimony which is
sufficiently conclusive as to the existence of moral insanity, though
they have not designedly  and in  set  terms marked  it as a distinct
form of mental derangement.
  The following remarks by M. Esquirol, expressed as they appear
to have been  without the design of supporting any system or theory,
prove that the writer was led by his ample experience to adopt an
opinion similar to that of Pinel.   He regards at least the perverted
state of the  moral feelings as not less  essential to insanity than that
of the intellectual faculties, and even as furnishing in some instances
the whole manifestation of the disorder.
  " The insane conceive an aversion for those persons who are most
dear to them, revile them, ill-treat  them,  anxiously  shun  them, in
consequence  of their mistrust, their  suspicions,  and their fears.
Prejudiced against every thing, they are afraid of every thing.  A
few appear to form an exception to  this general rule, in preserving
a sort of  affection for their relatives  and friends ; but this feeling
of attachment,  which is sometimes excessive, subsists without confi-

  * Traite Medico-Philosophique surl'alienation mentale: 2de  edit. Paris, 1809,
p. 156. 
MORAL INSANITY.
23
dence in those persons who before the attack of disease had been
the directors of the thoughts and actions of the patient.   A melan-
cholic, who is devotedly attached to his wife, is deaf to her counsels
and advice.  A son would sacrifice his life for his father, but will
not make the slightest attempt, in  compliance with the  entreaties
of the latter, to overcome the morbid impressions which occasions
him so much grief.
  "This moral alienation is so constant," says M. Esquirol, " that
it appears to me to be the proper characteristics of mental derange-
ment.   There are madmen in  whom it is difficult to discover any
trace of hallucination, but there are none in whom the passions and
moral affections are not disordered, perverted, or destroyed.  1 have
in this particular met with no exceptions."
  " A return to the proper and natural state of the moral affections,"
says the same writer, " the desire of  seeing once more children or
friends;  the  tears of  sensibility ;  the  wish manifested  by the
individual to open his heart and return into the bosom of his family,
to resume his former  habits, afford  a certain indication of  cure,
while the contrary dispositions had been  a mark of approaching
insanity, or the symptom of  a  threatened  relapse.  This  is  not the
case when there is  merely  a  disappearance  of  the hallucination,
which then only is a certain sign of convalescence, when the patients
return to  their natural  and original  affections."*
  I shall  have  occasion in the  sequel to  cite the opinion  of this
excellent  observer, expressed in still stronger  terms as  to the exis-
tence of  a form of mental  derangement,  which comes under the
definition of moral insanity.
  M. Georget has described a morbid  state  of  the  feelings and
active principles of the mind, or of the  propensities and habits, as
a particular modification of madness.   He observes " that individ-
uals predisposed to  mental  disease by  a faulty  education or by
previous attacks, have  often continued for a long time, or perhaps
even during their whole lives,  to attract observation by caprices in
their deportment, by something eccentric in their manner and habits
of life,  by an ill-regulated fondness for pursuits  of  the fancy, and
the mere  productions of the imagination, combined with  a striking
inaptitude in the study of the exact sciences."  The last-mentioned
particular will scarcely be sufficient to excite a  suspicion of madness
in this  country, whatever may be the  case  in  France.   "These
persons are noted," continues the same writer, " for singularity of
opinions,  of conduct, for transitory fits of  intelligence, or sallies of
wit, which are too strongly  contrasted with their habitual  state of
nullity  or monotony ;  for a levity in thoughts, a weakness in  judg-
ment, a want of connexion in  their attempts  at  reasoning.    Some
individuals are presumptuous, desirous of  undertaking every thing,
and  capable of applying themselves to nothing; others  are extrava-
gant and mobile in the utmost degree intheiropinions and sentiments;
* Esquirol, Diet, des Sc. Med. torn. xvi. 
24
MORAL INSANITY.
many are susceptible, irritable,  choleric, and passionate ; some are
governed by pride  and haughtiness without bound ; a  few  are
subject to vague anxieties or to panic terrors.
   It must be remarked that, although M. Georget has described this
state of disease as a first stage, or as what he terms, with M. Esqui-
rol, the incubation of madness, yet as he says that it often lasts
through the life of  the individual, we may consider his testimony
as given, in point of fact, in favour of the real existence of the dis-
order here described, as a particular modification of insanity.  There
are,  indeed, numerous instances in which phenomena, similar to
those of the previous  stage, last for many years, perhaps to the end
of life ; sometimes maintaining their  ambiguous and undefined char-
acter, in others becoming aggravated in degree, but without under-
going a transition into that form of madness which is attended with
illusions and strongly-marked disturbances of the intellectual facul-
ties.
   The term which  I have adopted as designating this disease, must
not be limited  in its  use to cases which are characterised merely
by preternatural excitement of the temper and spirits.   There  are
many other disordered states of the  mind which  come under the
same general division.   In fact, the varieties of moral  insanity  are
perhaps as numerous  as the modifications of feeling or passion in
the human mind.   The most frequent forms, however, of the dis-
ease are those which are  characterised either by the kind of excite-
ment already described,  or by  the  opposite  state  of  melancholy
dejection.   One of  these  is, in many instances, a permanent state;
but there are cases in  which they alternate or supersede each other ;
one morbid condition often lasting for a time, and giving way, with-
out any perceptible cause, to an opposite  state of the temper and
feelings.   The  prevalent character  of the disorder  is sometimes
derived from the constitutional disposition of the  individual; but
there are instances in  which it is strikingly different from his natu-
ral temperament: lively  and cheerful persons become dejected and
melancholy, while the gloom)' and taciturn change their disposition
for one that is sanguine and excitable.
  A considerable proportion among  the most striking instances of
moral insanity are those in which a  tendency to gloom or sorrow is
the predominant feature.   When this habitude of mind is natural
to the individual and comparatively slight, it does not constitute
madness ; and it is  perhaps impossible to determine the line which
marks a transition from predisposition to disease ; but there is a de-
gree of this affection which certainly constitutes disease of mind,
and that disease exists without any illusion impressed upon the un-
derstanding.  The faculty of reason is not manifestly impaired, but
a constant feeling of gloom and sadness clouds all the prospects of
life : the individual, though surrounded with all the comforts of ex-
istence, and  even,  exclusively of his disease,  suffering under  no
internal source of disquiet, at peace with himself, with his own con-
science, with his God, yet becomes sorrowful and desponding.  AH 
                       MORAL INSANITY.                    25

things present and future are to his view involved in dreary and
hopeless gloom.   This tendency to morbid sorrow and melancholy,
as it does not destroy the understanding, is often subject to control
when it first arises, and probably receives a peculiar character from
the previous mental state of the individual, from his education, and
his religious or irreligious  character.   Persons of well-regulated
minds, when thus affected, express grief and distress at the inapti-
tude of which  they are conscious to go through the active  duties of
life: frequently they feel a horror of being driven to commit an act
of suicide or some other dreadful crime.   This idea  haunts them,
and renders them fearful of being a moment alone.   It, however,
subsides, and such cases often terminate in recovery.   Persons of
an opposite character  give themselves up to  taedium vitas, to mo-
rose disgust; they loathe their very existence, and at length, unless
prevented, put an end to it.
  A state of gloom and melancholy depression occasionally gives
way after an uncertain period to  an opposite  condition of preter-
natural excitement: in other cases this last is the primary character
of the disease.  Individuals  thus affected are always in high spirits,
active and  boisterous, full of projects and enterprises.   Such a habit
of mind within a certain degree is natural to many persons ; but in
those instances which form cases of moral insanity, it is beyond the
limit that belongs  to  natural variety of character, and has besides
peculiar features.  In some  cases it appears in  persons whose tem-
perament is the  very reverse of the state described ;  and  in such
examples it is  so  much the  more  striking.  In this form of moral
derangement the disordered condition of the  mind displays itself
in a want of self-government, in  continual excitement, an  unusual
expression of  strong feelings, in thoughtless and extravagant con-
duct.  A female modest and circumspect becomes violent and ab-
rupt in her manners,  loquacious,  impetuous, talks loudly and abu-
sively against  her  relations and guardians, before perfect strangers.
Sometimes she uses indecent expressions, and  betrays without re-
serve unbecoming feelings and trains of thought.   Not unfrequently
persons affected with this form of disease become drunkards; they
have an incontrollable desire for intoxicating liquors, and a debauch
is followed by a period of raving madness, during which it becomes
absolutely  necessary to keep them in confinement. Individuals are
occasionally seen in lunatic asylums who under such circumstances
have been  placed under control.   After  the raving fit has passed
off, they demand their release ; and when they obtain it, at the first
opportunity resort to their former excesses, though perfectly aware
of the consequences which await them.
   In examples of a different description the  mental excitement
which constitutes this disease is connected with religious feelings,
and this is often the case when the  period of excitement has been
preceded by one of melancholy, during  which the  individual affect-
ed has laboured under  depression and  gloom,  mixed with appre- 
26
MORAL INSANITY.
hensions as to his religious state.   A person who has long suffered
under a sense of condemnation and  abandonment, when all the
springs of hope and comfort have appeared to be dried  up, and no-
thing has been for a long time felt to mitigate the gloom and sorrow
of the present time and the dark and fearful anticipations of futurity,
has passed all at once  from one extreme to another: his feelings
have  become of a sudden entirely changed ; he has a sense  of lively
joy in contemplating the designs of Providence towards him, amount-
ing sometimes to rapture and ecstacy.   Such  a change has been
hailed by the relatives of the individual  thus affected, when they
have happened to be pious and devout  persons,  as  a happy transi-
tion from a state of religious destitution to one of acceptance  and
mental  peace;  but the strain of excitement is too high, the expres-
sions of happiness too  ecstatic to be long mistaken : signs  of pride
and haughtiness are betrayed, and of a wild and boisterous deport-
ment, which are quite unlike the effects of a religious influence,
and soon unfold the real nature of the case ; or it is clearly displayed
by the selfishness, the  want of natural  affection, the variableness of
spirits, the irregular mental habits of the individual.  In  the cases
to which I have now referred, there has been no erroneous fact im-
pressed upon the understanding; no illusion or belief of a particular
message or sentence of condemnation or acceptance specifically re-
vealed : a disorder so characterised would not fall under the head of
moral insanity.   The morbid phenomena in the  cases of disease
which I am now attempting to describe extend  only to the state of
the feelings and spirits, the temper, the preternaturally excited sen-
timents of hope and fear, and the results  which these influences are
calculated to produce in the mental constitution.
   Besides  the more  usual aspects of moral  insanity which  refer
themselves to  morbid depression  and excitement, particular cases
are marked by the prevalence of certain  passions and mental habits
when displayed under modifications of which the human mind in a
sane state appears scarcely to be susceptible.
   One of the most  striking of these forms  is distinguished  by an
unusual prevalence of angry  and malicious feelings, which arise
without provocation or any of the ordinary  incitements.  All the
examples of madness without delirium reported by Pinel belong to
this class of disorders.  On this account the cases described by Pinel
failed for a  long time  to produce conviction on my mind, as  to the
existence of what he terms manie sans dilire, or folie raisonnante.
I am  now persuaded that he was correct in his opinion, and I have
even been led to generalise his treatment.  M. Esquirol has assured
me that his impression on this subject was similar.   He considered
Pinel's cases as inconclusive, and for a time was disposed to  enter-
tain strong doubts  as to the existence of insanity without  intellec-
tual error or delusion.  M. Esquirol has expressed his conviction of
the reality of this form of mental  derangement.   Medical writers,
as well as other reporters, have generally endeavoured to reconcile 
MORAL INSANITY.
27
these phenomena with the established opinion respecting the nature
of  insanity,  by  assuming,  on conjecture, the existence of some
undetected illusion.  These conjectures  have their  foundation in
attachment to system ; they are not supported by facts.   There are
instances of  insanity in  which the whole disease, or at least the
whole of its manifestations, has consisted in a liability to violent fits
of  anger breaking out without cause, and  leading to  the .danger or
actual  commission of serious  injury to surrounding persons.  The
characteristic feature of this malady is extreme irascibility depend-
ing on a physical morbid cause. There are other instances in which
malignity has a deeper die.  The individual, as if actually possessed
by the demon of evil, is continually indulging enmity and  plotting
mischief, and even murder, against some unfortunate object of his
malice.  When this is connected with the false belief of some per-
sonal injury actually sustained, the case does not fall under the head
of moral insanity. It involves hallucination or erroneous  conviction
of  the understanding ; but when the morbid phenomena include
merely the expressions of intense  malevolence, without ground or
provocation actual or supposed, the case is strictly one of the nature
above described.
   In many instances the impulses or propensities to  which the in-
dividual is subject, rather than  his feelings or habitual temper and
disposition, give the principal or sole manifestations of insanity.
This is the form of  madness to which, when accompanied with ex-
citement, Reil,  Hoffbauer,  and other German writers, who, how-
ever,  have written  since  the observations of  Pinel, have  termed
 reine  tollhiet.  Many instances  are well known in which a sudden
 impulse to commit some  atrocious act has arisen in  the mind of a
 person otherwise apparently sane, and certainly in full possession of
his intellectual powers.  The impulse has often been resisted  by
 reason and voluntary effort;  it has been  confessed with grief and
 alarm to physicians or other persons, who have  been entreated to
 adopt precautions of safety in order to  prevent  some  lamentable
 catastrophe.   In other cases crimes have  been perpetrated without
 any fixed object or  motive, and the punishment of the law has fallen
 upon  the unfortunate victim of disease.
    Some insane persons  display  their  condition by a propensity to
 commit every species of mischief, though devoid of any feeling of
 malevolence.  A case of this description, strongly marked,  was
 lately pointed out to me in the York Lunatic Asylum, by Dr. Wake,
 the able and intelligent physician to  that institution.  The indivi-
 dual is a youth of good  temper, cheerful and active, having no de-
 fect  of  understanding that  could  be  discovered, even  after long
 observation. He is  continually prone to commit every kind of mis-
 chief in his power, and not long ago escaped from his confinement
 and made his way to Bishopthrope Palace, with the design to set jt
 on fire.   Dr. Wake has assured  me that several cases have occurred
 precisely similar to that above related in all  essential  symptoms, 
28
MORAL INSANITY.
during his superintendence of York Asylum, which has continued
eighteen years.*
  A propensity to theft is  often  a  feature of moral insanity, and
sometimes it  is  its leading if not the sole characteristic.  I have
lately seen a  lunatic, confined  in an  asylum, who would only eat
when he had stolen food, and his keeper made it a constant practice
to put into some corner within  his  reach various articles destined
for his sustenance, in order that he might discover and take them
furtively.  Many instances are upon record of individuals noted for
a propensity to steal, without the desire of subsequent possession,
though in other respects of sound mind, or at  least not generally
looked upon as deranged.  Probably some of these would afford,
if accurately scrutinized, examples  of  moral insanity, while others
might be found  referrible to eccentricity of character.   The dis-
crimination—if indeed  the two  things  are  essentially different—
could only be made in particular instances by taking into the account
a variety of circumstances, such as the hereditary history of the in-
dividual  and his consanguinity with persons decidedly insane, his
former character and habits, and the inquiry whether he has under-
gone a change in these respects at some particular period of his life.
   Eccentricity of conduct, singular and absurd habits, a propensity
to perform the common actions of life in a different way from that
usually practised, is a feature in many cases of moral insanity, but
can hardly be said to constitute sufficient evidence of its existence.
When, however, such phenomena are observed in connexion with a
wayward and  intractable temper, with a decay of  social  affections,
an aversion to the nearest relatives and friends formerly beloved,—
in  short, with a change in the moral character of the individual, the
case becomes tolerably well marked. With some of the traits above
described, it happens not unfrequently that extreme penury is com-
 bined, and  the aggregate of peculiarities makes  up a  character
which is generally the laughing-stock of the neighbourhood or of
the whole circle of  acquaintance by which the individual is sur-
rounded.
   A variety of instances are mentioned by systematical writers in
 which the unusual intensity  of particular passions or emotions has
 been thought to constitute mental disease, and a series of compound
 epithets  has been invented  for the purpose of affording  names to
 such states of the mind and its affections. Nostalgia and erotomania
 have  been  considered as  disorders  of sentiment; satyriasis  and

   * Dr. Joseph Frank saw, at Bedlam, a child  ten years of age, who was con-
 stantly under the influence of an irresistible impulse to break and destroy every
 thing that came in his way.  This child appeared in other respects as reasonable
 as one could desire; he even seldom failed to demand, of his own accord, the
 punishment allotted to  the mischief which  he had committed.  M. Guislain,
 Traite sur l'Alienation, torn. i. p. 217.  Some other cases of moral insanity
 occurring in children will be mentioned in the sequel. See chap.iv. sect. 2.  On
 Predisponent Causes, article Jige. 
MORAL INSANITY.
29
 nymphomania of the physical feelings.  The excessive intensity of
 any passion is disorder in a moral sense ; it may depend physically
 on certain states of the constitution ;  but this does not so  clearly
 constitute madness as the irregular and perverted  manifestation of
 desires and aversions.   There is reason to believe that this species
 of insanity has been  the real source of moral phenomena of an
 anomalous and unusual kind, and  of certain perversions of natural
 inclination which excite the greatest disgust and abhorrence.
   Facts have  occurred within my knowledge which afford proof
 and illustration of this remark.  A young man, previously of most
 respectable character, became subject to severe epileptic fits, which
 were the prelude to attacks of violent mania, lasting, as it generally
 happens in this form  of the disease, but a few days,  and recurring
 at uncertain intervals.   These complaints  after a time disappeared
 in a great measure, but they left the individual excessively irritable
 in temper, irascible, and impetuous, liable to sudden bursts of anger
 or  rage,  during which he became dangerous to persons who were
 near to him.  Of symptoms of this description, a state approximat-
 ing to the satyriasis of medical writers is no unusual accompaniment,
 but in the present instance the diseased propensities of the indivi-
 dual were displayed in such a manner as to render confinement in a
 lunatic asylum the only preservative against criminal accusations.
   A form of mental derangement has been described by some writers
 which is peculiar to old age.   It is not of frequent occurrence, butcer-
 tainlyexistsasaparticularmodificationof madness.  Ithasbeen termed
 delirium senile, but more properly by Dr. Burrows, who  has accu-
 rately distinguished it, senile insanity.   It constitutes a variety of
 moral insanity.
   This disordered state makes its  appearance in old men who have
 never before  been  insane or suspected of any tendency to  mental
 derangement.   It consists, like other forms of moral  insanity, in a
 morbid excitement of passions and a remarkable perversion of the
 temper and propensities.  The whole moral character of the person
 is changed.   " The pious," says  Dr. Burrows, " become  impious,
 the content and h.ippy discontented and miserable, the prudent and
 economical imprudent and ridiculously profuse, the liberal penurious,
 the sober drunken."  In some elderly persons impulses which  had
 long been effete become of a sudden excited, and a strong tendency
 to vicious habits is displayed.  " In fact the reverence which age
 and the conduct suited to it always command,  is converted into
 shame and pity at the perversion of those moral and social qualities
 which, perhaps, have hitherto adorned the patient's declining days."
 This description coincides accurately with the character  of moral
 insanity.   There are  instances, though rare, of the appearance of
 hallucinative madness  in old  persons, but the case we have now
described is of a different character, and consists in a disordered
condition of the moral or active powers alone.
  The prognosis in cases of moral insanity is often more unfavour-
able than in other forms of mental derangement.   When the disor-
  April, 1837.                4 
30
MONOMANIA.
der is connected with a strong natural predisposition, it can scarcely
be expected to terminate in recovery.  Such we must conclude to
be the case in  those instances in which  the  phenomena bear  the
appearance of an increase  or exaltation of peculiarities natural to
the individual, and noted as remarkable traits in his previous habits.
When,  likewise, this  disease has  supervened on  some  physical
change  in  the constitution, it is likely to be permanent, unless  the
circumstances under which it arose can be reversed ; and for bring-
ing about such  a salutary result, we  have too often to regret that
the art of medicine affords very inadequate resources.  If, however,
this morbid state of the mind has been the effect of any external and
accidental cause, which admits of removal, or if the individual  can
be abstracted from its influence or defended against it, there is reason
to hope that the disorder may gradually subside.   Such recoveries
have  in  fact taken  place within the sphere  of  my own  personal
observation.  But unless the desired change  has been made at an
early  period, the  disease is  likely either to  be  permanent,  or to
terminate in another form of insanity.


Section II.—Of Monomania, or Partial Derangement of  the
                        Understa nding.

   This form of insanity is characterized by some  particular illusion
or erroneous conviction impressed  upon  the understanding, and
giving rise to  a partial  aberration of judgment.   The individual
affected is rendered incapable of thinking correctly  on subjects con-
nected with  the particular  illusion,  while in  other  respects  he
betrays no palpable disorder of mind.
   Melancholia  is the  term by which this species of  insanity was
distinguished by medical writers from the age of  Hippocrates* until
within a few years.  This  expression, as  it was well observed
by M.  Esquirol, suggested  the idea,  not always consistent with
facts, that partial derangement of the  understanding is essentially of
a  gloomy  character, or connected with sadness  and despondency.
The illusions which possess  the  mind  are not constantly, in indi-
viduals partially insane, indicative of grief  or melancholy.   Some
patients of this description are  proud and elated, and  fancy them-
selves kings or emperors,  but on ordinary  subjects are capable of
talking coherently if not rationally ; they  appear to  be happy in
their  delusions.  Others are  insane  upon  some metaphysical  or
abstract  notion, on  which  they talk absurdly,  but without any
predisposition to grief or mental dejection.  Melancholia seemed to
be an improper designation  for cases of  this kind ; and  the  term
monomania, which was happily suggested  by M. Esquirol, has been
universally adopted in  its place.*   The meaning attaehed by former

   * The terra melancholia has, however, only become improper, in modern times;.
for anciently this word, in ordinary language at least, conveyed no idea of  gloom ' 
MONOMANIA.
31
writers to melancholia was, however, precisely the same  as  that
which is  now expressed by monomania.   It is thus laid down in
the most  explicit terms by Van Swieten.   " A mania distinguitur
melancholia, quod  nondum adsit ssevus ille furor, qui in maniacis
observatur.  Prseterea et  illud signum diagnosticum  melancholias
est,  quod  uni  et eidam cogitationi pertinacissime  inhaereant tales
aegri, et fere circa hanc illamve opinionem delirant tantum ;  in  reli-
quis omnibus sanam ostendunt mentem et ssepe accutissimum inge-
nium."
   The  notion, however, which many persons entertain as to the
nature of this disease, is far from being correct in its full extent.  It
is supposed that the mind of the  monomaniac is perfectly sound
when its faculties are exercised on any subject unconnected with a
particular impression, which  in itself constitutes the entire  disease.
Cases are indeed on record, which, if faithfully related, fully come
up to this description.   In general the real character of monomania
is very different.   The individual affected is, under ordinary circum-
stances, calm, and exhibits no  symptom of that  perturbation  and
constant  excitement which are observed  in raving madness.   But
on  careful inquiry  it will be found that his mind is in many
respects  in  a  different condition  from that of perfect health.  The
habits and disposition have, perhaps, been  long, in a greater or less
degree,  in the  state which  characterizes  moral  insanity.   If we
advert to the order and connection of morbid phenomena, we often
learn that on a settled and habitual melancholy, or on a morose and
sullen misanthropy, long  growing  and indulged, or on some other
disordered and perverted  state of the  feelings and affections, a parti-
cular illusion has  more  recently  supervened.  An individual of
melancholic temperament, who has long been under the  influence
 of circumstances calculated to impair his  health and call into play
 the morbid tendencies of his constitution, sustains some unexpected
 misfortune, or is subjected to causes of anxiety ; he becomes dejected
 in spirits, desponds, broods over  his  feelings till all the prospects of
 life appear  to him dark and  comfortless.   His inclinations are now
 so altered  that  no motive has sufficient influence over him to rouse
 him to voluntary and  cheerful  exertion.   During this period, if
 questioned as to the causes of his mental dejection, he will probably
 assign no particular reason for it.   At length his gloom and despon-
 dency becoming more and more  intense, his imagination fixes upon
 some particular  circumstance of a distressing  nature,  and this
 becomes afterwards the focus round which the feelings which harass
 him concentrate themselves.  This circumstance is often some real,

 or dejection.  Melagcholan meant simply to  be mad, to be out of one's  mind.  In
 that sense exactly the word is often used by Aristophanes, without any reference
 to lowness  of spirits; see Plutus, v.  366, 904.  Birds, v.  14.   A distinction,
 however, was made by medical writers, though it was by no means  constantly
 observed.  Hippocrates, speaking of the case of Timocrates, says, " Mairwmenos
 de upo choks melaints epie to pharmakon."  Here mania includes melancholy as a
 particular variety.   (Epidem. 5.) 
32
MONOMANIA.
 occasionally some trifling act of delinquency for which the indivi-
 dual expresses the strongest and perhaps disproportionate self-con-
 demnation.  In other instances an unreal phantom suggests itself, in
 harmony with  the prevalent tone  of the feelings,  which  at  first
 haunts the mind as possible, and is at  length  admitted as reality.
 Other individuals begin by indulging morose and unfriendly senti-
 ments towards all their acquaintance, magnifying'in imagination every
 trifling neglect into a grievous contumely.   They fancy, at length,
 that they find in some casual occurrence glaring proofs of premedi-
 tated designs to  ruin them and  expose them to the contempt  and
 derision of society.   The disease in these cases  has its real com-
 mencement  long before the period  when  the particular  illusion,
 which  is only an accessory symptom, is discovered,'and even before
 it became impressed  on the imagination; but  it is  not until that
 impression has taken place that the case assumes the proper character
 of monomania.
   The illusion which torments the monomaniac is generally some-
 thing bearing a near relation to his former habits of  business, or to
 the usual occupation of his thoughts.  I was consulted some years
 ago on the case of a youth who had become insane,  as  his  friends
 supposed, through unusual excitement and exertion  of  mind.   He
 had been attending the sermons of a preacher noted for the vehe-
 mence of his language, and at the same time had devoted himself to
 studies for which he was unprepared, to the neglect  of sleep  and
 bodily exercise.   He became depressed in spirits, and  disordered
 both in body and mind.   The morbid feelings  which afflicted him
 at length conjured  up for  themselves an  imaginary cause, which
 soon became indelibly impressed upon his belief.  He fancied him-
 self to be suspected of some horrible crime, for  which  a  process
 had commenced  against him ;  and whenever the door of his room
 was opened, he supposed that  officers  of justice  were  coming to
 apprehend him.   This youth was the son of an attorney  in a county
 town, who was frequently employed in criminal prosecutions.
   That  the  order  and succession  of morbid  phenomena  in  the
 development of this disease is really such as I have described it to
 be, I shall prove, in the following section, by the statement of some
 cases in which the actual supervention of  erroneous belief or illusion
 on  a previously  existing moral insanity was clearly marked, and
 admitted of no doubt.*
  Medical writers have distributed  the forms  of monomania into

  * This account of the nature and succession of symptoms in monomania
exactly coincides with the observations of Jacobi.  " Das  verstandesleiden
ent3teht bei diesen Seelenstorungen durchaus nur in Folge des Gemuthsleidens,
wird  durch dasselbe unterhalten, und verschwindet nicht nur mit demselben,
sondern wird auch durch, auf das Gem\ith gerichtete, Einwirkungen gehoben.
Der melancholische  wird nicht durch  diese oder jene  traurige Idee  in seine
Krankheit gesturzt, sondern die Idee entsteht weil er an solcherKrankheit leidet.
Eben so wenig machen  die lacherlichen Absurditaten, in denen sich der Narr
gefallt, diesen zum Narren, sondern er muss sich darin gefallen, weil er an einer
Krankheit leidet die  dieses bedingt." 
MONOMANIA.
33
 many classes or divisions.  The subdivision would be endless if we
 were to constitute as many different kinds as there are modes and
 varieties of  hallucination ;  but the most proper and useful distribu-
 tion is founded on the prevailing passions or feelings  which give
 origin and impart their peculiar character  to the disease.
   Mental dejection or melancholy, which extinguishes  hope and
 gives the mind up to fear and the anticipation of evils, lays the
 foundation for many kinds  or varieties of monomania.   The most
 numerous and the worst instances are those in  which the thoughts
 are directed  towards the evils of a future life.   The unseen state
 opens the most ample scope to the dark and gloomy anticipations of
 melancholy and remorse, and hence it is selected by the desponding
 monomaniac as a  field for the  exercise of  his self-torturing  imagi-
 nation.  If the habits of his mind lead him to fix by preference on
 scenes  connected with  the  present  life,  he  still finds imaginary
 objects of terror and disquietude.   Two centuries ago persons were
 every where to be found  who fancied  themselves  possessed  by
 demons, just as the ancients were pursued and agitated by the furies.
 Daemonomania occupies  an  important place  among the forms  of
 insanity described by the old writers,  and  we are informed  by
 Jacobi that this is still the character which, in some catholic coun-
 tries, insanity connected with superstition frequently assumes.  " In
 modern times," says M. Esquirol, " the  punishments  which the
 priest denounces have ceased to influence the  minds and conduct of
 men, and governments have  recourse to  restraints of a different
 kind.   Many lunatics express now as much dread of the tribunals
 of justice as  they formerly entertained of the influence of stars and
 demons."  " C'est toujours la  pusillanimite, l'inquietude, la crainte
 qui aggissent sur ces infortunes, comme elles 6taient la  cause des
 maladies  des  possedes.   Tel  individu  est  aux  Petites-Maisons,
 parcequ'il craint la police,  qui eut ete  brule autrefois  parcequ'il
 aurait eu peur du diable."
   When fear and apprehension subside into a  confirmed and settled
 despondency, as the latter state of feeling  is less agitating than the
 former, the mind displays more the appearance  of tranquillity, but
 it is a deceitful  calm, concealing  profound grief and  misery.   Of
 this description, however, are some of the most remarkable  cases
 of intellect apparently sound  in  all other respects, but  labouring
 under one delusion, on which,  as on certain data, individuals reason
 correctly and acutely.   Such illusions turn always on some circum-
 stance connected with the person of the lunatic, his treatment  by
 his relatives or by society in this  world, or his destiny  hereafter.
 Many religious persons,  labouring under a predisposition to  grief
 and despondency, have conceived the opinion  that they are doomed
 to future perdition, their own cases forming particular exceptions to
 the otherwise merciful  dispensations of Providence.  A  singular
modification of this result of despondency is related in the striking
case of  Samuel  Brown, who, at a time when  all the powers of his
mind subsisted in full vigour, conceived  that  his rational soul had
                              4* 
34
MONOMANIA.
gradually perished under the displeasure of God, and that an animal
life merely was left to him, in  common with the brutes.
   A great number and  variety of cases coming under the  same
head,  of monomania associated  with fear and  despondency, are
instances in which the apprehensions of the individual are concen-
trated  on his bodily  feelings, or relate to some diseased or  preter-
natural state in which he conceives  himself to exist.   In the first
stage this disease is hypochondriasis ; the patient dwells constantly
on some  trifling  ailments, which  he magnifies in apprehension,
broods over, and on account of  which he makes himself miserable.
In this form hypochondriasis constitutes a variety of moral insan-
ity, and a  hundred  cases  of this  description are to be found for
one  which actually makes  the  transition into  erroneous belief.
When this change has taken place, the disorder is accounted a deci-
ded one of insanity, as when a  man fancies that his head has grown
larger  than his body, that his legs are made of glass, that he has a
wolf or a fish in his stomach.   The absurd ideas which the diseased
imagination frames in order to account for trifling bodily  suffering
are as  numerous as they are strange and surprising.   I well remem-
ber a lunatic who laboured apparently under neuralgic pains.   He
fancied that the physician to whose care  he was  confided had  the
power  of torturing him by electricity, and that invisible wires were
spread through every part  of the house as conductors of the fluid,
which  was used at night  as the  instrument of cruel  and tyrannical
persecution.   Many a flatulent hypochondriac has fancied the exis-
tence of a goblin or  demon in his stomach ; and  the association
between his internal feelings and the idea by which it was accounted
for, has become so firm  that nothing in future has  been capable of
changing it.   A case exemplifying this  remark  is  related by Dr.
Jacobi, which is so curious  that  I have determined to extract it.*
   " A  man, confined in the lunatic asylum at Wiirtzburg, in other
respects rational, of quiet, discreet habits, so that  he was employed
in the  domestic business of the house, laboured under the  impres-
sion that there was a person concealed within his  belly, with whom
he held frequent conversations.   He often perceived the absurdity
of this idea, and grieved in acknowledging and  reflecting that he
was under  the influence  of so  groundless a persuasion, but could
never get rid  of it.  It was very curious to observe," says Jacobi,
" how, when he had but an instant before cried, < What nonsense !
is it not intolerable to be so deluded?' and while the tears which
accompanied  these exclamations  were  yet in  his  eyes he again
began  to talk,  apparently with entire conviction, about the whisper-
ings of the person in his  belly, who told him that he was to marry
a great princess.  An attempt was made to cure this man by putting
a large blister  on  his abdomen, and at the instant when it  was
dressed and the vesicated skin snipped, throwing from behind him
a dressed-up figure, as if just extracted from his body.  The exper-

 • Dr. Max. Jacobi's Sammlungen fur die Heilkunde der Gemuthskrankheiten. 
                          MONOMANIA.                       35

 iment so far succeeded that the patient believed in the performance,
 and his joy was at first boundless in the full persuasion that he was
 cured, but some morbid feeling  about the bowels, which  he had
 associated  with the  insane impression, still continuing, or  being
 again experienced, he took up  the idea that another person similar
 to the first was still left within him, and  under that persuasion he
 continued  to labour."*
   Dejection of spirits combined with malevolent feelings gives rise
 to misanthropical  monomania,  which is a very frequent form of the
 disease.  The individual who labours under it is almost as miserable
 as the melancholic or hypochondriac.   He  fancies himself the object
 of hatred and persecution,  of secret machinations, of plots of all de-
 scriptions, sees enemies in  his dearest friends, suspects poison  in his
 food, and imagines that injuries of every kind are perpetrated or at
 least designed against him.   A case very descriptive of this variety
 of monomania will be related in the next section, in which its super-
 vention or moral insanity is clearly evident.
   Excess  of self-love is an ingredient in every  modification of
 monomania, and when this is combined with an elate and sanguine
 disposition instead of depressed spirits and a morose temper, it pro-
 duces cheerful  illusions, which  always maintain  their relation  to the
 person of  the lunatic.  A  monomaniac fancies himself  a king, the
 pope, a favourite of heaven.   This, however, does not constitute a
 single delusion, leaving the mind  perfectly sane in other respects :
 the same individual magnifies  himself in  other relations.  I saw
 lately a lunatic  at Bicetre  who fancies  himself a monarch.  Per-
 ceiving me, as I suppose, to be  a stranger,  he accosted me with the
 words, " Je parle  toutes les langues."  Most gay and cheerful mo-
 nomaniacs display a degree of  this insane vanity.  A characteristic
 case of the same kind  was given by Bonetus, which Dr. Arnold has
 extracted in his work on insanity.
   I believe that the remarks which I have made on  the varieties of
 partial insanity above mentioned,  and the  mode of  its  origin, will
 be found to apply to every instance of monomania, properly so
 termed.  The illusion is always some notion as  to the powers, pro-
 perty, dignity,  or destination  of  the  individual affected, which is
 engrafted upon his habitual state of desire  or aversion, passion and
 feeling.
  There is another class of illusions, which belong not to insanity,
 but to extasis.   They  constitute,  not a  simple  erronenous  notion,
 impressed  on the belief like the hallucinations of the monomaniac,
 but an entire imaginary scene displayed  to his view  like a series of
 real transactions,  or  a continuous dream.   When  the individual
perseveres  in believing their reality, a species of derangement en-
sues, but it is so peculiar and so unlike any of the ordinary forms

  * Sammlungen  fur dieheilkunde der Gemuthskrankheiten, herausgeg-von Dr.
Max. Jacobi, Elberfeld, 1822,1, b, p. 21. 
36
CASES OF MORAL INSANITY
of madness, as to require a separate consideration under the head of
ecstatic affections, to which I have referred it.
  Before I proceed to describe the remaining forms of mental de-
rangement, I purpose to  lay before my reader the statements of a
few select cases exemplifying the character of  moral  insanity, as
well as  that of monomania, and likewise of some which  tend to
illustrate the connexion between these two forms of disease, and the
transition from  one into the other.
Section III.—Cases  exemplifying the  Description of Moral
  Insanity and that of Monomania, or illustrating the Relation
  between these Forms of Disease, and the Transition from one
  into the other.

  The first case that I shall relate, is one which for some years bore
precisely the character attributed  to moral insanity.  During this
period many of the friends of the individual affected supposed  him
to be only very  eccentric ; while some, who  had opportunities of
observing him closely, were convinced  that he was deranged.  His
disorder at length broke out in a form which admitted of  no doubt,
viz., that of monomania accompanied with great distress of mind,
and it terminated in suicide.   I give the details of this case as I re-
ceived them from an intimate friend of  the individual affected.
  Case 1.—A. B., a gentleman remarkable for the  warmth  of his
affections, and  the amiable simplicity of his character, possessed of
great intellectual capacity, strong powers of reasoning, and a  lively
imagination, married a lady  of high mental endowments, and who
was long well known  in  the literary  world.   He  was devotedly
attached to her, but entertained the greatest jealousy lest the world
should suppose that, in consequence of her talents, she exercised an
undue influence over his  judgment, or dictated  his  compositions.
He  accordingly set out with a determination of never consulting
her, or yielding to her influence, and was always careful, when en-
gaged in writing, that she should be ignorant of  the  subject which
occupied his thoughts.  His wife  has been often heard to lament
that want of sympathy and union of mind which are so desirable in
married life.   This peculiarity, however, in the  husband  so much
increased, that in after  years the most  trifling proposition  on  her
part was canvassed and discussed  by every kind of  argument.  In
the  mean time he acquired strange peculiarities of habits.   His love
of order, or placing things  in what he considered order or regularity,
was remarkable.  He was continually  putting  chairs, &c.  in their
places ; and if articles  of  ladies' work or books were left upon  a
table, he would take an opportunity unobserved of putting them in
order, generally spreading the work smooth, and putting the other
articles in rows.  He would  steal  into  room* belonging  to other
persons for the purpose of arranging the various articles.   So much 
                      AND OF MONOMANIA.                   37

 time did he consume in trifles, placing and replacing, and running
 from one room  to  another, that  he was rarely dressed  by dinner-
 time, and often apologised for dining in his dressing-gown, when it
 was well known that he had done nothing the whole morning  but
 dress.  And he would often take a walk in a winter's evening with
 a lanthorn, because he had not been able to get ready earlier in the
 day.  He would run up and  down the garden a certain number of
 times, rinsing his mouth with water, and spitting alternately on one
 side and then on the  other in regular  succession.   He employed a
 good deal of time in rolling up little pieces of writing-paper which
 he used for cleaning his nose.  In short his peculiarities were innu-
 merable, but he concealed them as much as possible from the obser-
 vation of his wife, whom he  knew to be vexed at his habits, and to
 whom he always behaved with the most respectful and affectionate
 attention, although  she could not influence him in the slightest de-
 gree.  He would, however, occasionally break through these habits ;
 as on Sundays, though he rose early for the purpose, he was always
 ready to perform service at a chapel a mile and a  half distant from
 his house.  It was a mystery to his intimate friends when  and how
 he prepared these services.  It did pot at all suprise  those who
 were best acquainted with his peculiarities, to  hear that in a short
 time he became notoriously insane.   He  fancied  his wife's  affec-
 tions were alienated from  him,  continually affirming that it was
 quite impossible  she  could have any regard for a  person who had
 rendered  hiniself so  contemptible.  He committed several acts of
 violence, argued vehemently in favour of suicide, and was shortly
 afterwards found drowned in a canal near  his house.   It must  not
 be  omitted that this individual derived a predisposition to madness
 by hereditary transmission :  his father had been insane.
   Case 2.—The second  case is one which  had likewise for a con-
 siderable period the character of moral insanity, and degenerated
 into, or assumed that of monomania.  The details which I relate
 are such as I collected from the friends of the  individual, and from
 his own communications.
   C. D., a gentleman about  thirty years of age,  has  laboured  for
 several years under symptoms of moral insanity.  He has been long
 dejected in spirits and morose in temper, dissatisfied with  himself,
 and suspicious of all that surrounded him.  He was capricious and
 unsteady  in his pursuits, frequently engaging in  some  new study
 in the most sanguine  manner, and soon abandoning it in despair of
 making any progress, though possessed of good talents  and consi-
 derable acquirements of knowledge.  He passed the requisite period
 of time at one of the  universities, but could not be prevailed upon
 to go in for his degree, either through timidity and want of resolu-
 tion, or, as it was conjectured by his friends, from a morbid appre-
 hension that  the  examiners would  not deal fairly with him, and
 award him the station to which he aspired and believed himself en-
 titled.   He applied  himself afterwards to  the  study of medicine,
and then to that of metaphysics,  and  speedily relinquished  both. 
38
CASES OF MORAL INSANITY
He frequently changed his residence, but soon began to fancy him-
self the object of dislike to every person in the house of  which he
became the inmate.  His peculiarities appearing to increase, he
was visited by two physicians, who were desired  to investigate the
nature of his case.   On being questioned narrowly as to the ground
of the persuasion  expressed by him, that he was disliked by the
family with which he then resided, he replied that he heard whis-
pers uttered in distant apartments of the house indicative of malevo-
lence and  abhorrence.  An observation was made to him that it was
impossible for sounds so uttered to be heard by him.   He  then
asked if the sense of hearing could  not, by some physical change in
the organ, be  occasionally so increased  in intensity as to become
capable of affording distinct perception at an unusual distance, as
the eyes of mariners are well known to be accommodated by  long
effort to very  distant vision.  This was the only instance of what
might be termed hallucination discovered in the case after a minute
scrutiny.   It seemed  to be a late suggestion.   The individual had
been for years labouring under a gradually increasing moral insanity.
His judgment had become  at length perverted by the intensity of
his morbid feelings, and admitted  as real an erroneous impression,
suggested by his fancy, which happened to be in  harmony with his
feelings, and served to account for them.
   Case 3.—This case was strictly one of moral  insanity for some
years  after its commencement,  and  it maintained that  character
throughout its duration,  except  that at  one period, under  great
excitement, the patient  began to display signs of an approach of
monomania, in the groundless suspicions which she expressed re-
specting the persons who were about her.   These symptoms, how-
ever, continued but for a very short time, and have never recurred.
At the period when this individual came under my observation, her
disorder had precisely the character  of moral insanity.
   E. F-------is a maiden  lady,  aged about  forty-eight, of short
stature, and somewhat deformed.   " Her natural  disposition was
steady and industrious ;  she accomplished her undertakings by dint
of application rather than by energetic or sudden efforts.  She was
constant rather than ardent  in her attachments,  free from resent-
ment, never the subject  of lively emotions ; a great respecter of
truth, just and very exact in all that she said or did.  Her charita-
ble acts were commensurate with her  means, deliberate, and the
result of principle rather than arising  from the mere impulse of
compassionate feeling.  She was cautious and reserved in her  com-
munications, and scarcely if ever formed any familiar and particular
intimacies with young persons of her own sex.  Being debarred by
her  infirmities from associating with  the  young and active, she
seemed more like an adult member of the family  than a child.   She
was very clever in  arithmetic and  in all  matters of business, and
was fond  of regulating and controlling the little affairs of those who
formed the domestic  circle surrounding her.  Young persons and
servants,  finding that they derived advantage  from her advice, 
AND OF MONOMANIA.
39
generally  gave her an  opportunity  of gratifying  her inclination.
Her dress, which was always plain and in good taste, was to her an
object of greater attention than it often is to persons of fashion."
  In March 1822 she was attacked by severe inflammation  in the
lungs, attended by expectoration of bloody mucus. This was the first
time in her life when it was  necessary to confine her to bed.  She
submitted with great reluctance to the restrictions that were need-
ful  for her recovery, and  would  not be persuaded,  until she had
heard the opinion of an old friend of her family, who is a medical
practitioner, that  the means adopted were proper and required  by
her case.  She was then,  however, in a great measure reconciled,
and after seven or eight  weeks was so far recovered as to bear a  re-
moval  into her native county. At this period nobody believed that
she would survive another winter.   Her  restoration  to her usual
state of health was very slow, and her sister, who was her constant
companion, perceived with sorrow that  her  temper was now much
changed.  She appeared restless,  always wishing to go somewhere,
or to do something to which she  was unequal ;  becoming unjustly
irritated when she could  not urge  her sister, whose health and
spirits were declining, to  fall  in  with  her  ideas, and occasionally
giving way to her reproaches which were  keenly  felt.   She tried
every method of persuasion to induce her sister to go to the neigh-
bourhood of London, though for  the preservation  of her life the
latter had been obliged to  give up the custom of spending the win-
ter there, and  the attempt was considered dangerous to her. Every
inducement, every argument was suggested to promote this favourite
object  : other towns were too warm and  too cold, too  hilly,  too
much intersected with water, too foggy.  In 1827 she determined
to go without her sister to H-------, near London.   She went, and
from her letters her sister  perceived that she was living in a state of
excitement far surpassing  that of her former habits ; paying short
visits to her friends  in  the surrounding villages,  going out in  the
common short stages, without so much regard to weather as was usual
to  her even  in the summer ; receiving small  parties at home, at-
tending a very crowded church, writing a great many letters, &c.  &c.
She used  to write to her sister in rather a boastful  style, frequently
mentioning her  good health and high spirits, as if to justify  her
choice of a residence near the metropolis.   When the sisters  met
during the summer  at their  house in----shire, her  high spirits
were gone, she looked more aged than the time elapsed would have
led any one to expect, took less interest in her garden, appeared ex-
hausted, and,  without contributing her share to the conversation,
used frequently to sleep in her chair.  She lay much in bed, nursed
herself up, and in October went  again to H----, as  much agog as
ever.   Another winter passed much as the  preceding one had done.
She spoke much again  of  her high spirits, visited much,  was
observed to be unusually  liberal  in her presents to  most of her ac-
quaintances.  A second  summer of inertness was succeeded by a
winter at H-----.  She was now weak, indisposed for visiting,  and, 
40
CASES OF MORAL INSANITY
in fact so much worse as to be unable to follow her inclinations. In
the spring of 1830 she had an attack of the same nature as that in.
1822, but not so severe or lasting.  In the summer she was nearly
as before, and quite as eager to resume  her plans, as enthusiastic in
her commendations of every body and  every thing at H----.
  About this time some riots took place in London, and more were
apprehended.   She now  expressed  herself as apprehensive  that
" very awful times were at hand," and  wrote frequent letters to her
sister full of indecision, and expressive of distrust in her  servants,
her host and his family. A friend who called upon her " was shocked
to find her  in so low a way."   He thought her unfit to be alone,
and she was unwilling to  adopt any plan for leaving her lodgings,
or having any one with her. She said she should be happy  with her
sister, and knew that she  should be taken care of by the latter, but
dreaded becoming a burden to her and  making her ill ; yet feared   *
that if she  did not go  to her sister, " some one would put her where
no one would know, and cause her to sign papers which she ought   ^
not to sign."  She was evidently apprehensive of being sent  to a
lunatic asylum.   She thought her host  was a writer of " Swing let-
ters,"* and dreaded that he might fill  the house with combustibles
and blow it up with her in it.   A medical man who was  taken to
see her, said that  she was in a state of great mental excitement, and   .
ought to be taken to  her  sister as soon as possible.   The frost was
severe when she was escorted to her sister, who was  then settled at
Bristol, yet she took  no cold,  experienced no injury from fatigue,
and lost that feeling of terror to which she had for some time  been
subject.  Since she has been with her  sister, she has been increas-
ingly obstinate, suspicious, undecided, restless, parsimonious even to
meanness, indisposed  to any employment bodily or mental, except
as far as relates to a most troublesome  interference with the  most
minute actions of others.  Could she have her own way, she would
control  the food, dress, and employment of every  one near her.
She has become negligent in dress, and comparatively dirty in her
habits, yet  has an insatiable desire for new clothes, which she never
finds the right time to wear.  She is constantly predicting  her  utter
ruin,  is sure she will not have  money enough to live until such and
such a time ; knows that enough will not be found to pay Dr.----;
knows he will not let any one of so shabby an appearance be long
in his house ;  does not know where she shall  go when he is tired of
her ; thinks that " it is the devil that makes her behave as she does;"
" that her heart is hardened to do what she ought not to do ;" " she
is like the man spoken of in  the Gospel, who could not be bound
even with fetters."  She sees people look at her ; hopes they do'nt
think she drinks too much ;  is quite sure she never did. These im-
pressions are continually varying ; but no sooner is her mind tran-

  * It may hereafter require to be explained  that, about the period above men-
tioned, the threatening letters of incendiaries in various parts of the country fre-
quently bore  the signature of Swing. 
AND OF MONOMANIA.
41
quilized on one subject than another source of disquietude arises,
so that she exhausts every person who is long with her. Her bodily
health is better than it was for years previous to her mental derange-
ment.  A  constitutional asthma, to which she has been subject from
the age of six or seven  years, has nearly subsided, and the habitual
profuse expectoration  has   considerably diminished.  She wears
less clothing, and appears less sensible to cold  or damp than here-
tofore."
   I had several interviews with the subject of the foregoing rela-
tion, during some of which she gave replies to a variety of questions
referring to the past and actual state of her health, both bodily and
mental.  No impression could be traced in her mind that bore the
character of insane hallucination.  The  circumstances most obser-
vable in her condition was a perpetual disposition to find fault with
every  action, even the  most trivial, that was witnessed  by  her.
When asked if she was  not aware of this propensity, she seemed to
give an unwilling affirmative to the question, and  she was plainly
aware of the fact, for on the inquiry being made whether the habit
had only  existed of  late years, or had  been a part of her natural
character, she steadily averred that such was not her natural dispo-
sition, " that she  was formerly very different."
   Case 4.—This case is one of moral  insanity with high excite-
ment, which never displayed any of the signs of intellectual mad-
ness, and terminated in  recovery.
   G.  H., a farmer, several of whose relatives had been the  subjects
of mental derangement, was a  man of sober  and  domestic habits,
and frugal and steady in his  conduct, until about his forty-fifth year,
when his disposition appeared to have  become suddenly changed,
in a manner which  excited the surprise of his  friends and neigh-
bours, and occasioned grief and vexation in his family.  He became
wild,  excitable, thoughtless, full  of  schemes and  absurd  projects.
He would set out and make  long journeys into distant parts of the
country to purchase cattle and farming-stock, of which he had no
means of  disposing ; he bought a number of carriages, hired an
expensive house  ready  furnished, which had  been inhabited by  a
person much above his  rank, and was unsuitable  to his condition.
The following  incident was related as an instance of his capricious
conduct.  He had expressed a desire to  survey an estate  belonging
to a gentleman in the neighbourhood, with a view of becoming his
tenant, and  had been told  that he  should  be conducted over the
ground whenever  he chose  to call  upon the steward.   The time
which he selected for this purpose was the middle of a dark night.
The steward was awakened, and listened with surprise  and suspi-
cion to the proposal.  He remonstrated  for  some time, but finding
G. H. determined on  his purpose, and pleading a positive  promise
from the landlord of the estate, he at length acquiesced, and accom-
panied the  farmer, with a  lantern,  over  the  fields.   G. H. made
remarks on the  trees which denoted the quality of the soil, the
thickness of the hedges, and the usual signs which distinguish good
  April,  1S37.                5 
42
CASES OF MORAL INSANITY
from sterile land.  He had gone over the estate, and took his leave
just as the morning light began  to dawn.   G. H. was irascible and
impetuous, quarrelled with, his neighbours, and committed an assault
upon  the clergyman of the  parish, for which  he was indicted  and
bound to take his trial.   At length his wife became convinced that
he was mad, and  made  application for his  confinement in a lunatic
asylum,  which  was  consequently effected.   The medical  practi-
tioners who examined him were convinced of his insanity by com-
paring his  late  wild habits and unaccountable conduct with  the
former tenor of his  life, taking  into consideration the tendency to
disease which was known to prevail in his family.   The change in
his character alone had produced a full conviction of his madness in
his friends and relatives.   When  questioned as to the motives
which had  induced  him to  some of his late proceedings, he gave
clear and  distinct replies, and  assigned, with  great ingenuity, some
plausible reason for almost every part of his conduct.   After a period
of time passed in quiet seclusion, his mind became  gradually tran-
quilized ;  the morbid excitement of his temper and  feelings disap-
peared, he was set at liberty, and has since conducted himself with
propriety.
  A brother of the  above -patient  has been at two different times
confined in the same asylum, labouring under symptoms of derange-
ment  in  all essential particulars resembling  those  above detailed.
His disorder has consisted chiefly in  morbid excitement, wildness
and irregularity of  conduct, differing from  his usual habits and
character, without any hallucination or disturbance of the intellec-
tual faculties.  He has, on both occasions,  remained  in the asylum
until he was fully convalescent, and after his departure has ackow-
ledged his conviction that  he had been deranged,  and  in a state
requiring  control and seclusion from society.
  Case 5.—It may be doubted whether this case may be set down
as one of moral insanity or of intellectual derangement.   The indi-
vidual  had, probably, by nature a very weak understanding ; yet I
think  it.probable that the impressions which  had fixed themselves
on his  mind were modified by  disease.
  I. K. had been for many years confined  in a  lunatic asylum,
when, an  estate having devolved upon him by inheritance, it became
necessary  to subject  him anew to an investigation.   He was exam-
ined by several  physicians,  who were unanimous  in the opinion
that he was  a  lunatic ; but a jury considered him to be of sound
understanding, attributing his  peculiarities  to  eccentricity, and he
was consequently set at liberty.
  The conduct of this individual was  the  most eccentric that can
be imagined :  he scarcely performed any action in the same manner
as other men ; and some of his habits, in which he obstinately per-
sisted,  were singularly filthy and disgusting.   For every peculiar
custom he had a quaint and often ludicrous  reason to  allege, which
indicated  a strange mixture of shrewdness and absurdity.   Among
other  singular customs, he made  it a regular  practiee to open his 
AND OF MONOMANIA.
43
window at a certain hour every night, and cry out murder exactly
twelve times, and  to go every day after dinner into the middle of
the quadrangle near his room, and throw up his hat  into the air a
precise number of times, vociferating at each throw.   It was disco-
vered that his motive for acting thus was  a  notion that  by consis-
tency and uniformity of  conduct he afforded a proof of his sanity.
When a person whom he understood  to be  a physician  attempted
to approach him, he recoiled with horror,  and  exclaimed, "If you
were to feel my pulse, you would be lord paramount over me the
rest of my life !"
   This individual  was set at  liberty, and has lived for many years
on his estate, where his conduct, though eccentric, and not that of
a sane man, has been without injury to himself or others.
   Case 6.—L. M., a working tradesman,  of industrious and sober
habits, conducted himself with propriety until about forty-six years
of age, and had accumulated a considerable property from the fruits
of his exertions.   About that period he lost his wife, and after her
death become more and more penurious.   At length he denied him-
self the  comforts, and in a great measure even the necessaries of
life, and became half-starved and diseased  ; his body was emaciated
and beset with a scaly eruption.  Mr. S------, a gentleman who
had long known him, hearing of the condition into which he  had
sunk, sent a medical practitioner to visit  him, by whose advice L.
M. was removed from a miserable dirty lodging to a lunatic asylum.
Mr. S------, who was present on the occasion, observed that  L. M.,
previously to his quitting the room in which he had immured him-
self, kept his eyes fixed on an old trunk in the corner of the apart-
ment.   This was afterwards emptied of its contents, and in it were
found, in  the midst of various articles, dirty  bank notes, which  had
been thrown into it apparently at different times, to  the  value of
more than a thousand pounds.   L. M., after his removal to an asy-
lum, where he  had wholesome food  and exercise, soon  began to
recover from his  bodily infirmities, and at length became anxious
to be at large.   At this time I was requested to visit him.   I con-
versed with him for some time, in order to  ascertain  his mental
condition.  He  betrayed no sign of intellectual delusion, nor did it
appear that any thing of that description had ever been a part of his
complaint.  His replies  to questions were rational according to the
extent of his natural capacity.  He was determined to go and manage
his property, and  get a wife who should  take care of him.   In a
few days after his release he was married  to  a servant belonging to
the lunatic asylum where he had  been   confined.  His  new  wife
found after some months that it was impossible to endure the strange
conduct of her husband, and after trying various expedients, brought
him back to the asylum, with a  certificate from a medical man, who
had examined  him and  declared him to be insane.   He still re-
mains in confinement, and his derangement is now more complete
than formerly, as it plainly involves his  intellect, which is under
the influence of various illusions. 
44
CASES OF MORAL INSANITY
   L. M.'s disorder consisted, at the period of his  first confinement,
in a perversion of moral habits, in which was a penury so extreme
as to prevent ordinary care for self-preservation.   His disorder had
greatly increased at the period of his second confinement.
   Case 7.—N. 0., aged about fifty-five, was subject some years ago
to epileptic  fits, which were not frequent, nor were they supposed
to affect his  intellect.   They were attributed to his manner of liv-
ing.  He used  but little exercise, was in the habit of  dining often
in  company, and  drank daily  too much  port wine.   His counte-
nance  was  florid, and  his body  was evidently  plethoric.  Some
years ago events occurred which overwhelmed him with grief and
despondency :  the occupations  in which his mind  had been engaged
were entirely broken off, and nothing remained on which he could
attach  hope or  interest.  Without sustaining the least injury in the
powers of his understanding, still fully capable of reasoning in the
most correct manner on the circumstances of his state,  as acute and
intelligent as ever he had  been, he underwent a total change in his
manners and  habits.  He took to his bed, and would never rise
from it unless compelled ; and  he would scarcely ever dress him-
self.  I saw him on two or three occasions after the interval of some
years from the  time  when his change of habits had taken place, and
once when it was  requisite for  him to transact some business.  To
this he was  perfectly competent.   He could not be prevailed upon
to put on his clothes ;  he was  dirty, and negligent of  his person ;
irascible to such a degree  that he would  sometimes strike the per-
sons who had the care of him, and who often took him out for the
benefit of air and  exercise, on which occasions it was found neces-
sary to put on him a straight waistcoat.   I found, on inquiry,  that
the state of his  mind was that of constant despondency, and that he
was without any power of rousing himself to the most trifling ex-
ertion.   In  the same state he continued, and though not in a  lunatic
asylum, he was considered by his relatives to require the constant
superintendence of a physician, who devotes his time chiefly to the
cure of the  insane, and whose assiduous  management  supplied, in
some degree, the total want of self-control.   I advised  confinement
in a lunatic  asylum, but this was  perseveringly declined ; and the
event was calamitous.
   The preceding cases, with one  exception, were published in the
article 'Insanity' contributed by me to the "Cyclopaedia of Prac-
tical Medicine."   Since that paper was  printed, I have had  oppor-
tunities of making inquiries  at different lunatic asylums and  among
medical correspondents interested in the  subject of mental disor-
ders; and from many whose abilities and opportunities of observa-
tion led me  to  place a particular value on their judgment, I have
solicited an opinion as to the existence of moral insanity as a distinct
form of mental derangement.   In these  inquiries I have scarcely,
if ever, failed to obtain some strong evidence in confirmation of my
previous opinion.  Dr. Wake of York assured me that  many in-
stances  have occurred in  the  York  Asylum precisely coinciding 
AND OF MONOMANIA.
45
 with the description I have given of this disorder, and that he con-
 siders no point relating to the history of mental derangement better
 established than its existence.  Dr. Bompas has shown  me several
 examples precisely of similar character, and has communicated other
 information to the same effect, either from the records of cases kept
 by his predecessor Dr.  Cox or from his own  notes.  The house-
 steward of Bethlem pointed out some examples of a similar descrip-
 tion, and assured me that there are always  instances of insanity in
 that hospital in which the conduct, temper, and habits of the patient
 are alone disordered, while the reasoning faculty remains unaffected.
 I am under  great obligations to  Mr. Hitch, the resident medical
 officer of the Gloucester Lunatic Asylum, for communications  with
 which he has favoured me on  this and other  subjects, and particu-
 larly for a series of most interesting examples, which I shall pre-
 sently insert, and which, with  the notes  of another case kindly
 given me  by Dr. Symonds, will, as I trust, leave nothing deficient
 in the history of moral  insanity.   I  shall first insert Dr. Symond's
 case, which is characteristic of some peculiar features of moral mad-
 ness, and shall conclude with the communication from  Mr. Hitch,
 which will be given entire as  I derived it from him, or with a  very
 trifling abridgement.
   Case 8.—" Some time ago  I was requested to  visit a gentleman,
 in order that I might give my opinion on the propriety of placing
 him under control, as  one incapable of conducting his  affairs.   I
 was previously put in possession  of the following facts.  Several
 years ago he laboured under an attack of acute mania, from which,
 although it subsided sufficiently to allow his being set at liberty, it
 was the opinion of those who had  closely observed him,  that he had
 never completely recovered.   In his social relations he had become
 fickle, suspicious, and irascible; he was reckless in his expenditure,
 and  uncertain in  his projects,  while his general behaviour was such
 as to impress almost every one who came in contact with him, that
 he was what  is commonly designated 'flighty' or  'cracked ;' yet
 there was no evidence that he entertained any belief in  things mo-
 rally or physically  impossible,  or  in opposition  to the general
 opinion of mankind.   It was  true that among other absurd acts  he
 had published a volume containing a  history of family grievances,
 described in hyperbolical language ; and although  the  statements
 were false, it was difficult to say whether they emanated  from a dis-
 eased imagination, or were wilfully feigned for a malicious purpose.
 A few months before I visited him, he had suffered a severe  con-
 cussion of the brain, and since his recovery had conducted himself
 more extravagantly than ever.   He  advertised for sale  property
 which he knew to be entailed  ; after a little increase of income by
the death of a near relative, he commenced great alterations in his
residence,  and  before they were  finished suddenly left  his family,
together with a large establishment, under the care of a  youth, his
son, who was provided with no other means of supplying the wants
of the household  than  a power of attorney  for collecting rents.
                              5* 
46
CASES OF MORAL INSANITY
Soon  after his departure, for which he had assigned no reason, he
despatched orders for the removal  of every kind of property that    |
admitted  of conveyance, such as  furniture,  cattle, &c,  from his
estate  to  a  distant place where he was  then sojourning.   If his
directions were not immediately attended to  by his  son, he was in
the habit of writing letters to him of the  most violent and abusive
description.   Some of these productions were shown to me, and I
found not only the expressions most ridiculously disproportionate to
the subjects, but the whole  style  so confused and  incoherent, and
the external superscription so absurd, that it seemed impossible to
believe that any person  of  sound mind could  have indited them.
Many other strange practices were mentioned, but there was one
fact that made a very strong impression on my mind.   Having heard
that certain individuals, strangers to himself, but deeply interested
in the welfare of his family, had made inquiries respecting his move-
ments, he printed a pamphlet, professedly for their instruction in
his domestic history.   A more insane document than this I scarcely   I
ever perused.   The sentences were so involved and undistinguished,
that, although the ideas were not absolutely incongruous with each   !j
other, it was impossible to collect more than the general tenor of a
long  passage.   The greater part  consisted of  allusions to  events,
persons, and places, without any names or other clue being afforded,   j
and of  appeals to the reader, as if the latter were in possession of   \
facts that seemed known only to the writer.                         ™
   " I was able to learn very little of his personal condition, excep-
ting that he was extremely irregular, and dirty in  his habits, and
this very important circumstance, that he  was in the constant habit
of passing his evacuations in bed.
   " He had latterly committed so great injury to property in which
he had only a life-interest, had involved himself so deeply in debt,
and was, notwithstanding, so lavish and absurd  in his expenditure,
that it became a very desirable object to enforce some restraint upon
his actions.   Having  with  some difficulty obtained an interview
with him under the  pretext of conversing  with him concerning
certain members of his family, towards whom he had coneeived a
most unfounded hostility, I  endeavoured, by a  variety of  expedi-
ents,  to discover any latent hallucination, but failed in my attempts.
He manifested a morbid emotion of enmity for certain persons, and
addressed one of  them who was present in coarse and indecent
language ; but on  my questioning  him as to the cause of his aver-
sion, he was ready enough  to  vindicate  his feelings  by means of
stories and allegations that I knew to be groundless, but which did
not necessarily involve any insane conviction on his part, and might,
therefore, have been  fabricated with an intention to  deceive.  Al-
though, while conversing on these subjects, he manifested intense
earnestness, and accompanied his discourse with theatrical gesticu-
lations, he very  easily, on  my leading  the way, passed off to  a
discussion of  matters  quite foreign and  indifferent, and returned
with  equal facility to  his domestic  wrongs.   Interrogations  as to 
AND OF MONOMANIA.
47
the motives of  his conduct on various occasions produced answers
by no  means unplausible.   The  most extravagant notion  that he
betrayed was in an avowal  of  his resolution to change his name,
for no  other reason than that he might not be disgraced by bearing
the same name  as his wife.
  " After due deliberation I came to the conclusion, that, although
I had been unable to trace any  positive  intellectual error, there was
such a morbid condition of the  feelings, habits, and  motives, as  to
constitute a case of what has  been  correctly  designated  by Dr.
Prichard as moral insanity.  I therefore did not hesitate to sign the
usual certificate."
   I shall conclude this section with the before-mentioned commu-
nication from Mr. Hitch.
  " I could easily furnish a great number of instances coinciding
with your description of moral insanity.  We  have recognised
them here for  a  very considerable time, and term  individuals  so
affected,  ' insane in conduct and not in ideas,' a distinction which
has often led us into a  difficulty of explanation and  a  still greater
difficulty of producing conviction, when justifying our detention of
a patient who has made a plausible and very reasonable tale to the
visiting  magistrates.  Your discrimination of this disease from
intellectual insanity, and the further  separation of the  latter from
actual  madness or mania, has much gratified me : it accords with
my own observations, and tends to support a  belief, which I have
long indulged, that many who have been convicted of crimes ought
to have been pronounced insane.   I do  not imagine that you desire
to have a long series  of  cases, resembling  each other in general
character, and differing only in some particular features, but presume
that you are rather desirous of  ascertaining  how far  others, whose
opportunities of observation entitle them to hold an  opinion on the
subject, have been led to form conclusions similar  to your own.   I
shall send you  an extract from  my note-book, containing the out-
lines of a few cases which have excited a strong feeling of interest
in my  own mind.
   " Case 1.—Mr. W., aged about forty, was a corn-dealer and baker,
and a  man  of  mild  and retiring disposition ;  steady  in  business,
regular and domestic in  his habits, highly  conscientious, religious
without ostentation,  correct and  cautious in his conversation, and
kind and benevolent to all persons.   His health was considered to
be delicate, but he was never ill ; and  he  avoided  great exertion,
feeling himself not equal  to it.   He  was a  married man and had
several children, of whom he was extremely fond.   He experienced
some severe losses in his business which weighed  heavily upon his
mind,  and he  became  exceedingly depressed.   He made a great
effort to rouse  himself from his despondency,  and exerted himself
with the view of recovering for his family what he had unavoidably
lost.   He was, to a great extent, very soon rewarded for his efforts.
It was shortly afterwards observed by his friends that his increased
exertions had improved his spirits, which, it  was  remarked, had 
48
CASES OF MORAL INSANITY
 become  much  more  elevated  than  they were previously  to  his1
 depression.   He now began to  extend his business, in which he was
 become  more  keen ; at market he displayed more acuteness  in
 buying and  selling, and seldom  trusted to others any thing he could
 accomplish himself; and he was ever watchful of an opportunity to
 make purchases or to  effect sales to his advantage.  These changes
 in his habits went on until the character of industry appeared to
 his friends to be over-performed, and they feared that he indulged
 something like unnecessary exertion and  anxiety, and that  his
 excessive activity of mind and body would destroy his health.  His   ;
journeys became longer  and more frequent, and his nights were
 greatly shortened ;  and he was  often absent from his  accustomed  1
 place of  worship on Sundays.   After some months had passed, and
 while these  changes were going on, his family ventured to remark
 to him that such extended journeys  to transact uncertain business
 withdrew his attention from that at home, which was regular and
 profitable.   For the first time he was then observed to speak in a
 tone of voice, and with an expression of feeling, which had never
 belonged to  him.  Still his family and friends had no fear of mad-
 ness, but entertained a dread lest he should overstep  the line of
security in business, or undermine his bodily health by excessive  I
exertion.  His  temper, which was naturally  so mild, from this time
grew  hasty  and irascible ; he  became  incapable of  hearing  an
opinion opposed to his own,  and was  irritated if a check was offered   i
to his present proceedings.  Still he prosecuted the same scheme of
 business  without as yet deviating from  his course ; he extended
but did not  alter his plans ; and  thus were more than ten months
disposed  of.   A change now became manifest in his feelings towards
his family ; he frequently  spent  his evenings in the  society of
others rather than in that of  his wife and children, to which practice   '
he had ever  been habituated.  He  spoke  in  approbation  of all  he
saw elsewhere,  and  found innumerable faults and objections to what
was done at  home :  his children were less engaging and intellectual
than those of his neighbours ; and his wife's domestic arrangements
were less complete,  and he was  evidently less attached to her.  He
was at this time in the habit of taking freely of stimulating drinks,
to which he  had never been accustomed, and excused himself under
the plea  that his great exertions required support.   He became
addicted to strange women ;  and the  fact being brought home  to
him by his wife, brought on the crisis which had been long approach-
ing.   Having given vent to  the most passionate expressions, and
threatened violence of the most  serious  character, he quitted his
home,  forsook  his  family and  his business, wandered  about the
country, sleeping in the  open  air, and subsisting by the meanest
artifices.   His friends  at length  found him, and  consigned him  to
my care.   Twelve months had  fully elapsed from the time  when
they perceived  a change in his natural habits.
  " When I  received him, the expression of his countenance was
animated and lively ; great activity was indicated by the quickness 
AND OF MONOMANIA.
49
of his  eye ;  but the unsteadiness of his looks,  together with  a
quivering smile  playing about his lips, marked it  as an  activity
without object or motive.  His face was pallid, the conjunctiva
finely injected, the pupil contracted, the head was hotter than the
rest of the body, and the hair, which was  thin, felt crisp ; the
tongue was foul and the bowels constipated ; the hands and feet were
colder than the rest of the body ; and the  former had that soft  feel
peculiar to the highly nervous:  the pulse was slower than natural,
feeling full and bounding,  but it could be compressed, and the cur-
rent of blood checked by the slightest pressure ; the respiration
was tranquil and regular, slow, and scarcely perceptible by looking
at the chest.  In conduct and manner he was anxious, eager to be
doing something; moving from place to place without any apparent
object; removing  every article  of furniture  that was  moveable ;
abounding in speculations and  new projects ;  proposing long jour-
neys to be executed in haste ; talking incessantly, but coherently,
and for the most part rationally, upon a great variety of subjects ;
he used no expressions of antipathy against his family, nor  indeed
against any person ;  but it was evident that the mention of his wife
or children greatly increased his  agitation.   He had no fixed notion
which influenced his conduct,  and  no  delusive  ideas.   When
addressed on the subject of his situation, he was fully aware of the
place  he  was in, and  knew  the reason  of  his  confinement; he
attached no blame to any one for placing  him under my care, and
admitted that he had  felt unlike himself for some months, but had
flattered himself that his health was improved, and that his increased
spirits were the legitimate consequences of this and of his improved
finances :  he was conscious of his conduct to his family, but neither
blamed himself nor extenuated it.  On business he would converse
most rationally:  but if the opportunity had presented itself,  would
have expended his money in the most useless purchases.  He was
capable of making the nicest calculations connected with  his own
affairs, and was correct in all his data when speaking to a second
person ; but  when left to  himself, his conduct  and language were
ridiculous in  the extreme.
   " This individual perfectly recovered in about three months.
   " I copy this case as one in which the deviation  from healthful
and natural habits were complete, and  brought  about in the most
gradual manner.   It  is worthy  of remark, from the momentary
conviction which the individual obtained of his state when he ceased
to direct his own movements and to be his own master.   He often
told us, on his recovery, that the idea that he  had been mad for
some time, and was then so, flashed across his mind  at the moment
when he entered the establishment.
   " Simple as this case is, and it is one of  the most simple we meet
with, we  yet find associated all the  forms of  moral debasement.
Simple over-excitement was the commencement  of the disorder ;
but a  change in  the  habits of life and temper, a perversion  of the 
50
CASES OF MORAL INSANITY
natural feelings and affections, a loss of the sense  of moral recti-
tude, and a complete deprivation of self-control, gradually followed.
  " Of this description of cases I have met with very many instan-
ces, not in those who  have fortunately been treated as insane, but
who,  remaining at large, have gone on  from one misfortune to
another, till they have become beggared in estate  and reputation,
and sunk at length into a loathsome jail  or a wretched workhouse.
  " Case 2.—The following case  is not  a common one.   In the
spring of 1827 I was requested to visit the daughter of a farmer, in
some branches  of  whose family insanity  existed.  The little girl
was only seven  years old.  She was reported by her  parents to
have been a quick, lively child, of ready apprehension, mild dispo-
sition, affectionately fond of the members of her family, and capable
of quite as much application to her school duties as children usually
are.   She  had been sent home from school in consequence of a
great change which had taken place in her conduct.   She had become
rude, abrupt, vulgar,  and perfectly unmanageable  ; neglecting her
school duties,  running wildly  about the fields  and  gardens, and
making use of the most  abusive language, when  chidden for her
misdemeanours.   I found her in this  state, with  the addition of
having become extremely passionate, in consequence of  corrections
to which she had been subject, and to escape which she was prone
to invent falsehoods.   She was also changed in her appetite, prefer-
ring raw vegetables to her ordinary food ; and she would sleep on
the cold and wet  ground rather  than in her  ordinary  bed.  Her
parents had  no control  over her; indeed she appeared to despise
them in proportion as they kindly remonstrated with her.  She was
 cruel to her younger  sisters ; taking every opportunity to pinch or
 otherwise  hurt  them, when she thought she could escape observa-
 tion.  She could  not apply herself to  any thing,  but had yet a
 perfect knowledge of persons and things, and  a complete recollec-
 tion of all that had occurred and of all  she had learned previously
 to her illness.   Her general health was  much disordered ; her little
 eyes glissened most  brilliantly ;  the pupil was contracted,  though
 expanding widely if she  was suddenly  excited ; the conjunctiva
 was reddened ; the head was hot;  the surface of the body of about
 the natural standard ; the extremities of a lower  temperature, and
 the palm of the hand had  as  completely the peculiar feel  of the
 nervous as a grown person : her person had a disagreeable odour ;
 the bowels were much disordered, from the various strange things
 she had eaten.  Dr.  B---- saw  her in conjunction with me ; and
 we endeavoured to improve her  general health, hoping that by so
 doing we should  remove some exciting cause for her disturbed feel-
 ings: we  were disappointed.   As she grew worse, and her parents
 by mismanagement,  sometimes humouring her, sometimes  harshly
 correcting her, were likely to render her still more disordered, I
 took her into  my own house, and placed her  under the care of my
 wife.  At this time she had taken to eat her own fasces and to drink 
AND OF MONOMANIA.
51
her urine, and she would swear like a fish-woman, and destroy any
thing within her reach ; yet she was fully conscious of every thing
she did, and generally appeared  to  know  well that she had  done
wrong.   Having committed some mischief  or destroyed something
which was fragile, she would often  run to my wife, and  exclaim,
" Well ! Mrs. H----, I have done it!  I have done it!  I know you
will be angry, but I can't help it ;  I felt I must break it, and I could
not let it alone until I had !"  Amongst her pleasures  was that of
dirtying herself  as frequently as she had  clean clothes ;  indeed she
would rarely pass her excretions  at the proper place, but  reserved
them for the carpet of the  sitting-room, or for her own clothes.
When she  had accomplished this end, she  would jump about and
exult ; but the little creature would often induce my wife to smile
at her, when, with an expression of countenance, which was always
intelligent, made  up  of cunning, feigned  regret, and  a  subdued
smile, she would say,  " Well, Mrs. H----,  'tis too bad  of  me ; 'tis
really very foolish, and  I will try to be better ;  but you must for-
give me because  I am mad."  At other times she would  be so far
conscious of her situation as  to cry bitterly, and  express her fears
that she should become like her aunt, who was a maniac.  In addi-
tion to all these  indications  she lied,  stole any  thing  which she
thought would be cared for, and either hid or destroyed it ;  and
swore in language which it  is  difficult to  imagine that the  child
could ever  have heard.
   " I could never detect in her any fixed idea, either of fear or
belief, which influenced her  conduct.  She acted from  the impulse
of her feelings, and these were unnatural and unhealthy.
   " She recovered in about two months.
   " Case 3.—The following case has some interesting points, and I
therefore transcribe it.  A gentleman of  good connexions, of good
education, and of mental capabilities far above the general average,
was brought up under  the  most advantageous circumstances that
wealth can command, to the surgical branch of our profession.   He
was fond of literary pursuits, and had rendered himself  an  orna-
mental member  of society by a careful and  critical course of general
reading.   In his disposition he was mild, kind-hearted, obliging,and
generous, and his attachments and affections were strong and ardent.
Educated as a gentleman, he possessed what is essential to the cha-
racter__the highest  moral  and religious principles without enthu-
siasm or fanaticism, and the strictest regard for that correct conduct
which is due to  those of his own rank  in society.  An  unfortunate
excess to which  he was seduced when his duties in London were
fulfilled, laid the foundation  for a complete subversion of his cha-
racter.   He became irregular in his habits, negligent of his person,
careless of the society he fell into, addicted to drinking, suspicious
of his friends, wantonly extravagant, perverse  in disposition, irri-
table and overbearing.  Indulging himself in idleness for several
years, and in dissipation when he had the means, he reduced himself
to the' condition in which he became known to me. My first acquain- 
52
CASES OF MORAL INSANITY
 tance with him was under the effects of a long debauch, and the his-
 tory of that will contain the recent history of the man.   Being still
 fond  of  reading, he prosecutes  his studies quietly but ardently for
 some weeks together, during which time indications of excitement
 show  themselves.   He  becomes  more inclined  to  talk  and less
 disposed to read.   In his conversation he assumes a loud and dicta-
 torial tone, is impatient of interruption, intolerant of contradiction,
 and bears with ill  grace the most modest expression of an opinion
 differing from his own.  He becomes abrupt in his manners, speaks
 coarsely of mankind generally, and ill of all his friends and relations.
 Of those most nearly connected  with him he speaks disrespectfully,
 and holds them up  to ridicule upon all  occasions, introducing their
 names when totally uncalled for, merely to gratify  his perverted
 feeling.  A greater degree  of impatience  is occasionally felt with
 some bodily sensation, which leads him to the use of ardent spirits
 for its relief or removal.  Excepting at such times, this gentleman's
 habits are  most abstemious ;  he never  drinks any thing  stronger
 than  beer,  and frequently  tastes  water only for weeks  together.
 When, however, this thirst for  ardent  spirits comes on, a fondness
 for low society accompanies it.  On these occasions he repairs to a
pot-house, takes  his mixture amidst the lowest of mankind, treats
 all the brick-layers  and hod-carriers who will drink with him, tells
 them  tales, and recites, to them for days and nights together, if they
 will listen to him, and ceases only when the reluctant  integrity of
 mine  host will draw no more for him, or, which is more commonly
 the case, when his cash is exhausted  and his credit of no avail.
 During these lamentable debauches he seldom gets drunk, although
 drinking and smoking incessantly ; he falls into a state of abstraction
 for a time,  and doses and  sleeps until the uneasy sensations within
 the stomach rouse him, and  impel him to call for more drink. His
 condition, when no more drink  is allowed  him, is distressing ;  he
 intreats and orders,  implores  and  commands,  grows violently
 enraged,  experiences a  hysterical  or  epileptic convulsion, sinks
 into a chair or on the  ground, and  falls into a sound sleep.   This
 continues from  twenty  to thirty  hours, when  he awakes to the
 horrors of  his  situation, and to  the mortification  arising from his
 folly.   No  longer  is to be  found  the  high tone, the overbearing
 demeanour, or the authoritative language; he is the humblest of the
 meek, and  continues depressed for several weeks.   Then he enjoys
 a period of tranquillity, to be succeeded  by the overbearing conduct
 before-mentioned, and to be  finished within the period of three
 months by  another visit  to  the society of tinkers and labourers.
 In his state of depression I first  saw him, free from any kind of
 delusion, and regarding the world as having in it  no spot that was
 not too good for so mean a being as himself.  He was desirous of
 redeeming  his past  follies by a life of usefulness and activity; was
 regardless of the kind of occupation to  which he might be subject,
provided only he was made useful and industrious.  To sweep the
 shop and open the shutters of  a huckster or tallow-chandler,  would 
AND OF MONOMANIA.
53
have been regarded by him as a valuable appointment by way of a
beginning.  When, however, employment of the simplest kind was
proposed to him, he found himself wanting in resolution to engage
in it.  He could busy himself about nothing, change from one trifling
engagement to another, but would not steadily employ himself.  In
about three weeks the depression had  left  him, and for some time
he was enabled to enjoy the rational amusement of reading, in which
he greatly delighted,  particularly works  of history and  philology,
memoirs, &c.   For about  six weeks he spent his time usefully and
rationally in this occupation, when he began  to think himself entitled
to  his liberty ;  he requested  permission  to take some exercise,
which was permitted him without superintendence ; he grew louder
and higher in  his tone of conversation, began to hold himself above
his fellow-patients, and  ceased not  to quarrel and disagree  with
them ; his manners, formerly agreeable, were now much changed,
but not so far  as to allow us to remark such alteration to him without
encountering the chance of failing to produce conviction.   At the
expiration of three months from the time  I  received him,  he was
discharged,  '  having  no disordered  ideas,  and  having  conducted
himself  upon  the whole  like  a sane man.'  In five  days  I  was
requested to take charge of him again, and I found him  in a village
pot-house, in  the midst of company low, vulgar, and  disgusting;
without  money, almost without clothes, which he had sold  to pur-
chase liquor, to share with his contemptible companions.   I removed
him to confinement, where three other months were spent, much as
those already described, and within ten days from his second  release
he repeated  the same  indiscretions, and was replaced in an asylum.
   " Case 4.—A form of moral insanity striking to the mere obser-
ver, but  a most  disagreeable one to  those whose duty it is  to take
charge of such cases,  is described in the following notes.  It is the
case of---------, an  account of whom is given in the ' Sketches
of Bedlam' p.  135.  Having been an inmate of numerous asylums
both public and private, the directors of which I believe were glad
to get rid of him, and some of whom, to my knowledge, rejected
him,  he  became a patient of ours.   Notwithstanding all that has
been said of his delusions  on the subject of property by  the author
of ' Sketches  of  Bedlam,' I could never discover a permanently
delusive  notion in him during nearly  two years spent with me.  He
enjoyed,  for I  may in  truth use  the term,  the art of lying and the
pleasure  of boasting to an extreme degree.  To a stranger he in-
variably  represented  himself as a man of great wealth—vast im-
portance, in  his  neighbourhood—a  magistrate,  and  all that  was
grand.   His tale was never brief; he had  the art of making it so
plausible that few were in haste to leave him, and none ever left him
without feeling a regret that a  man apparently so sane should be
shut up from society.   He usually laughed  at the effect of his tale
when the visitor was gone, and  especially if he succeeded, which he
always attempted, in  obtaining money or  snuff.  He would  then
ridicule \\\e flats, as he termed  them, and chuckle over his success,
  April, 1837.                6 
54
CASES OF MORAL INSANITY
considering the tax thus levied as a legitimate toll, taken, no matter
how, from  those whose ill-directed curiosity prompted them to look
at the afflicted as they would at an exhibition of wild animals.  His
proneness  to lying was not confined to the gratification of his own
wants and  wishes  by false representations ; his most general appli-
cation  of this well educated  propensity  was in the production of
mischief and  disturbance.   He had  always a  false report to me of
the servants who superintended him—his food was withheld from
him—his beer was drunk  by the  keeper or a fellow-patient—his
clothes were  worn bv others, and  he was robbed of his snuff and
tobacco.  Amongst his fellow-patients he ever delighted in  creating
a disturbance, and  when this occurred, he invariably reported the
offended party to be the aggressor.   He would prepare himself, on
every day  when the visiting  magistrates were expected  to examine
the house,  with a budget of lies and misrepresentations, and with
the most unfounded and malevolent calumnies  against the officers
and servants  of the establishment. If he succeeded in exciting atten-
tion to his complaints, and  to create a suspicion that there existed
some ground for the serious charges he preferred, his next  pleasure
was to abuse  the gentleman who had lent  an  ear  to  his calumnies,
and to boast how easily he could deceive  the  wisest magistrate or
the most careful examiner.   He was equally an adept in stealing as
in lying.   Once in a week at  least  it was necessary to unpick the
lining of his  coat,  waistcoat,  and  breeches ; to open the ticking of
his bed ; to remove the head  of his bedstead, and to examine holes
in the wall of the airing-ground, which he was known to have made
and to have partly filled with dirt or leaves.  Here were found the
knife-cloths,  spoons, forks, and all  small  articles belonging to the
gallery ; the  night-caps,  handkerchiefs, combs, and  brushes of his
fellow-patients  ; half-picked  bones which  he had abstracted from
the plates of  his fellow-patients unobserved ;  portions of bread  and
cheese taken  in a similar manner, and articles of mere rubbish taken
for  the mere  pleasure of stealing :  these were secreted, as observed,
in holes or in his bed, or sewn up in the linings of his dress,  and
not unfrequently a pocket was made in the tail or back of his shirt.
He was not  often  passionate ; sometimes he was violently so,  but
on  ordinary occasions he had  the power of controlling his anger.
He was, in reality, one  of the happiest fellows  alive,  but he  was
ever complaining and expressing dissatisfaction and discontent.  He
had no bodily ailment, but' he would be always sick, if  thereby he
could improve or vary his diet. He was very fond of novelty,and
would devise various plans in  order to  be moved to different parts
of the establishment.   Sometimes he would become noisy for  this
purpose, at others dirty.  He was extremely malevolent if offended,
but the feeling  did not  last  long,  for as soon as the bodily incon-
venience attending his offence had subsided, his disposition to injure
ceased also.  Though he was one of the most depraved men  that I
ever saw, he  yet possessed many good qualities.  He  was extremely
watchful and anxious for the  sick ;  was always ready to assist  the 
AND OF MONOMANIA.
55
servants when a patient was turbulent and likely to do mischief ; ever
defended the keepers, if other patients charged them with unkind-
ness ; would make himself extremely useful when any thing was
to be done in his gallery ; corrected obscene or impious language in
others, and seemed to tolerate no mischief or wickedness which was
not entirely his own.
   " In general his judgment was quick and correct ; he had quick
perception, strong memory, great discretion in matters of business,
was a good calculator, and would tell me  what his quarterly expen-
diture had been, and from what sources the amount should be paid,
with all the accuracy of a banker.  Though he was occupied with
calculations for the sake of boasting, and swelled  a  small property
into an enormous  wealth, he knew  and spoke frequently of his
exact income, and was always careful that his expenses should not
exceed it.
   " His madness appeared to me to consist in part in a morbid love
of being noticed, perhaps admired and approved, though he had too
much acuteness and too long an experience in the reverse of appro-
bation to expect that any one could  admire the extent to  which  he
prosecuted his ingenious art of tormenting.
   " He is now  at large,  and has been in the management of his  af-
fairs for three years, in which time he has sold an estate advantage-
ously, and conducted his business with profit.   He is still addicted
to lying, but I believe is  too wary to commit theft, excepting amongst
his immediate friends.
   " Case 5.—The following  case displays  a  change of habits and
feelings and a sacrifice of natural affections consequent upon causes
which had previously generated ' a bad temper.'  Mrs.----, aged
thirty, the wife of a man  engaged as  a cloth-worker,  is employed,
when equal to her work, in a department of the same business. She
appears to be in good general health, and is reported to have always
enjoyed it.   She is the  mother of  eight children, is in comfortable
circumstances,  was always  industrious  and  careful,  took much
pleasure in her domestic duties, and  was fond  of her husband and
children.   Her friends  report her to have had naturally a bad tem-
per, over which she never exerted any control ; and they add that
its too frequent indulgence, to the great annoyance of her  husband's
peace, has on some occasions suggested remedies not the most mild.
She appears to have given way to  the most violent paroxysms of
passion, followed by a morose and unyielding sullenness.   About
twelve months ago a change  was observed  in her habits ; she took
less interest in her domestic concerns, neglected her children, abused
her husband, and evinced the greatest hatred  of him.  Shortly after
this change appeared, she quitted  her husband's house and went to
lodge with  a neighbour ; here her habits were so disagreeble, and
her disposition so  dissatisfied, that she  soon received a dismissal.
She then resided with her sister, who parted with heron like terms,
and  many others received  her and  removed  her  from them  for
similar reasons.   She at length obtained admission  to the parish 
56
CASES OF MORAL INSANITY
workhouse, where she found herself treated as people usually are in
that hospital of idleness, and she made return  for such attention and
accommodation as she had received by breaking the windows and
the crockery  of the  poor inmates.   She escaped  the  punishment
threatened her for this by seeking refuge  in her husband's house,
when she returned the kindness he had shown in receiving and pro-
tecting her by destroying all of his  that was frangible.   She had
previously discovered a small sum of money, his occasional savings,
which she spared him the trouble of expending, by giving away a
part and throwing away the remainder.  Her husband then consigned
her to the Lunatic Asylum, and I have her under my care.
   " Her  leading desire is to lie in bed, where, if I  would allow her
to remain, she would stay the whale week.   She frequently refuses
her food.  When up, if no notice is taken of her, and  no inquiries
made of  her  as to her health and feelings, she will  conduct herself
with  propriety for some days.  Sometimes, however,  she will roll
on the ground and indulge in  the most violent screams and excla-
mations without apparent cause or object, and then return to what-
ever occupation she  had been previously engaged in.   If requested
to do any kind of work, she declares her incapability, from weak-
ness, pain, or some other cause, and in a few minutes sets about some
other employment requiring greater exertion.   When addressed by
me in my usual visits to the wards, she throws herself into- a vio-
lent rage, and  without replying to my inquiries,  falls suddenly to
the ground as though she had fainted, or she rolls  herself as before
mentioned and screams, or she seats herself and cries and sighs as if
in the greatest distress ; hut if I enter into conversation with ano-
ther patient on any subject with which she is familiar, as the locali-
ties of her neighbourhood, the clothing business, or such  matters,
and take an opportunity to address a question for  reply, she joins
in the conversation with the full command of her intellect.  As a
disagreeable and unmanageable patient, without actual violence, she
exceeds  most with whom I  have  met.   Her mind appears totally
unaffected as to  its  understanding portion, but in the moral  part
completely perverted.
   " Case 6.—A man was discharged from this establishment about
two years ago, reported cured, whose eccentricities and extravagant
conduct had drawn upon him the anger and almost the dread of an
extensive neighbourhood.  He was about thirty-five years of age,
a shoemaker  by trade and married ; addicted to an irregular life,
and fond  of drinking.  His natural disposition was lively  ;. he abound-
ed in  a peculiar kind of wit, and  had an endless series of marvellous
talcs  at  his command, which, when exeited,  he  told with  great
humour,  and  he rendered himself thereby a welcome  guest at the
village alehouse.  Here he was also prone to those petty  mischievous
tricks which  are vulgarly denominated ' fun,' and he was an amu-
sing companion in his sphere.  However, his love of sport did not
rest in the gambols of the beer-house : he became restless and disin-
clined to his  own business, made frequent  excursions  to different 
AND OF MONOMANIA.
57
towns and villages under the pretence of seeking fresh work, was
noisy and coarse in his play at the tavern, and eventually left the
neighbourhood of his residence.  He took with him the kit of a
travelling tinker, and set up the business of a knife and scissors-
grinder, of which he knew nothing.  He exulted in the  havoc he
made in the cutting-instruments which  were entrusted to him, but
did not continue his new trade more than a day or two, when he
disposed of  his kit and  began to  sell old clothes.   This  pursuit he
exchanged for another, and  that for something new.  In about a
fortnight he returned home, and instead of entering his house by
the door, he  ascended the  roof,  removed  the tiles, and entered
through the  ceiling.  This he continued to do, making his entrance
and exit from the top of the house.  He would  amuse himself at
night by driving a pig fastened to a cord  through the village, upon
whose nose  and tail something had been fastened  to cause him to
squeak, and  thus disturb  the neighbours.   He would exchange the
farmers'  cattle and remove  their gates during the night, and  before
morning was some miles  out of the way.   He would often run ten
or twelve miles in a straight line without any motive, disregarding
fences, corn-fields, brooks, or any thing.   Whatever his fancy led
him to want he  made no scruple  to take, regardless to whom it
might belong, and when  he had made the use of it which he thought
proper, was  not particular in returning it.  For many of these acts
be was taken before a magistrate; but his assumed simplicity or his
sagacity, added to  a  plausible tale, saved him from punishment on
all occasions but one, when he was sent to a house of correction for
a month  as a disorderly vagrant.  He eventually was deemed to be
mad, and sent to me.  I  found him one of the most mischievous of
beings ; his  constant delight was in creating disorder to effect what
he called < fun ;'  but he had no motive, no impression on his mind
which induced him to this conduct, he was merely impelled by his
immediate feelings.  When he recovered his tranquillity, he had
a perfect recollection of all that he had done, and wondered how he
could have taken so much trouble to make himself appear ridiculous !
In this man's state of health I  found nothing wrong, excepting that
he did not sleep.   His eye was not glistening, but his pulse was, as
I so constantly observe it, easily compressed.
  " Case 7.—A personal friend of mine was of sanguine tempera-
ment, possessed quick  perceptions, warm feelings, strong attach-
ments, the most  delicate sense  of what was due to others,  and a high
sentiment of honour.  He was a member of the legal profession, in
which he stood high ; he worked hard, and had been amply rewarded
for his talent and industry.  He was hasty in disposition, and from
defective management in early life  had  never  been led to keep his
warm feelings in  check.  He often grew hot  in  argument, and
almost violent if offended, but he quickly became  cooled, and was
as friendly as ever.  An affront was once  offered  him  in public,
which he instantly resented by violence ;  this was followed by a
repetition of annoyances and  insults offered to him by parties who
                              6* 
58
CASES OF MORAL INSANITY
were under personal obligations to him, but who,  as he felt, ought
to have been beneath his resentment.   His mind dwelt much upon
the subject, and his life was embittered by it.   Although his dispo-
sition was of that generous kind, that, excepting in the instant of
danger, he would always have  done a kind  more  readily than an
unkind act, yet towards these parties he always felt malignantly :
he watched opportunities to cross them in their purposes, helped
them more deeply into their difficulties if he found them in a dilem-
ma,  and readily lent himself to oppose  them in any and all ways.
So completely were his good feelings perverted, that if in the midst
of his pleasures, and he was a man who enjoyed the refined  plea-
sures of polite society in the highest degree, the name of either of
these parties was mentioned, or  any  circumstances caused him to
think of them, a damp would be thrown upon his feelings, his face
would flush, his brows lower, and  those who knew him  could but
too well read the commotion that was within.   For about two years
he was the subject of this loss of self-control, and died of a paralytic
seizure, upon which apoplexy supervened  in a few h-ours, whilst
preparing his mind to encounter a disagreeable duty in adjusting
some family matters of a pecuniary kind which were in dispute.
  "During the time when my friend was thus the subject of morbid
irritability on one point, he was also a martyr to headache of a very
severe  kind, attacking him with the suddenness of an epileptic fit,
and  varying in intensity of pain to so great a degree as to produce
convulsion, almost that of epilepsy.  He, however, never lost his
consciousness, even for a minute, during these  paroxysms. On every
other subject he could control his temper as much as usual, and had
no disorder of ideas.   He  was well aware and admitted how con-
trary his  malevolent  feeling was  to those religious principles to
which he  subscribed, and in his attachment to which he was sincere
and  fervent; but his best efforts could never remove the demoniacal
impulsion.
  " Case 8.—A young lady, of no striking personal charms, but of
good general appearance and of fashionable manners, had received
the best possible education to  fit her  for ' the world of fashion,'
and she had availed herself of the opportunities presented to her to
render herself accomplished.   Indeed, she was conspicuous for the
share she had  acquired of those  merely external accomplishments
which  by many are deemed indispensable.   In  a word, she was a
clever and a fashionable young  woman.  She had  attained the age
of twenty-three years, and  had been ' introduced,' or, as I believe
the term is, she had come out, and was  distinguished  in 'the beau
monde.'  She became greatly shocked on learning suddenly the
embarrassed  circumstances of her  father, which must necessarily
remove her in some degree from scenes of  pleasure.  She became
dejected and melancholy ; soon afterwards  sullen, obstinate, negli-
gent of her person, idle, and disgusted with her accomplishments ;
coarse and unpolished in her language, abusive, and passionate.   She
appeared to have no other delusive idea than that in which she was 
AND OF MONOMANIA.
59
educated, viz. that ' the only world was the world of fashion ;' and
that as she  was now out of that world ' she was dead,'—a delusion,
which was  not a change in her ideas.  However, her friends associ-
ating  these expressions with the lamentable change in her habits and
feelings—for I  should have added that she hated all her family but
one sister—very properly placed her under treatment.  In private
lodgings she  was unmanageable.  Never subject to be opposed, she
of course could not brook control; and the efforts ineffectually made
to execute  my directions only  aggravated  her  case.  As  she was
left solely to  my management, I removed her to the Asylum.   She
was just as I have described her ;  I soon became to her an object of
dislike and derision: my  necessarily firm  conduct was to her the
extreme of coarseness  and cruelty ; and she represented  me as  fit
only for the  post I held, that  of  a jailor.  Under these feelings I
received her, and had the  good fortune to restore her within three
months to her friends, not perfectly recovered, but much  relieved;
for there had been originally an error in her education, which would
have  required that her mind should  have been remodelled ere she
could have been pronounced sane.
   " To these cases I could add many others, varying in the manner
in which the disease shows itself, and  influenced  by the habits,
associations, education, &c.  of the patients; but it does not appear
to me that  you will desire them;  and I will, therefore, add one,and
almost the  only clear case I ever saw, of monomania.
   " Case 9.—The son of a wealthy  tradesman, residing in a coun-
try town, was one of several children, having the  blessing of kind
and discreet parents.   He was educated carefully, and as a school-boy
was particularly attentive to his duties; passed through his labours
with  credit ; was  never considered  wanting in capability  ; but his
diffidence,  for I will use that word for the present, was so great, that
he always  dreaded the repetition of his lessons, fearing that  he
should be rejected, though this scarcely ever occurred.  On leaving
school his father gave him a choice of pursuits, and he selected his
father's business.  With the commencement of his duties  his father
assigned him a  liberal allowance of pocket-money, and placed within
his reach every convenience and  comfort a young man of  domestic
habits could desire.  For awhile everything proceeded satisfactorily;
when suddenly he announced  to his  father that it was no  longer of
any use for him  to  be deceived,—he felt his mental capabilities
unequal to the execution of what  was assigned  to  him, and  he
should injure the trade.   So far was this from  being the case, that
at the time alluded to,  although young in the business, he  was quite
as competent to it as any one connected with it.  The ground  of
incapacity  was of course debated in the family, and all  that the
young man could  advance was, that he knew his talents were infe-
rior to his brothers', and that  he  should never do his  business
correctly.   His father, a  man of judgment,  proposed  to  him a
change of  scenery and objects.  He sent him to Manchester, where
he entrusted him  to make extensive purchases.  These he effected 
60
CASES OF MORAL INSANITY
very much to his father's satisfaction and  advantage.   The young
man thought otherwise ; returned in  low  spirits ;  bemoaned his
want of talent, and returned to his former occupation.  Here he
still dwelt upon  his want of ability ; and fearing he should injure
his father's business, he preferred  making a personal sacrifice; and
with only a small sum of money and a few clothes he set off  clan-
destinely for Liverpool, intending to embark for America.  He did
not find the Liverpool ship-owners so ready to  make sacrifices as
himself; and as his funds were inadequate to pay his passage-money,
he was obliged to write to his brother  for pecuniary assistance to
effect his object.  His brother very properly  replaced him under
his father's roof.   He very soon repeated his attempt to escape with
like effect; and  soon after his  second  return took  poison with a
view to destroy  himself.   Upon this he  was placed  under my care
in the Asylum.  I found  him in every way a man  calculated for
business, excepting in the estimate he entertained  of himself.   He
was quick in perception, active in body, persevering, fond of money,
knew the value of articles, possessed very good  general judgment,
and was a very acute  calculator ;  but he  distrusted his capabilities.
His general health was much disordered, probably from the lauda-
num he had taken : this was restored.   He was treated with great
mildness and with an  unbounded confidence, to which encourage-
ment of every kind  was  added ; and  having spent  three  months
very usefully to  me, he returned to his father's house  and prosecuted
his business most  satisfactorily  for upwards  of a year, when his
want of confidence returned, and he left home again.   He now does
so frequently, and  after a short absence  returns, takes no notice of
what has occurred, and  no remark  is made by his family.  They
perceive, however, that his  affections are changed ;  he avoids his
father, speaks harshly to him and angrily of him, and is suspicious
of the rest of his family.
  " An elder brother, without evincing any symptoms of madness,
had destroyed  himself; and I  fear the same event in this case.
  " We have at  the present moment a woman in the house, sent to
us in consequence  of her repeated attempts to destroy herself.  She
has been with us but a few days, and is  at present  suffering from
having swallowed a quantity of diluted  sulphuric acid prior to her
admission.
  " She is perfectly intelligent; has not  one disordered idea that I
can detect, but the impulse of destroying herself.  She states that
she has  been  always subject to hysteria, which  has  at times occa-
sioned her much  suffering; that  her desire to  destroy herself is
preceded by hysteric sensations—fulness of the bowels, flatulence
and rising in the throat, and constriction of the fauces—but that
these  symptoms are followed by a rush of something, not of blood,
into her head.    Her head  and  face at these times feel  hot, but the
skin is not so reddened or flushed as her  sensations would lead her
to suppose.  She says that a ringing or  burring  noise is heard in
and about her head, and that these sensations last from a few minutes 
MANIA.
61
to a quarter  of an hour; that during their continuance she feels
prone to inflict injury upon those who are about her,—to do mis-
chief to the  surrounding furniture, &c;  but  that on the sensation
'going down,'—that is  her expression,—she becomes more and
more wretched, and would then gladly destroy herself.   Her health
is much impaired.
  " We had  a similar case, a short time since, in a respectable farmer
upwards of sixty  years  of age, whose mind was  unaffected with
disordered ideas, and who, by means of a  nail, made a hole in  the
skin of his throat, into which he forced his finger, and actually tore
a large rent.   He had no motive likely to incite him to  self-des-
truction."
          Sect. IV.—Of Mania, or Raving Madness.

  Characteristics of the disease.—In mania, or raving madness,*
the derangement of the understanding is not limited, as it is in mono-
mania, to one subject or to one train  of thoughts, nor does it cease to
be manifest, as in that disease, during intervals, when the attention
is withdrawn  from a particular  subject   In the form of insanity
now to be described, the mind is perpetually in a state of confusion
and disturbance, which  affects all the intellectual faculties, and in-
terferes with their exercise even for the shortest  period.  Mania
may be observed to differ from monomania in two respects : first,
in the circumstance already noticed,  that the derangement of the in-
tellect  is not partial, or involving but one series of ideas :  secondly,
that the mind being generally in  a state of perturbation and excite-
ment, the patient talks with vehemence, or raves on  every subject
which  for the moment occupies his attention.   This last charac-
teristic is  often  the  most striking, since maniacs,  though  their
thoughts are not clear and collected on any subject, are often chiefly
intent  upon  impressions of a peculiar description.  Some rave in-
cessantly about subjects connected with religion, and repeat texts
of scripture with  the greatest volubility.   Some imprecate curses
upon those who surround  them  and restrain their violent efforts.
Others talk in the  most obscene and indecent manner.   Thoughts
which  associate themselves with  some particular idea or feeling are
often uppermost in the mind.  This, however, is not invariably the
case.   In some instances  the mind passes in rapid transition from
one subject to another, and the current of ideas, always hurried and
confused, is liable to be turned  aside  by any casual association or
suggestion.
  Description.—This form of madness generally makes its appear-
ance and reaches  its highest pitch more rapidly  than others, and it

  * The term raving madness may be used with propriety as an English synonym
for mania.  All maniacs display this symptom occasionally, if not constantly,
and in greater or less degrees.  The verb from which mania is derived means
precisely what we express by the verb  to rave. 
62
MANIA, OR
is termed accordingly, when that is the  case  in  a  marked degree,
acute mania.  There are, however, in most  instances premonitory
symptoms, lasting for some days or even for some weeks, before
the existence of mania becomes fully established.  During this period
the individual experiences occasional fits of  excitement and confu-
sion, by which his understanding is disturbed. He passes some days
in a state of feverish agitation and general uneasiness : he is full of
activity, and displays a morbid energy in the pursuits on which he
is intent, in which, however, he performs nothing ; his projects are
for the most part trifling and absurd.  He neglects food, loses his
appetite, passes sleepless nights, either lying awake and  fatiguing
his mind with anxious speculations, or rising often, walking to and
fro in a state of uneasiness and perturbation.   At length his reason
is found to  be  disordered : he appears scarcely to  know what he
says,  talks  nonsense, repeals  his  words frequently, is  unable to
complete  the  sentences  which  he begins, and makes ineffectual
efforts to recollect his thoughts, utters rapid  and  confused expres-
sions in an impetuous manner ; cries, laughs, appears irritable and
prone to anger, though, perhaps, naturally of mild and sedate tem-
per ;  is impatient of the most trifling opposition,  and absurdly ob-
stinate and  capricious ;  expresses his feelings with  an unreasonable
degree  of warmth and  enthusiasm.  It is often remarked by their
relatives and  others, who have an opportunity of observing the
conduct of individuals thus affected, that the state of their minds
resembles that of persons intoxicated, and  that their attempts to
collect their thoughts and express themselves with correctness are
like  the efforts of men  half  drunk to continue conversation and
prove themselves to  be sober.   The morbid state of a person under
these circumstances is always apparent to those who surround him;
but it is sometimes  doubted whether he is  completely mad and a
proper subject for restraint, until some attempt being made to oppose
him  and interfere with his wild pursuits, he breaks out into a degree
of violence which  obviously  requires coercion,  and sometimes,
though  this is  not a constant  phenomenon in mania, shows that he
has laboured under the influence of an unperceived delusion, an in-
sane and absurd impression  as to his own person, or his relation to
others.   Such  an impression,  if it exists, is  not found to be a per-
manent delusion, like that of the monomaniac ; it is soon forgotten,
or gives way to some other phantasm.
   The  disease generally increases in violence, and is several  days,
perhaps  weeks, before  it reaches its  highest degree of intensity.
During this period the  phenomena of derangement vary according
to the predominance of particular  feelings.  In some fear, in others
anger, in all some violent emotion  has the sway. Many individuals
are seized occasionally with painful  agitations, with fits of terror ;
they are under apprehension  of some  undefined  evils impending
over them ; they pass sleepless  nights, and cannot even lie in their
beds ; and by day they are in a constant state  of uneasiness and rest-
less action.  Others break out frequently into the most violent expres- 
RAVING MADNESS.                   63
sions of rage and enmity against their relations, who are under the
necessity of exercising more  or less of restraint and resistance to
their absurd proceedings, and  have, perhaps, threatened to put them
into confinement, or have even carried the proposal into effect.  They
utter imprecations against  those  persons who have deprived them
of their liberty, declare that they will obtain vengeance, and bring
them to condign punishment.   The nearest relatives and the most
affectionate friends of the lunatic are now among the objects of his
most vehement displeasure. As the disorder approaches its highest
pitch,  the current of ideas becomes more  and more  turbid ;  the
thoughts and feelings are expressed with cries and ejaculations, with
agitation displayed  in the  manners and  countenance, with violent
and irregular movements and  jestures ; the internal sentiments or
feelings so absorb  the  attention that  the patient becomes  almost
unconscious of external impressions.  Many individuals abandon in
their own persons all regard to cleanliness and decency, and become
filthy and disgusting in the extreme.   All the functions of the body
are in  these circumstances  of the disease affected ; the bowels are
irregular, the tongue is furred, the skin cold and clammy.   The
patient excreates saliva,  mixed with mucus.   His features become
haggard and maniacal ; his eyes  watery and suffused.  In some in-
stances the countenance of the individual is  so much altered  in ex-
pression, that his nearest relatives would scarcely recognise him.
   The state of highest excitement, which may be termed the acme
of acute mania, has been ably described by Pinel, though perhaps in
colours somewhat too vivid.  He says, " the patient sometimes keeps
his head elevated and his looks fixed on high; he speaks in alowvoice,
or utters cries  and  vociferations  without any apparent motive ; he
walks to and fro, and sometimes arrests his steps as  if excited by
the sentiment of admiration, or wrapt up in profound reverie.  Some
insane persons display wild excesses of merriment, with immoderate
bursts of laughter.   Sometimes, also, as if nature delighted in con-
trasts, gloom  and  taciturnity prevail, with  involuntary showers of
tears, or the anguish  of deep sorrow, with all the external signs of
acute mental suffering.   In certain  cases  a sudden reddening of the
eyes and excessive loquacity  give presage  of a speedy explosion of
violent madness, and the urgent necessity of a strict seclusion.  One
lunatic, after  long intervals of calmness, spoke at first with volu-
bility, he uttered frequent  shouts of laughter, and then shed a tor-
rent of tears ;  experience had taught the necessity of shutting him
up immediately, for his paroxysms were at such times of the greatest
violence.  It is often observed that  extatic visions in the night  are
the preludes to fits of maniacal devotion ; and by enchanting dreams,
or by the fancied  apparition of a beloved object, it sometimes hap-
pens that  erotic madness  breaks out with violence, when it may
either assume the character of a calm reverie, or display nothing
but extreme confusion in  the ideas, and the entire subversion of
reason."
   When the disease has taken a firm hold on its unfortunate victim, 
64
MANIA, OR
 it sometimes gives rise to all the  internal effects, and displays  all
 the external phenomena which the most intense feelings of human
 misery, resulting from the real calamities of life, may be imagined
 to produce.   The  maniac who  becomes the subject of  violent ex-
 citement  " is seen in a  state of extreme agitation, with  his face
 flushed, his eyelids inflamed, and  his  eyes  sparkling, his  temples
 beating violently ; he talks, cries, sings,  grieves, gets  into fits of
 rage by night and  by day, and  is  incapable of taking  rest.  The
 melancholic, also, in  extreme agitation, but wrapt up  in  himself,
 goes to seek in some quiet and dark  recess a refuge from his panic
 terrors, from his gloomy and despairing thoughts ; or the means of
 putting into  execution  his baneful  designs.   The insensible and
 stupid, incapable of any  thing, remain unconscious of surrounding
 objects, and do  not exert themselves to satisfy their most urgent
 wants.  At this period of madness there is a constant want of sleep:
 the patient often experiences a feeling of tension and of heat in the
 head, without, however, complaining of it."   Sensibility to exter-
 nal impressions, as well as to all bodily changes, is so much lessened,
 that blisters,  cauteries, as well  as exposure  to intense cold, will
 sometimes produce but little expression of pain or distress.
   A striking and graphical description of the phenomena of raving
 madness in  cases which display the greatest intensity of  the disease,
 has been drawn by Chiaruggi, and has been cited with high com-
 mendation by Professor  Heinroth.   The  following  is an  abstract
 of it.
   Among the phenomena of the first  stage of this disease, we are  at
 first struck by impetuous, audacious,  shameless habits, a  bold men-
 acing aspect; the natural evacuations are deficient; the skin becomes
 of a slaty colour ; the forehead  contracted ;  the eye-brows drawn
 up ; the hair bristled; the breathing hurried.   The countenance be-
 gins to glow ; the eyes become  fiery and sparkling ; the looks are
 wandering and scarcely ever fixed ; the eye-lids are b)>- turns drawn
 widely open and closely shut;  the eye-balls are prominent, as  if
 pushed forward  out of the  orbits.  With  this wild and  menacing
 appearance is combined  a patient endurance of hunger, and a re-
 markable insensibility of cold.  If sleep visits the patient at all,  it
 is short, unquiet, and easily disturbed.  In the  second stage, anger,
 violence, and the loss of reason manifest themselves in their great-
 est intensity ;  shrieking,  roaring, raging,  abusive expressions  and
 conduct towards the dearest friends and the nearest relations, who
 are now looked  upon as the bitterest enemies.   The patient tears
his clothes to tatters, destroys, breaks in pieces whatever comes in
his way.  A striking  and characteristic circumstance is the pro-
pensity to go quite naked.   Whoever touches the patient is abused
or struck by him.   Strange confused  ideas, absurd prejudices occu-
py the mind.  Stillness soon follows, or a murmuring sound, as  if
the patient were  alone : on the other hand, when he is alone,  talking
and gesticulating as if  he  were in company.   If such  individuals
are confined and tied during the height of their paroxysms, for their 
RAVING MADNESS.
65
 own security or that of others, nothing can be compared to the truly
 satanical expression which  their  countenances display.   In this
 state they throw hastily away with cries and shrieks all the  food
 presented to them, except fluids, which thirst compels them to re-
 ceive.   When after some days hunger begins to be felt, they swal-
 low every thing with  brutal  greediness ;  they even devour, as it
 has often been observed, their own excrements, which, black and
 offensive, escape from  them in great quantity, or smear with them
 clothes, beds, and walls.  Notwithstanding his constant exertion of
 mind and body, the muscular  strength of the patient seems daily to
 increase ;  he is able to break the strongest bonds and even chains ;
 his limbs seem to acquire a remarkable nimbleness and  pliability,
 and a singular aptitude of performing movements and actions which
 appear  almost supernatural.  Chiaruggi saw a woman who, clothed
 in  a straight waistcoat and laced down in her bed  like a  child  in a
 cradle,  drew out her limbs from this double  confinement with the
 greatest nimbleness  and pliancy.   Bold, however, and impudent as
 such patients are, yet they are, according to  common  observation,
 although not without exceptions, easily daunted by a strong threat-
 ening voice, by the  sight of stocks, by close  though harmless re-
 straint.   After their violence  has expended itself, they become still,
 gloomy, appear to be  reflecting or brooding over something ;  but
 they break out again, before it can  be anticipated, into a new storm
 of rage.  At length  comes on the third stage.  A real cessation of
 violent paroxysms now ensues,  exhaustion, sleep though unquiet,
 disturbed by fearful  dreams.   The  pulse is small, the aspect of" the
 whoJe body squalid, the countenance pallid and meagre.  The pa-
 tient is obdurately silent, or sings and laughs in a strange manner,
 or  chatters with  incessant volubility.   These uncertain  intervals,
 which often put on the appearance of  fatuity, are frequently inter-
 rupted  by new but short renewals  of  violence.  Memory for  the
 most part remains unimpaired through all the  stages, and  during
 the highest intensity of the disease  the  senses appear to acquire an
 unusual degree of acuteness and susceptibility.   A patient who had
 recovered  described to Chiaruggi all the scenes of his wild reverie
 and long-continued mental  perturbation.   It has often been observ-
 ed that  maniacal patients of this description are never attacked by
 any  epidemic,  and are seldom affected by any contagious  malady.*
 According to Mead and many others, even consumptive disorders,
 dropsies, and other chronic  maladies have disappeared on the acces-
 sion of  violent insanity.  When patients are  not  freed from  the
 disease  after a succession of attaeks, which come on like so many
paroxysms of fever,  one or the other of the  following events  en-
sues : either the powers of mind are exhausted  to that degree that
the disease subsides into a permanent fatuity ;  or this appearance of
fatuity is only a space of calmness  interposed  between relapses  of
violent  madness, which now and then break out, like the eruptions

              * This observation is not without exceptions.
  April, 1S37.                7 
66
PHENOMENA OF PROTRACTED INSANITY.
of a volcano after a long  period of repose ; or the patient falls into
a state of melancholy or of complete mental confusion ; or,  finally,
his madness becomes chronical, and he scarcely recovers from this
condition, in wThich sense  and understanding  appear  to be lost in
incoherence.   Chiaruggi saw a woman who had sat during twenty-
five years on a stone floor, in a fearfully demented state, beating the
ground with her chains without ceasing by day or by night.*
   It has often been observed that acute attacks  of mania attain their
utmost degree of intensity, and begin to decline or undergo a remis-
sion  or a species of imperfect crisis, at a period of no long duration
after the first appearance of severe symptoms.  It is the opinion of
M. Esquirol that such a change may generally, or at least frequently,
be perceived to take place within the  course of a month from the
commencement of  an acute attack.  Certain it is that in the gener-
ality of cases the symptoms of extreme violence subside in a greater
or less degree after a time, and that intervals at  least  of comparative
quietness are perceived.   From such a remission may  be dated the
commencement of the chronic or  advanced stage of madness.


Section V.—Of the Phenomena of Protracted Insanity, or of
        the advanced or Chronic Stage of that Disease.

  The ultimate tendency of insanity is to pass into a  state of mental
decay, or of obliteration  of the intellectual faculties, which will be
described hereafter under the designation of Incoherence or Demen-
tia; but before the transition into this deplorable state  has completely
taken  place, there is, in  most cases of protracted mental derange-
ment,  a  stage of  uncertain duration, which may be termed the
chronic period of madness.  This  is  the state in which the majority
among the inmates of lunatic  asylums continue for  years to exist.
In some instances  it lasts during life, the mental  faculties  never
becomingentirely obliterated even after the lapse of twenty or thirty
years.   It is, however, itself a state of great intellectual weakness,
in which none of  the operations  of the  mind  are performed with
energy or effect.  The memory, the judgment,  the powers of atten-
tion and of combination are so much impaired, that  the individual
is wholly inadequate to the duties of society, and  incapable of any
continued conversation ; his actions and conduct are without steadi-
ness  and consistency ; his thoughts  are  deficient  in concentration
and coherence.  In fact this  may be  considered  as a prelude  or
commencement of that state of incoherence or dementation which
will be described in the sequel.  It is  a combination of the pheno-
mena of mania or monomania with those of dementia.
  On comparing the modes of action which  are to  be observed in
an assemblage of lunatics in the advanced stage  of  insanity, we find
  * Chiaruggi, della Pazzia in genere ed in spezie.  Heinroth's Stoerungen des
Seelenlebens, 2 abschn :  Formenlehre. 
           PHENOMENA OF PROTRACTED INSANITY.         67

the different forms of the  disease in  some measure  blended and
passing into each other;  they are at least not so distinctly marked
as in the early period.   The symptoms belonging to one form of
madness are often confounded  with those of another, and  from the
combination there results, as it has been remarked by a  writer of
extensive observation  and research, an assemblage of phenomena
which bears little or no similitude to the description found in books
and commonly entertained.
   An  opinion  has  been  maintained that, in all cases of insanity,
periods of monomania, of mania, and  of dementia or incoherence,
take place successively.*   Nothing can be more erroneous  than
such  a notion,  although it is true that  the two former of these
morbid conditions sometimes  pass  into each other.  Many  indivi-
duals continue  long to  display the characteristics of mania, but
except during particular  periods of renewed violence  or agitation,
to which most are subject, they become more tranquil than at the
commencement  of their complaint.   They display signs of incipient
dementia, combined with morbid  activity of body, in which the
excitement characteristic of their disease exhausts itself into  almost
perpetual action.  Lunatics  of a different class fall into a state of
calm  reverie ; their imagination,  abandoned to itself without the
control of judgment, gives  itself  up to wanderings without end :
even  in attempting to converse, or when their attention is excited
by questions, these  individuals exhibit  a strange mixture of reason
and of mistakes, both as to facts and inferences.   Others, and these
are a  greater number, are chiefly governed by some particular
passion or mental habit:  many of  the latter are under illusions as
to their own persons and their relations to other individuals.   M.
Pinel says, " I was frequently followed at the Bicetre by a general,
who said that he had just ben fighting an important battle, and had
left fifty thousand men dead on the field.  At my side was a mon-
arch who talked of nothing but his subjects and his provinces.  In
another place was the prophet Mahomet  in  person, denouncing
in the name  of  the Almighty.   A  little further was a sovereign of
the universe, who could  with a breath  annihilate the earth.  Many
of them seemed to be occupied by a multiplicity of objects, which
were present to their imaginations.  They gesticulated,declaimed,and
vociferated  incessant^, without appearing to see  or hear any thing
that passed.   Others, under illusive influence, saw objects in forms
and colours which they did not really possess.   Under the influence
of an illusion of that kind, was a maniac who mistook for a legion
of devils every assemblage of people that he saw.   Another  maniac
tore his clothes  to tatters, and  scattered the straw on which  he lay,
under the apprehension that they were heaps of twisted serpents."
   These cases belong to  monomania, the morbid impression  having
reference to one subject or favourite  idea ;  but after the vigour of
intellect has broken down under protracted disease, the mind is not

    * M. Bayle, Nouvelle Doctrine des Maladies Mentales. Paris, 1825. 
6S
PHENOMENA OF PROTRACTED INSANITY.
 so tenacious of particular impressions as in the early stage of gradu-
 ally approaching insanity.  The illusions displayed at this period
 are not, like those of the melancholic  in  distinctly  marked cases of
 partial  insanity, silently cherished in  the  recesses  of the mind,
 brooded over in solitude or in gloomy reserve : they are less uncon-
 nected  with the present objects  of sense, and are for ever changing
 with the casual alterations of feeling or temper.   In a great number
 of those lunatics who  are threatened with general paralysis, or in
 whom  this affection has already displayed its  symptoms, a very
 remarkable form of monomania  has been observed.  The prevailing
 state is most frequently one of exaltation and joyous delirium.  The
 imagination in patients of this  class is puffed up with the belief of
 great possessions;  "they fancy themselves  the owners of millions
 of money, of towns, provinces, empires, worlds."   Intoxicated with
 their good fortune, they abandon themselves to the flattering  ideas
 which  occupy their minds.  Their joy diffuses itself over  their
 features, their gestures, and they beam with a sort of tumultuous
 gladness, so much the more lively as they fancy  it to be partaken
 by all who surround them, and on  whom they lavish promises of
 bestowing fortunes, jewels, palaces, and gardens.  " A man, says
 M. Calmeil, " who had been employed  in a  gaming-house, said to
 me one day with a  mumbling  articulation, and supporting himself
 with difficulty by one hand against a table, ' Being the most puisant
 of emperors,  I shall build  a  new Paris in four hours : the streets
 shall be paved with gold ; they shall meet in a great square which
 shalloccupy the midst; they shall have on each side two rows of galle-
 ries like a bazaar;  every where there shall be a  display of bronzes,
 statues, and marble columns.   The  beds in the apartments shall be
 made of rosewood ; in the place of curtains  there shall  be mirrors,
 which shall be fixed at the four corners by  hinges  of diamonds."'
 This writer observes that the particular aspect of  illusion  now
 described has often afforded a prognostic of general paralysis several
 months before its actual appearance.*   It continues during a great
 part of  the duration of paralysis, of which the course will hereafter be
 described,  but gives way gradually to the increase of dementia, and
 the morbid ideas of exaltation are obliterated with the last, traces of
 intelligence.   In other instances this joyous monomania undergoes
 a transition into a  variety of  maniaeal  delirium,  with excessive
 agitation and violent anger ; and this state has continued, with short
 intervals of quietude, until  the  death of the individual r in some
 instances it terminates in dementia.t   Monomania with melancholy
dejection is, according to the observations of M. Calmeil and others,
rarely the  condition  of  the mind in  these protracted eomplicated
 cases. %
  In  a  great  number of protracted  cases the disorder  has  a  very
different aspect: the principal phenomena of disease refer themselves
to some particular habit or active propensity: in these examples no
* M. Ca,lmeil, p. 32S.     \ Ibid. p. 330*     % Ibid. p. 33$. 
INCOHERENCE.
69
distinct hallucination or illusion can be traced, and the condition of
the individual come under  the  description of moral insanity.   I
have  frequently seen one person in a group of lunatics who is per-
petually and busily employed in numerical calculations.  He  has
generally a slate and a pencil in his hands, and runs up to any stran-
ger who presents  himself to  show  some reckoning which he  has
just made, and ask if  it is correct.  The subject is perfectly unim-
portant, and  generally turns upon  dates  taken from  an almanack.
Another lunatic, who was under my own care during a long period,
was never so  happy as when he was busily employed  in making
rhymes: he  was  a  man of colour from St.  Domingo, and wrote
verses in French,  which had occasionally some glimmerings of wit
and point.   He would immediately accost any person whom he saw,
and demand  a subject for an acrostic, which was very soon finished.
An individual, who  has been many years in confinement, is for ever
carrying on law-suits, and wearing out the patience of all his visitors
by a hurried but circumstantial detail of a case which, as he flatters
himself, is to come  on at the next quarter sessions.  Almost every
variety of human pursuit becomes occasionally the subject in relation
to which madness is exhibited, and the disordered state is displayed
in many instances rather in  the mode of action  and conduct, com-
bined with a degree of  general weakness or  diminished vigour of
mind, than in any of the hallucinations or illusions which are com-
monly regarded as characteristic of monomania.


            Sect. VI.—Of Incoherence or Dementia.

   Incoherence is a very peculiar and well-marked form of mental
disorder.   The mind in this state is occupied,  without ceasing, by
unconnected  thoughts and evanescent emotions ; it is  incapable  of
continued attention and reflection, and at length loses the faculty of
distinct perception or  apprehension.  Numerous examples of this
disease, or decay of  the mental powers, are to be met with in every
receptacle containing a considerable aasemblage of deranged persons.
It was termed by Pinel demence or dementia, and that designation
has been adopted by many late writers.   Pinel complained of  the
poverty of the French language in words fit for denoting the differ-
ent varieties  of mental disease.  We have no reason for bringing a
similar imputation against our own, or for  adopting, in  this  or in
other instances, Latin terms.   Such  a practice  is very  inconvenient
on  many  accounts,* and a  more appropriate epithet  cannot be

  » There are many reasons which render it advisable  to adopt English rather
than Latin technical expressions, as far as the former are available.  For example,
if a physician informs a jury summoned in an inquiry  " de lunatico," that the
person who is the subject of examination is in a state of dementia, he will prob-
ably convey no information, and must be prepared with  a definition of the term,
which involves a discussion.  By using the term incoherence he will convey a
correct idea, if  not a complete one, of his meaning. 
70
INCOHERENCE,
devised for the  disordered state now to be described than that of
incoherence, which expresses, in fact, its most striking and general
feature.  This consists in a want  of coherence, or of the usual and
natural connexion or association between ideas,  thoughts, and emo-
tions.  Pinel has thus briefly defined it: " Idees incoherentes entre
elles, et sans aucun rapport avec les  objets exterieurs."   He after-
wards explains this definition or expands it, and I shall cite his own
expressions,  which  I  find  it  difficult  to  translate  with perfect
precision.  " Une mobilite turbulente et incoercible, une succession
rapide et comme instantanee d'idees qui semblent naitre et pulluler
dans l'entendement, sans aucun impression faite sur les sens; un flux
et reflux continuel, et ridicule, d'objets chimeriques qui se choquent,
s'alternent, se detruisent les uns les autres sans aucun intermission
et sans aucun rapport entre eux; le meme concours incoherent, mais
calme, d'affections morales, de sentimens de joie, de  tristesse, de
colere, qui naissent  fortuitement et disparoissent  de  meme sans
laisser aucune trace, et sans avoir  aucune correspondance avec  les
impressions des objets externes; tel est le caractere fondamental de
la d6mence dont je parle."
  Incoherence is either a primary disease, arising immediately from
the agency of exciting causes on a constitution  previously healthy,
or it is a secondary affection, the result of  other disorders of the
brain and nervous system, which, by their long duration  or severity,
give rise to disease in  the structure of those organs.   The causes
which produce the state of incoherence as an original  disorder are
nearly the same with those which in other cases excite  madness in
the first instance ; they are such agents as break down the powers
of the mind by their overwhelming influence, or destroy them by
vehement emotions.*   Secondary incoherence or dementia follows
long-protracted  mania, attacks of  apoplexy, epilepsy or paralysis, or
fevers attended  with severe delirium.   This decay of the faculties
has been termed fatuity or imbecility, and it has been  confounded
with  idiotism, which in all its  degrees and modifications  is a very
different state.   The distinction,  which  is very important, has not
always been kept in view by writers on disorders of the mind,'and
even  in the works of Pinel we find it sometimes overlooked.   M.
Esquirol has the merit of having drawn more  accurately the  line
of discrimination.   He refers to dementia all the cases  of effete or
obliterated intellect which are the results of maniacal or other dis-
eases, and are  incident to  persons originally  possessed  of sound

  * M. Calmeil has described two cases of dementia, in which incoherence and
the loss of the rational  faculties commenced,  and reached the last  degree, with-
out any symptoms of other insanity. Several strongly-marked cases  are repor-
ted by Pinel.  The individuals mentioned by  M. Calmeil had paralysis compli-
cated with dementia.  In these instances weakness of memory and intellect came
on gradually together with the first symptoms of general paralysis, and increased
until all traces of understanding,  moral  feeling, and  even  of the instinctive
impulses or merely animal powers were entirely obliterated, no degree whatever
of maniacal agitation having  been displayed through the whole  course of the
disease.  (M. Calmeil, ouvrage cite, p. 324.) 
OR DEMENTIA.
71
faculsies, and includes those defects only under idiotism, which are
original or congenital.   " The imbecile," he observes, " have never
possessed the  faculties of the understanding in a state  sufficiently
developed for the display of reason.   The victim of dementia was
once endowed with them, but has lost this possession.  The former
lives neither in the past nor the future ;  the latter has some thoughts
of times past, reminiscences which  excite in him occasional gleams
of hope.  Imbecile persons in their habits and manner of existence
display the semblance  of childhood ; the conduct, the  acts of the
demented preserve the characteristics  of consistent age,  and  bear
the impress derived from the anterior state of the individual.  Idiots
and cretins have never possessed memory, judgment, sentiments :
scarcely do they present, in some instances, indications of the animal
instincts, and their external conformation plainly indicates that they
were not organized to  be capable of thought.
  A want of sequence, or connexion between the ideas, a  failure of
that aptitude in  the mental constitution by  which in  the  natural
state one momentary condition of the mind follows  in the train of
its antecedent, seems to be the fundamental or essential circumstance
in this state of disease; and it not only constitutes the most striking
phenomenon of incoherence, but perhaps accounts for all the peculiar
features which accompany it.   Hence the defect of memory, which
appears in the first and slightest degrees of this affection, and the
incapability  even of  distinct apprehension which  occurs in the
advanced stage,  when sensations are no longer the  antecedents of
perception or recognition ;  and hence the moral indifference as to
the present and  the future for which demented persons  are remark-
able.   The faculty or capability of receiving impressions  is found
in all demented  persons to be impaired ; and this circumstance has
been strongly pointed out  by M.  Esquirol, whose  description of
dementia is the best  and  most original  that has  been  drawn.*
" Dementia," says this excellent  writer,  " deprives  men of the
faculty of adequately  perceiving objects, of seeing  their  relations,
of comparing them, of preserving a complete recollection of them;
whence results the impossibility of  reasoning correctly.  Demented
persons are incapable of reasoning, because external  objects make
too feeble an impression upon them ; because  the organs of trans-
mission have lost a part of their energy ;  or,  lastly,  because the
brain itself has  no longer sufficient strength to receive and retain
the impression which is transmitted to it; hence it necessarily results
that the sensations are  feeble, obscure, incomplete: being  unable to
form a true and  just idea of objects, these  persons cannot compare
them, or exercise abstraction or association of ideas; they are not
capable of a sufficiently strong attention ; the organ  of  thought has
not energy enough : it has  been deprived  of that vigour  which  is
necessary  for the integrity  of its  functions.  Hence  the  most
incongruous ideas succeed each other;  independent  of each other,
* Diet, des Se. Med. t. viii. p. 13. 
72
INCOHERENCE,
they follow without order and  connexion ; patients repeat words
and entire sentences without attaching to them any precise meaning;
they talk, without being conscious of what they say.   It seems  as
if unreal expressions were heard by them in their heads, which they
repeat in obedience to some involuntary or automatic impulse, the
result of previous habits or of  fortuitous  association with objects
which strike their senses."
  The following table, taken from M. Esquirol's treatise, will serve
to illustrate the forms of disease  which  are  included by  medical
writers under the  common  term of dementia.   It is styled by M.
Esquirol a table of causes.  The  table exhibits  the distribution  of
235 cases of dementia ; the first column contains the number of pa-
tients admitted at  the Salpetriere during the years 1811 and 1812 ;
the second  column is  the report of the author's private  establish-
ment, and is limited to persons of the  higher or more opulent classes
of society.

                       TABLE OF C A.USES.
                Number of individuals,
Physical Causes.
                                4
                                6
                                3
                                0
                                3
                                2
                                2
                                4
                                2
                                2
                                2
                                8
                                6
                                6
                                7
Disorders connected with the catamenia	. 11
Critical period .....	. 29
Consequences of childbirth	. 5
Blows upon the head	. 3
Progress of age ....	46
Ataxic fever.....	1
Suppression of hemorrhoids	0
Mania......	14
Melancholia.....	13
Paralysis......	3
Apoplexy......	. 3
Syphilis and abuse of mercury Faults of regimen ....	6
	0
Intemperance.....	9
Masturbation.....	. 4
Moral Causes.	
Disappointed love ....	1
Fright......	4
Political excitement ....	0
Disappointed ambition	0
Poverty......	5
Domestic griefs.....	8
192
73
Total.
}»195
40
235
  Of the several degrees of incoherence.—Incoherence, or demen-
tia,  exists in several stages or degrees, which present different phe-
nomena ; and the description of one is, therefore, not applicable to
another.   We find no difficulty in recognising four degrees in this
state, each of  which is characterised by peculiar features.  If the
disorder commences in the first degree, it goes on successively to
the  more advanced ; but the  more  severe  degrees, or the greatest 
OR DEMENTIA.
73
development of the morbid phenomena, may appear at once, as the
immediate effect of causes which destroy the  powers of mind, or
produce disorganization of the brain.
  The first stage or degree may be termed that of forgetfulness, or
loss of memory.   Its chief  characteristic is a failure of memory,
especially as to recent events.
  The second degree brings with it a total abolition of the power
of reasoning,  depending on a loss of voluntary control over the
thoughts.   It may be termed the  stage of irrationality, or loss of
reason.
  In the third degree the individual affected is  incapable of compre-
hending the meaning of any  thing that may be  said to him.  It may
be styled the stage of incomprehension.
  The fourth stage is characterised by loss of instinctive, voluntary
action.  The individual is found to be destitute even of the animal
instincts ; he cannot obey the calls of nature.  This is the stage of
inappetency, or loss of instinct or volition.
  First degree of incoherence or dementia.   Impaired memory.
—The first stage of  this affection is distinguished by forgetfulness
of recent impressions, while the memory retains a comparatively
firm hold of ideas laid up in its recesses from times long past : the
power of reasoning within the sphere of  distinct recollection is not
remarkably impaired, and the faculty  of judgment is exercised in a
sound manner when the attention can be sufficiently roused.
  The disease of incoherence approaches most  gradually and slowly
when it comes on as the symptom and accompaniment of old age ;
it is in such instances that its several degrees are most clearly recog-
nised and distinguished. It is particularly in this  modification of
dementia, that we have an opportunity of tracing  most distinctly
the approach and observing the  phenomena of  the first stage; of
noting its commencement and  slow advances.   It seems to begin
with dulness of perception or apprehension.   The organs of sense
are not so perfect in advanced age as in the more healthy and vigor-
ous periods of life :  sensation is not so acute ;  but it is rather in the
subsequent  recognition which the mind makes of the ideas presented
to it, than in sensation itself, that the defect chiefly lies.  Percep-
tion, indeed, takes place, but the  impression is momentarily  evan-
escent.  The individual sees and  hears ; he replies to questions, but
his attention is so little excited that he speedily forgets what he has
said, and  repeats the same remarks or inquiries after a few minutes.
At the same time ideas long ago impressed upon the mind remain
nearly in their original  freshness, and are capable of being called up
whenever the attention  is directed towards them.   Sensations pro-
duced by present objects are so slight, and the  notions  connected
with them so confused and indistinct, that the individual  affected
scarcely knows where he is ;  yet he recognises without difficulty
persons with whom  he has long been  acquainted, and if questioned
respecting his former life, and  the transactions and pursuits of his
youth or manhood, he will often give pertinent and  sensible replies. 
71
INCOHERENCE,
The disorder of his mind consists not in defective memory of the
past, but in the incapacity for  attention and for receiving the  influ-
ence of present external agencies, which, in a different state of the
cerebral organization, would have produced  a stronger effect upon
the sensorium, or seat of sensation and perception.
  I well remember conversing more than once with a gentleman
advanced in age, who had passed  the greater part of his life in ac-
tive exertions,  which he had  relinquished when his memory had
rather suddenly become defective.  He remembered the events of
his youth, talked  of his father, who, as he said, had come from  Scot-
land with a pack  upon his back to settle in  the town where he  after-
wards resided; he said that the latter had thriven in business and
had become rich, mentioned a variety  of particulars which proved
that impressions made upon his mind up to a certain period of his
life were still fresh, and made some remarks and general reflections
indicating that  his reason was  yet sound.  The  same person  could
scarcely give any account of what had passed during the last fifteen
or twenty years.   He could not recollect the names of his grand-
children, though  they had been  frequently in his society, and he
scarcely seemed to be aware of their existence.   He appeared not
to know where he was, but often fancied himself travelling and at
an inn when he was at home, in the house which had  been his abode
for many years.
   The following  description of a case of senile dementia will  serve
perhaps still further to exemplify the state of the sensorium and of
the mental faculties in this affection.  .
   A. M., aged  about seventy years, was in his youth  a farmer, but
changed that occupation for the business of a baker, which he fol-
lowed until  he had  accumulated property sufficient for his main-
tenance.  He has been living  for several years in retirement, and
without any regular employment.  His memory is said to have un-
dergone a gradual decay.  When he is questioned respecting present
objects and circumstances, he generally gives clear and distinct an-
swers, but can seldom recollect what has occurred but a short time
previously.  In half  an hour after he has been visited by his medi-
cal attendant, who is an intimate acquaintance, he will say, if asked,
that he has not seen him for several days.   His recollection of per--
sons whom he knew in the former periods of his life, and of events
which then  happened  him, is tolerably  clear, but at times, and
especially after sleep, he does not know where he is.  He sometimes
fancies, at night,  on waking from a short sleep,  that  he is engaged
in his former occupations.  He then rises  from  bed,  and  sets him-
self busily to prepare for lighting a fire in his oven,  beats the wall,
calls  his men up, and  asks if the faggots are  ready.   He cannot be
persuaded without great difficulty  that he is in -------street, and
has nothing to do with the baking business.  At other times he will
get up in great haste to  go down and see  somebody who  is wating
for him on business, or thinks  that there is a  horse standing for him
at the door, calls  for his  clothes, and  wonders that his friends are 
OR DEMENTIA.
75
so tardy in assisting him.   At these periods his state is not  that of
ordinary somnambulism.  He sees and knows some at least of the
persons who are about him, and will converse with them. He some-
times, during the daytime, wonders where he is, does not know the
place though he has resided in the same house for some years. The
hostess, who is  an old acquaintance, at length  convinces him that he
his at her home.  When his recollection is roused, and his thoughts
are drawn into  the  right  channel, he  has a  correct knowledge of
persons, and shows  not the slightest trace of  maniacal  illusions, or
of any thing approaching to the character of ordinary madness. He
is glad to see his old friends, shakes hands with them in his wonted
cordial manner, is on the best terms with  his relatives, and never
displays the least deviation from the natural and habitual state of his
feelings and affections.
   Senile dementia,  or the decay of the mental faculties, is  not the
lot of old persons universally, though it is a condition to which old
age may be said to have tendency, and to which  in the  last stage of
bodily decay some  approximations are generally to be perceived.
The change which time alone will perhaps sooner or later bring on,
in those who long survive the allotted duration of man's days, may
be accelerated by a  variety of circumstances.  Among these  is a life
of too much activity and excitement, of mental exertion  beyond
what the constitutional strength of the individual is capable of sup-
porting without constant effort; excessive anxiety and eagerness in
the pursuit of  business, or intense  and unremitted application to
studies of whatever kind.  The minds and bodies of men are only
fitted for exertion in certain degrees, which, however, differ in dif-
ferent individuals; but the powers of all are limited. All have need
of occasional respite  from  labour, and the  appointment  of  rest
during one day in seven is, from physical considerations alone, cal-
culated to  promote the well-being of individuals and of society.
We may observe that among those who have neglected this ordin-
ance, there have been many who have suffered the penalty in this
life.   Some have terminated a rapid and perhaps brilliant career of
unremitting and successful exertions by suicidal  madness, of which
too many and  too well-known examples  might be  cited ; others,
though in a longer measure  of time, have accelerated the period of
intellectual decay.
   A second cause of  senile dementia, next  in  the frequency of its
operation  to that which we  have just mentioned, is the too liberal
use of vinous or other alcoholic liquors. The same affection has been
observed frequently to make its appearance in men long engaged in
active pursuits, soon after they have relinquished their business or
professions, and have laid themselves by to enjoy  ease and leisure
for the remainder  of their days.  The disease often appears in  a
more marked and sudden manner in elderly persons who have sus-
tained a slight  attack of apoplexy or paralysis, which has perhaps
been speedily  recovered, and  might  be expected  to have left but
slight traces of disease.   That expectation is verified  so far as the 
76
INCOHERENCE,
 sensitive and motive powers are concerned, but the seat of intellect
 is found to have been shaken in its very centre.
   Senile dementia is entirely distinct  from that species of moral
 insanity which appears occasionally, as we have already observed,
 in aged persons.   The  former  is  merely a loss of energy in  some
 of the intellectual operations.  It brings with it nothing morbid or
 unusual in the state of the feelings or affections, no tendency to de-
 praved or  unaccustomed habits, nor, commonly, any change in the
 temper and general disposition of mind.   Individuals to  whose lot
 this complaint has fallen are seldom unhappy on account of it, and
 if they are in any degree aware of their condition, they bear it with
 patience and cheerfulness.
   These remarks are only applicable in their full extent to dementia
 when limited within the first degree.  This disease, as it  advances,
 involves the feelings and moral  affections : in the higher stages of
 dementia, whether occasioned  by the  progress of age or by other
 causes, the temper becomes changed and the disposition perverted.
   It is in senile decay that  the  phenomena of incoherence in the
 first degree are most strongly marked.   Traits of the same descrip-
 tion may, however, be observed in other cases of dementia.  The
 memory of those who labour under this disease  in the early stage
 from whatever  cause and in whatever period  of life it may have
 arisen, is that of aged  persons, more tenacious of long-past than cf
 recent events :  the latter  make  so feeble an impression that it is
 speedily obliterated.   In such persons all  the powers of the mind
 are greatly weakened :  they have no aptitude to any train of thought
 or action, and they are quite unable to fulfil the duties of their busi-
 ness or profession : they cannot combine a variety of considerations
 in order to come to  any practical conclusion; cannot enter with
 earnestness into any affairs of  importance, or  comprehend any
 continued  conversation: all  their discourse is  marked by  diffuse-
 ness and incoherence.*
  The second  degree  takes place in every instance  in which the
disease continues.  It is, perhaps, most conspicuous in cases which
are the sequalae of mania, or ensue after that disease has lasted for a
considerable time : in some instances, as I have before remarked, it
is the condition which disorder of the understanding assumes in the
onset, and as the immediate effect of some powerful agencies which
overwhelm the mind, as of sudden grief or joy, amazement, fright,
which, in popular language, are said to  render their victims idiots.
  Second degree of incoherence—Loss of the reasoning power.—
The second degree of incoherence brings with  it a total  abolition
of the power of reason: the energy of the will in  directing the
course of the thoughts, which is essential  to  every process  of rea-
soning, is impaired to such a degree as to preclude the exercise of
this faculty.
  Difficulties have engaged the attention  of metaphysical writers
* M. Calmeil de la Paralysie chez les Alienes, 
                         OR DEMENTIA.                      77

 with reference to the power of the will  over  the thoughts in  the
 healthy and sound state.  It has been said that the mind is so sub-
 jected to physical laws, that we cannot by an effort call up a single
 idea; that the thoughts follow each other  by laws of succession
 independent of voluntary  control, that the will  has in  some way a
 power of modifying the succession  of ideas is, however, certain,
 otherwise we should  be incapable  of conducting  any process of
 reasoning or argument.  Professor Dugald Stewart  has shown that
 this controlling influence is exercised by fixing  the attention exclu-
 sively and by voluntary preference  on certain trains of thoughts.
 It is, however, still through the associations which exist among the
 ideas, and  by  modifying the results  to which  the important prin-
 ciple of association gives  rise, that this voluntary control can alone
 be  exercised,  and it is easy to conceive that  when any  morbid
 change has ensued in the connecting  faculty  by which the ideas, if
 we may so speak, cohere, when they become  disjoined and  incohe-
 rent, no  longer  following each other  in  their  natural order of
 suggestion, the mind loses the power of reasoning through the shat-
 tered condition  of its instrument.   The  loss of voluntary power
 over the succession of ideas is so great in a certain period of demen-
 tia, that the individual affected is incapable by any effort of mind of
 carrying on the series of  his thoughts to  the end of a sentence or
 proposition. He hears a question, apprehends sometimes its meaning,
 and attempts to answer; but before he has uttered the half of  his
 reply, his mind becomes confused and bewildered, some accidental
 suggestion turns aside the current of his ideas, which are too loosely
 associated  to remain, even in  a short train,  coherent: his expres-
 sions become consequently absurd  and irrelevant.   It is sometimes
 easy to  observe  the point at which the intention  of the  speaker
 ceases to  direct  his words, and at which the  ideas are drawn aside
 into a different course.  The individual begins  to talk of one thing
 and before he has spoken  half a  minute he  has  wandered  into
 subjects  so remote  from it that some care is required  that  the
 by-stander may be enabled to trace the links by which his thoughts
 have reached the point at which they are found.   This degree of
 incoherence is generally to be observed as a prelude to a more severe
 and complete form, which will  next be described.  Until the mind
 has passed into the more advanced stage, glimmerings of sense and
reason are displayed:  the individual affixes  some  meaning to his
 words, though  he soon forgets it.   The  memory is not entirely
 lost, though much impaired; its defects resembling in kind those of
 senile memory, but exceeding them in degree.   Many individuals
in this degree  of dementia know and remember their friends or rela-
tives, but  scarcely display signs of emotion or sensibility on being
visited by them.  Not a few even in this state are capable of being
employed  in  mechanical  occupations.  Females knit  or sew, or
perform  any  work  with their hands to which they had  been
previously habituated;  and men draw, or write letters or sentences,
in  which, however,  their  imbecility is   generally conspicuous.
  April, 1837.                8 
Tfr
INCOHERENCE,
Some patients  have occasional  periods of  greater excitement, in
which the symptoms of a more active state of madness resume their
prevalence.
  The physical-health of patients thus affected is in  general tolera-
bly good ; they are often fat, have good appetites, digest their food,
sleep well, and if in the  previous stages of the disease they had
been emaciated, they  often  recover  their  natural degree of plump-
ness on the approach  of dementia.   Hence the return of physical
health without  a corresponding improvement in the state  of the
mental faculties, is; is it has  been  remarked  by M. Esquirol and
others, an unfavourable prognostic in cases of maniacal disease.
  There are, however, some rare cases of recovery from this stage
of dementia.   Pinel informs us that many, especially young persons,
who had remained in the Bicetre several years or months in  a state
of absolute  fatuity,  have  been  attacked  by  a paroxysm  of acute
mania of  twenty, or  five-and-twenty, or  thirty days' continuance.
"Such paroxysms," he adds,  "apparently from  a re-action  of the
system, are im  many  instances succeeded  by perfect  rationality."
The same result has been  observed on the restoration  of demented
persons or of maniacs in the advanced stage of insanity after severe
attacks of fever attended  with  delirium.   Such attacks are  often
fatal to lunatics ; but of those who  recover  them,  not a few are
subsequently restored to the possession of their faculties.
   Third degree  of incoherence—Incomprehension.—The third
degree of dementia is characterised by inability to comprehend the
meaning of any question or proposition, however simple, that may
be addressed to the person  affected.   If the attention can be ever so
slightly roused, the reply attempted  is always so remote from the
subject as to indicate  plainly that the question has not  been  under-
stood.
   This may be termed the confirmed stage  of incoherence ; that
epithet applying to it in a  still more striking'manner than  to any
other degree of the disease.  It might' also be termed the instinc-
tive stage.   Reason  being entirely lost,  and the instinctive or
mechanical principles of action, as they are termed, still remaining
in  vigour, the' latter display themselves more remarkably.  The
 demented person is the creature of instinct and habit.
   Physical activity is often remarkably displayed by persons reduced
to this state, and it assumes the  appearance of trick or habit.   Some
jump or run to and fro, or walk round perpetually in a circle.   Some
danceand sing, or vociferate frequently.  Many talk incessantly in
 the most unmeaning jargon,  attaching no  ideas whatever to their
 words; others pas?their  time unceasingly in muttering  half sen-
 tences and  broken  expressions, in  which it  is scarcely possible to
discover any link of  connection ;  or if any association can be traced
in their thoughts, it is of the  most trivial kind, and depending on a
word or  on some  sensible object which for a moment attracts a
degree of attention.   Many,  on the other hand, sit in silence, with
3-sedate.and. tranquil look, sometimes with a vacant smile or with 
OR DEMENTIA.                      79
an unmeaning stare, and scarcely  pronounce a syllable for weeks,
or months, or even for years.   A few remain crouched in a  parti-
cular posture,  which they  always prefer, though to bystanders it
seems the most uneasy and  even  painful ;  if placed  in a different
manner by those who have the care of them, they soon resume their
habitual position.  Many demented persons crowd round a stranger
who happens to visit a lunatic asylum and gaze at him, having just
enough intelligence to perceive something new and  to which they
are not accustomed  in his aspect.  Some  individuals  in this  state
have a propensity to adorn  themselves  in a strange  manner:  they
take any thing that  happens to be in their way, and append  it to
their dress, which is singular and ridiculous.
   M. Esquirol has  described in a  striking* and accurate manner
the  aspect of  countenance peculiar to dementia, and  especially
belonging to this stage of the disease.   " To the disordered state of
the intellectual faculties," he says, " the following symptoms are
added : the face  is  generally pale, the  eyes moistened with tears,
the pupils dilated, the look  wandering, the countenance motionless
and  devoid of expression ; frequently the  muscles of one side are
relaxed and give the face a distorted appearance ; the body is some-
times lean and emaciated, at others it is loaded with fat ; in  such
instances the face is  full, ruddy, the neck short; in a few persons no
outward sign can be perceived indicative of the  decay of intelli-
gence."
   Fourth and last  degree of Incoherence.  Loss of Instinctive
Jiction : Inappetency.—In the last stage of this affection even the
animal instincts are  lost.   The miserable  victim  of  disease, when
reduced to this state, has  merely organic or physical  existence; he
appears scarcely conscious of life, has neither desires nor aversions,
and  is unable to obey the calls  of nature.
   Scarcely any exhibition of human suffering can be  more deeply
affecting than  the aspect of  a group of  lunatics reduced to the last
stages of  fatuity, and those who  have never witnessed such a spec-
tacle can hardly imagine so abject a state of mental degradation.  In
a group of this description  an individual maybe seen always stand-
ing  erect and  immovable, with his head and neck bent  almost at
right angles to his  trunk, his eyes fixed upon the  ground, never
turning them round, or appearing by any movement or gesture to be
conscious of external impressions or  even of his own existence.
Another sits on a rocking chair, which  she agitates  to and fro, and
throws her limbs into the most uncouth positions, at the same time
chaunting or yelling a dissonant song, only capable of expressing a
total inanity of ideas and feelings.  Many sit constantly still, with
their chins resting on their breasts, their eyes and mouth half open,
unconscious of hunger  or thirst, and almost destitute of the feelings
which belong to merely physical  life ;  they would never lie down

   *  See the description of Demence, by M. Esquirol.  Diet, des Sc. Med. torn.
viii.  p. 13. 
80
GENERAL PARALYSIS
 or rise were they not placed in bed and again raised by their atten-
 dants.   A great proportion of the patients who are  reduced to this
 degree of fatuity are found to have lost the use of their limbs in a
 greater or less degree by partial or general paralysis.
   From such a state it is scarcely imaginable that recovery ever took
 place, but patients in the last stage  of fatuity often linger for many
 years.   Their state,  however,  is not always  uniform :  some  of
 them  have comparatively lucid  intervals, in which nature seems to
 make an effort to light up the mind and  recal lost impressions and
 ideas.  I have often observed a patient who sits all day in a wooden
 elbowed-chair, with  his  chin hanging over  his  breast, appearing
 hardly conscious of existence, and unable to assist himself in the
 calls of nature, who would not eat if food were not actually put into
 his mouth.  He has been for several years in  the same state, except
 that he occasionally appears to rouse himself, and for a short time  to
 recover an unusual degree of animation.   At such periods he will
 sometimes read a chapter in the Bible with a clear voice and a dis-
 tinct and intelligible  articulation.  Such occasional variations in the
 state of demented persons are  not infrequent.   They are capable
 of being raised  by favourable influences from  a  lower degree  of
 their disease into one which is above it in the scale.
   The last stages of this mental disease are commonly styled idiotism
 and fatuity;  but these terms are liable to the objection that they tend
 to confound dementia, which is  an acquired state  and the result  of
 disease, with a natural and congenital defect.
   Dementia is often complicated with paralysis  of a peculiar kind,
 which will be described in the following section.


 Sect. VII.—Of General Paralysis complicated with Insanity.

   A variety of disorders are occasionally complicated with insanity.
 The proper place for describing most of these will  present itself in
 a  future section  of this work.  But there  is one  morbid affection
 which, on account of its  frequent occurrence in  conjunction with
 mental derangement,  as well as for some other reasons, must be
 looked upon as nearly related to that disease, and must therefore be
 described  in  connection with its history.   I allude to a  peculiar
 modification of paralysis, which  is often observed  in the advanced
 stages of insanity, and especially in cases  which are passing or have
 already degenerated into dementia.
   M.  Esquirol was the  first  writer who directed the attention of
physicians to this morbid  state, and painted out the incurable nature
of insanity complicated with paralysis.*   General paralysis, he says,
 is  often indicative of inflammation of the meninges, and must not be
confounded with  those paralytic affections which are consequences
of cerebral hemorrhage, of cancers, or tubercles in the brain, or of

               * Diet, des Sciences Medicales, torn. viii. 
OF THE INSANE.
81
 ramollissement of that organ.*  It sometimes appears with the first
 symptoms of insanity, during the acute period often so remarkable
 at the outset of the disease; in some instances it precedes, and in
 others supervenes  on mental  derangement.   Its commencement,
 at whatever period of insanity, is often without any striking appear-
 ances.   It has a  course peculiar to itself, ever increasing while the
 mental powers diminish.   Whatever character  the disorder of the
 mind  may have  presented, it soon  passes, when complicated with
 paralysis, into a state of chronic dementia ; and paralytic lunatics
 seldom survive, according  to M. Esquirol, longer than from one to
 three years.  Their last moments are ushered in by convulsions,
 cerebral congestions, diarrhoeas, gangrenes affecting those  parts of
 the body which sustain its weight after all muscular movement and
 support have been lost.
   This  form of  paralysis  is much more frequent in  men than in
 women.  Of one hundred  and nine paralytics  under the observation
 of M. Esquirol during three years at  Charenton, ninety-five were
 males.   "When I was charged," says that writer, " two years since,
 with the service of the department of the insane at Bicetre, during
 the absence of M. Pariset, who had been sent  to Cadiz, I  was struck
 with the difference on comparing the  number of paralytic men at
 Bicetre with  that of female paralytic  lunatics  at the Salpetriere.
 The same observation has been made elsewhere.  It has not escaped
 Dr. Foville, physician-in-chief to the asylum at St. Yon, near Rouen.
 Of three hundred and thirty-four lunatics at that hospital, an  eleventh
 part, or thirty-one, were paralytics, of whom twenty-two were men
 and nine women."
   At Charenton,  according to M.  Esquirol,  the  proportion  of
 paralytics is more  considerable :  it forms one-sixth of  the  whole
 number of admissions ; of six hundred and nine lunatics admitted
 in three years, one  hundred and nine were paralytics.   The propor-
 tion among males is enormous, compared with that among females.
   Thus, of 36b" male lunatics   ...   .95 were paralytics.
     "   "  253 females.....14   "     "
  Paralysis is complicated  more especially with the mental disorder
 of those lunatics  who have been  previously  addicted to excessive
 libertinism, or such as have suffered from  the  abuse of mercury  or
 of spirituous liquors.  Do  these circumstances account for the dif-
 ferent proportion between male and female paralytics?  They appear
 at least, says M. Esquirol, to explain the fact of the greater number
 of paralytic  males  at Charenton  compared with that  at  Bicetre.
 The lunatics admitted at Bicetre are poor  men, whose laborious life
 has given them more energy of  resistance against the causes  above
 pointed out as exciting paralysis.  These causes must have exercised
 less influence on men of active life, given to manual labour, exerci-

  * Rapport  Statistique sur la Maison Royale de  Charenton, par M.  Esquirol,
 Medecin-en-Chef.  Annales d'Hygiene publique etde Medecine Legale.  Paris,
April 1829.
 1                            8* 
82
GENERAL PARALYSIS
sing less intelligence, and fatiguing less their brains.   The lunatics
of Charenton have been persons in easy circumstances, possessing
greater means  of satisfying their  passions, exercising professions
which excite the brain, and accustomed to less activity of  body.
  The pathology of this disease has been very much illustrated by
the excellent work of M. Calmeil, who has  investigated its  causes
and relations with great accuracy at the hospital of Charenton, both
during the superintendence of M. Royer-Collard, and  subsequently
to the death of that distinguished physician, under the auspices and
availing himself of the information of M. Esquirol.*
  In  extensive hospitals  devoted to the reception of lunatics, are to
be found, as M. Calmeil  observes, a large number of individuals
deprived in a  greater or less degree of the  power  of voluntary
motion.   Some cannot speak without difficulty ; others totter in
walking, or are unable to keep themselves erect without some point
of support ; some are affected with hemiplegia or with paraplegia;
others are erippled in all their four members; in a certain number
we  observe contractions either of an arm  or a leg.  All these disor-
ders of the locomotive power are included under the common term
of paralysis by authors who  have written on mental derangement.
By  the use of  terms so comprehensive, many things are confounded
which are very different in  their nature.  The form of paralysis
now to be described  is very distinguishable in its symptoms and
history from those affections which result from sanguineous conges-
tion in the brain, from sanguineous  effusion, and from acute ramol-
lissement,  though occasionally eomplicated, as we shall  observe,
with these  accessory  changes of structure and  their results.  The
former affection constitutes a distinct species of disease, having its
peculiar causes, symptoms, course, and terminations.
  M. Calmeil has observed three degrees  in the general paralysis of
insane persons, of which  the  distinguishing characters are as fol-
lows:—
  1.  Paralysis in the first degree.—An impediment in the move-
ments of the tongue is the first indication  of this form  of paralysis,
and it has often become already very apparent while no embarrass-
ment is as yet discovered  in  the  movements  of the  limbs.  The
articulation is  no longer perfect, the patient is obliged to use effort
in speaking, his words are uttered tardily and with a sort of mum-
bling and stammering like that of persons intoxicated.   If the patient
is desired to put out his tongue, he does it without any discoverable
deviation ; the muscles of the mouth and face preserve their natural
position ; nothing unusual can be perceived except a kind of muffled
articulation, which might escape remark from a person not directing
attention to the circumstance.
  2. Paralysis in the second degree.—The symptoms of the second

  *  De la Paralyste consideree chez les Alienee.  Reeherches  faites dans le
service de feu M. Royer-Collard et de M. Esquirol.  Par L. F. Calmeil, M. D.,
&c.   Paris, 1826. 
OF THE INSANE.
83
degree are those of the first period with increased intensity.   The
power of the tongue in articulating is more imperfect;  scarcely a
word is  pronounced distinctly,  and  it  is  necessary to  guess the
meaning of every word.   When the individual is sitting and at-
temps to walk, he raises  himself slowly by fixing his hands upon
the arms of his chair ; being once erect, he does not immediately
go forward with security, but like a  child  who measures his first
steps he seems to balance himself, and to totter from right and left;
he then ventures to walk, and goes a  greater or less  distance, but
with  a vacillating movement according to  the degree of strength
that remains to him.  When reposing on his bed, he is able to move
all his extremities in every direction.   The upper extremities dis-
play less evidently the effects of  paralysis ; yet in certain subjects
there is a degree of stiffness in the arms, which are with difficulty
raised to the summit of the head.  The muscles of the neck parti-
cipate in the general weakness ; the chin has a tendency to rest upon
the chest;  the muscles  of the trunk  are impaired in  strength, and
the body rests ill at ease upon the pelvis.
  These individuals feel,  see, hear, and perceive  odours ; but the
energy of sense is singularly obtunded.  Slight impressions upon
the skin and the nostrils are disregarded ; it is evident  that those
points of the  brain which are subservient to sensation are not less
affected than those which  belong  to locomotion.
  Persons  in this stage of paralysis  are generally in an advanced
degree of dementia ;  their want of cleanliness is  extreme ;  their
clothes are continually imbued with their excretions, which escape
without notice,  either through want  of attention,  or, what is less
probable, from a real paralysis of the sphincters.
  During the second as well as the first stage of general paralysis,
the functions of merely physical life are nearly in a healthy state ;
the circulation is natural, sleep  undisturbed ; digestion  and other
functions of the alimentary canal are performed in a healthy  man-
ner, and the flesh is firm and plump.
  3. Paralysis in the third degree.—Nothing is more  deplorable
than  the aspect of a lunatic  affected with  general paralysis in the
third degree.  Those injuries of  the brain which affect the intellect
and the powers of movement, now approach the very  last  point.
These patients, motionless and insensible, are reduced to a state of
mere vegetation ;  there existence is a kind of slow death.   Some
individuals are not able to articulate  a single word, and  only utter
vague and confused sounds.   The lower  extremities  are so weak
that standing is impossible. A period  arrives when even, in sitting,
the individual can no longer raise or extend his legs ; the hands and
arms have not lost so entirely their power of action, but it is evident
that they participate in the general weakness.   Often  there remains
no trace of intelligence ; food must be put into the patient's mouth ;
he is totally insensible to excretions,  and pays  no attention to sur-
rounding objects, and is almost destitute of impressions.   He hears 
84
GENERAL PARALYSIS
 indeed, sees, tastes, and  perceives strong odours ; but is scarcely
 affected by any sensation.
   Digestion, which at first was strong, is at length lost with the
 other physical powers; the body becomes more and more emaciated;
 at length the skin sloughs.  The lateral parts of the back, the lum-
 bar regions, the cellular tissue which covers the coccyx, the sacrum,
 the  sciatic tuberosities, become the seat of suppuration.   CCdema
 takes place in the depending parts ; hectic fever accelerates the ex-
 haustion of physical life.
   M. Calmeil has well observed  that death seldom follows,  as the
 simple consequence of the cerebral disease ; the abdominal or tho-
 racic viscera generally become affected ; the lungs are found to con-
 tain suppurating  tubercles,  and  the  intestinal canal to be inflamed
 or ulcerated.
   The  disease of  general paralysis,  simply considered,  runs the
 course above described  gradually and  even slowly, the symptoms
 appearing and developing themselves in a regular succession.  This
 is not the proper place for entering upon the statement of necrosco-
 pical observations,  but it is necessary to remark that,  according to
 theTesults obtained by M. Calmeil,  the phenomena displayed by
 dissection are very uniform in the disease now described when un-
 complicated with accidental disorders.   Dissection has proved  that
 this species of paralysis  arises  not from  effusion of blood in the
 brain, from acute  ramollissement, or sanguineous  congestion ; it
 almost uniformly depends upon a chronic inflammation which takes
 place in the substance  of the  brain, especially at its surface or cir-
 cumference.  But this appearance is liable to deviations from acces-
 sory or  supervening disorders ; the changes above enumerated are
 sometimes found in addition to that alteration which  is proper to
 general  paralysis, and in  such  instances  additional symptoms have
 displayed themselves during life.  The principal of these accessory
 diseases are the following :—
   1. Congestion  in  the brain.—Tn  general  paralysis  there is
 throughout a marked tendency to accumulation of blood in the brain,
 and this tendency is in some instances so  strong that the individuals
 affected are liable to attacks of coma, which threaten and  at length
 end in the sudden extinction of life.   To these attacks lunatics are
 equally  liable in each degree of  the  progress of general paralysis,
 and having once experienced  them are exposed  to relapses, to pre-
 vent which the utmost care is required on the part of the physician.
 In some instances the first onset of general paralysis is dated from
 an attack of this description.
  Necroscopy displays in such cases injections  and infiltrations of
 blood or of bloody serosity in the tissue of the membranes and on
 the surface of the brain.
  2. Hemorrhage in the cerebral substance.—One example only
of this complication occurred within the observation of M. Calmeil.
The patient, after labouring under dementia with general  paralysis 
OF THE INSANE.
85
was suddenly attacked by hemiplegia of the left side. Besides other
phenomena an apoplectic cyst was found in the corpus striatum on
the right side of the brain.
  3.  Simple hemorrhages between the two laminse of the arach-
noid.—This is a much  more rare event than effusion  into the sub-
stance of the brain, and its diagnosis, as M. Rostin has observed, is
very obscure.   It takes place in the course of general paralysis, and
is followed by sudden death with phenomena somewhat various.
  4.  Ramollissement, properly so termed, seated in a point of
the cerebrospinal system.—In cases in which this morbid change
existed, additional symptoms had been complicated with those of
general paralysis, such as occasional agitations or convulsions, and
total abolition of locomotive power in the lower limbs.
  5.  Erosions of the cerebral surface.—M. Calmeil has remarked,
with reference to the nature  of convulsive phenomena, that he has
never been  able to  detect any clearly marked differences in the
morbid appearances found in  the brains of paralytics who have ex-
pired in convulsions, and in those of paralytics who have never suf-
fered any such attacks.
  It results, from a great number of observations purposely made
by MM.  Calmeil, Esquirol, and others,  that general paralysis com-
mences  sometimes long  after mental derangement ; in other  in-
stances simultaneouly with it; while in comparatively-a few cases it
precedes the manifestation of disorder in the mind.  There are many
lunatics who never become affected by this disease.  Among those
who are affected by it, some have experienced it after labouring un-
der insanity during many years.  According, however, to M. Cal-
meil, among the lunatics at Charenton its appearance has taken place
almost always soon after  the  commencement of insanity.  A  few
individuals have continued to display all the vigour of intellect for
some time after they were attacked by this  form of paralysis, and
derangement has afterwards  supervened.   This observation might
be subject to some doubt if it were not a fact clearly ascertained by
M. Esquirol, in whose practice it was exemplified by a very remark-
able instance.
  The duration  of general paralysis is various.   M. Calmeil says
that the mean duration in the cases which have  been  observed  by
him has appeared to be thirteen months.   M. Calmeil confirms the
observation of M. Esquirol that some live eight months, a year, or
two,  and  that few survive more than three years under this com-
plaint.   The  disorder is generally progressive,  the symptoms  be-
coming  slowly  more and more aggravated; but  exceptions have
occurred to this remark.   A  few individuals have  recovered sud-
denly such a degree of strength as to be able to walk several miles
in a day, and even to resume their occupations for a time.  The
ultimate  prognosis,  however, is most unfavourable.   M.  Royer-
Collard, whose opinions were formed with  great caution and reserve,
had come to the conclusion that lunatics who displayed undoubted
indications of general paralysis were incurable.   During the expe- 
86
GENERAL PARALYSIS
rience of twenty years in a vast establishment for deranged persons,
he had not seen one established recovery among the patients  who
had been attacked by  this disease.  M. Esquirol likewise  regards
it  as  generally incurable, though three instances  to  the  contrary
have occurred within his experience.  At Cbarenton, as  M. Cal-
meil assures us, it is so regular an observation that individuals who
on their  entry into the wards  display any of the well-known signs
of paralysis perish at the end of no long period of time, that the at-
tendants who are ignorant of medicine, could scarcely be persuaded
that there was for such patients any chance of cure.  General state-
ments are, however,  seldom without  exceptions, and two  cases of
recovery are reported by the writer last mentioned.
   It appears that general paralysis is a much more frequent accom-
paniment of insanity  in the hospitals of Paris  than in some other
places.   Thus, in the south of France, Dr. Delaye found only five
paralytics among one  hundred and eleven lunatics at Toulouse ; and
Dr. Rich has not recognised the  disease among one hundred and
thirty-two insane patients in the hospital at Montpellier.   Vulpes,
who was well acquainted  with its phenomena, reported to M. Es-
quirol that there were scarcely three or four cases among five hun-
dred lunatics at the asylum of A versa, in the kingdom of Naples.
Yet M. Esquirol seems inclined  to doubt the  correctness of this
observation of Dr. Burrows, that general paralysis is a comparatively
rare disease in England.   He says that when  English physicians
shall have become able to distinguish the symptoms of this disease,
they will find  in  England, and particularly in London, as  many
paralytics  among  the inmates of lunatic asylums  as there are in
Paris.   I have  made many inquiries with a view to determining
this question, but have met with considerable difficulties in obtain-
ing satisfactory information.   This has arisen in part from the want
of discriminate arrangement of cases in some of the public lunatic
asylums, and in part from the  circumstance that this particular form
of disease is not well known  in England, and distinguished  from
other modifications of paralysis.  I have,  however, in  several in-
stances  obtained satisfactory  results.   The  opinion which these
inquiries have led  me to adopt is that the disease in question  is by
no means an unusual phenomenon in this country,  especially in the
public hospitals for lunatics, or among the classes of persons who
are principally found  in such hospitals.  It  has  been distinctly re-
cognised by physicians and others who have the superintendence of
English asylums.  But it appears to be comparatively rare in pri-
vate establishments ; at least this has been the faet in those particular
ones to which  my inquiries have been directed.   The difference
apparently depends on the  classes of persons from which the in-
mates of these establishments are respectively drawn.   Dr.  Bompas
has assured me that this paralysis has occurred  in strongly marked
cases in the private asylum under his care at Fishponds, near Bris-
tol ; but it appears to  have been there not more frequent than in the
south of France.   Out of  two  hundred and eighty-five  patients re- 
OF THE INSANE.
87
ceived into this asylum during a given  period  of  years, only five
became the victims of general paralysis.   Two of these were mari-
ners, and one a dealer in spirits ;  one was a military man, and  the
ntth a gentleman's groom r the two last were supposed to have been
ot temperate habits.   Dr. Bompas adds  that the speech  of all was
sooner or later affected, but that the first symptom  generally ob-
served by htm has been a degree of unsteadiness in  locomotion, and
an inability to walk straight.  In the  Reflreat belonging to the So-
ciety of Friends, near York, this disease  is of still more°rare occur-
rence.   Mr. Take has sent me the following reply  to my inquiries
on this subject.  « We have had one case, and but one, of the < para-
lyse des  alienes.'   It occurred a few years ago.  The patient was
one  of  our highest  class-, wholly unconnected  with  our religious
society  : a man who had lived freely, to  say the least,  till nearly
sixty years of  age.  The symptoms corresponded  most accurately
with the  description  of this  disease.  We have just now an  old
colonel who has been with us about  two years, and who, as our
surgeon*  informs  me, is likely to afford another example of this
form of paralysis."
  At Bethlem I was assured by the house-steward, who is a man of
great sense and acute observation, that  he has  in  many instances
recognised the early symptoms of this disease.   Patients are dis-
missed from Bethlem  when they manifest any indication of para-
lysis, and the events of such cases cannot, on  that account, be cor-
rectly noted ;■ it was,  however, known  that  most individuals  so
affected have died within a year  or  two after leaving the hospital.
The disease, as-it  has-occurred in Bethlem, is characterised by the
same symptoms as  at Charenton, viz. by imperfect muffling articula-
tion, by tottering in the gait, weakness and inaccuracy in the volun-
tary movements.   Monomania1, with pride and  the illusive  belief
of great possessions, is the mental disease which has been noticed
in the  majority of these  cases.  This was a spontaneous remark of
my informant, who, previously to my inquiries,  had never heard of
the disease described by M. Esquirol ; and it confirmed in the be-
lief that the same  affection  has been recognised by him.  Among
the lunatics in  St.  Peter's Hospital in Bristol,  general paralysis has
frequently occurred.   Some cases have been strongly marked, but
I am not able to state with confidence of'accuracy their proportional
number.  Dr. Whally, physician to the Lancaster Asylum, assures
me that there are  always cases in  that hospital  exactly coinciding
with M. Calmeil's description of the " paralysie des alienes."  He
has not  mentioned in what proportion  they occur.   The asylum
contains three hundred  and fifty  patients, of whose diseases one
principal  cause is  the prevalent habit of dram-drinking.  I have
been informed by Mr. Hitch, the  resident medical  officer at  the
Gloucester Lunatic Asylum, that many instances of the same dis-
ease have occurred in  that hospital.  He says, " I find in the records
* Mr. Caleb Williams.- 
88
STATE OF THE FACULTIES
of the establishment, that sixteen well-marked cases of this disease
have passed under our view since May, 1828.   Of the sixteen cases
which I  have had  under my charge, fifteen were males  and  one
female."   This proportional excess in the number of male paraly-
tics is in accordance with the observations of M. Esquirol.  With
respect to the event of these cases, it is reported that they  were all
ultimately fatal.   The  female died after an  attack of menorrhagia,
and her death was thought  to be its  consequence.   Of the males,
five died  in the house, six were  discharged as incurable and harm-
less, and three were removed by their friends.   Mr. Hitch adds,—
" Of the individuals discharged and removed by their friends, all
are since dead, at least so I am  informed."*
  There is a modification of paralysis, of much more frequent oc-
currence.in conjunction  with protracted insanity and dementia, in
English hospitals for lunatics, which differs in duration and  in some
of its features from  the  paralysie  generate of  Esquirol.   It resem-
bles the debility of old age. Patients labouring under it are crouched,
with their heads hanging forwards ; if they attempt to raise them-
selves into the erect posture, their  limbs  tremble, they stoop and
totter, like men in  the  extremity of old age ;  some stand leaning
against a wall  for  whole days,  with their  bodies  curved forward,
and their heads and necks at an  angle  with  the perpendicular line;
their  upper extremities shake and hang useless ; such individuals are
always in an advanced stage of dementia ;  but in this state they re-
main  for many years :  others become  bed-ridden, and remain long
incapable of any  voluntary movement, till  at length the powers of
physical life become impaired and gradually extinguished.


 Sect. VIII.—Observations on the State of the  Sensorial and
          Intellectual Functions in Cases of Insanity.

  The inquiry in  what precise  changes  from the healthy  state,
whether in structure or functions in the brain or in any other part
of the organized  fabric, the proximate  cause of madness consists,

  * Mr. Hitch has added to the above remarks the following details :—" Of the
patients who died in the Asylum, three were examined post m rtem   The scalp
was found preternaturally thickened and  fully injected ; the periosteum  of the
skull was also more than usually turgid ; the skull firmer than natural, the diploe
wanting, and its  place filled with solid osseous matter, resembling ivory more
than bone ; the vessels of the dura and pia mater  highly turgid ; the arachnoid
raised in patches  by fluid between it and the pia mater; fluid in  the ventricles;
the substance of the brain generally firmer than in  other subjects, and its vessels
dilated  and full of dark-coloured blood."
  " With reference," he adds, " to your short sketch of the progress of  this
peculiar palsy, I cannot omit a remark which I find in my notes on several of
these cases, viz. that the tongue appeared flabby or relaxed, and larger than natu-
ral, and tremulous.  I have at the same time noted a suspicion that such an in-
dication was unfavourable.   Some of the cases, however, in  which this appear-
ance was observed, have terminated in recovery, although I have also noted that
a slight difficulty of utterance accompanied the tremulous state of the tongue." 
IN MORAL INSANITY.
89
belongs to the theory of the disease.  The present is not a suitable
opportunity for entering into this subject.   But a correct statement
of the phenomena, and, as far as these are accessible to research, of
the relations of the phenomena to each  other, is requisite in order
to complete the history of insanity.
   The state of the faculties is very different in the several forms of
mental derangement.
   The conditions of the mind and of  the nervous system connected
with  moral insanity, is a subject  involved in deep  obscurity.
The phenomena observed in this  form of mental disorder are so
difficult to explain, that we might be tempted to doubt its existence
as a primary affection, and to refer the appearances ultimately to the
unperceived influence of delusive notions impressed upon the under-
standing.   In spite, however, of all the considerations which might
incline us to this view of the subject, it must.be acknowledged that
the disordered feelings of insane persons,  and the perverted state of
their affections, are not to be explained by attributing them to erro-
neous impressions  on the belief, which  might  seem sufficient to
account  for  them.   The morbid phenomena which  this disease
displays in the moral constitution or feelings are independent of any
corresponding affection of the understanding. This is an assertion
which  may be proved as matter of fact;  and the appeal for proof
must be made to experience and observations.  The sudden  anger
of a person labouring under moral insanity, and subject to paroxyms
of rage, is not the result of fancied provocation which the individual
has sustained  from  him who is the victim or object of his malice.
It is not the revenge of supposed injury, but an immediate impulse
arising spontaneously in the mind, which is diseased  only  in its
moral constitution.
   M. Broussais, adopting M. Pinel's  opinion, has admitted this fact,
and offers an explanation according to his peculiar theory.  He says,
" There results from a perversion of the  natural  desire of society,
cruelty, a delight in destroying, an impulse unreasonable, and even
condemned by the individual by whom it is experienced, to inflict
suffering upon the friends whom he tenderly loves, and  to put them
to death.   This perversion and  that of suicide are  often found in
conjunction.  The  causes of this morbid  state," continues M.
Broussais, "consist always  in  irritation  of  the trisplanchnic
apparatus, and especially in that of the stomach, acting on the
brain.   This last viscus," continues  M. Broussais, "may be such,
by its normal constitution, as to give a propensity to cruelty  ; but
in the morbid state it  is a s-ense  of  uneasiness  perreived  through
the whole  splanchnic apparatus,  comprehending the brain  itself,
which  renders  ideas  of murder  predominant in spite of reason.
This horrible perversion  may be considered, as well as that of sui-
cide, as a species of chronic anger  or hatred, which  impels the
individual sometimes against himself, sometimes  against other men
or against inanimate objects.  We have already considered it under
a subacute form in furious mania ; but in  the modification in which
   April, 1S37.                9 
90
STATE OF THE FACULTIES
we now describe it,  it is entirely chronic and apyretic.  In fact it
may be extremely obstinate, and  conceal itself under the appear-
ances of  calm,  of joy, of benevolence, until  the lunatic finds the
opportunity of executing his horrible project."
   " In the mediate degree of irritation, monomaniacs who are aware
of such growing aversions for their friends or  associates condemn
these feelings, and are afflicted by the consciousness of entertaining
them.  There are lunatics, females especially, who grieve at the
thought of no  longer loving their husbands, their  children,  their
neighbours, and for that reason alone think themselves unworthy to
live."
   " In its slightest  degree  this perversion  produces moroseness,
impatience, and dislike to certain individuals  ; a state which we so
often observe in children of  different ages, and  in many adult per-
sons whose  imperious, ungrateful,  and selfish dispositions, skilfully
dissimulated under  ordinary circumstances, are sure to discover
themselves  on  the  slightest  uneasiness, and  especially under the
existence of irritation in the digestive apparatus."*
   Such is M. Broussais'  theory of these phenomena.  It must  be
allowed that various irritations, and especially those in the digestive
organs, often give rise to irritability of temper; but  that any such
state as that which M. Broussais has described  is a cause, and  even
the  principal cause, of moral  insanity, and  in particular of that
intense excitement of malevolent propensity  which leads to murder
and suicide, is a position which, before it can be admitted, requires
proof ; and no such  proof has been afforded by  the ingenious writer
who has advanced this hypothesis.  It must  be confessed that this
subject is as yet enveloped in obscurity.
   I shall now offer a few remarks on  the state of the mental and
sensorial faculties in other varieties of insanity.
   Consciousness is generally unimpaired in persons labouring under
this disease.  There have been some instances in which  lunatics
have appeared  to make singular mistakes in  relation to the  objects
of consciousness.  They have been known to talk and reason about
their own feelings as if the latter belonged  to or were experienced
by another person.   These are not frequent cases ; and in  general
the insane have distinct apprehension of their personal identity, and
refer their sensations correctly to themselves.
   Sensation likewise generally remains unimpaired in lunatics:
nothing proves, at least, that the organs of sense  are the  seats of
disease, or that those  processes in  the  nervous  and cerebral struc-
tures on  which sensation  depends are in a disordered state.  The
sensations produced  by light and  sound are sometimes morbidly
acute ; but  this arises from temporary  and accidental affections of
the organs of sight and hearing, or of the brain, independent of the
principal disease,  and is by no means  characteristic of insanity.
The insensibility to painful impressions which lunatics occasionally
* M. Broussais, sur l'Irritation et la Folie. 
IN INSANITY.
91
display is more nearly  related to their state  of derangement;  it
results from the intense  excitement of internal feelings, and from
the attention of the mind being powerfully directed to other objects
and sensations.  Such instances are perhaps not so frequent as they
are supposed to be ; and in general lunatics  are not  remarkably
insensible of external impressions.
   Perception of external objects is generally unimpaired, in cases
of insanity, when unmodified  by other contingent disorders.  In
some instances, however, this faculty is singularly affected  by mor-
bid impressions on the mind, or by the influence of some prevailing
hallucination.   Such impressions pervert the convictions to which
sensation gives rise, even when that faculty itself is uninjured.   I
have  seen an insane female confined in an  asylum, who had  a firm
persuasion that her husband was dead.  When he came to visit her,
she asserted that it was the devil,  who had assumed his form. Per-
ception and memory here gave a true evidence, but the  mind was
preoccupied by a false  opinion, and disregarded their testimony.
These are instances  of what Dr. Cullen terms "false judgments," or
" errors as to the relations of things."   Cullen very correctly di-
vides maniacal illusions into two kinds.  " There  is sometimes," he
says, " a false perception or imagination of things present that are
not:  but this is not a constant  nor even a frequent attendant on the
disease.   The false judgment is of relations  long before laid up in
the memory."*   This means that the illusion seldom refers to the
scene actually present, but to the impressions of memory.  When,
however, morbid reverie becomes very intense, it produces halluci-
nations or false impressions which represent unreal objects as actually
present.  Even in this case it does not appear that perception is im-
paired.  Some particular phantasms, the  creations of  reverie, are
presented to the mind, otherwise diseased,  in colours so vivid as to
produce an effect similar to that of actual perception ; the patient in
the mean while makes  no mistakes with  regard to place or time ;
his perceptions of external objects are correct and uniform whenever
his attention is directed to perceptible things ;  but be is  so intent
upon his reverie, that for the most part he totally neglects them ; his
fancy becomes so intense in its operation as to carry him away from
the influence of his  external perceptions, and to environ  him with
unreal scenes.
   That insanity does not consist in disease of the sensitive or per-
ceptive powers appears the more clearly when we compare the state
of a lunatic with that of individuals who have really laboured under
affections of the organs of sense, giving rise to  false impressions on
the sensorium.   The celebrated histories  of Nicolai, the father of
Bonnet, and Pascal, have been cited  in connection with  this remark
by Jacobi ;t and   nothing  can  be more complete than the proof


  * First Lines, ^ 1558.
  f Beobachtungen uber die Pathologie und Therapie der mit Irreseyn verbunde-
nen krankheiten, bd. i. §99. 
92
STATE OF  THE  FACULTIES
which they afford, that however erroneous may be the  impressions
which take place under circumstances of disease  in the  organs of
sense themselves, the evidence of  such impressions is corrected by
a sound judgment, and fails of producing  erroneous  belief.   Such
cases are entirely distinct  from those of insanity.  The  hallucina-
tions of the insane, as M. Esquirol has well observed, are intellectual
phenomena totally independent of the organs of sense, and may take
place even though these organs may have been destroyed or so af-
fected as to be no longer capable of any function.  Thus there are
deaf persons who fancy that they hear words and speeches; and
blind men who think they see a variety of objects.  These  phenome-
na depend on processes carried on entirely in the brain, without any
participation on  the part of the sensorial organs.*
  There are cases of a morbid state coming under the denomination
of insanity which form an  exception to the preceding remark, for
in them sensation itself appears to  be disordered, or if not so, sen-
sation modified by  bodily  disease  becomes the occasional cause of
mental  aberration.  In these instances there is  some local disorder
which gives rise to painful or unusual feelings or preternatural  sen-
sations, and the mind mistakes the cause.   Reil mentions the  case
of a female who became insane after suffering under a disease which
affected  the  nerves.   She believed, in mid-day and with her  eyes
open, that she was pursued by spectres of different forms  and sizes.
When her eyes  were covered, and light  intercepted,  the illusion
ceased.   In a case cited by Dufour, a cataract gave rise to disorder
of the understanding, but this was  only  at  first;  when the patient
became habituated to the disease, he recovered  his reason.  Caspar
mentions the case of  a youth who  perceived the smell of fuel and
smoke,  and afterwards refused sustenance under an impression  that
all  his  food was impregnated with this offensive odour.  M. Guis-
lain, who has referred to  these examples  of sensorial  disease, re-
marks that the faculties of smell and taste being more  especially
connected with  the functions of physical life, afford fewer instances
of morbid alteration than  the other senses.t
  To all those instances in which  there is disorder of sensation, or
at least  a diseased state of  parts without the brain, affecting the or-
gans of sense in  such a way as to occasion, the  mind itself being in
an unsound state, erroneous impressions and false- belief, M. Esqui-
rol  proposes to affix the term illusion, which he distinguishes  from
hallucinations, before described.   As instances of illusion, M. Es-
quirol mentions  the casev of a female who  fancied that she  had a
living animal in her stomach, and was found on examination to  have
laboured under a cancer of that viscus ;  and another instance  of a
woman  who believed that  the pope  was holding a council in her
belly, and who was discovered  to  have laboured under chronic in-

  * Observations on the Illusions of the Insane, by M. EscjuiroJ.   Translated by
Mr. Liddell.  Lond. 1833.  P. 2, 3.
  t Guislain, Traite d'Alienation, torn, u 
IN INSANITY.
93
 flammation of the peritoneum.  A general officer, who had become
 insane when  labouring under rheumatism in his knee, used to seize
 the affected part, and striking it with the other hand exclaim, Wretch,
 thou shalt not escape !  supposing that he had  seized a malefactor.
 All  these are probably  cases originally of the  nature of hypochon-
 driasis, in which, after  that disease has long continued, the judgment
 gives way, and illusive notions are admitted, nearly as in  the ordi-
 nary examples of monomania, the  mind receives and cherishes hal-
 lucinations which coincide with the prevailing state of the sentiments
 and disposition. Perhaps the term hypochondriacal illusions would
 sufficiently characterise this form of mental error or disorder,  with-
 out  making so great a change in the ordinary acceptation  of terms
 as that proposed by M. Esquirol.
   With  the exception of these cases, in which there is some previous
 disorder distinct from  insanity and  affecting  the  organs  of  sense
 themselves with morbid and generally painful impressions, it would
 appear that sensation and  perception are nearly in their usual state
 in persons deranged as to  their understanding, and that it  is in the
 latter that the  disease, or manifestation of disease, is principally
 seated.
   But in what disturbance of the understanding itself does insanity
 consist ?   What particular intellectual process  is that which under-
 goes the peculiar modification characteristic of madness ? and what
 precisely is this modification ?  It must be confessed that  to  these
 inquiries nobody has yet given a  satisfactory  reply.   No  modern
 writer, however, with whose works I am acquainted, has examined
 the subject with more attention and with greater acuteness  of analy-
 sis than M. Guislain ; and if he has not succeeded in illustrating it,
 his failure is perhaps owing to the inscrutable nature of the  research.
 This writer has compared the opinions of Aristotle, Descartes, Locke,
 Condillac, Leibnitz, Kant, and others, on the nature of  the intellec-
 tual processes termed comparison, judgment, and ratiocination.   He
 cites with peculiar approbation La  Romiguiere, who, in his Lecjons
 de Philosophie, has drawn an ingenious and correct distinction  be-
 tween the mental  operations  of  comparison and  judgment.  It is
 erroneous, according to La Romiguiere, to term, with Condillac, this
 last faculty a mode of sensation.  " In judging," he says, " the mind
 does not act.  We have already acted when occupied in performing
 comparison ;  but the perception of the relation between ideas com-
 pared comes subsequently to the act of comparing  itself, and  is its
 immediate result;   the exertion of the mind is finished in the instant
 when it  perceives  the  relation."   The perception of relation is,
 then, judgment in the  sense which La Romiguiere attaches to the
expression ; comparing  is the antecedent process.  The relation
 being once recognised by the centre of perception, a new idea  is
acquired.  "Judgment," says M. Guislain, "has  for  its elements
our sensations ;  but the ideal object which the mind by it perceives
is totally distinct from every sensation previously obtained through
the sensual organs.
                              9* 
94
STATE OF THE FACULTIES
  " Reasoning or ratiocination is the  recognition by the mind of a
certain connexion between a number  of such ideal objects.  In this
process we pass from one  proposition to anolher: it enables us to
recognise the order and disorder which exists in our thoughts, their
resemblances and differences, the connection by which they ap-
proach to identity.
  " If in ratiocination we recognise  the act of judging as a part of
the process, we yet do not confound these two operations of the un-
derstanding.  Ratiocination is conversant with superior  orders of
ideas, which have no longer the external world for their foundation.
This is the peculiar faculty of man.  Some brutes appear to be en-
dowed with  a species of intelligence, but  they  never distinguish
cause from effect, or form comparisons and judgments on  the inter-
nal objects which the mind furnishes  to the centre of perception."
—" We reserve the term judgment for the perception  of relations
which the mind receives from the  external senses, while we adopt
that of reasoning for the comparison which the centre of intellect
makes between  ideas furnished spontaneously by the understanding
without the immedate aid of external sense.  The act of ratiocina-
tion comprehends in it as subordinate processes—first, imagination,
which furnishes the store of ideas ; secondly, attention, directed to-
wards the ideas furnished by the mind ; thirdly, judgment exercised
on its appropriate objects.
   I have endeavoured to abbreviate the observations of M. Guislain
on the processes of the mind in  some morbid changes of which in-
sanity may  be thought to consist.   He has defined them with accu-
racy, but has not succeeded in the discovery, what precise deviation
from the healthy and usual state of these processes constitutes men-
tal derangement.  He cites the example of a man confined at Ghent,
who reasons with perfect correctness on  every subject, and even,
his premises being allowed, on  a false conviction  that his wife has
destroyed her children, which is the particular illusion under which
he labours.   To which of  the intellectual operations whose united
exertion constitutes the power of reasoning, are we to look, in this
instance, for the deviation from health ?  The individual can reason
soundly on all subjects,  only he can  never be  brought to doubt or
to exercise his faculty of judging  and reasoning  on  the subject of
this  false impression.  The will seems  in  default or defective as
much as or more than the power.
  Perhaps we may observe in general, that the  power of judging
and of reasoning does not appear to be so much  impaired in mad-
ness as the disposition to exercise it on certain subjects.   There is
often a manifest unwillingness to admit any evidence which appears
contradictory to the false notion impressed  upon  the belief, while
£reat ingenuity is even displayed in the  attempt to find arguments
which may  seem to render it more reasonable.
  I have endeavoured to prove in the preceding sections of this
chapter, that monomaniacs begin by having disordered feelings and
inclinations, and that their intellectual disease appears to follow.  It 
IN INSANITY.
95
is often said that judgment is independent of the will, that men are
therefore irresponsible for belief or disbelief, which depends upon
the evidence submitted to their judgments.   Yet nothing is more
certain than the great influence which the will and inclinations ex-
ercise over the understanding in the processes of ratiocination and
judgment.   The exercise of the mind in attention, in the perform-
ance of comparison, reflection, abstraction, judgment, reasoning, is
so far a voluntary exercise that the will and inclination  perpetually
interfere without our consciousness, and modify  the  result.  Most
men think, believe, opine on particular subjects in harmony with
the general temper of their characters, or of  their sentiments and
inclinations.   If we could discover the particular rationale of this
influence, by which the previous habitude of the mind modifies the
operations which are termed, by eminence, intellectual, we should
perhaps approach  the clue which may explain the deviations from
the natural state of the human mind constituting insanity.
   By some writers it has been supposed that a  great part of the
derangement of lunatics depends on a disordered state of the faculty
of attention.  Professor  Hoffbauer, who  translated  the work  of
Crichton, and who has been  best known  out of his own country as
the author of a celebrated  treatise on medical jurisprudence, has
maintained in  his  " Untersuchungen  fiber  die  krankheiten der
seele," that many disorders  of  the intellect orginate from  certain
defects in the power of attention.*   Attention has been  observed to
be too concentrated in monomania,  and  in  mania altogether dis-
tracted, or in fact  totally impeded in its exercise.  Hence the me-
lancholic broods particularly over one train  of thoughts, and  the
maniac continually wanders:  his attention passes  in rapid transi-
tion,  or rambles from one object to another.  There is truth in these
observations, but  they do not furnish a  solution of the principal
difficulties which  environ the subject of our investigation.
   It  has  been well observed  by M. Georget, that insane persons
uniformly entertain a full conviction of their perfect sanity.  " They
are convinced that all that they feel and think is true, just, and rea-
sonable ;" in  a word they believe themselves  in perfect health, and
they  often treat as fools those who do not think like them ; nothing
can shake  them in this  conviction ; no  arguments, not even the
most positive proofs, can cause them to  change their  impressions
and opinions.  When they are  confined, they exclaim against the
injustice of the proceeding, and imperiously  reclaim their liberty ;
inculpate one person after another ; and accuse men and demons,
actuated by envy, jealousy, revenge, as having  caused  their suffer-
ings, and  as  persecuting them by hidden  means even in their most
secret thoughts."   Yet, as the same author observes, there are some
patients who are  well aware of the disorder of their  thoughts or of
their affections, and who  are deeply afflicted at not having sufficient
strength of will to repress it.
  * Hauptsitz der verstandeskrankheiten, vol. i. p. 82. in Hoffbauer's Unter-
suchungen. 
96
STATE OF THE
 Section IX.—Disorders in the State of the Physical Functions
                    attendant upon Madness.

   The phenomena of insanity, properly so termed as characterising
 the disease, are those which refer to the state of the mental faculties;
 but other processes of the living body, besides  the  functions of the
 brain, are likewise disordered in many, perhaps in most instances
 of madness.   There is, in these cases, besides the morbid condition
 of the  brain and nervous system, more  or less of disturbance in the
 physical functions ; the secretions, excretions,  appetite, and diges-
 tive processes  are  frequently disordered.  Medical writers have
 differed in opinion as to the relation which  these affections bear to
 the cause of insanity.   Pinel has stated it to be the result of his in-
 quiries, that the primary seat of mental alienation is generally in the
 region  of the stomach and intestines, and  that from that centre  the
 disease propagates  itself,  as it were, by  irradiation, and deranges
 the understanding.  Others have looked upon the disorders in  the
 functions of the viscera as  merely contingent results of a primary
 disease, seated in or immediately affecting the  brain.   Whichever
 of these opinions may be correct, the general, or at least the fre-
 quent co-existence of  disorder in the physical  functions with  that
 affection of the brain from  which the deranged  state of the mind
 immediately results is an indisputable fact.
   The  physical functions are differently affected in different forms
 of madness.   In disorders of slow and gradual accession, and espe-
 cially in those cases in which the mind is melancholy and depressed,
 a torpid state  of the vital and  natural functions for the most part
 prevails ; the circulation is languid ; the pulse weak and generally
 slow ;  the skin cold and clammy ; most of the secretions are defec-
 tive ; the bowels  are torpid, and sometimes obstinately constipated
 and flatulent,  requiring strong doses of aperient medicine.  The
 appetite is defective ;  digestion  is impaired. Emaciation and loss
 of strength inevitably result from these causes,  but  they are some-
 times not so striking as any person would  anticipate.
   Attacks  of maniacal disease, which  break out  suddenly with
 great excitement of the passions, with general disturbance of the in-
 tellectual faculties, or with incoherence, are almost always accom-
 panied by symptoms of fever or of pyrexia more  or less acute.
 The pulse  is  rapid,  often full, and beating with disproportioned
 strength in the carotid and  temporal arteries ; the skin is hot and
 the tongue white ; there is thirst, with loss  of appetite, headache,
 sleeplessness, and great irritability ;  the secretions are deficient, the
 urine is highly coloured and scanty, and the bowels are constipated.
 The face is often flushed ; the eyes  are glossy and suffused ;  the
conjunctiva is  injected with blood, and the  pupils are  contracted.
 The patient sometimes complains  of pnin  in the forehead and tem-
ples, with a sense of weight upon the head, or of constriction, as if
the scalp were tightly  drawn.  Want of rest is often  a troublesome 
PHYSICAL FUNCTIONS IN MADNESS.            97
and distressing symptom. Many patients pass whole nights without
closing their eyes, or when they obtain sleep, it is short and agitated.
In other instances a few  hours of sound sleep are the prelude to a
paroxysm of renewed excitement, the maniacal symptoms breaking
out,  on  waking, with increased violence.
  All the symptoms which refer themselves in a perceptible manner
to the head are liable to undergo occasional exacerbations during the
continuance of madness.  Increased heat of the scalp, redness of the
eyes, fulness and strong pulsation of the carotid and temporal arteries,
want of sleep  and consequent irritation of the temper and feelings,
indicate and precede or accompany renewed periods of violence in
the symptoms of mental  derangement.
  In many instances of maniacal  disease there is much disturbance
in the functions of the intestinal canal.  This observation has been
made more particularly in persons whose  general health has been
previously much neglected ; in the inmates of some lunatic asylums ;
in individuals of the lower class,  who have been subjected to hard-
ships and unwholesome diet, as well as to cold and a damp unwhole-
some atmosphere ;  in cases  in  which  the disease  has followed
excesses of  various kinds,  or confinement on ship-board, with the
use of salt provisions.  In many  instances of this description it has
been found that the bowels  had been long in a confined and torpid
state.  In those instances in which it is stated that the bowels are
open and even more loose than natural, it often appears  on  further
examination that  a  long-continued  torpor and  constipation have
given way to diarrhoea ;  the abdomen, which had previously been
swelled with indurated matter, has become more distended than be-
fore, flatulence being added to the load of solid contents but partially
discharged.  The evacuations are thin and watery, or contain mucus
mixed with vitiated bile and recent  aliment in an undigested state.
Sharp and transient pains  are experienced in various parts of the
abdomen, which is  often tender on pressure ; at length,  in very
neglected cases, dysentery supervenes and brings on extreme ema-
ciation.  The tongue is often red or  covered with a brown fur, and
the mouth and fauces with  a  viscid  mucus,  which,  together with
saliva, the patient spits out in all directions.   There is great thirst
and a peculiar fetor of the  breath, which extends to the whole per-
son.  The appetite is depraved ;  in  many cases the  patient has an
aversion to all food ; in other instances he has  a keen and vora-
cious desire for  it,  and  greedily devours without selection every
thing eatable  that falls in his way.   The  skin  is cold ; there is  a
remarkable  coldness  of  the extremities, resulting from the damp
state of the skin and the want of energy in the circulation through
the extreme vessels.  In some cases of long duration  papular or
scaly eruptions are observed ; and in exhausted and debilitated sub-
jects, furunculi appear in  various parts of the body, which are much
disposed to  slough.
  Cases of madness, coming on  with some  degree of rapidity are
often preceded and sometimes accompanied or followed by suppres- 
98
TERMINATIONS OF MADNESS.
sions of natural or customary discharges, by the  disappearance of
external diseases, or the cure or suspension of internal complaints.
The relation which  these changes bear to  madness as causes or
results may be  different in different cases ; they are connected cir-
cumstances of that disease.   The catamenia, if  not  suppressed
previously to the manifestation of maniacal symptoms, soon become
scanty, or cease  entirely after  its actual  appearance.  Lochiae and
other analogous effluxes are suppressed ; ulcers, which  had become
habitual and  had long discharged, are dried up;  chronic eruptions
generally  disappear, or are materially lessened ;  symptoms of pul-
monary phthisis in various stages cease or become mitigated in a
remarkable degree.   On the decline of mental disorders, it is often
found that the return of such discharges, or the revival of suspended
trains of morbid phenomena, is the harbinger of restoration to a sound
state of mind, though not to complete bodily health.
                       CHAPTER III.

             OF THE TERMINATIONS OF INSANITY.

Section I.—General Remarks on  the Duration and Termina-
                      tions of Insanity.

  The  duration of insanity  is various, and  admits  of no general
estimate.  In some instances  this disease has subsided within a few
days after its  commencement ;  in  others it has  continued many
years.   It was observed by Dr. Greding, and the remark has been
repeated by M. Esquirol, that it is by no means uncommon to meet
with inmates of lunatic asylums  who have been twenty, thirty, or
even forty years in confinement.   The same observation must have
occurred to every person who has been in the habit of visiting such
establishments.
  Recoveries as well as deaths take place  at various intervals from
the commencement of the disease.  If neither of these events occurs
at an early period,  the confirmed stage of  mental derangement suc-
ceeds,  in which the disease  begins  sooner or later to assume the
character of dementia or incoherence. In this case the ultimate event
is death.  For the  sake of distinctness in  completing the history of
insanity, it is usual to consider this disease as having three termina-
tions ;  first,  in recovery ;  secondly, in dementia ; and thirdly, in
death.    I have already described the second of these events, and I
shall now proceed  to state  the facts  and  circumstances which are
connected with the terminations  in recovery and in death. 
RECOVERIES.
99
Section II.—Of Recoveries from Insanity,  and, first, of the
  various  Circumstances which have an influence on their pro-
  portional Number.

  It is important, in relation to the history of this disease, to deter-
mine, as far as this can be done, the proportion of cures or of reco-
veries, which take place in  a given number of cases.  This is also
of practical importance in respect to the arrangements to be adopted
for  the care or restoration of lunatics.   Information  connected with
the same inquiry is likewise  of advantage  for prognosis, or for
estimating  the  prospect of recovery in particular instances of the
disease.
  Recovery is the event of  insanity in a large proportion of cases,
especially of such as occur  under  particular  circumstances.  The
circumstances which have the greatest influence on the event of the
disease  are, its  existence in a simple form, or as complicated with
other disorders ;  the particular  character  of  the mental affection,
some modifications of insanity being, according to universal experi-
ence, more susceptible of  cure than others; the duration of  the
complaint,  or the interval of time which has elapsed from  its com-
mencement ; the age, sex, and constitution of the patient ;  and the
nature of the causes which may have given rise to the disease.
  I Shall now consider the influence of  these several circumstances
and conditions  before I  proceed  to the estimates which have been
formed of  the  proportion  of recoveries in  any given  number of
cases.

                           ARTICLE I.

Of the Complication of Insanity with other Cerebral Disorders.
  There are several disorders occasionally complicated with insanity.
Those which have  their seat  in the brain may be  supposed, for
obvious  reasons, to render, by their  complication  with  mental
derangement, recovery from that  state much more  difficult and
improbable than it otherwise is found to be.
  The complication  of  insanity or  dementia with general paralysis
is,  perhaps,  without exception,  the  most unfavourable.  In  the
attempt to form  a  prognosis in any particular case, or in separating
curable from incurable  patients, those who are acquainted with the
history of insanity examine with care whether progression is per-
formed with perfect freedom and security, whether the articulation
is free from embarrassment, or  is affected  by lisping or mumbling.
If any of these phenomena of general  paralysis are discoverable,
however slight in degree, the  case is usually considered  as hope-
less.*
  Epilepsy is likewise a disease  the  combination of which with
* M. Calmeil, de la Paralysie des Alienes, p. 8. 
100
CIRCUMSTANCES AFFECTING
insanity is most unfavourable.  But  we  must  distinguish those
instances  in which fits of convulsion, more  or less displaying the
epileptic  character, occur in maniacal  cases during the periods of
high excitement, from the violent mania which appears as the sequel
or occasional interlude of severe and inveterate epilepsy.   It is the
latter combination which is so deplorable:  fits, more or less resem-
bling epileptic paroxysms, sometimes occur under the circumstances
above  described, without rendering  the  case desperate,  or even
appearing to exercise much  influence on its tenor; yet they are to
be regarded, under all circumstances, as unfavourable indications.

                          ARTICLE II.

                    The form of the disease.
   The form of the disease is of great consequence in respect to the
probable event.   " At Charenton, as every  where," says M. Esqui-
rol, " a greater proportion in  the cases of  mania are cured than of
any other variety of madness.   He  adds that  dementia is  scarcely
ever  cured.t  Out of 209  recoveries at Charenton, the numbers
were as follows:
          Mania..........   115 cases out of 226
          Monomania •......    91      „       289
          Dementia........     3      „        99
209              614
   It must be observed that in the aggregate of cases were included
109 paralytics, 19 epileptics, and 4  idiots ; so that  the number of
curable cases of insanity from which an estimate is to be formed of
the success of medical treatment is reduced to 487 ; and  of  this
number upwards of two-fifths were cured.  It is  remarkable  that
the greater sanability of maniacs, in comparison with monomaniacs,
had place only in males.   From this it would appear that monom-
ania is comparatively  a more curable disease  in  females  than in
men.

                         ARTICLE  III.

                   The period of the disease.
   The previous duration of the disease is a circumstance of great
importance in estimating, at any given time, its probable termina-
tion.   The probability of recovery is very much greater in the early
than in the advanced periods.  Dr. Willis  declared  that 9  lunatics
out of  10 recovered, if they were placed under his care within three
months from the attack.   Dr. Burrows has reported 221 cures out
  * Statistique, p. 136, in the " Annales d'Hygiene;  item, art. Folic in Diet, des
Sciences Med. 
THE NUMBER OF RECOVERIES.
101
of 242 recent cases.   Dr. Finch has stated that 61 out of 69 patients
recovered who  were received into his asylum within three months
after the first attack of their disorder.   From the experience obtained
at the Retreat near York, to which I shall  have  occasion  again  in
the sequel  to advert, it appears that 7 out of 8, or perhaps a larger
proportion of recent cases have terminated in recovery.
   The inquiry  during what time recovery is still probable, and what
degrees of probability there are at  different periods, has been fre-
quently pursued, especially by French writers.   Some facts, tending
to illustrate this question, were contained in a memoir presented by
M. Pinel to the National Institute in 1800.   It appeared  from this
memoir that the greatest number of recoveries from madness take
place in the first month of its duration ; the recoveries during the
first being compared with those of succeeding  months.   The mean
time for the duration of the disease, in cases terminating favourably,
was fixed in the same document at from  five to six months.   This
result was deduced from  a selection of cases from which the author
excluded all those which  had been under previous treatment, as well
as cases of long duration. A longer term is assigned to this disease,
in cases terminating in recovery, by Mr. Tuke in his account of the
Retreat at  York ;  and M. Esquirol, whose  accuracy of research in
subjects of this nature gives to his authority the highest value, con-
firms the opinion of Mr.  Tuke.   He has drawn this conclusion from
a statement of the cases  admitted  into the Salpetriere during ten
years, as shown by the following table:—

    Table of recoveries at  the Salpetriere during ten years.
Admis-												Totals of
sions.												Cures,
	1804.	1805.	1806.	1807.	1808.	1809.	1810.	1811.	1812.	1813.	1814.	
209	64	47	7	4	3	2	. .	1	1	. .	. .	129
212		73	54	4	2	2	1				1	137
206			78	49	10	3	1	1	1	. .		143
204				60	55	11	1	. ,	2	. .		129
188					64	57	4	2	1	. .	2	130
209						48	64	9	4	1	3	129
190							48	51	7	1	3	110
163								44	30	8	3	85
208									75	41	11	127
216										50	49	99
     2005                                              1218


   It seems that the report on which this table was founded exten-
ded from the year 1804 to 1813; 2804 female lunatics were admit-
ted during this interval, of whom 795 were considered as incurable,
on account of their  advanced age, or because they  were idiotic,
epileptic, or paralytic subjects.  The remaining 2005 were put under
treatment without regard to the  duration  or  peculiar character  of
their disease.  Out of  this number, 604 were cured during the first
  April, 1837.               10 
102               CIRCUMSTANCES AFFECTING
year, 497 in the second, 86  in the  third, and 41 in the seven suc-
ceeding years.  From these data M. Esquirol draws the following
conclusions : first, that the greatest number of recoveries are obtained
in the two  first years ; secondly, that  the mean duration of cases
that are cured is  somewhat short of one year ;  thirdly, that after
the third year the probability of cure is scarcely more than one in
thirty.
   From another table published by M. Esquirol, it appears that, out
 of 269 maniacal patients, 27 were cured  in the  first month of their
 illness, 34 in the second, 18 in the third, 30 in the fourth, 24 in the
 fifth, 20 in the  sixth, 20 in the seventh,  19 in the eighth, 12 in the
 ninth, 13 in the tenth, 23 after the first year, and  18 after two years.
 The same writer has made a remark in illustration of the  greater
 proportion of recoveries observed in  the early period of madness,
 which  is worthy of attention.  He says, " I have constantly obser-
 ved that in the course of  the first month from the commencement of
 the disease a very marked remission takes place.  About that period
 the maniacal excitement, which had  previously run its course as an
 acute disorder, seems to have reached its termination as such, and it
 is then that it passes into  a chronic  state,  the crisis  having been
 incomplete.  This remission, which  I have watched with the great-
 est accuracy, must be attributed to the complaints which are compli-
 cated with madness at  its commencement."  The author implies,
 though he does not clearly express himself, that the natural  termi-
 nation of  the disease, when not  interrupted by the coexistence of
 other maladies, or by  organic lesion  in the brain, is in the very
 early stage.
   The following table  of recoveries  at  the  Gloucester Lunatic
 Asylum,* drawn up  by Mr. Hitch, affords similar results.  It
 includes cases of very long duration, and will be found so much the
 more interesting.

   * The Gloucester Lunatic Asylum is under the superintendence of Dr. Shute.
 Mr. Hitch is the resident medical officer. 
MALES.—Table I. Showing the time that each case required for its treatment to effect recovery ; arranged in a line
                                with the length of time it had existed prior to admission.
Duration of the No. of
disease prior to Cases
  admission.
Time occupied in the treatment to effect recovery.
 1
 2
 3
 4
 5
 6
 8
12
 4
 5
 6
 7
 8
 9
10
 1
 2
 3
 4
 8
10
11
15
40
week
months
year
21
II
11
17
 5
 3
 8
14
 5
 1
 6
 1
 I
 0
 1
 6
11
 7
 1
 1
 3
 0
 1
 1
0 11
0  2
0  6
I  2
0 10
I  1
0  2
0  6
0
0
1
0
0

0
0
0

0  9
0  3
I   6
 1
11
 3*
1  4
0 10
0  1*
1  3
IjO
30
2|0
40
0  30  4
1  00   3
0  5
0  2
0  1
0  4
0  3
0  1
0  8
0  30  2
0  7
0  10  60  3
0  70 11
0  1
0  5
0  3
0  3
0  2
V. M.
0  1
These three cures occurred in the same individual, whose recovery from the relapses occupied  the time respectively stated.
               iccurred at intervals of four months: he is now well.  I usually denominate such cases " relieved."
The relapses
»
a

a
3
w
w
w
o

w
tq
o
o
<
w
73
i—i
M
CO
o 
FEMALES.—Table I.  Showing the time that each case required for its treatment to effect recovery ; arranged in a ane  £
                             with  the length of time it had existed prior to admission.                               *■
Duration of the	No. of											Time			occupied in the treatment to effect recovery.														
disease prior to	Cases.																												
admission.			1							1			1																
		Y.	M.	v.	M.	Y. M.	Y.	M.	Y.	M.Y.		M.	Y. M. V.		M.	Y. M.	Y. M.	Y. M.	Y. M.	Y. M.	Y. M.	Y. M.	Y. M.	Y. M.	Y. M.	Y. M.	Y.M.	Y. M.	Y. M
1 week . . ,	11	3	20		1	0 60		2	o	60		2	o i'o		3	0 5	0 1	0 1											
2 "	11	1	00		3	0 40		3	0	30		5	0 50		3	0 2	0 5	0 2											
3 "	4	0	3 0		1	0 30		3																					
4 "	22	0	6 0		4	0 20		2	0	40		2	0 70		2	1 1	I 10	0 4	0 7	0 9	0 2	0 3	0 30		0 4	1 0	0 3	0 8	0 4
5 "	3	0	5 0		4	0 6				|																			
G "	6	1	4 0		6	0 71		1	0	40		6																	
8 "	9	3	101		7	0 40		3	0	30		6	0 20		2	0 9													
12 "	13	1	6 2		2	0 100		4	0	42		2	I 40		8	0 90		0 3	0 3	0 3									
4 months .	3	0	2 0		4	0 7																							
5 "	2	0	100		5																								
6 "	8	0	30		3	0 10	0	3	0	32		7	0 20		5														
7 "	0																												
8 "	0																												
9 "	2	1	3	0	4																								
10 "	1	1	0																										
1 year . . .	6 il		90		8	0 4	0	9,0		4	0	3																	
2 "	5 0		5:0		9	0 5	0	50		9																			
3 "	2 1		02,		.4																								
4 "	1 0		4																										
8 "	0 1																												
10 "	2 0		91		0																								
11 "	1 4		3																										
17 "	1 3		3																										
20 "	1 3		6																										
 
                 THE NUMBER OF RECOVERIES.              105

   Although the probability of cure after the third year fs so small,
 there are, notwithstanding, as we find  from these tables, examples
 which prove that we ought never to despair of the recovery of luna-
 tics ; and M. Pinel, from Baumes, cites the case of a lady who passed
 twenty-five years in a state of lunacy, within the knowledge of the
 whole country where  she lived, and who suddenly  recovered  her
 reason.  "I have seen," says the same writer, "a girl who from the
 age often years was in a state of incoherence, with suppression of
 the catamenia.   One day, on rising from bed, she ran and embraced
 her mother, exclaiming, t Mamma, I am well!'   The catamenia had
just flowed spontaneously, and her reason was immediately restored.
 M. Esquirol has repeated this relation, adding his  own evidence.
 He has reported other facts of a similar kind.   " Tout le midi a re-
 teuti, il y a quelques annees, de la guerison d'une dame qui apres
 vingt-trois ans  fut guerie spontanement d'un acces de  manie com-
 plique de fureur."   M. Chambeyron observed, at the  Salpetriere, a
 young woman  who fell into a state of dementia after a maniacal fit.
 She cut open her abdomen with a scissors.   A portion  of intestine
 and nearly the whole of the epiploon came out through the wound.
 As soon as suppuration was established, the intellects of the patient
 appeared sound.  After the cicatrization a large blister was applied,
 and the improvement was for a time maintained.   At the time when
 the report was given, the state of the  individual still gave much
 greater promise of  her restoration than could be entertained before
 the accident which  changed the character of the disorder.   M.  Es-
 quirol adds, " Que de faits je pourrais citer de guerisons inattendues
 ou tardives, qui ont trompe ^experience la plus etendue, et les calculs
 les plus severes."*  These facts are sufficient to prove that in  the
 duration of the disease alone there is no  reason to despair altogether
 of recovery.   A few instances of the same kind  have occurred in
 several lunatic  houses or public hospitals, from the superintendents
 of which I have obtained information.  Some striking  and, indeed,
 surprising examples may be seen in the above table of the Glouces-
 ter Asylum.

                          ARTICLE IV.

                             Jlge.
   The age of patients is a consideration of great importance as to
the prospect of recovery.   M. Esquirol observes that the  most fa-
vourable age for recovery is between  the twentieth and thirtieth
year, and that few are cured after the fiftieth year. The same writer
has given a table of ages in reference to the 209 recoveries at Cha-
renton, to which I have before alluded.   In  this it seems that  the
greatest number of cures were from the twenty-fifth to the thirtieth,
and from the thirtieth to the thirty-fifth year.  This is the period of
life during which the greatest physical energy subsists, and in which

                 * M. Esquirol's notes to Hoffbauer.
                              10* 
106  CIRCUMSTANCES AFFECTING NUMBER OF RECOVERIES.

acute madness breaks out  most frequently, while intermittent or
recurrent cases have not yet had time to pass into  the continued
form.  Recoveries diminish progressively from the forty-fifth year
to the  end of life.   The diminution  is more abrupt in females, and
more uniform in men.  We must observe that cases occurring before
the twentieth year  are the  most numerous in males, and that the
greatest number of attacks manifest themselves in men from twenty
to twenty-five, and from  twenty-five to thirty.  In  females the
greatest frequency begins between twenty-five and thirty, and it is
not diminished until after forty-five.   The table before cited shows
that advanced age does not  preclude hope : twenty men are marked
as having recovered after the fiftieth year, in which number were
four out of  twelve lunatics who had  exceeded  their seventieth
years.*

                          ARTICLE  V.

                              Sex.
   It has been observed by  many writers that insanity is, generally
speaking, more curable in  women than in men.

                          ARTICLE  VI.

                            Season.
   The summer produces a  greater number of recoveries than other
seasons.  If we  divide the  aggregate of recoveries by trimestres, it
appears that they are most  numerous in that of the summer and au-
tumn.   Summer being  the season at which  violent mania most
frequently breaks out, and this form of the disease being more rapid
in its course than others, it  may be supposed the  greatest number of
males  will probably be cured  in the summer : females recover in
greater numbers during the autumnal months.  These observations,
made by M. Esquirol  on  the  report of Charenton, coincide with
those formerly  obtained by him from the hospitals of Bicetre and
the Salpetriere.t


                         ARTICLE VII.
              Circumstances  of the constitution.
   When insanity is manifestly  connected with some condition of
the natural functions which is susceptible of change by the progress
of life  or by medical art, there is on this ground hope of a favourable
termination.  Recoveries take  place in females  at critical periods.
M. Esquirol  has related that he  observed two instances of dementia
in females which had continued from early youth and terminated at
the appearance of the catamenia.  Another female at the Salpetriere,

         * Statistique de la Maison Royale de Charenton, p. 135.
         f Statistique, et artic. Folie in Diet, des Sc. Med. 
            PROPORTIONAL NUMBER OF RECOVERIES.        107

whose derangement began at that period, recovered at the time  of
Ufe, when the catamenia cease.*
Section III.—Of the proportional Number of Recoveries in
                            general.

  The proportional number  of cures effected, or to speak more ac-
curately, of recoveries which take place  in any  given number of
cases of insanity, is very differently estimated by different writers.
  Dr. Burrows has reported from his own experience 240 cures in
an aggregate of 296 cases of various descriptions ; 221 cures from
242 recent cases ;  19 cures from 64 old  cases ; affording a proper-
tion  of 81  in 100 of all cases, and of  91  in 100 of recent cases.
  So great a proportion of recoveries, which, however,  coincides
nearly with the  statements of Dr. Willis, has surprised many per-
sons.  Dr. Maximilian Jacobi says that it can only be explained by
referring to the practice which he believes to prevail in England, of
discharging patients  from lunatic asylums at a very early period
after apparent recovery, or as  soon as the phenomena of insanity
have ceased for a time to be  displayed, and before a real and per-
manent cure has  been obtained.   Dr. Jacobi has given a report of
cases admitted into a new public asylum  under his management at
Siegburg in Westphalia, where he says that patients are always re-
tained until their recovery is confirmed,  and this  he considers as
affording a more just example of the ordinary proportion of reco-
veries, though still, as he supposes, more favourable than the general
average in hospitals which admit patients of all descriptions.  In
this, out of 100 cases,  40 are marked as dismissed in  a state of
complete recovery, and 6 as improved and displaying alleviation of
the  disease.t
   Dr. Jacobi is certainly under an error as to the practice which he
imputes to the superintendents of lunatic asylums in England, of
dismissing patients before their recovery is established. It is plainly
not the interest of those who conduct private establishments to err on
this  side, and in most of the public hospitals in this country the
proportion of recoveries is by no means  so great as to require such
an explanation.   The subject to  which these inquiries refer  is one
of so much importance that my readers will probably be interested
with a more extensive collection of the facts which bear  upon it.
   M. Esquirol  has  for  many years carried on very extensive and
accurate researches into the statistics of lunatic establishments,  in
which  he  has been followed by physicians in different countries,
particularly by Dr. Burrows and  Sir A. Halliday in England, by M.
Guislain in Belgium, and by Dr. Jacobi in the Prussian  territories

   * Esquirol.  See Jacobi's Sammlungen fur die Heilkunde der Gemuthskrank-
heiten, B. i. s. 339.                                  .
   tBeobachtungen uber die Pathologie und Therapie der mit Irreseyn verbun-
denen Krankheiten von Dr. Max. Jacobi.  Elberfeld, 1830, p. 173. 
108
PROPORTIONAL NUMBER
 on the Rhine.  In these inquiries the proportion of recoveries forms
 the most interesting topic.
   In a table given by M. Esquirol in the Dictionnaire des Sciences
 Medicales, we find the  following calculation of recoveries taken
 from the reports of French asylums.
 French Lunatic Asylums.          Dates.           Admissions.  Recoveries.
   Charenton......from Nov. 22, 1798 to 1800, 22 July   97  ..    33
                               1803........       499  . .   161
   Salpetriere............from 1801 to 1805 ..      1002  . .   407
      „     ............from 1804 to 1813 . .      2005  . .  1218
      „     ............from 1806 to 1807 . .       531  . .   286
      „     ............from 1812 to 1814 . .       891  . .   413
    In M. Esquirol's private
     establishment........from 1801 to 1813 . .       335  ..   173

                                     Totals  ..    5360  . .  2691

   In a more extended calculation  given  in the first volume of the
 Memoirs of the Royal Academy of Medicine, we are informed that
 out of 12,592 cases  of insanity which were treated in the Salpetriere
 and the Bicetre, 4968 cures were registered.
   M. Esquirol  has lately reported that  at the  Royal  Hospital  of
 Charenton, on a totality of cases occurring in 1826-1828, including
 incurable cases of all descriptions, one-third of recoveries was ob-
 tained,—a proportion which  he sa3rs may  be honourably compared
 to that of any other hospital  equally indiscriminate in admissions.*
 Nearly the same results was  declared in  a  report made officially in
 Paris in 1825, of the state of hospitals for  lunatics during the three
 preceding years.   Dr. Burrows has copied this report, in which it
 appears that in an aggregate of 2506 cases, including those deemed
 curable and incurable, the recoveries were  34 in 100 or 1 in 2.90.t
   The following  statements  were collected by M. Esquirol from
 English  lunatic hospitals.
  English Lunatic Asylums.         Dates.        Admissions.  Recoveries.
      In Bethlem Hospital .. from 1748 to 1794   . .  8874 . .  2557
          „       „      .  in . . . , . . 1813  . .   422 . .   204
      In St. Luke's.......from 1751 to 1801   . .  6458 . .  2811
      In York Asylum.....................   599 . .   286
      In the Retreatnear York from 1801 to 1814  ..   163 ..    60

                                     Totals   16516 . .  5918
   From  this calculation  it appears that the proportion  of cures
formerly obtained in English  lunatic asylums was in some instances
less than that which is reported  from  the celebrated hospitals in
France.   This is the more remarkable  when we  take into our ac-
count the peculiar regulations of the great lunatic establishments
of London.  The hospitals of Bethlem and St. Luke impose certain
exclusions elsewhere unknown.  They reject all patients who have

            * Statistique de la Maison Royale de Charenton.
            j- Dr. Burrows' Commentaries on  Insanity, p. 251. 
OF RECOVERIES.
109
been more than twelve months insane ; those affected by paralysis,
however slight, and by epilepsy or convulsive fits ; idiots, the aged
and infirm ; those discharged  uncured from other hospitals : there
are likewise other exclusions besides those above mentioned, and all
persons who have not recovered at the expiration of one year are
dismissed.   Yet, on comparing the reports  of these hospitals with
those of other institutions, the regulations of which are  less favour-
able to a high proportion of cures, and where no selection or exclu-
sion exists, we  do not find, as Dr. Burrows remarks,  the relative
number  of recoveries to be so great  as might be expected.   It is
indeed surprising to observe that the reports of Bethlem Hospital,
of a century and a half ago, give a greater proportion of cures than
those of many years preceding 1817, when an improvement took
place in the  arrangements of that establishment.   Dr. Burrows re-
marks on the authority of Stow, who derived his information from
Dr. Tyson, physician to Bethlem Hospital, that" from 1684 to 1703,
1294 patients were admitted, of whom 890 were cured, which is a
proportion of two in three.  But from 1784 to 1794, 1664 patients
were admitted, of whom 574, or rather more than one in three, re-
covered.
   We cannot explain the difference which is displayed by this state-
ment.   It is impossible to imagine that any want of attention or of
skill in  the  superintendence of the hospital or in the treatment of
the disease would adequately account for so great a difference in the
results,  and  there is, I presume, no ground for entertaining the sus-
picion that any such defect really existed.
   A much more favourable average of recoveries has  taken place
in the recent admissions at Bethlem  Hospital, since the removal of
the institution to its new site, and the alterations that have been
made in its arrangement.  The following report, which I have ob-
tained through the kindness of Mr. Lawrence, sufficiently proves this
fact, 
110
PROPORTIONAL NUMBER
		Discharged.					
Remaining from	Admis-sions.	Cured.	Uncured.	By re-quest of friends.	Improper objects.	Died.	Remain-. >ng.
1819	81						
1820	124	60	33	11	22	4	
1821	135	43	36	7	28	6	
1822	165	66	43	5	27	11	
1823	145	72	49	4	19	5	
1824	155	59	55	5	31	6	
1825	170	70	48	7	29	12	
1826	162	70	63	6	24	6	
1827	149	64	41	2	15	9	
1828	204	111	48	6	34	6	
1829	195	126	42	2	29	10	
1830	201	110	45	4	30	6	
1831	212	98	55	5	41	6	
1832	163	92	41	,2	35	5	
1833	184	83	44	4	21	7	124
	2445	1124	643	70	385	99	124
   In order to estimate the result of the plan on which the hospital
of Bethlem is instituted, we must subtract from the entire aggregate
of admissions the number of patients who were subsequently exclu-
ded as improper objects.  Thus 2445—385=2060 will be the total
number from which 1124 cures were obtained, amounting to consi-
derably more than one-half of the aggregate.   It  is probable, from
the result of the facts before stated in reference to the periods of the
disease at which recoveries are obtained, that  a great proportion of
patients discharged uncured were still curable.  We have seen that
among the patients of the Salpetriere, the number cured  during the
second year are nearly as five in six to those who  recovered during
the first.  If we might presume that among the patients dismissed
from Bethlem at the end of the first year, which is understood to be
the case with those who are still uncured, a proportion  of curable
cases still remains, approaching nearly  to that which exists in the
Salpetriere among the  patients who remain  still uncured in the
hospital at the expiration of  their first year, this would raise the
recoveries at Bethlem to a very high proportion indeed.  We are
not  authorized to  draw any positive conclusion on  this subject,
but  we  can   hardly fail to  entertain  a  strong  doubt  as  to  the
propriety of  the regulation  still subsisting  at Bethlem, and a sus- 
OF RECOVERIES.
Ill
picion  that it is a relic of the ignorance of our predecessors which
calls loudly for such a revision and adaptation to the improved state
of knowledge, as would  ere  now  have  been  obtained  under our
continental neighbours.
  The following  reports from English provincial lunatic asylums
are taken from Dr. Burrows.  They display a greater proportion of
recoveries than the returns given by M.  Esquirol, and very nearly
agree with the report from Siegburg. I believe that in the hospitals
to which they refer, no principle of selection is adopted.
   In Stafford Asylum, from 1818 to 1828, admissions 1000 ; cured
429 ; or about 43 in 100.
   In Wakefield County Asylum for the West Riding of Yorkshire,
from 1S19 to 1826, admissions 917; cured 384; or about 42 in loo!
   I have obtained a later and more ample report of the Lancaster
County Asylum, through the kindness of Dr. Whally.
Report of the Lancaster County Asylum.
Dates.	Admissions.		Recoveries.		Deaths.		Remain or dis-	
							missed uncured.	
Admitted								
before	Male.	Female.	Male.	Female.	Male.	Female.	Male.	Female.
June 24.								
1817	35	25	7	1	3	0	25	24
1818	75	48	12	4	10	10	70	59
1819	35	17	15	10	9	2	79	64
1820	44	36	24	14	26	6	71	77
1821	38	22	12	9	9	6	88	82
1822	62	42	16	16	12	5	117	102
1823	63	52	20	15	21	12	135	120
1824	44	43	21	25	14	18	137	117
1825	76	55	35	20	18	18	158	132
1826	60	48	39	26	38	27	137	123
1827	83	52	27	26	37	20	144	128
1828	57	57	31	18	24	20	143	146
1829	76	58	22	22	33	15	160	164
1830	76	63	35	30	30	16	166	178
1831	83	62	37	37	39	21	166	180
1832	90	72	34	35	42	37	177	186
Totals . .	997	753	389	308	344	233		
Gen. Tota	Is 17	50	61	n	5	77		
  Here the recoveries are to the admissions within a small fraction
of 2.5, or about 40 in 100.
  The  following is a similar  report of the Gloucester Asylum
drawn up by Mr. Hitch. 
Report containing the annual statements of admissions into the Lunatic Asylum at  Gloucester from the
                                            period of its opening.
	Before July, 1823.	1824.	1825.	1826.	1827.	1828.	1829.	1830.	1831.	1832.
Patients already in the house ..... Admitted in the year ......	0 68 68 7 1 1 2	57 43	75 47	78 37	79 07 146 31 4 14 7	90 54	91 55	101 63 164	103 35	92 45
		100	122 23 8 6 7 44 158 41	115 16 5 7 8		144 29 2 12 10 53 316 117	146		138	137
Recovered ........ Relieved* ........ Removedf ..... Died....... . .		11 4 5 5					25 9 7 4	40 6 10 5 61	23 1 17 5	26 1 12 4
	11	25		36	56		45		46	43
Total number admitted from the opening Total of recoveries ......	68 7	111 18		195 " 57	262 88		373 142	436 182	471 205	516 231
* Many of these are stated to have been discharged on trial, and to have recovered in a short time after their dismissal.
f Removed either by request of friends or as harmless and incurable, some of them demented, or subject to epilepsy of long duration. 
OF RECOVERIES.
113
  The proportion of  recoveries, without taking into the account a
considerable number which afterwards took place among those dis-
missed  as  relieved and on trial,  is  here very great, viz.  234 in
516, which approaches nearly to one-half of the total number ad-
mitted ; a circumstance the more striking, as no selection is used in
the admission, lunatics of all descriptions being reckoned fit objects
to receive the benefits resulting from  this excellent establishment.
  A highly favourable result  has  been  afforded by the experience
of the Retreat near York.  I  have obtained, through the kindness
of Mr. Tuke, a table exhibiting the numbers of admissions into this
asylum from  1S12 to 1833  inclusive, with the results of all the
cases.   The admissions of each year  are divided into three classes,
one for cases of  less than three months in duration, a second for
cases of more than three but less  than  twelve  months, and a third
for cases of more than twelve  months ;  to these three a fourth class
is added for cases of  relapse re-admitted.  The summary of this
table will convey the general  results : it is as follows: —
					Removed	
Cases classed as	above.	Recovered.	Died.	Removed.	improv-ed.	Remain.
First class .	63	51	8	1	2	1
Second class	65	28	IP	6	3	18
Third class	101	31	15	17	4	34
Fourth class	105	58	17	U	I	16
Total	334	168	50	37	10	69
  From  this table it appears that out of three hundred and thirty-
four admitted between the years 1812 and  1833 inclusive, one hun-
dred and  sixty eight  have recovered, fifty have  died, thirty-seven
have been removed by the friends unimproved, and ten in  an im-
proved state, and sixty-nine remain.*
  Of the eight  deaths reported in the first  class of cases, four took
place very soon after admission ; one by phthisis, under which the
patient laboured in an advanced stage at the period of admission;
one by apoplexy, of which the patient had had fits prior to admis-
sion ; one from self-injury; one from fever, the case  having been
one, not  of insanity, but of febrile deliiium. It is obvious that these
cases ought in all fairness to be subtracted from the number of ad-
missions, when we attempt to estimate the  probability  of recovery ;
and this,  joined to another consideration, will  raise the proportion
in recent cases, as Mr. Tuke has pointed out, from somewhat below
7 in 8, the rate at which he has estimated  it, to somewhat above 9
in 10.   The consideration referred  to is  the  following.   Several
cases entered in the most  recent class were  those of persons who had
been long eccentric, and whose aberration had only advanced a short
step beyond that  state  by which  they had been always  or long

  *  Previously to 1811 there had heen twenty-nine cases admitted of the most
recent class, of which twenty-six are reported to have been dismissed recovered.
  April, 1837.                 11 
114
TERMINATION  OF
characterised, but of which the partiality or the familiarity of friends
and relations had hardly allowed them to suspect the  real nature.
"' These,'' says Mr.  Tuke, " are properly  old cases ; and if we were
to exclude these from our list together with those connected with
disorders speedily terminating life as consumption and apoplexy,
I should say that, according to the result  of our experience, the
probability of recovery from insanity in recent cases is greater than
as nine  to one."
    Section IV.—Of the Termination of Insanity in Death.

  Insanity is not to be reckoned among the diseases which are very
dangerous to life.  The state  of  the  brain  on which it depends,
though incompatible with the continuance in a sound state of those
functions with  which the mental  operations  are associated, is yet
such as to carry on other processes, dependent on the brain, which
are subservient to physical existence.
  This conclusion is established in a  most  convincing manner by
the duration of insanity, and the cases even of longevity which oc-
cur among lunatics.   We are informed by M. Desportes that among
the lunatics at Bicetre in the beginning of the year 1822, one had
been  lodged there fifty-six  years, three upwards  of forty years,
twenty-one more than thirty years, fifty upwards of twenty years,
one hundred and fifty-seven  more than ten  years.  At the  Salpe-
triere the entry of patients was dated,  seven  cases from fifty to fifty-
seven years, eleven from fifty to sixty, seventeen from forty  to
fifty.
  I. The morbid state of the brain is, however, liable to increase
beyond the limit above adverted to, and then the usual phenomena
dependent on  severe  cerebral  disease are  manifested.  It is well
known that lunatics are subject  in  a much  greater proportion than
other persons to apoplexy, paralysis, convulsions, and all  the trains
of symptoms depending on different  degrees or modifications  of
cerebral congestion.*
  II.  Another mode by which madness brings on  a fatal termination
is by the exhaustion arising from continued excitement.   There are
many cases of maniacal  disease in  which the ceaseless excitement of
the feelings, the constant hurry of mind and agitation of  body, the
total want of rest and  sleep, and the febrile disturbance of the system
which frequently  ushers in the attack  of madness, and is  a promi-
nent feature  in cases of this description, bring on  a very marked
reduction of strength  as  well as of flesh  : the degree  of ema-
ciation is  sometimes  extreme.   In  general this  state of excite-
ment gradually abates,  or  the means adopted  to  lessen it and
tranquilize the system  are  attended  with success : but this is not
uniformly the case, and some maniacs  die completely worn out and
Calmeil sur la Paralysie des Alienes. 
INSANITY IX DEATH.
115
exhausted.  It is in part owing to this cause that the mortality
among lunatics is more considerable during the two first years from
the period of their attack than in the succeeding years, a fact which
appears to be established by the calculations of M. Esquirol.   In the
Salpetriere the number of deaths is even much greater in the first
year than in the second.  Of seven hundred and ninety lunatics who
perished  in  that hospital  between the  years  1S04 and 1814, it
appears that three hundred and  eighty-two died in the first  year
from  their admission, two hundred and twenty-seven in the  second
year, and one hundred  and  eightj'-one during the seven succeeding
years.
   Many lunatics are carried off by diseases of the abdominal and
thoracic viscera,  which are  complicated with madness.   Pathology
does  not  enable  us to explain  the connection   between  organic
diseases of the lungs or bowels and disorders in the condition of the
brain, and hence many have  been inclined to regard the combina-
tions of morbid states to which we now advert as accidental.   They
are perhaps too numerous to be attributed to chance.   The  combi-
nation of madness, as well as of some other affections of the brain and
nervous system,  with morbid states of the  liver and the intestinal
canal, was pointed out  some years since in my work On Diseases of
the Nervous System.   The conjunction of insanity with pulmonary
phthisis is a  fact established beyond doubt by the observations of
M. Esquirol, who remarks that phthisis often precedes  the appear-
ance  of melancholia, or accompanies it.  The disease of the lungs
is in  such instances latent;  the patients lose their strength, become
emaciated and suffer under slow fever,  sometimes attended  with
cough  and diarrhoea;  the phenomena  of madness  rather increase
than abate under these  circumstances, and continue until death.  On
the examination  of  the body, the lungs  are found  tuberculated or
affected by melanosis.*
   Diseases of the heart are not unfrequently complicated with mad-
ness.   We are assured  by M. Foville, that, of the bodies of lunatics
which  he examined after death  during three  years, five out of six
displayed some  organic  disease of either  the  heart  or the great
vessels.   This was very  frequently  hypertrophy  of the  heart.
These  morbid changes, however, are probably, as  M.  Foville has
observed, more  frequently results  of the continued agitation, the
violent efforts and cries, which in such patients bring on diseases in
the thoracic organs, than predisposing causes of  cerebral disorder.
That this, in some instances at least, is the true explanation of such
facts I am convinced from  my own observation.
   Diseases of the intestinal canal, whether  they exist or not at the

   * Dr. Greding, of Waldheim, found that forty out of one  hundred maniacs^and
twenty of  twenty-four melancholies, laboured under pulmonary phthisis.  The
same  writer says  that seventy-six  among one  hundred maniacs, and twenty
among twenty-four melancholies, were found to have effusion either in  one or in
both of the cavities of the thorax___See Crichlon's Extracts from Greding on Insa-
nity. 
116
TERMINATION OF
onset  of  the maniacal  attack,  are  among  the  frequent causes
of death.   A state  of  obstinate constipation  often  continues for
a long time, attended by its usual accompaniments.  It gives way,
and  is followed by  or  alternates with  diarrhoea, which wastiis  the
strength of the patient and terminates in a fatal dysentery.  When
the body is examined, the intestines are found sometimes distended
and  loaded with  indurated  matter, at others  empty and pale, with
disease of the mucous coat, discoloured and  abraded patches or
ulceration, and gangrenous spots.
   In protracted  cases  death  either  results from  increase in  the
disease of the brain,  which disease up to a certain  degree  had only
interfered with the  operations subservient  to the  mental  faculties,
but at length becomes incompatible with the merely physical func-
tions of the same organ; or it is the result of accidental disorders,
which, owing to  the peculiar  state of the brain  and other  organs in
lunatics, are more than usually fatal to them.
   Many lunatics in  the advanced stage labour under  a degree of
cachexia bordering  on  scurvy.  The  skin is  beset  with  scaly or
papular eruptions, or discoloured in patches;  furunculi appear in
different parts of the body, which are much disposed to become
sloughy; the gums become  red and sore, and bleed; the surface of
the body is cold, with a clammy perspiration ;  diarrhoea and abdo-
minal pains  accompany these symptoms;  the  patient apparently
suffers under defective nutrition and a gradual decay of physical life,
and  dies in a state of extreme emaciation or marasmus.
   The preceding are perhaps the natural results of  the diseases
under which lunatics suffer in connection with their original com-
plaint.  A great number, however, are carried   off  by  disorders
which may be considered as accidental, but to which the  condition
of body in patients of this description renders them more than other
individuals liable.  Fevers which assume more or less of the typhoid
character, severe  catarrhs, and pulmonary affections, are  the most
frequent of these.  It will be supposed that fevers which  affect the
brain are fatal to lunatics, and such is the fact in a very marked
degree.
   The diagnosis of accidental diseases  in  lunatics presents, as M.
Georget has  well observed, remarkable difficulties. Some patients
of this description are  continually making  unfounded  complaints,
deceived by their erroneous or  fancied sensations. " On  the other
hand, many  lunatics labour  under very severe affections without
revealing them  by any expression, either because these  affections
are latent and do not  occasion suffering, or because the  disturbed
state of their minds does not allow their  sensations  to  reach the
centre of perception.  In this last relation the medical  treatment of
lunatics is much more obscure and difficult than that of young chil-
dren, because the latter are conscious of their ailments, and express
them  by their cries.   When we observe  a  lunatic,  who had pre-
viously been  agitated and furious, become morose and taciturn,  and
at the same  time lose  appetite, seek repose, and  display a suffe- 
INSANITY IN DEATH.
117
nng and dejected expression, we ought  to examine  him  carefully:
he is  threatened with  some acute disease.  The development of
symptoms will soon point out the seat and nature of the complaint,
and consequently by what remedies it is to be opposed.   But chro-
nic affections are so slow in their approach and concealed in respect
to their symptoms,  that they often reach to a very advanced stage
before their existence  is suspected, unless the organs affected are
examined before their diseased condition has manifested  itself.  We
find the lungs full  of  tubercles, with  cavernous excavations  and
abscesses, or in a state of atrophy, in the bodies of individuals who
had neither coughed nor expectorated, nor experienced pain or
dyspnoea  during life ;  they had become gradually debilitated, had
taken to their beds, and after a continually increasing emaciation,
had at length sunk.   The disorganization of the lungs had only been
discovered by the  aid  of auscultation  and percussion.   We must
not then wait for the expression of complaints on the part of lunatics,
in order  to have due watchfulness  excited  to the means which are
necessary for preserving their existence."
   The following table given by  M. Esquirol, in his statistical re-
port of the Royal House of Charenton, serves to illustrate the com-
parative mortality resulting from different forms of madness.

   Table of mortality in relation to different varieties' of de-
                         rangement.
                        Men.          Women.          Totals.
  Mania...........    39    ......    21   ......    60
  Monomania.......    25    ......    18   ......    43
  Dementia.........   89   ......    26   ......   115
  Idiotism.........    0   ......     1   ......      1
  Died after recovering)   2               0              2
    from insanity . .  . .$
Totals ...    155             66            221
  " The mortality fell chiefly on persons in a state  of dementia.
This," as M. Esquirol observes, " is to be expected, since dementia
is almost always the ultimate condition to which continued insanity
leads, of whatever form, and because dementia is the form of disease
with which paralysis is chiefly  complicated.  There is likewise  to
be remarked a great difference between the numbers  of men who
sink under dementia and those of women : thus we have in the for-
mer eighty-nine, and  twenty-six in the latter.  Next  to dementia
mania is the most fatal, and it is more destructive to  men than  to
women  : this, however, is explained by the circumstances that we
admit more men than  women, and  that men are more subject  to
mania than women."*
* Statistique, ubi supra, p-108.
           11* 
118
RELAPSES AND
   It appears generally that the mortality at Charenton was  much
 greater among the male than among the female patients.   This is
 attributed in part to the  comparatively  greater prevalence  of  gene-
 ral paralysis among the former.   The fact is equally striking in the
 reports of some English hospitals, as in that of the Lancaster Luna-
 tic Asylum, given in a previous section,  in which the deaths of
 males are 344 in 997, or about 1 in 3, and  those of females are 233
 in 753, or about 1 in 3|.  Among the lunatics in St. Peter's  Hos-
 pital in Bristol, the difference is still greater in the relative numbers
 of deaths of males and  females  ; and  Mr.  Brady, the intelligent
 medical officer under whose immediate care  the patients are placed,
 has assigned this difference to the cause  suggested by M. Esquirol.
   With respecWo  the mortality at different seasons, it  is observed
 by M. Esquirol that in general the  months of December, January,
 and February, are the most fatal to deranged persons.


     Section V.—Of Relapses, and of recurrent Insanity.

   Recoveries from madness are in many instances complete.  There
 are numerous persons who have been insane for six ortwelve months,
 or during a  longer period, and have afterwards entirely recovered
 the vigour of their  intellectual faculties, so as  to be  capable  of as
 great and effective mental  exertions as previously to the attack.
 Others, and perhaps these  are the  majority, are  curable only to a
 certain point.  These persons remain, as M.  Esquirol has observed,
 in such a state of susceptibility that the  slightest causes give rise to
 relapses, and they  only preserve  their sanity by continuing to live
 in a house where no mental agitation or inquietude, no  unfortunate
 contingency is likely to fall to their lot, and throw them back into
 their former state.  There are other individuals whose faculties have
 sustained such a shock that they  are never capable of returning to
 the sphere which they had held in society.   They are perfectly ra-
 tional, but have not sufficient mental capacity to become again  mili-
 tary officers, to conduct  commercial affairs, or to fulfil the duties
 belonging to their appointments.   Such cases  may  be about one-
 tenth  in the number of recoveries.
  Convalescents are subject to relapse as are those who are advancing
 towards recovery from other diseases.  But  lunatics are in many
 instances likewise prone to  a recurrence of the disease  after it has
 been entirely removed, or at least after  its manifestations have long
 ceased to be observed.   The same observation may be applied toother
 disorders of the nervous system.   It would  seem that one attack
of disease has in these cases left the patient with a stronger  predis-
position than he formerly had to the complaint, whatever  it  may
have been, and that the morbid tendency is strengthened after every
renewed incursion.  The.most trifling circumstances have in these
instances sufficient influence to produce  the morbid condition of the
brain and of the mind.   At length the patient is scarcely ever in  a 
RECURRENT INSANITY.                 ng
lucid state ;  the intervals lessen in duration, and  become more and
more imperfect in degree, until finally the disease is in a great mea-
sure permanent.
  The proportion of cases in which madness is recurrent  has been
overrated.  According to M. Pinel, in 71 cases out of 444 recoveries
relapse took place, or, rather, the disease was in those instances re-
current.  This gives  somewhat  less than one-sixth  of the  whole
number as recurrent ; but the same writer allowed that out of the 71
cases 20 patients had previously relapsed, or had undergone several
attacks, 16 had left the hospital at too early a period, 10 came after-
wards under treatment and recovered without relapse, 14 had given
themselves up to grief and intemperance, and several others were
under  circumstances unfavourable to continuance  in health.  M.
Esquirol published a report of 2804 recoveries, in which number
only 292 recurrences  of disease took place, that  is,  a little  more
than one-tenth.  M. Desportes, however, has stated that, in 1S21,
52 recurrent cases were recognized at Bicetre, out of 311 admissions,
that is, about  17  in a hundred ; at the Salpetriere in  454 admis-
sions there were 66 relapses, about 15 in a hundred, or one-seventh.
But in the proportion of recurrent cases indicated by this last report,
it is probable that there were, as  M. Georget  has well  observed,
many  cases  which had been discharged in a state of incomplete  re-
covery, as well as a considerable number of drunkards, who come
habitually every year to spend a few weeks in Bicetre or the Salpe-
triere, having been picked up in the streets in a state of intoxication.
The following table, furnished by Mr. Hitch, illustrates this sub-
ject.


 Table showing the number of cases in which relapses have occa-
  sioned re-admission; distinguishing  the paupers from  the
  others, and the males from females.

The total number of cases admitted before June 30,1834, is 546
Number of those whose names appear in the entry-
   book more than once....................  68
      Of these 68, 49 are males.
                  19 "  females.
      Of the 49 males,   1 has been admitted   14 times = 14
                        3          "          3   "   =   9
                       13          "         2   "   =26

                       17                               49

      Of the 19 females, 3 have been admitted  3 times =   9
                        5          "          2  "   =  10
8
19 
120
CAUSES OF INSANITY.
 Of the 17 males, 10 are paupers.
                   7 others.

                 17

Of the 8 females,  4 are paupers.
                  4 others.

                   8
  " It is to be observed that many persons re-admitted are  such as
had been removed uncured by the wishes or caprices of the friends.
Others  are  cases  of  periodical excitement ;  as, for  instance, the
gentleman admitted fourteen times, who spent  his life in five weeks
of excitement and five weeks  of depression, with the variation
scarcely of a day.   He died at Dr.-------'s, whither he had remo-
ved on account of  our fire.  Some have been discharged * relieved
on trial,' whose friends have found it  necessary to replace them,
and some have relapsed after an apparently perfect cure."
  In all instances we  may consider it as certain that the improba-
bility of recurrence increases with the length of the interval during
which the patient has existed without manifesting signs of renewed
disease, and  that it is also greater in proportion to the completeness
of the  recovery.   When the  energy  of mind  is  fully restored,
relapse is much less to be feared  than when it remains weak and
excitable.
                       CHAPTER  IV.

               OF THE CAUSES OF INSANITY.

Section I.—Nature of the Causes  of Insanity :  Distribution
                    under different Heads.

  There are many questions connected  with the theory of mental
disorders, which are yet and will perhaps always  remain involved
in obscurity ; but two  departments of inquiry  are accessible to us
from which  we may expect to obtain resources  for elucidating that
subject.  One of these comprehends  the antecedents of insanity,
or all that is or can be known as to the previous conditions of which
mental  derangement  is  the consequence  or result.  The other
includes necroscopical phenomena, or the appearances discovered by
dissection in the bodies of the insane,  and likewise a comparison of
these appearances with the  symptoms or manifestations  of  disease 
PREDISPOSING CAUSES.
121
which had been observed during life.   I shall devote the two fol-
lowing chapters to a consideration of these subjects.
  The causes of insanity have been differently distributed.   Some
divide them into remote or predisposing, and immediate or exciting
causes ; others into moral and physical causes.   I shall  adopt this
latter division, but shall first, for  the  sake of clear and distinct
arrangement, consider the facts which refer to predisposition, or the
susceptibility of mental disorders,  and the circumstances which
modify it and tend to augment its influence.  These may be com-
prehended under the term predisposing causes.
  Under  this  head, of predisposing causes of insanity, may be
considered, first, constitutional predisposition,  whether hereditary
or originating with the individual ; secondly, among the circum-
stances which modify this predisposition, the influence of sex and
age;  thirdly, the marks which denote  or render it  manifest, viz.
external peculiarities of organization, form, and complexion; fourthly,
circumstances which augment it,  as previous attacks of insanity
and other diseases of the brain ; lastly, the influence of  education,
moral and physical, in modifying the organization of the body and
the predispositions of  the mind.


         Section II.—Predisposing Causes of Insanity.

                           ARTICLE I.

   Of constitutional  predisposition, whether hereditary  or
                           original.
   A  certain  peculiarity of natural temperament  or  habit of body
is a necessary condition for  the development of insanity  : without
the previous existence of this condition the causes which give rise
to the disease will either act upon the individual without any noxious
effect, or they will call forth some other train of morbid phenomena.
A natural predisposition may  be  inferred to have existed in every
instance in which the disease  has appeared.
   The constitutional peculiarity whence arises the predisposition to
insanity, is not generally distinguished, or to be certainly recognised
by  any remarkable external characters.   The fact that it exists and
is a necessary condition to the development  of mental disease, is to
be inferred from the consideration  that the causes   which induce
madness in one  person are precisely similar to those  which in other
individuals are observed to call forth disorders of a different kind.
For example, we may observe that, among the physical agents which
give rise to madness, there  is none  more influential  than  intemper-
ance  and the habitual use of ardent spirits.  A very considerable
proportion of  lunatics in the lowest  classes of society in  some
countries owe their disease  to this habit.  But it is only in  a cer-
tain proportion of persons addicted to intemperance that the pheno-
mena of insanity make their appearance.   Others, under the influence 
122
CONGENITAL  PREDISPOSITION.
of the same noxious cause, are affected with apoplexy or paralysis ;
in many the brain escapes and the  liver becomes disordered, or
dropsy takes place, with or without disease of the liver ; in  some
the lungs become the seat  of morbid changes.  It is  evident that
there must be an original difference in  the habit of body whence
arises the diversity of results brought about by the same or very sim-
ilar external agencies.   This original  difference is apparently a
peculiarity in the congenital constitution of each  individual. It
may be transmitted from parents, or  it  may  arise de novo, as other
varieties in the congenital  structure are known to do.   Hence it is
comparatively of little moment, as  far as an individual is concerned,
to inquire whether his morbid predisposition  has  been derived by
hereditary descent, or has sprung up with himself.   It may, indeed,
be observed that peculiarities which  arise in  a race are often com-
mon to several  individuals even in  the first generation.   Albinos,
for instance, though the offspring of parents of ordinary complex-
ions, very frequently have brothers or sisters resembling themselves.
In like manner, diseases which appear  for the first time in a family
often  affect several  members of  it.  They partake of the  same
peculiarity  of  structure,  which  is  congenital and  constitutional,
though not inherited.
   If these remarks are well  founded, it must be apparent that hered-
itary madness is not less curable than a disease having symptoms of
the same description, which  has not been previously observed  in the
family of the person affected by it.
   That the predisposition  to insanity, when it has  once  arisen, is
frequently transmitted, is  a  fact too well  established  to  admit of
doubt; it constitutes a feature in the history of the disease.
   In a following section of this chapter  I shall  give  some  state-
ments which are intended to indicate  the proportional number of
cases in which insanity  has been known to arise  from hereditary
predisposition.
   M. Esquirol  affirms that persons born before their  parents had
become insane are less subject to mental disease than those who are
born after the malady has  displayed itself.   He makes a similar re-
mark as to individuals who inherit the disease only on one side, in
comparison with persons whose ancestors on both sides had been
affected by it.  According to Burton the offspring of parents advanced
in years are more subject than others to melancholy madness.
   Another observation relating to the hereditary transmission of this
morbid tendency is, that the  disease is apt  to show itself in different
individuals of a  family at a particular period of life. M. Esquirol has
made this remark, and he  has mentioned several facts in illustration
of it.  " Two sons of a  merchant of Switzerland died insane at the
age of nineteen years. A lady, aged twenty-five years, was attacked
by puerperal madness ;  her daughter suffered in like manner  at the
same age.   In one family  the father, the son, and the grandson, all
committed suicide about their fiftieth year.  There was at the Sal-
petriere a  prostitute who had  thrown  herself into  the river  seven 
PREDISPOSING CAUSES.
123
times ; her  sister  drowned herself in a fit of intoxication.   There
exists near Nantes a family in which seven brothers and sisters are
in a state of dementia.   A gentleman, affected  by the first events
of the revolution, remained during ten years shut up in his chamber.
His daughter, about the same age, fell into a similar state, and re-
fused to quit her apartment."   Dr. Burrows says that  one of the
youngest lunatics under his care  was a boy of Jewish family, whose
father and mother were insane :  his six brothers and sisters  became,
like himself, deranged on arriving at the age of puberty : the  indi-
vidual who  was under the care of Dr. Burrows recovered in three
months.  M. Falret has observed that melancholy occasioning suicide
is perhaps the most frequently hereditary among all the forms of
insanity.  He mentions a case in which females of three successive
generations  either committed or  attempted  suicide.*   Dr. Rush has
also mentioned examples of hereditary suicide.
   This predisposition to  insanity,  says  M. Esquirol, is not more
surprising than are the predispositions to gout, to phthisis pulmo-
nalis, and other diseases, in a different point of view.  " It may be
traced from  the  age of infancy : it furnishes the explanation of a
multitude of caprices, irregularities, and anomalies, which at a  very
early period ought  to put parents on their guard against the approach
of insanity.  It .r.ay furnish useful admonitions to those who pre-
side over the education  of children.  It is advisable in such cases to
give them an education tending to render the habit robust, and to
harden it against the ordinary causes of madness, and particularly
to place them under different circumstances from those with which
their parents were environed.  It is thus that we ought to put in
practice  the aphorism  of Hippocrates, who advises to change the
constitution of individuals in order to  prevent the diseases  with
which they  are threatened by the hereditary predisposition of their
family."
   It is an inquiry highly interesting in many respects, what causes
or  previous  circumstances lay the original foundation for the ex-
istence of that congenital or inborn peculiarity of constitution which
renders certain individuals predisposed to become, when acted  upon
by exciting causes, the  victims of this disease.  In  order to throw
any light on this subject we must go back an entire generation, and
inquire how and by what means the parents can be so affected  as to
render their offspring physically weak  and predisposed  to  become,
under circumstances which have no such effect on  others, deranged
in their understandings.   It seems probable that any causes which
tend to produce enervation and debility in parents will have an effect
on their  offspring.
   It is a general opinion that marriages between persons near of kin
have such an effect, and that the mental faculties, display it  even
more than the physical.  The apparent results of frequent marriages
within a confined circle have been noted in some royal familes, both
* Falret de l'Hypochondrie et du Suicide, p. 6. 
124
CONGENITAL  PREDISPOSITION.
in ancient and in modern times.  The offspring of marriages between
cousin-germans  are very often observed to be weak  and defective
both in mind and body.   The  children of such families often die
durin^  infancy,  or  if they grow up,  are  frail and imbecile.  M.
Esquirol affirms that many facts have occurred within the sphere of
his information, proving that a strong predisposition to madness has
arisen from some accidental fright sustained by the mother during
pregnancy.  Marked cases of this description are said to have oc-
curred during the period of the revolution.
   In many instances one particular form of mental disorder seems
to be transmitted in families.   This has  been observed  already in
respect to the derangement which occasions suicide.   M. Pinel has
mentioned an affecting instance in which dementia occurred in
several individuals of  a family, nor is this fact of  very rare occur-
rence.  As the particular  form of insanity is  determined  in a great
measure by the natural temperament, and as peculiarities of tem-
perament are hereditary, the predisposition to mental disease, where
it exists in a family, is likely to be determined in its type or char-
acter.  This, however, is not uniformly the fact.   There are many
instances in  which one individual is  affected with melancholy de-
jection and a  tendency to monomania, while another of the same
 kindred is subject to attacks of raving madness.    Insanity displays
in  a similar way its  alliance to other  diseases of  the brain.   The
relatives of  insane persons labour frequently under diseases of the
 same class, such as  paralysis, chorea, epilepsy, congenital idiotism.
 In many instances it has  been  observed that, while some members
 of a  family are manifest lunatics, others are only eccentric in char-
acter, displaying peculiarities  of habit,  conduct,  and disposition,
 which, though  constituting in  reality a  degree  of moral insanity.
 may not render such individuals altogether unfit to be at large, and
 to enter, as much as they  are disposed to do, into the intercourse of
 society.
   There is reason for believing that this  one circumstance of con-
 stitutional tendency to mental  derangement is by itself more im-
 portant,  in respect  to  the origination and the frequent  occurrence
 of the disease, than all the  other causes,  both predisponent and oc-
 casional, taken together.  It cannot be said with  propriety to give
 rise  to insanity alone  and without  any exciting contingency ; but
 if it be very strong, the disease will take  place under the agency of
 ordinary and very slight causes.


                            ARTICLE II.

                             Of sex.

   Coelius Aurelianus, who lived in the age of Trajan and Hadrian,
 and who wrote with  more accuracy of discrimination thap any  of
 his  predecessors on disorders affecting the mind, stated that both
 mania and melancholia occurred more frequently  in  the male than 
SEX.
125
in the female sex.*  It is doubtful whether this writer made the
assertion after adequate research, for which there were probably no
data to be obtained in his age.   His conclusion is at least contrary
to the general fact observed in modern times.
   The relative proportion in which the two sexes are affected with
insanity has been a matter of discussion among those who have occu "
pied themselves with the statistics of this disease.  The subject has?
not long since, been investigated  by M. Esquirol in the most elabo-
rate and  satisfactory manner, in  his valuable report on the  Royal
House of Charenton.  As this is  not the place for the statistical his-
tory of insanity, it would  be contrary to my present design to enter
into an extended  consideration of the evidence from which the con-
clusions are deduced, and I shall  confine myself to  a  statement of
the general  results.
   In the hospital of Charenton, during the years to which M. Es-
quirol's report has reference, the proportion of male patients admit-
ted  to that of female was three to two.  This  proportion  is the
result of peculiar circumstances, and  is very  different  from that
which obtains  elsewhere, as  well in France  as  in other countries.
From a variety of public documents it appears that in the great hos-
pitals of the Salpetriere and Bicetre an  inverse  proportion to that
above stated holds in the  numbers of the two sexes, male patients at
Bicetre  being  to females in the Salpetriere only as two to three.
This, however, does not hold throughout France.  It appears from
a great number of published and private documents which M. Es-
quirol has collected, that in the cities in  the south of France the
number of male is somewhat more  considerable than that of female
lunatics ; while in the  northern departments the number of females
predominates in a greater degree ; but that  in all France the number
of insane women is  to  that of insane men very nearly in the pro-
portion of 14 to  11.  From Spain, the returns which M. Esquirol
has been able  to obtain are very defective: the result, which can
only be looked upon as a presumptive one, since it rests on few data,
and may hereafter be  modified by more copious information, gives
an excess of one-fifth  in  the  number  of female  lunatics compared
with that of males.  In Italy, it appears from  the  documents ob-
tained that the proportion is different, there being more insane men
than women, particularly in the  kingdom  of Naples.  In all Italy,
5718 male lunatics were reckoned, and 5067 females.   In Holland
and Belgium, according to the  information  given  to the world by
M. Guislain, it appears that the  number of females in the  lunatic
asylums is much more considerable than that of  males, being as 34
to 29 ; and this excess  on  the side of females is rather greater in the
southern, or Belgian provinces, than in those of the north, or in the
present Dutch kingdom.   In Great Britain and Ireland the  propor-
tion of male to female  lunatics is  as 13 to 12.  In England tfie num-

   *  Coelius Aurelianus, Morb. Chron. lib. i.—Esquirol, art. Folie, in Diet, des
Sc. Med.—Heinroth, Stoerungen des Seelenlebens, b, i. s. 85-87.
   April, 1S37.                12 
126
PREDISPOSING CAUSES.
ber of men insane compared to that of women is more considerable
than in Scotland and in Ireland.  This  excess in  the proportional
number of male above that of female lunatics in England is greater,
according to Dr. Burrows, in the higher than in the lower classes of
society.   M. Esquirol who has cited this observation, adds a paral-
lel remark in respect to the comparison of different orders of society
in France, insanity being  apparently more  prevalent among men
compared with women in the higher than in the lower classes.
   In the same  memoir M. Esquirol computed that in the north of
Europe the proportion of male to female lunatics is greater than as
above stated: he says that it is as three to two.  In this are included
the results obtained from reports of lunatic asylums in various parts
of  Germany, in Denmark, Norway, and Russia.   Subsequently to
the publication of this report by  M. Esquirol, Dr. Max. Jacobi has
given us extensive  information  on  the  state of lunatic  asylums in
the Prussian  provinces  on the Rhine.  In the different establish-
ments of that country the total number of male lunatics  in the year
1824 was 1180, and that of females 835.  The result nearly coin-
cides with that deduced by M. Esquirol from other documents for
the general proportion of Germany.
   In a later memoir which appeared in 1830, M. Esquirol has given
some new results from the statistical reports on lunatics  in Norway,
published by Dr. Hoist.   He  reduces  the  proportion  of  male to
female lunatics in that country to an excess  of one-sixth instead of
one-third part.
   In the United States of America it  appears  from  information
given by Dr. Rush, by Portman of Massachusetts, and  a report of
the asylum in Connecticut printed in 1827, that the number of in-
sane men is greater than that of female lunatics.   Later researches
have rendered  this observation more precise.  In the states of New
York, Pennsylvania, and  Connecticut  the  proportion  of  males to
females is very nearly as  two to one.
   On summing  up the results of  his  inquiries,  M. Esquirol  has
 shown that in a sum total of  76,526 lunatics, confined, though  not
 all at the same period, in asylums  or hospitals in various parts of
 the civilized world, there were  37,825  males and 38,701 females.
 Thus the proportion of males  to that of females is, a fraction being
 neglected, 37 to  38.  This difference is so much the less consider-
 able, as in the general population the number of males somewhat
 exceeds that of  females.  Yet, small as it  is, it is sufficient, as M.
 Esquirol observes, to refute the assertion of Coelius Aurelianus, who
 supposed that women are less subject to insanity than men.

                          ARTICLE III.

                              Age.
   Idiotism and imbecility are observed in  childhood, but insanity,
 properly so termed, is rare before the age of puberty.   Cases, how-
 ever, have  sometimes occurred which have exemplified almost 
AGE.
127
every form  of insanity at an earlier period, and almost as soon as
the mental faculties  begin to display themselves.  One case of
madness was observed by Dr. Joseph Frank in St. Luke's Hospital,
when he visited that asylum in 1802, occurring in a child two years
of age.  Dr. Haslam  has recorded  three  instances of insanity in
children.   In one of these the disease  appeared after small-pox,
attended  by  convulsions and delirium.   In  the two other cases in-
sanity was combined with more or less of imbecility: in one of them
there was inaptitude to mental application, combined with symptoms
of moral insanity, a perversion of natural feelings, and an ungovern-
able disposition to give way to violent passion.   In  a preceding
section of this  work  I have  inserted the  history of a strongly
marked  case  of moral  insanity occurring  in  a child.  Another
example, in which the symptoms were of a  different kind, but still
falling strictly within the definition  of moral insanity, was reported
in the Annales d'Hygiene et de Medecine  Legale for 1832.   On
this case M. Fodere has made some  observations in his late work on
the varieties  of madness.*
   M.  Esquirol has described two cases of mania commencing at the
eighth and  ninth years, one occasioned by fright during the siege of
Paris, the other following an attack  of fever: he has likewise men-
tioned an instance of melancholia  combined with marasmus  in  a
child eleven years old, who had a remarkably large head, and for
his age great application to learning.
   After the age of fifteen mental derangement  is no longer a  rare
 phenomenon, but it assumes, generally speaking, various aspects at
 different ages of life.   Soon  after  puberty, while in females the
 constitution is making efforts to establish the catamenia, or in young
 persons  who grow  rapidly, symptoms  of mania or melancholia
 occasionally appear.   In the three or four years which succeed this
 period, hysteria in females, and  the excitement occasioned by th«
 sexual passion in  males, or the vices  which  are often consequent,
 give rise to the same  diseases in more numerous examples.t  " In
 the vigour of youth," says M. Esquirol, " mania breaks out  with
 all its varieties of excitement ; melancholia is more frequently the
 lot of the middle period of life, and dementia chiefly threatens
 advanced age.  In youth," he continues,  " derangement of the mind
 has a more acute  and violent course, and  more often  terminates by
 a remarkable crisis ; in middle age it is  a more chronical disorder,
 is more often complicated with diseases of the abdominal viscera,
 and is resolved by hemorrhages from  the  hemorrhoidal veins or by
 diarrhoeas ; at a later period it is combined with paralytic affections
 or with  apoplexy, and recovery  is less to be expected.  Yet  these
 remarks are  liable to exceptions.   Dementia sometimes occurs  to
 young persons.   We have," says M. Esquirol,  " in the Salpetriere

   * Traite Medico-Legale sur les differentes especes de Folie, par M. Fodere.
 Strasburj, 1832.                           _
   f Esquirol sur la Folie.  Jacobi's Sammlungen, i. 2J-1. 
128
PREDISPOSING CAUSES.
two women, one eighty and  the other eighty-one years old, who
were  attacked  with  raving  madness,  and who recovered."  He
mentions another maniac who had been under his care at the age of
seventy-eight, but adds, that " these  individuals still possessed the
vigour of constitution which is generally peculiar to a much earlier
period of life."
  The years of life in which insanity is most frequent are, accord-
ing to the calculation of M.  Georget, those between thirty  and
forty  ; next to these are the  years  between twenty and thirty;
thirdly, come  those between forty and sixty.   M.  Esquirol adds
that the proportional  number of females attacked before their twen-
tieth and after their fiftieth year is greater than that of men, whence
he concludes that females are  more  in danger of insanity at the
early  and late periods, and men in the intermediate years of life.
The susceptibility of madness takes place rather more early  in the
female than in the male sex, and in persons belonging to the opulent
than in those of the laborious classes  of society.
  According to a calculation given by M. Georget, the admissions
of lunatics into different hospitals  in England and France took place
in the following ages:—

    From 10 to 20 years of  age........356
       „  20  to 30    „     „     ........1106
       „  30 to 40    „     „     ........1416
       „  40 to 50    „     „     ........861
       „  50 to 60    „     „     ........461
       „  60 to 70    „     „     ........174
       „  70 and upwards..........35
                                                      4409

  This table affords sufficient evidence to establish the fact that the
frequency of insanity as occurring at the different periods of life, or
the proportional number of individuals attacked by  mental disease
at the several ages, is just what  MM. Esquirol  and Georget have
stated.  But though this is true absolutely and without reference to
the proportional numbers of individuals existing in society who have
respectively attained  the several ages or periods of  life, it is by no
means apparent that the same  relative frequency holds  when these
proportions are taken into the account.   For example, 174 individ-
uals becoming insane between sixty and seventy   is, absolutely, a
smaller number than 1416  who  are  seized with insanity  between
thirty and  forty years of age, but we have  no evidence  that the
former is a smaller number in  proportion to the numbers of persons
existing between sixty and seventy,  than the latter is to the number
of individuals existing between  thirty and forty.
  M. Esquirol is well aware that this relative computation puts the
matter in a different point of view, and  he has expressed to me  his
conviction  that when due  attention  is  given to it,  the result wil 1 
TEMPERAMENT.
129
indicate  a proportionally increased frequency of  mental  disease
with the advancement of age, or, in other  words, that the longer
men live after attaining maturity, the more obnoxious they contin-
ually become to the causes which give rise to derangement or lesions
of the understanding.   He  has given  a brief survey  of the  data
from which this result is deduced, in an excellent memoir on the
Statistics of Insanity, published in the " Annates d' Hygiene et de
Medecine Legale  for  1830."   The general  conclusion is, that the
predisposition to  mental  derangement increases  with advancing
age, though in an irregular scale.   The increased  number of insane
persons compared with the population of that age is very striking
between fifty and fifty-five years.   From seventy to seventy-five
and from seventy-five to eighty it becomes  enormous, owing to the
frequency of senile dementia.

                         ARTICLE  IV.

Of temperament: peculiarities of complexion and of form which
  are supposed to denote predisposition to insanity in general,
  or to particular forms of the disease.
  No observation relating to madness  is more common than the
connection of particular complexions  with its different varieties.
Persons of the melancholic temperament, or those who have certain
external peculiarities which  are well known as characteristic of the
constitution of body so termed, are certainly more often  affected
with melancholy madness than others, and  they are more prone to
this than to other forms of insanity.  Individuals of the sanguine
temperament are more frequently raving under accessions of violent
mania.  It has been observed by M. Esquirol, that when persons of
the lymphatic or phlegmatic temperament, or those who have a pale
exanguious constitution, fall into mania or monomania, their disor-
der is more liable than that which occurs in other constitutions to
pass into dementia or  incoherence.  An apoplectic form,  a  thick
head and short neck, mark a predisposition to dementia.  Imbecile
persons and idiots are  not remarkably of one temperament  more
than of others.
  According to M.  Esquirol, insanity has a somewhat different
course, as occurring in  persons of different temperaments.  Persons
of choleric temperament,  or those  who  have black hair and  eyes,
with warm vigorous  constitution, become  violently maniacal, but
have a shorter  and more acute distemper, and  more frequently
terminating in marked crisis than others : the sanguineo-phlegmatic,
or persons of fair, pale complexion, with flaxen  hair, fall more readily
into a chronic disease: the dark-haired are gloomy monomaniacs  :
red-haired  lunatics are disposed  to anger  and violence ; they are
treacherous and dangerous.*
  A table, indicating the varieties of temperament or of complexion

        * Diet, des Sc. Med.  Jacobi's  Sammlungen, b. i. p. 298.
                              12* 
130
PREDISPOSING CAUSES.
which displayed themselves in the lunatic hospital of the Salpetriere,
proves that the numbers of individuals of each complexion in that
establishment were nearly in the proportion of their respective num-
bers in the population of Paris.  It hence results that no particular
temperament indicates  a  greater tendency to madness than others,
if we speak of that disease generally and including under the term
all its varieties.   The numbers are as follows :—
  " Hair chesnut brown in one hundred and eighteen cases ; blond
in thirty-nine ;  grey or white  in thirty-six ;  black in thirty-one ;
yellow or red in two.  Eyes of  a chesnut or brown hue  in one
hundred and two ; blue or light in ninety-eight ; black in seven-
teen."
  The varieties of temperament and the peculiarities of organization
belonging to individuals are so related to predisposition to mental
disease, that I cannot omit the consideration of these  subjects  ; and
it is impossible  to  enter  upon the inquiries which  are connected
with  them,  without interrupting by a long  digression a series of
facts of which I am anxious to give a brief and distinct statement.
I shall, therefore, refer to a supplementary note some further re-
marks on peculiarities of structure and constitution as connected with
insanity.

                          ARTICLE  V.

  Previous attacks of insanity and other diseases of the brain.
  Among the most powerful of the influences which tend  to aug-
ment the susceptibility of mental disease in persons  naturally pre-
disposed to it, we must reckon previous attacks of insanity and the
previous existence of some other disorders affecting the brain, which
though  totally unlike their madness in their phenomena, are shown
by experience to be its frequent harbingers and antecedents.
   There have been instances in which individuals have  sustained
repeated attacks of insanity during a  certain  period  of their  lives,
and have seemed afterwards to have lost all predisposition to the
disease.  They  have recovered their entire  sanity  and vigour of
mind, without any relic or trace whatever of  the calamity through
which they have passed.   The late admirable and truly excellent
Robert  Hall was a remarkable instance of this kind.   Other  morbid
predispositions are sometimes  of temporary  duration.   Some per-
sons, for example, and even whole families, have a predisposition to
phthisis or other constitutional disorders at  a particular period of
life ; and it has  been noted, in the latter instance, by relatives or
medical attendants, that if the particular period has passed for some
years, the threatening malady ceases to give cause of apprehension,
and the susceptibility of a disorder which has long  been dreaded
and with great difficulty warded off, entirely disappears for the re-
mainder of life.
   But there are likewise numerous instances in which an attack of
madness leaves the individual  affected  more  prone to the disorder 
EDUCATION.
131
      than he originally appeared to be.   His recovery is  partial :  he is
      more susceptible of impressions, more irritable, irascible, excitable
      than he previously was.   This susceptibility augments with every
      renewed attack, and at length the individual  has but short and im-
      perfect intervals of comparative health and tranquillity.
        Insanity is often consequent on, and intimately  connected with
      various diseases of the brain.   Maniacal symptoms sometimes dis-
      play themselves in persons recovering partially from  severe paraly-
      sis  in  the  form of hemiplegia, or after fits of apoplexy.   These
      instances are quite distinct from  the combination of madness  or
      dementia with general paralysis, of which an account has been given
      in the preceding chapter.   In the cases now adverted to, the injury
      which  the brain has  sustained from  the hemiplegic or apoplectic
      attack must be considered as laying the foundation of insanity.  Epi-
      lepsy still more frequently gives rise  to a  similar  affection.   I  am
      not at present alluding to the decay of intellect or the modification
      of dementia which ensues on long-continued or severe epilepsy.  It
      occasionally happens that the paroxysms of this disease appear to
      usher in at every return an attack of violent mania, which generally
      continues for a few  days and  then  subsides.  In other instances
      signs of mental derangement become permanent,  and  either take
      place of the original affection and supersede it, or continue  to  be
      complicated with it.
         It has often been observed, and the remark might be supported
      by many facts, that the form  of insanity to  which epileptics  are
      subject is of the  most dangerous  and violent description.  Indivi-
      duals labouring under it are sullen and irascible, and commit occa-
      sionally atrocious acts.  Moral insanity with a propensity  to homicide
      has often been  observed to take  its rise under such  circumstances.
r      In other cases the moral derangement induced by epilepsy has been
      violent satyriasis, or these morbid dispositions have been combined
      in the  same individual.  There are instances  of epileptic insanity,
      however, in which fits of boisterous mania, resembling attacks of
      drunkenness, have been the only symptoms of derangement.

                                ARTICLE VI.

                               Of Education.
         The  influence  of  erroneous education in  increasing the suscepti-
      bility of mental derangement must be reckoned among predisposing
      causes, though  of a different class from the  circumstances already
      enumerated.
         There are two different points of view under which the injurious
      effects of wrong education may  be  considered.  By too great  indul-
      gence and a want of moral discipline, the passions acquire greater
      power, and a character is formed subject to caprice and to violent
      emotions : a predisposition to insanity is thus laid in the temper and
      moral  affections of the individual.   The exciting causes of madness
      have greater influence on persons of such habits than on those  whose 
132
MORAL AND PHYSICAL
feelings are regulated.  An overstrained and premature exercise of
the intellectual powers is likewise a fault of education which predis-
poses to  insanity, as  it does  also to other diseases of the brain.
These are two considerations which are of  the greatest importance
with respect to the welfare of families to  which an hereditary con-
stitution may belong, rendering them  more liable  than others  to
cerebral diseases.   They are distinct in themselves, and each might
furnish a theme for an extensive treatise,  most valuable in a practi-
tical point of view.  Under the first head it would be necessary to
consider the efficacy of those plans of education of which  the pro-
fessed object is to form a character remarkable for sedateness, for the
strict discipline of the  feelings, and, as far as this is attainable, for
the abolition of strong passions and emotions.  Such, undoubtedly,
would be the kind of moral education  best adapted for those who
are constitutionally liable to insanity.   The second remark, on the
regulation of mental exercise in young persons whose nervous sys-
tems  are feebly constituted, has a more extensive bearing than on
the subject of insanity.   It brings forward a suggestion which is of
very  general interest in these times,  in which mental  exertion  is
stimulated to the utmost; and too  great sacrifices are often made to
the cultivation of intellect, or even to the mere acquisition of know-
ledge, while the education of the moral  affections  is considered as  a
matter of secondary importance.


Section III.—Of the Productive  Causes  of Insanity: Moral
                     and Physical Causes.

  I now proceed to consider the productive causes of insanity, or the
conditions in which individuals predisposed or originally susceptible
are found to promote the development of mental disease.  Moral
causes of insanity, as it is well understood, are all  the circumstances
which exert an influence immediately on the mind or they are states
of the mind itself giving rise to disorder in the exercise of its faculties.
Physical causes are those agents which affect the body, and exert their
influence on  the mind through the medium of organic structure.
  Modern  writers on insanity are by no  means unanimous in  the
opinions they have formed, as to the comparative  influence of moral
and  physical causes  in  the production  of  mental  derangement.
Some  have ascribed  the greatest  importance to  the first  class of
agents, and others to the latter.  It must be observed  that those who
maintain the greater power of physical causes appear to have inclu-
ded among them many very important circumstances which  are
rather to be considered as influences predisposing to  insanity, or as
constituting a kind  of preliminary condition, without the actual
presence of which neither physical nor moral agents will  produce
their effect.   Congenital predsposition  must exist as the  ground-
work in all instances: this is reckoned a physical  cause,  and such  it
is in one sense, but for obvious reasons it is not to be taken in the 
CAUSES OF INSANITY.
133
amount in the comparative estimate to which  I  am now about to
advert.   If this article is abstracted from the  comparison, a more
decided preponderance will appear on the side of moral causes as
the principal agents concerned in the development of mental disor-
ders.
   Several authors of various countries, who  have differed widely
among themselves in other respects as to the nature of insanity, have
been of one sentiment in ascribing great  importance in this respect
to moral causes.  Professor Heinroth, who is among this  number,
has maintained his opinion, as usual, in a speculative and theoretical
manner: others, as M.  Guislain and Georget, have deduced a similar
conclusion from facts.  A great part of the evidence on this question
has been furnished by MM. Pinel and Esquirol, who incline, on the
whole, to  this view of the subject.
   Some have argued in favour  of this opinion  from general consi-
derations connected with the history of insanity, its alleged increase
with the advancement  of civil society.   Among nations existing in
a  savage  state,  in which  the  human mind is uncultivated and its
higher faculties remain undeveloped, it appears that mental diseases
are comparatively rare phenomena.  Travellers  among barbarous
nations, and  naturalists and physicians who have  resided among
them and have described their physical characters  and diseases, have
generally reported madness to be unknown among such  tribes of
men.  It  comes forward  with  the dawning of civilization, and per-
haps keeps pace, though  its increase is  modified  by other circum-
stances, ,with the advancement of mental culture.   The  proofs of
this general  observation can  only  be  collected from a survey of
facts which  refer to the frequency of mental  derangement in diffe-
rent places and times.  Such a survey  belongs to the statistical
history of insanity, a  subject to which  I must devote a separate
consideration in a later  part  of this work ;  and  I  must refer  my
readers to the facts which I shall there accumulate.   For the present
I have only anticipated the inference.
   From the rare  occurrence  of insanity in  rude nations, and its
comparative  frequency in  those  which are  civilized, it has been
argued  that the most  influential  causes of the disease are circum-
stances connected with the improved state of human society.   The
restraints  imposed by  social order, the diversity of interests which
are excited in  civilized communities, the mixed and  diversified
feelings which are called forth by a variety of sometimes arduous
pursuits,  long-continued griefs and anxieties, disappointment of
hopes  long  cherished,, causes  which act  powerfully on the  moral
affections  rather than on  the animal passions, particularly great and
long-continued exertion of the intellectual powers;—these are some of
the most obvious traits which distinguish human life in the civilized
state  from the manner of existence peculiar to savage men.   It is
among these circumstances, as some celebrated writers have thought,
that we are to look for the causes which are most influential in the
development of mental diseases. 
134
MORAL AND PHYSICAL
  These considerations are entitled to some  regard.  We cannot
deny or easily call in question the facts on which they are founded ;
yet the  general assertion  that insanity belongs  exclusively to  the
civilized condition of our species goes beyond  all probable expecta-
tion, and might be disputed on theoretical grounds, if we were at
liberty to proceed upon such a foundation.   In a barbarous state of
society the passions are under no restraint; the emotions  are  im-
petuous ; hatred and malignity are in perpetual exercise ; the fierce
and sensual desires which are common to mankind and the inferior
tribes are indulged without limit.   Nor are the intellectual faculties
without their exercise  in  carrying  on the stratagems of barbarous
warfare. We should conjecture that such a state of society in which
the passions are in perpetual and violent  agitation would produce
not unfrequently the moral causes of madness. The fact, however,
appears to be otherwise.
  I am  not without a suspicion that there is something in the state
of civilization which tends to promote the existence  of that con-
genital state of bodily structure on which predisposition to mental
diseases depends.  This, however, is a subject on which I cannot
enter further at present.   I must now advert to the more strict re-
sults of observation.
  Experience itself has led many to the conclusion that moral causes
are mainly influential in the development of diseases of the mind.
No writer  has maintained this opinion to a greater extent than M.
Georget.  " The observations," says M. Georget, " which I have
had in my power to make, the more numerous ones  which I have
compared in authors, have convinced me, that, among one hundred
lunatics, ninety-five at least have  become such  from the influence
of affections and of moral commotions : it is an observation become
almost proverbial in the hospital—the Salpetriere,—' qu'on perd la
tete par les revolutions d'esprit.'   The first question that M. Pinel
puts to a new patient who still preserves some remains  of intelli-
gence, is, Have you undergone any vexation  or disappointment ?
Seldom is the reply in the  negative.   It  is," continues the same
writer, "in the age in which the mind is most  susceptible of strong
feelings, in which the passions are excited by the  strongest interests,
that madness is principally displayed.  Children, calm  and  without
anxiety, incapable  of long and  extensive combinations of thought,
not yet  initiated into  the troubles of life, and old men,  whom  the
now vanishing illusions of their preceding age, and their  increasing
physical and moral weakness render indifferent as to events, are  but
rarely affected.  The same remark applies to persons who in their
constitution approach to the character of children or  of old  men."*
M. Georget evidently supposed persons far advanced in  life to be
less subject to mental derangement than they are, according to  the
later researches of M. Esquirol.   The derangement, however, so
frequent in old age is senile  dementia and  not  insanity in the or-
* De la Folie, par M. Georget, &c. Paris, 1820. 
CAUSES OF  INSANITY.
135
dinary forms, and to these the present question and the remarks of
M. Georget chiefly refer.
   In a computation made by M. Pinel from the observations of five
years,  cases  of insanity produced by moral  causes were, to those
occasioned by physical causes, in  the  proportion  of 464 to 219.
The following are the particular numbers from which this result is
deduced.


   Cases of mania ....$??! ^^ ?°m T1*.1 CfUS6S'
                     (165 arising from physical causes.
   Casesof melancholia $14* ar.is.inS [™m m°ra! causes'
                     i  46 arising from physical causes.
   Cases of suicide . . J  3* ar!s!n§ !!rom m°ral causes'
                     £   8 arising from physical causes.

   Cases of dementia.. J  *f ar!s!nS Jrom m°ral cauS6S'
                     I  31 arising from physical causes.
   n     c •,. ,.      C  26 arising from moral causes.
   Casesof idiotism. .^„,   • •  °r      i_  •   i       *
                     I  31 arising from physical causes.

   M. Esquirol's  tables are more instructive as to the particular
causes of  insanity and their respective influence.  According to va-
rious calculations deduced  by this writer, it  appears that  moral
causes are on the whole  far more numerous and  influential than
physical ones in inducing insanity.   This is especially observed with
relation to the higher classes of society, physical causes having pro-
portionally a greater influence on the lower orders.   It appears also
that females are  subjected to  the  operation  of physical causes in
many respects more than males.  In a memoir presented by M. Es-
quirol to  the Society of Medicine in  1818, it  was concluded  that
cases of madness occasioned by moral  causes are, to  those  arising
from physical causes, in the proportion of 4 to 1.
   The following tables, by the same writer, include cases belonging
indiscriminately  to the different forms  of insanity, and display the
particular nature of the causes which are most powerful, as well as
their comparative influence.  The tables exhibit cases of females
belonging to the lower  classes in which  the influence of physical
causes in the production of insanity is the greatest ;  they likewise
exhibit corresponding aggregates from a higher grade of society.
  * Journal de Physique; mois de Septembre, 1808.  Guislain de 1'Alienation,
torn. i. p. 149. 
136    ^            MORAL AND PHYSICAL
Table of cases produced by moral causes.1
In the Salpetriere
 during the years
 1811 and 1812.
In M. Esquirol's
private establish-
    ment.
Domestic grief.............    105
Disappointment in love........     46
Political events.............     14
Fanaticism................      8
Fright...................     38
Jealousy.................     18
Anger...................     16
Poverty, reverses of fortune.....     77
Offended self-love...........      1
Disappointed ambition........     —
Excess in study............     —
Misanthropy..............     —
Reverses
31
25
31
 1
 8
14

14
16
12
13
 2
Sum .
323
Sum . .  167
                   Table  of physical causes.

                              In the Salpetriere.

Hereditary predisposition!.....    105   ...
In M. Esquirol's
private establish-
     ment.
Convulsions suffered by the mo-1
  ther during pregnancy  .... 5
Epilepsy................
Irregularities in menstruation . . .
Consequence of parturition  . . . .
Critical period............
Advanced age .............
Coup de soleil.............
Blows or falls on the head.....
Fever ..................
Syphilis ................
Mercury................
Intestinal worms...........
Apoplexy...............
  11

  11
  55
  52
  27
  60
  12
  14
  13
  8
  14
  24
 60

361
150
  2
 19
 21
 11
  4
  4
  4
 12
  1
 13
  4
 16

120
  * Art. Folie, Diet, des Sc. Med.  Jacobi's Sammlungen, band i. p. 309.
  f This article is separated, and does not in propriety belong to the table of phy-
sical causes. 
CAUSES OF INSANITY;                  137
The causes of mania, separately considered, are given as fdllows:'
1.  Moral causes.
In the Salpetriere.
Domestic griefs......    62
Reverses of fortune  ...      6
Poverty (misere)  ....    19
Disappointment in love .    58
Jealousy..........     4
Injured self-love  .....     1
Fright ...........    36
Anger............     2
Excess in study  .....     0

                         183
In M. Esquirol's Establishment.
                  Females.
Males.
   9
  13
   0
   4
   1
  15
   1
   1
  10

  56
20
 6
 0
 4
 8
 7
 6
 1
 0

62
2. Physical causes.
Hereditary predisposition .   88
Masturbation.........    8
Menstruation.........   27
Consequencesofparturition   38
Critical period........   12
Abuse of wine........   14
Coup de soliel........   2
Exposure to fire  ......   12
Falls or blows........   8
Mercury  ...........   2
Suppression of scabies ...   3
Suppression of tinea capitis   2
Ulcer healed........    1
Fever  .............   3
Apoplexy...........   0
132
38
 6
 0
 0
 0
 0
 3
 2
 1
 2
 1
 2
 0
 4
 1

26
37
 2
11
19
 8
 0
 0
 0
 2
 1
 0
 6
 0
 1
 1

51
  The causes of  melancholia, meaning monomania with melancholy
dejection, are thus stated  by the same writer :—t
       Moral causes.
Domestic cares......   60
Reverses, misery.....   48
Disappointed love  ....   42
     Physical causes.
Suppressed catamenia .  .  26
Critical age.........  50
Puerperal state.......  35
  * Art. Manie, Diet, des Sc. Med. Tobsucht, p. 372, in Jacobi's Sammlungen.
Guislan, Alienation, i. p. 151.
  f Art. Melancholie, Diet, des Sc. Med. Jacobi's Sammlungen, i. 418.
    May, 1837.                13 
138
MORAL AND PHYSICAL
Jealousy...........   8
Frights  ...........  19
Injured self-love......  12
Anger............  18

                        219
Falls on the head.....   10
Masturbation........   6
Dissipation.........   30
Abuse of wine.......   19

                         165
  Hereditary predisposition is marked 110.
  M. Guislain has cited, from Nasse's " Zeitschrift fur psychfschen
aertze," a statement drawn up by Hayner from the  Lunatic Institu-
tion at Waldheim, of which the result differs considerably from that
of the French hospitals ; the report is, however, drawn  up in so
different a manner that it is scarcely possible to make a satisfactory
comparison.   It is as follows :—
       Moral causes.
Immorality......
Violent illusions .  . .
Obstinate passions .
25
10
18

53
     Physical causes.
Hereditary predisposition  23
Malconformation......  54
Mechanical injury  ....   9
Previous disease  .....  41
Metastases.........  12

                        139
  We have, from M. Esquirol, a later statement of the cases in the
Maison Royale de Charenton, which  is appropriated to persons of a
higher rank in society  than those who are remitted  to  the other
hospitals  near  Paris.  The  following table  contains  the  results of
three years' observation.*

                          Physical causes.

           Hereditary predisposition.........  93 cases.
           Mat-turbation................  23
           Libertinism  ................  24
           Use of mercury   ..............  16
           Abuse of wine...............  64
           Insolation.................   7
           Effect of carbonic acid gas.........   2
           Suppressions  of habitual evacuations   ...  13
           Consequence  of parturition   ........  10
           Blows on the head.............   4

                                          Total .  . 256
* Annales d'Hygiene Publ. et de Medicine Legale.  Avril, 182 
CAUSES OF INSANITY.                  139
                Moral causes.
Domestic griefs   ..............   89
Excessive study and watching.......    8
Reverses of fortune............   20
Passion for gaming............    2
Jealousy..................   13
Disappointments in love..........   21
Injured self-love..............    6
Fright...................    7
" Devotion exaltee"............   18
Excess of joy...............    1
Reading romances.............    8
Total  . . 192
  M. Esquirol  observes  that it  is from a variety of circumstances
very difficult to obtain adequate  information as  to the previous con-
dition of persons who are brought for treatment  to Charenton, and
that there  is strong reason for  believing that some of the causes
marked down have been  productive  of  madness in  mueh more
numerous instances than as displayed by the tables.  He has found
proof that hereditary  predisposition  has  existed  much  more  fre-
quently than the accounts received indicate.  He says that immoral
habits and the use of mercury, of which the injurious results can be
recorded only in a  comparatively small number  of cases, are yet
very  frequently productive of that deplorable species of paralysis
which becomes complicated with dementia and monomania.   Excess
in the use of intoxicating fluids, which gives rise exclusively to
delirium tremens, is also a frequent cause of mental derangement.
Love, jealousy, excessive devotion, are principally causes of madness
in females.   In treating of the causes of insapity in general, we have
only  to  estimate the different  effects resulting  from  the circum-
stances of age, sex, education, and fortune, in order to ascertain the
principal diversities  which are  to be  found  in the appearance and
development of the disease in various departments of society.
   I shall  now offer some further remarks on the effects produced
by the most important of the agents above enumerated.
          Section IV.—Of particular moral Causes.

                           ARTICLE 1.
                       Care and anxiety.
  Care and anxiety, distress, grief, and mental  disturbances, are by
far the most productive causes of insanity.  A sufficient proof of this
remark may be found at once by inspecting the preceding tables
drawn up  by  M. Esquirol.   In the first table, domestic griefs,
poverty, and  reverses of fortune, taken together, comprise consi- 
140
CAUSES OF INSANITY.
 derably more than one-half of the whole number of cases attributed
 to the influence of moral causes.
   These causes are at all times influential in civilized countries, and
 hence one principal  reason why insanity prevails in proportion to
 the  cultivation of society.   Poverty and  reverses of fortune are
 sustained in very different degrees in different places and  times;
 and this accounts for the fact  that insanity appears under particular
 circumstances to be more frequent than under others.
   Anxiety  and agitation of mind caused by political events, have
 occasionally produced a very  decided effect on  the numbers  of per-
 sons becoming deranged.   M. Esquirol declares that the  law of
 conscription increased the number of lunatics  in France, and that at
 every period of this  levy many individuals were received into the
 hospitals who had become insane through the excitement and anxiety
 occasioned  by it; they were  partly from the number of those on
 whom  the  lot  fell, and  partly  from their friends and relatives.
 "The influence of our political misfortunes has been so great," says
 the  same writer, "that I could illustrate the history of our revolution
 from the taking of the Bastille to the last appearance of Bonaparte,
 by describing in a series the cases of lunatics, whose mental derange-
 ment was  in connexion  with  the succession of events."   Political
 disturbances, like the mental impressions which give  rise to insanity,
 are among the exciting causes. They set the predisposing influences
 in operation, and  bring out some particular character of madness ;
 but  this impress, even if general, is still  only temporary.  At the
 destruction of the old monarchy many persons became mad through
 fright and  the  loss of their property.  " When the Pope came to
 France, religious maniacs were very numerous.  When Bonaparte
 made kings,  there were many kings and queens in  the madhouses.
 At the  time of the invasion of  France by foreign  troops, terror threw
 many into derangement.   The Germans  had  experienced the same
 effects at the era of our irruptions into their country."
   Under the same head must be  considered the influence  which
 different professions  or occupations exercise  in the production of
 mental  derangement.  M. Fodere, in his Treatise on  Insanity, has
 entered into  this inquiry : he  has endeavoured to estimate the moral
 and  physical influence of different habits and modes of employment.
 He concludes that the classes  of society which  furnish  the greatest
 number of inmates to the lunatic asylums  in France are those of
 traders, merchants, and military men,

                          ARTICLE n.

                     Passions and emotions.

   Next to the examples of insanity produced by care and anxiety,
 the  greatest  number  of cases  in  the preceding tables,  and  in  the
 evidence afforded by general observation, are those arising from the
influence of  strong passions and emotions.    The former class of
influences produce their effect  by slow and constant operation ; the 
PASSIONS AND EMOTIONS.                141
latter, sometimes at least,  by a sudden  action,  so  vehement  as  to
disturb those functions of the brain and  nervous system which are
subservient to  the exercise of the mental faculties, and give rise  to
manifest derangement.  The emotions of terror and of violent anger
are the most powerful and sudden to  which the  mental  constitution
of man is subject, and by them the nervous system is most severely
agitate I : this is apparent from other  effects which sometimes ensue
from the suddeti efficacy of these emotions, and  which take the
place of  mental derangement in persons who are not predisposed by
nature to the  latter disease ; such  are fits of convulsion, tremors,
palpitations, and syncope.  In M. Esquirol's table there are thirty-
eight cases of madness produced by fright; thirty-six of them  were
instances of  mania  or raving madness.   There are sixteen  cases
produced  by anger  or rage.   Mania is the form of insanity which
generally results from the operation of the causes above mentioned.
There are, however, instances in which dementia has displayed  itself
at once from the same  causes, in  an  advanced  degree.  Some in-
stances of this description are mentioned by Pinel.*
  The passion which nature has appointed for  the continuation  of
our race, and of which  the influence and effects, though universal,
are so greatly  modified and varied by education and external cir-
cumstances, gives rise to  numerous forms and  varieties of mental
derangement.   One of the most palpable facts connected  with this
subject is displayed  by comparing the numbers of married  and
unmarried persons in  great public hospitals.
  In  a  report  on the  numbers and  condition  of  lunatics  in the
different hospitals devoted to  their cure near Paris,  from the begin-
ning of 1801 to 1822, which Was presented to the general council  of
civil hospitals near Paris, by M. Desportes, it appeared that married
and  unmarried persons were victims of insanity in  the  following
proportions :—t
Total number of male  lunatics, imbeciles, and epileptics  in
  Bicetre, Jan. 1, 1822.............764
Total number of females in the Salpetriere at the same date .   1726
  They are distributed as follows :—

                                              Females. Males.
     Unmarried...........980   492
    Married............397   201
    Widowers and  widows.......    2S1     59
    Divorced............      5     3
    Not noted...........    53     9
Total  .   .   .   1726   764
  * Traite Philosophico-Medicale de la Folie, par M. Pinel.
  f Rapport fait au Consul General des Hospices- Civils de Paris sur le service
des alienes, &c  Paris, 1823.
                              13* 
142
CAUSES OF INSANITY.
  In Germany the  proportion of unmarried  to married  persons is
much greater, as may be judged  from the following enumeration,
which  I take  from  Dr. Jacobi's Statistik.   The total numbers of
1180 male lunatics and 835 females are thus distributed :—
                                              Females.  Males.
    Unmarried..........  .    599   974
    Married  ............156   176
    Widowed...........     80    30
  The disproportion which here displays itself is a very striking and
remarkable  circumstance, and  if  a  similar  result  were  generally
obtained, this would constitute a most leading feature in the history
of mental derangement, and  one which has not yet been adverted to
in its due importance.  The reports of most hospitals are not kept
with sufficient accuracy to authorise a determination whether this is
the fact or not, but it should become a matter  of careful inquiry.
  As it appears probable that celibacy tends to augment the num-
bers of lunatics, an  inquiry  will  obviously  be  suggested in what
manner this result  ensues.   Is  it  through the restraints which the
condition of  celibacy  imposes,  or   through the vices  to  which
unmarried  persons  are  more frequently  abandoned ?  M. Esquirol
is of opinion, that where one case of insanity  arises from the former
cause, a hundred result from the latter.
  We must take  into  our calculation that married persons lead in
general more regular lives, in all respects, than the unmarried ; that
they are for  the most  part more fixed in  their pursuits, and their
condition as to maintenance and employment; and  that they are in
a less degree subjected to causes which agitate the mind and  excite
strong emotions.    These remarks, however, apply principally to
men, and the  difference observed  in  respect to numbers is  almost
equally great among females.
  After making allowance for all deductions, it still  appears  proba-
ble  that the condition of married  persons is, cseteris paribus, much
le^s favourable to the excitement of madness than that of celibacy.

                         ARTICLE  III.

Apprehensions relating to a future state.—Of insanity connected
                   with religious impressions.

  There is  no subject  connected  with the history of insanity  on
which  more crude and  ignorant  notions are expressed than on what
is often termed religious madness.
  It cannot be doubted that in  persons predisposed  to insanity  by
natural, constitution, education, and  other circumstances  anxieties
connected with a future state of existence have  been the exciting
causes  of mental derangement.  This, indeed, would seem, a priori
more  likely than that  care respecting success in business, and  ij
matters of comparatively trifling moment, should produce  the same
yesult,   We should be inclined to suppose that  the former  caUse 
RELIGIOUS APPREHENSIONS.               143
would have the greatest influence, inasmuch  as the interests  con-
cerning which fears and hopes are raised are in  the one case incom-
parably more important  than  in the  other, were  it  not  for the
observation daily repeated by moralists and divines, that men are far
more concerned about the most trifling affairs of the present life than
about the most momentous which regard the unseen and unchangeable
state, and that this remark holds  good to a vast extent, even to the
exclusion of those who profess disbelief in a future existence.
   As a matter of fact, there is reason to believe that the number of
persons who become insane through  the influence of religious hopes
and fears, is much less  considerable than it  is  generally supposed to
be.  The circumstance that the mind of a lunatic is occupied  during
the period of his disease with ideas  and  feelings connected with an
invisible world, is no  proof  whatever that  the  derangement of his
understanding was  produced in  the first  instance  by  impressions
related  to the same subject.   To a mind already  prepared bjT  disease
to indulge fearful  thoughts  and gloomy forebodings, the unknown
future opens a wide  field which the imagination is  likely to select,
and  it  often dwells  upon the evils which it anticipates in  another
stage of existence, when the  original cause of  derangement has been
some misfortune of the present life, or perhaps some merely physical
influence.   It is the  opinion of a writer, whose judgment on subjects
of this nature deserves the highest regard, on account of the exten-
sive research and the deep reflection with which he has  investigated
the history of mental disorders, that instances of the last-mentioned
kind  are in fact incomparably more  numerous than  those in which
religious terrors have been the originating cause.*
   There is, however, no room for doubt that  distress occasioned by
such anxieties has really given rise to disorders of the mind.   Seve-
ral instances of this kind have, indeed, fallen within  my own sphere
of observation.  Some of these  have occurred among  persons who
had  frequented churches or chapels  where  the  ministers  were
remarkable for a severe, impassioned, and  almost imprecatory  style
of preaching, and for enforcing the terrors  rather than  setting  forth
the hopes and consolations which belong to the Christian religion.
Foreign writers have supposed this to be the practice of the  metho-
dists  in particular ;  and M.  Falret,  persuaded by the assertions of
Darwin  and Perfect,  mentions  the  prevalence of methodism in
England as a presumptive proof of  the frequency of suicide among
our countrymen.t   That none of the preachers of this sect have been
deserving of such a censure, I shall not venture to affirm;  but in the
present time at least, it cannot justly be  laid either  generally  or
exclusively  to their charge.   A vehement and impassioned mode of
preaching has often been the  practice in  other sects,  both  among
protestants and catholics, and in no  instance more remarkably than
among the itinerant missionaries of the latter church.:f

  * Dr.  Maximilian Jacobi's Sammlungen fur  die Heilkunde  des Gemuths-
kr-ankheiten. Th. i.
  f De PHypochondrie et du Suicide.   Par J. P. Falret, M.D., Paris, 1822.
  ^ " In the  kingdom of  Naples," says M» Berthollet, " a custom exists, of/ 
144
CAUSES OF INSANITY.
  Such accidental  excitements  are sometimes  the occasional  causes
of insanity, or rather they are the immediate antecedents of its actual
appearance or out-breaking ; but the conditions on which the exist-
ence  of this disease, under the modifications now described, seems
mainly to  depend are of more extensive influence.   It may be said
in one  sense that a preparation  is made  for this species of derange-
ment  in the  constitution  of the human  mind.   Hope and  fear,
anxiety respecting the future, are the principles in human nature by
which the care of self-preservation is insured.   In the lower orders
of the creation this object is attained by blind mechanical impulses
termed instincts, counterfeits of that care and  caution of  the  future
which  are peculiar to  man.   This  anticipation  of wants,  which
answers the end of foresight, varies in  its reach  according to the
necessities which are  to be provided for ; in most of the irrational
tribes it extends forward  only a few months, till the return of sea-
sons brings with it new resources for sustenance.*  The anticipations
of the human mind are alone bounded by no limit of time or  physical
circumstances ; the hopes and  fears of good and of evil  which are
allotted to humanity reach forward  into eternity.   Hence the inten-
sity which these anxieties are capable of acquiring  when the mind is
fully excited to entertain them,  and  to  yield itself to their influence.
  Various as are the anticipations, which human anxieties create or
embody in remote futurity, there is  one feature common to them all.
Their  prevailing  character  is  gloomy :  they  are  generally fore-
bodings of evils and calamities.  Horrible forms hang over  the path
which  the human imagination marks  out to  itself through the
unknown  regions of futurity.   Death  is the king of terrors, not by
the dread  of extinction,  but by  ushering us into an endless  world  of
anxieties.   It  has  often  been observed that  in all the mythological
fables of antiquity, the representations that prevailed respecting the
state of the dead were full of gloom ;  the abodes of the manes or of
souls were " loca  pallidula, frigida."  The explanation of  this fact

preaching in favour  of missions by a particular set of priests.   In order to
animate the faith of believers, they accompany their orations with particular acts,.
which are often of  such a nature  as  to  produce too powerful an effect on weak
minds.  They hold their hands over  flaming torches, and whip themselves with
scourges garnished with iron points.  Their sermons are prolonged till the close
of day, and  the feeble glare of a few flambeams heightens the effect of the scene."
" One of these sermons gave occasion to the case I am about to describe.  The
subject was hell.- to heighten the colouring of the frightful picture which the
preacher had traced, he took a skull in his hand, and having raised a question as
to the abode of the soul  to which it belonged, he exclaimed, invoking it, 'If
thou art in heaven, intercede for us;  if thou art in hell, utter curses.'   He then
cast it from him with violence." The lady, whose case is subsequently described
in M. Berthollet's  Memoir, was instantly affected by a morbid change in the
nervous system.
  Strong emotions excited by vehement preaching produce continually in females
and very sensitive persons fits of hysteria, and  in those who are predisposed to
mania there can be no doubt that similar causes give rise to attacks of madness.
  * See Dr. Hancock's excellent and truly philosophical work " On the Rela~
tions of Instinct to  the Higher Principles of Human Action." 
RELIGIOUS APPREHENSIONS.               145
 is, that such mythological fictions were the creations of fancy, but of
 the  fancy under a strong and  predominating influence of evil con-
 science.  A persuasion of moral demerit or a consciousness of guilt
 has  been deeply impressed upon  the minds of men in all  ages.
 With this  has been intimately connected the sentiment of responsi-
 bility,  the  conviction  of individuals that  they  were accountable
 beings, and that there were unseen powers whose cognizance nothing
 eludes, and from whose unerring justice even  death  can afford  no
 escape.  Here the imagination came  in to perform its part, and this
 it has done  with so much energy as to drive many individuals into
 insanity in  all ages of the world.
   The  preparatory circumstances and the foundation of this disease
 are not, then, limited in their extent to nations and times in which
 religion has existed in any particular  form.  They  belong to the
 condition and circumstances of human  nature, at least  of human
 nature  in a state not  altogether uncultivated and brutalized.  Ac-
 cordingly we are enabled to  trace examples of  this form of madness
 in every period of history, and even before  the era of authentic
 history.  A German writer* whom  I  have before cited  has taken
 pains to collect instances in  the early fables of Greece.  Even before
 the Argonauts, Melampus, according  to Herodotus, cured by means
 of hellebore the daughters of Prcetus, of whom it is said,
              " Proetides implerant falsis mugitibus agros."

 Hercules, Ajax, Orestes, Athamas, Alcmaeon,  laboured under reli-
 gious madness, as well as the famous exile hated of the gods, who is
 mentioned in words strikingly descriptive of insanity :
             " Qui miser in campis mcerens errabat Aleis,
              Ipse suum cor edens, hominum vestigia vitans."

   Cassandra, the Maenades,  the  Pythia, are reckoned by Heinroth
 as examples of a more exalted and ecstatic  period of religious mad-
 ness, and to these many other instances are added which I  shall leave
 to the recollection of my readers.
   The circumstances in the moral nature of  mankind on which  these
 phenomena  depend, have such influence  that there is no reason to
 hope that their effect will cease.  Yet  they have  been much  more
 prevalent in certain times and places than  in others.  It  has  been
 said  that in France, since the revolution, the  popular influence of
 religion has  been less than it ever was in any other civilized country;
 and I have been informed by French  physicians who have extensive
 means of information, that  instances have  religious  insanity  have
 become in a similar proportion rare.  But a question presents  itself
 whether this change has been on the whole a beneficial one, or may
 have  produced  evils greater than  the alleged advantage may  be
supposed to compensate.   We have to  consider this question  at
present  with reference only to the prevalence of madness,  and  in
* Heinroth's Stoerungen des Seelenlebens. 
146
CAUSES OF INSANITY.
this relation the  following remarks by a most competent as well as
an unprejudiced observer afford a sufficient reply to the inquiry.
  "The changes," says M. Esquirol,  "which have  taken  place
during the last thirty years in our moral sentiments and habits, have
produced more instances of madness in France than all our political
calamities.   We  have exchanged our  ancient customs and  fixed
habits, our old and established sentiments and opinions,  for specula-
tive theories and dangerous innovations.  Religion now only comes
forward as a formal usage in the solemn transactions of life ; she no
longer  affords  her consolations to the  afflicted,  or  hope to  the
desponding.  Morality founded  on religion is  no longer the  guide
of reason in the narrow and difficult path of life.   A cold egotism
has dried  up all  the sources of sentiment:  there no longer exist
domestic  affections, respect, attachment,  authority, or  reciprocal
dependences; every one lives for himself; none are anxious to form
those wise and  salutary provisions  which ought to connect  the pre-
sent age with those which are destined to follow it."
   I  shall now shortly advert to an inquiry which has often been
agitated, and which I cannot  well pass over entirely, whether there
are any systems  of  religion  or institutions  more  favourable than
others  to the health of the mind,  as far as security from  religious
madness is concerned, and whether in one church or community
of Christians there are more or fewer examples of insanity than in
others.
   It  has been supposed  by many persons that Roman catholics are
less subject than protestants to morbid illusions  on subjects connected
with  religion.   Dr.  Hallaran  declares  that in  the  public lunatic
asylum at Cork, which is inhabited by Roman catholics  in  the pro-
portion of ten to one protestant, " no instance within his recollection
has  occurred of mental  derangement in  the former from  religious
enthusiasm."   He adds  that several cases of this kind had  appeared
among the inmates of the same asylum, but that the individuals
affected were protestant dissenters.*   A similar opinion  as to the
comparative infrequency of religious madness among Roman  catho-
lics is supported by M. Guislain, whose work  on mental  alienation
has  communicated much valuable knowledge, especially  as to the
state  of lunatics and lunatic asylums in the Low Countries.  It has
been observed by  Leupoldt that  insanity is much more prevalent in
the north of Germany than in the southern parts of the same coun-
try.   This alleged  difference  is attributed  by M. Guislain to the
diversity of religion.   In the south of Germany the Roman catholic
religion prevails.  " On approaching the north," says  M.  Guislain,
" we meet  with the  reformed  church and its fanatical  discussions.
It remains to be proved," he adds, " whether we could not establish
the same relation, and deduce  the consequences which  result from
it, in our  kingdom.   Holland professes generally  the   reformed
worship ;  Flanders and Brabant Roman Catholicism.   This  would
furnish a  very interesting comparison.   We should have  to  deter-

   * Practical Observations on Insanity, by Dr. Hallaran.  Cork, 1818, p. 32. 
RELIGIOUS APPREHENSIONS.
147
mine  whether Holland affords,  in proportion to our catholic pro-
vinces,  the same  number of cases  of  lunacy, especially  of the
religious kind, as Burrows and others have admitted in the reformed
countries of Britain, and as Leupoldt has observed to exist in the
protestant  districts of  Germany.   It  would be  necessary to obtain
for this purpose  the exact numbers of the inhabitants of our houses
for lunatics.   As  yet we have  only on this subject  notions too
general to serve  as a basis for the comparison."*
   Nothing can be  more remote from the truth than the  impression
which the readers of these statements might perhaps derive  from
them, viz., that  Roman catholic countries possess an immunity from
the prevalence  of madness connected with  religious feelings and
ideas.   Jacobi,  who  has devoted much  attention to this subject,
observes that  Roman catholics are not more protected by the  insti-
tutions  of their church against insanity  with religious  illusions
than  protestants.   " Yet,"  he  says, " we  must  admit that the
character of religious madness in the members of these two commu-
nities, and the  manner  in which individuals become subjected to
them, is for the most part very different.   Every person who has
visited the lunatic  asylums in catholic Germany must be aware that
many inmates of these establishments belonging to the lower classes
have  been  brought into a species of  religious  madness by the delu-
sions  of a wild and unregulated imagination, excited by superstitious
phantasms, and  through neglect of the culture of the understanding,
and a proportionally overpowering  influence  of sensual passions ;"
and that  the  same remark holds good  in  Italy we learn, among
others,  from  Chiaruggi, who in  his work on  insanity expressly
declares that, in  Tuscany at least, most instances of melancholy owe
their  origin to  emotions excited by religion.!  History affords us,
indeed, innumerable  proofs  that religious insanity among  Roman
catholics  is any thing rather than  a rare phenomenon.  " I was
much struck," adds Jocobi,  " on finding that in the lunatic estab-
lishments  of  Franconia, especially  among persons  who had been
bred  up in the  Roman  catholic  communion,  the idea of diabolical
possession, in which  individuals  not  only believe  themselves  to be
in the power of Satan, but fancied that  they  conceal bodily a devil
within their own  persons, was remarkably prevalent ; while, on the
other hand, at Sonnenstein, as  Pienitz has assured  me, as well as at
Waldheim, and  in the Charite at Berlin, such an impression is very
rarely to be met with."   Dr. Jacobi gives  the details of one case of
this description, in which  cure  was  obtained by a method adopted
by Dr. Muller,  hofmedicus at  Wurtzburg.   He then continues his
observations on  religious insanity as  prevailing in Roman  catholic
countries.   The  following  remarks will probably  be read  with
interest.

   * Traite sur l'Alienation Mentale, &c. par Joseph Guislain, Medicin a Gand.
Amsterdam, 1826, torn. ii. p. 168.
   j; Chiaruggi della Pazzia in Genere ed in Spezie.   Jacobi, ubi supra. 
148
MORAL  CAUSES.
   " In returning," says the author, " to the consideration of religious
 insanity, 1 must further observe, that although  this form of mental
 derangement  is developed  in a different manner, and assumes a
 different  aspect among catholics and  protestants,  when  we  refer
 among the former to the lower orders of the people in places where
 education is neglected, the difference is by  no means so considerable,
 if we advert to places where the state of mental culture is higher, as
 it is in the better informed .classes professing the catholic religion in
 Germany, and especially among  the  younger  ecclesiastics  of that
 church.  Among these religious insanity arises from the same causes
 which have been already indicated as the most frequent and  influ-
 ential in the excitement of the same disease among protestants, viz.,
 doubts relating to religious controversy, and  anxiety concerning the
 future welfare of individuals.  In the hospital of St. John at Saltz-
 burg, there was, among  others, a  ward especially dedicated to the
 admission of insane  persons of the priestly order, and great as my
 surprise was  in observing this arrangement when I undertook first
 the  direction  of  that  institution, I afterwards found  reason to ac-
 knowledge its propriety.  During the period of my superintendence
 it happened in three instances that  young ecclesiastics in a state of
 derangement were placed under my care :  of these, two appeared in
 all probably to have become insane  in  the manner I  have just
 indicated.  Although it may be conjectured that a great number of
 catholic ecclesiastics, and  especially the members of some  monastic
 orders, where such still exist, may have been brought  into a state of
 derangement in a different way ; and indeed Chiaruggi, in the four
 cases of insanity  occurring  in ecclesiastics, among his 'Century of
 Observations,' makes  no  mention of such causes ;  yet other physi-
 cians, who have  had  greater opportunities  for experience in this
 kind have  found  the  fact I have stated  fully established.  We  may
 besides consider this  as certain,—that the religious feelings of late
 awakened  in  Germany, both among catholics  and protestants, and
 the general practice of reading the  scriptures connected  with this
 change both as cause  and effect, by powerfully directing  the spirit
 of inquiry to subjects of religion, must have stirred up and  excited
 the minds of many persons to such a degree, and, on the other hand,
 have thrown others into such  perplexing doubts, and into questions
 of conscience  so difficult of  solution, that  distraction and derange-
 ment of the mind have  been the consequence.  But if this result of
 the weakness of human nature is to be lamented, in respect to those
 who fall in such a manner  into religious  insanity,  yet it must not
 be denounced  generally as the greatest of all evils, as every one will
 be ready  to admit who  contemplates  the opposite extreme, and
 observes  how  in  France, for instance, while,  owing  to  a  general
 indifference to religion, very  few become deranged  through anxiety
respecting the  most important concerns that  can engage the human
 mind, the  generality  of men have their rational understanding
impaired through the influence of lower passions, and of vices which
are so much the more prevalent; and how, in the vast empires of the 
RELIGIOUS APPREHENSIONS.               149
feast, immunity from mental derangement is only the result of a
moral  and religious torpor,  which keeps the human faculties  be-
numbed and stupified."
   In order to be  justified in forming  any decided opinion as to  the
question  whether the catholic or protestant institutions are most
favourable to the development of insanity, it would be requisite to
compare the state in this respect of large bodies of people inhabiting
the  same or  similar countries, and in  other respects  living under
nearly similar circumstances.  It would not be sufficient to compare
the  people of northern Germany with those of the south, or even
the  Dutch with  the Flemings :  differences of habits, climate,  and
other external circumstances are here added to those of religion,  and
the former may contribute to any differences that may be found in
the proportion of lunatics to the population of the respective coun-
tries.  If even we should compare the  people of Ireland and Scotland
in these respects, we could not with confidence ascribe any difference
that might be found in the proportional numbers of lunatics to  the
prevalence of the catholic religion in  one and  the reformed church
in  the other, since  the  habits and characters  of these nations  are
strikingly different in other respects.   We must, then, look for
some decisive example in a country where the two churches co-exist,
and their respective adherents display in other particulars no marked
diversity in  their  character and  habits.   The  most appropriate
instance yet  adduced, and the most satisfactory irueans of  instituting
this comparison,  is afforded by the population of  the Prussian states
on the Rhine, where the  number  of persons professing  the  two
religions  is tolerably  well known, and the  number of lunatics be-
longing  to each  can be  more  accurately estimated than  elsewhere.
This comparison has been made, and the results have been published
by Dr. Jacobi, in a work which appeared some years later than  that
from which  I  have already made citations.  The following extract
from  his statistical table will  display the principal data on which
conclusions are founded.
   The table contains an account of the collective number of insane
persons existing  in  the  year 1S24, in  the lunatic establishments of
Dusseldorf, Aix-la-Chapelle, Treves, Cologn, and Coblentz, or in the
Rhenish provinces belonging to Prussia.  The total number of the
population of these provinces  is stated at  2,067,104, and the  total
number of lunatics at 2,015, which is nearly one to each thousand of
the population.  These 2,015  lunatics are  divided into four  sets,
according to  their religious professions, viz. into Catholics, Evange-
licals or Lutherans, Mennonites, and Jews.   The following are the
numbers  in the different provinces ;—-
May, 1837,
14 
150
MORAL CAUSES.
	Catholics.	Evangelicals	Mennonites	Jews.	Sum total.
Diisseldorf— Number of lunatics . . Aix-1 a-C hapelle— Number of lunatics . . Treves— Number of lunatics . . Cologn— Number of lunatics . . Coblentz— Number ef lunatics . .	395,031 544 320,793 301 301,505 202 323,283 283 250,613 236	239,840 241 9,382 11 32,804 18 50,001 48 121,595 101	847 4 3 47 2 333 2	5,495 9 1,782 3,451 1 4,049 5 6,248 9	641,213 331,960 337,807 377,335 378,789
  The result of this collation is that the proportion of lunatics in the
catholic part of the population, compared to that which is discovered
in the Lutheran population, is as eleven to ten, or one-eleventh part
greater.  The Mennonites and Jews give a still higher  proportion ;
but the numbers of them which are brought into  computation are
not sufficient to afford  the materials of any general  estimate or con-
clusion.
  It would seem from this comparison, which is the only document
as yet obtained that may  be considered as a tolerably fair and unex-
ceptionable comparison of the number of lunatics occurring in:a
catholic population to that which discovers itself in  a protestant
population  under similar circumstances, that the catholic religion  is
rather  more  favourable to the manifestation of insanity than the
protestant.
  I cannot with perfect propriety conclude this compilation  of facts
connected with religious insanity, without inserting the  remarks
of the writer already  cited on Mr. Tuke's Account of the  Retreat,
the lunatic asylum  belonging to the Society of Friends, near York.
Jacobi  published  a German  translation  of that  work, in  which
nothing seems to  have struck him more forcibly than the fact that
the species of insanity now under consideration occurs but in  three
instances in the list of cases given by the writer, or rather that there
are but three cases of derangement out of one hundred and forty-
nine which  can with  any probability be ascribed to anxieties 'con-
nected with  religious impressions.   "Equally remarkable it is that
in the list of causes, pride, ambition, jealousy, rage, debauchery,  as
well as extreme penury and care produced by hardships  and  vvant  of
the necessaries of life, causes so fruitful of madness  in  other estab-
lishments, are not even mentioned."   The exemptions  which this
remark implies from  the  most prevalent modifications  of derange-
ment which  occur in other communities, are attributed by Jacobi
to the strictness  of moral education and  discipline, for which he
says that the  Quakers in England are remarkable, to the restraints 
RELIGIOUS APPREHENSIONS.               151
imposed by them on the imagination and the indulgence of passions,
and to the absence of enthusiastical and mystical excitement in con-
nexion with religion.
  As several  years  have elapsed since the Account of the Retreat
Was  published, which drew forth these comments  from the distin-
guished translator of that work into the German language, it seemed
to me a matter of great interest to ascertain whether later experience
has  confirmed the  preceding observations,  or whether   cases of
religious madness have occurred of late in so small a proportion as
formerly among  those which have been  admitted at  the  Retreat.
With reference to  this  inquiry  I have received from the intelligent
and  judicious author of the Account  the most  satisfactory  informa-
tion.  Mr. Tuke says, " In regard to our cases of ' religious mad-
ness9 I may state that we  can only enumerate eight since  the close
of the year 1811 out of three hundred and  thirty-four admissions.
In none of these cases could it, as I believe, be said that the  religious
feelings which just succeeded, or perhaps rather first marked the
commencement of the disease, were excited  by any special  religious
means or occasion.  The patients were generally persons of rather
weak and of contemplative minds, and several of them were persons
who had not been educated in our society."
   It seems, then, that religious insanity so termed is a disorder from
which the Society of Friends are in a great measure exempt.  With
respect to the more general  question, whether insanity of  an)^ kind
prevails among  the Quakers  to a  great or  comparatively  small
extent, those writers who have  touched upon the subject have been
divided  in opinion.  Dr.  Haslam  says that  insanity  is very  rare
among the members of that society.  Dr. Burrows thinks it very
frequent among  them, and he accounts for the fact by another sup-
position, viz. that their marriages are  confined to the families of their
own society, and  therefore within a very  limited circle.  With
 respect to the first point, which only is relevant  to  my present
 purpose,  Mr.  Tuke has  furnished me with some data which are
 highly interesting.   He  says  that the  number of inmates of the
 Retreat who are members of the religious Society of Friends has of
 late years been usually about  sixty-four.   The total  number  of
 Friends in England and  Scotland does not, as he believes, exceed
 22,000 or 23,000.   The mean of these sums divided by the number
 of patients actually in the Retreat gives  2|f, or somewhat less than
 three in a thousand, which is a  very  high proportion, and  consider-
 ably exceeding  that which is  supposed to obtain in the general
 population of this and other countries.
   But there are considerations whieh render it  difficult  to believe
 that such a comparative result is correct,  and which seem  to lead us
 almost inevitably  to an  opposite conclusion, or at least show that
 some other considerations must be introduced in order  to explain
 facts which  turn out so contrary to all expectation from the known
 circumstances of the case.  We have seen that the cases of religious
 madness so termed, are so few in the Retreat, that the community to 
152
MORAL  CAUSES.
 which  that  asylum belongs may be  considered  as exempted in a
 great measure from that  modification of insanity.  But  the  same
 observation  may  be made with  reference to several of the  most
 prevalent  causes  of mental derangement.   Mr. Tuke informs me
 that  " not more than two cases of disease apparently connected with
 intemperance in drinking  have occurred  in the Retreat among the
 members of the Society since 1811."  This is well known to  be in
 many asylums  a  very productive  cause.   Extreme poverty and
 distress from actual  want forms a large article in the tables of  cases
 given by M. Esquirol and  others ; and  from this cause of madness
 the Quakers are likewise protected  by their habits and institutions.
 Mr. Tuke says, "We have had a few cases attributed to disappoint-
 ment of the  affections, and several to domestic afflictions, and disap-
 pointment in business."   Even  these are scarcely as numerous as
 those referred to the same articles in other establishments.   As to the
 suggestion of Dr. Burrows, that  insanity is rendered frequent in the
 Society of Friends  by the fact  that  their marriages are confined
 within  their own  community, we may remark that the numbers of
 this community are  upwards of twenty thousand.  Were  this  wri-
 ter's opinion well  founded, what  would  become  of  the royal
 dynasties and aristocracies in Europe ?   From  all these considera-
 tions we are brought inevitably to the conclusion which Mr. Tuke
 has drawn.  He says, " Unless, then, we have  a larger proportion
 of imperfect structures amongst us than obtains in the world at large,
 we ought  to have  fewer  cases  of  insanity in  proportion to our
 numbers than is found in the general population."
   But how is this, conclusion to be reconciled with the fact that the
 proportional number of cases is. actually greater than what is calcu-
 lated to obtain in  the general population.  Mr. Tuke observes, "If
 I were to enter into this subject, I should demur to  the  data upon
 which the  estimate of the proportion of lunatics  in England rests.
 I believe the. parliamentary returns to be so incorrect as to  afford no
 fair ground for the estimate which is made  ; whilst the knowledge
 of  each other which prevails  in  our Society, and  the character of
 the  Retreat, brings nearly all  the  cases which  occur among us
 into the calculation.  I  have no hesitation in saying  that  the stan-
 dard of sanity is in  some respects higher amongst us  than in the
 general population.   Moral improprieties  connected  with mental
 peculiarities are more easily and more frequently stamped as. insanity
 amongst us than in the world at large, while the care taken of our
 poor  prevents any individual of  that  class  from being allowed to
 roam, at large or remain at home on account of the expense, of main-
 taining him in our asyluni."
  The  truth, of these observations  cannot be  illustrated by  any-
 remarks of mine.   The more the subject is reflected upon, the more
 correct and well-founded will they appear.
  In a subsequent  chapter I shall advert to facts connected with this,
subject, when, I proceed to consider the statistical information that is,
\q be collected in, reference to insanity. 
PHYSICAL CAUSES.
153
           Section V.—Physical Causes of Insanity.

   The  physical causes which induce insanity act in some  instances
immediately on the brain ; in others  they affect that organ through,
the medium of other parts of the system.

                     1.  Injuries of the head.
   Injuries of the head are much more frequently causes of delirium
than  of insanity ;  but instances are  well  known  in which  they
induce  the latter affection, generally as a  remote  consequence of
delirium.  Several cases of this  description have occurred  within
my own knowledge.   In some instances madness has been  observed
to supervene on  injuries of the head  which appeared to  be  slight
and  occasioned at first little or no apprehension.  M. Esquirol is of
opinion  that insanity  occasioned  by this cause  ensues  sometimes
after an interval of several years.   This writer mentions the case of
a child  who fell on his head when three years of age ; he complained
from that time  of pains in his head : about the time of puberty these
pains increased, and at seventeen  years of age he became  maniacal.
A lady, whose  case is given by the same writer, was thrown from a
horse, and her head struck against a door. She lay for three months
in raving madness, recovered, and  died two years  afterwards of a
brain-fever.
   There are instances  in which a slight peculiarity of character, not
amounting to insanity, has remained long, and perhaps through the
life of the individual who has sustained a severe injury of  the head..
Sometimes this constitutes a kind of moral insanity  : the temper is
more irritable,  the feelings are  less under restraint than previously.
In other instances there has been greater energy and activity, more
of excitement  in  the  general character, which has  been thought a
change  for the better rather than a morbid alteration.*
   Cases of this description are  sometimes very remarkable.  I have
been informed  on good authority that there was, some time since* a
family,  not far from this  city, consisting of three boys, who were all
considered as idiots.   One of  them received a severe injury of the
head : from that time his faculties began  to  brighten, and he-1* now
a man of good  talents and practises as a barrister.   His brothers are
still  idiotic or  imbecile.   Van Sweiten mentions the case  of a girl
who was imbecile till she received an injury of the head, and under-
went the application of a trephine for the  removal  of a depressed
portion  of skull ; she  recovered, and became  intelligent.t  Haller
nas reported the case of an idiot whom a wound in the head restored
to understanding.

  * A case analagous to this has been recorded in  the instance of Father Mo-
billon, who is said to have acquired, after the operation of trepanning, asudden,
increase of his powers of understanding—See Dr. Cox on InsanUy,P. 104,
  + Van Sweiten, Comment, in Boerhaavii Aphonsmos, torn, 1.
                              14* 
154
PHYSICAL  CAUSES.
              2.  Insolations and exposure to heat.

  Insolation, coup de soleil, or exposure to the ardent rays of the
sun, is mentioned repeatedly in Esquirol's tables among the causes
of madness.   The disorder of the mind is here doubtless the result
of inflammation, or of a  state  bordering on  inflammation,  in  the
encephalon.
  It has been observed  that cooks and other persons exposed, in
consequence of their employments, to great heat, are from this cause
occasionally affected with  mania.

                        „ 3.  Metastasis.
  The pathological fact that diseases of  the brain, and among others
that of which  insanity is a manifestation, supervene on the cessation
of various discharges, on the healing of  old ulcers, on the disappear-
ance of cutaneous eruptions, on the cessation of inflammatory  disease
in membranous and other structures, on the removal of tumours, has
been observed with greater or less attention  by practical writers on
medicine from the time of Hippocrates,   Many cases illustrative of
this fact are  to be found in the works of Hildanus, Tulpius,  and
Hoffmann  ; and  Sauvages, among  the  forms of madness, has reck-
oned  one which he terms metastatic.   M. Esquirol says that even a
cessation of the usual discharge from, the nostrils, of leucorrhoea, of
blennorhcea, as well  as  the  disappearance of  scabies, of herpes, of
gout and rheumatism, has produced madness.   In general it may be
pbserved that the suppression of acute  eruptions, whether pustular,
exanthematic, or erysipelatous,  is followed  by acute  inflammatory
affections of the internal organs ; in such cases  the brain or its mem-
branes are  attacked by phrenitis or meningitis; while the disappear-
ance of chronic disorders  of the  same  class is the precursor of mental
aberration.'   The  suppression  of more  copious  discharges,  the
removal of large tumours, the disappearance in dropsical cases by
rapid absorption of deposited fluids without increased excretion, has
been  followed by determinations of blood to the head, giving rise to
fatal apoplexy or severe convulsions.
  I have seen some instances of mania supervening on inflammatory
rheumatism which had subsided.  These have been  cases of very
acute inflammation affecting the large joints, which had been reduced
by  too profuse bleedings, a measure which in this disease often gives
rjse to metastasis.

          4. Intoxicating liquors and other stimulants.

   Among  physical causes of madness,  one of  the most frequent is
the immoderate use of intoxicating liquors.  There is hardly a tribe
of the human race who have not  succeeded in inventing some method
of  producing intoxication.   Ardent spirits are perhaps, of all, the
most injurious in their effects, particularly on the lower  classes in 
SENSUALITY.
155
the northern  countries  of  Europe and  America.*   It  has been
repeatedly observed that a  large  proportion of the cases admitted
into pauper lunatic asylums arise from  this cause.   They are  in
general to be  reckoned  among the cases  most easily  cured, for,
although this is not uniformly the fact, it often happens that when
the exciting cause is removed, the effect begins  to lessen, and even-
tually  ceases.   When these patients are  prevented from obtaining
stimulating liquors, and are treated  with sedative remedies,  they
quickly show signs of amelioration and of the subsidence of disease.
   Drunkenness is a much more prevailing vice in England and in
Germany, than in France,  Italy, and  Spain.   M.  Esquirol  has
declared that this vice is by no means a frequent cause of insanity in
France, even in the lower classes.   Among  336 lunatics in his esta-
blishment, there were only three  who appeared to have lost their
reason through the habit of intoxication.   He adverts to the different
habits  prevalent in England, where, as he says, the greatest states^
men in the land are not ashamed of the most  disgraceful drunkenness.
This opprobrium may have been well  merited at the time when it
was uttered, but the habits of our countrymen have changed much,
particularly among the higher classes, during the last twenty years.
Intoxication, as it is well known, is still lamentably prevalent among
the lower orders, and  dram-drinking  is a very frequent habit, espe-
cially  in  large  cities, even  among females, and persons not of the
very lowest grade in society.   In public lunatic asylums in England,
it is generally known that, in a great proportion of the cases, dram-
drinking  is the exciting cause.   I  am  informed by Dr. Whally that
this is particularly  the fact in the Lunatic Asylum at Lancaster.
   The use of  opium and  other  stimulants is among the  exciting
causes of  madness, though of much less frequent  agency than the
ordinary  means of intoxication.
   To the same head we  must refer the use of mercury, which some-
times  occasions madness in persons predisposed.  By such individur
als this substance should he  used  either not at  all  or with extreme
caution,


                          5. Sensuality.
   Sensual vices are  frequent  causes  of insanity,  as the tables of
physical causes taken from M. Esquirol  sufficiently indicate.
   This writer  has observed that one-twentieth of the female lunatics
at the  Salpetriere have  been prostitutes.  These unhappy creatures,
after  abandoning  themselves to  excesses of all kinds, and  partly
through the effect of misery  and despair, fall  into dementia, and
often into that kind of the disease which is complicated with general
paralysis.

   * See, among other documents illustrative of this remark, M. Esquirol's Me-
moir on the Statistics of Insanity in the Aun. d-'Hygiene et de Medicine Legale.
An. 1830.. 
156
PHYSICAL CAUSES.
                     6. Intestinal irritation.
   A disordered state of the intestinal canal often becomes a cause of
 disturbance in the brain, by whatever antecedents the former disease
 may have been induced.   The state of the intestinal canal to which I
 allude is itself much more frequently of an inflammatory nature than
 it has generally been imagined, or at least than it was formerly sup-
 posed to be.  In that condition of the canal which gives rise to cos-
 tiveness alternating with diarrhoea, and accompanied with indigestion,
 flatulence and  eructations, anorexia and nausea, transient but  often
 acute pains in  the hypochondria, livid and yellow suffusions of the
 skin, viscid secretions  in  the mouth, or redness  of  the  fauces and
 palate, with  a glazed and dry surface, the whole train of symptoms
 often depends upon a low degree of chronic inflammation in the mu-
 cous membrane of the intestinal canal;  and this is perhaps a frequent,
 if not an ordinary state, in those cases in which  disorders of the ner-
 vous system supervene on complaints of the stomach and. bowels.
 This form of disease has been described by Dr.  Ferriar, and several
 other practical writers ; but it is to M. Broussais that we are indebted
 for a more ample development of its pathology.
   The enteric disorder, which lays  the foundation for maniacal symp-
 toms, as well as for  other affections  of the nervous system, is the*
 result in  different instances  of various and  very diverse noxious
 causes.   The most frequent is excess in the use of stimulant and indi-
 gestible food.  Too great indulgence of the appetite among the more
 opulent, and among  the lower  classes  long-continued  constipation,
 unwholesome diet, the  use of salt provisions, exposure to cold  and
 want, or neglect of warm clothing, give rise to diseases of the same
 description.
   Intestinal worms are one of the results of constipation.   Madness
 produced by  the last mentioned cause is probably of very rare oc-
 currence.  M. Esquirol has,  however, mentioned a remarkable in-
 stance of maniacal disease affecting a  young man, who  was cured at
 two different periods by the expulsion of a  large quantity of worms
 from the intestinal canal.   I shall have occasion  to enter more fully
 into the subject of enteric  and  other  visceral disorders, which are
 sometimes connected with insanity, when I proceed to the conside-
 ration of the morbid  appearances discovered by necroscopy.

      7.  Causes depending on states of the uterine  system.
   States of the constitution connected with irregularities of the ute-
 rine functions are well known to coexist or to  display  themselves in
 connection with various disorders of the brain.  Among these mad-
 ness is  one.   Maniacal affections of  this class  may  be mentioned
 under three heads.
  a. Dysmenorrhoeal affections.—Some females  at  the  period of
the catamenia undergo a considerable degree of nervous excitement:
morbid dispositions of mind are displayed by them at  these times, a
wayward and capricious temper, excitability in the feelings, morose-
ness in disposition, a proneness to quarrel with  their dearest relatives, 
NECROSCOPICAL RESEARCHES.             157
 and sometimes a dejection  of mind approaching to melancholia.
 These are distinct from the cases  of hysterical affection  connected
 with the same  periodical  causes of excitement.   The former  are
 sometimes the preludes of a far more permanent disease.
   b.  Suppressions of the catamenia.—Sudden suppressions of the
 catamenia are frequently followed by diseases of the nervous system
 of various kinds.  Females  exposed to  cold, undergoing powerful
 excitements, experience a suppression of the catamenia, followed in
 some instances immediately by fits of epilepsy or hysteria,  the attacks
 of which are so  sudden as  to illustrate the connexion of  cause and
 effect.  In attacks oT  madness the catamenia are for the  most part
 wholly or partially suppressed during the early periods, and in many
 cases it is not easy to say whether the suppression is the effect or the
 cause of  the  disease.   There are  instances, however, in  which  the
 circumstances sufficiently indicate the order of connexion.   Dr. Bur-
 rows has detailed a case in which suppression brought on by manifest
 causes was followed by mania.  We have already alluded to the case
 of a young female mentioned  by M. Esquirol, who suddenly exclaim-
 ed that she was  cured  of her disorder ;  her catamenia had flowed
 spontaneously, and her restoration to sanity was the immediate con-
 sequence.  Facts so decisive  in their bearings on pathology are  not
 6f very frequent occurrence, but their evidence  reaches further than
 the individual cases recorded.
   It often happens, that after  some  weeks or months in the duralion
 of madness, the  catamenia,  though  previously deficient, become  re-
 stored nearly to  their usual  state.  This,  like the other indications of
 improvement in merely  physical health, is only a favourable sign
 when it is accompanied by some amendment in the state of the men-
 tal faculties.   Without any  such change, it  rather gives  reason  to
 apprehend that the disorder is becoming inveterate, and perhaps al-
 ready making its transition from mania  into the incipient stage  of
 dementia.
   c. Puerperal madness is another modification of the disease con-
 nected with the state of the uterine functions.   The consideration of
this subject is too important to be taken up in a cursory manner, and
I purpose to allot to it a separate  chapter.
                        CHAPTER  V.

RESULTS OF NECROSCOPICAL RESEARCHES INTO THE CHANGES
         OF STRUCTURE CONNECTED WITH INSANITY.

Section I.—Morbid Phenomena  discovered in  the Head: Re-
  searches  of Morgagni,  Greding,  Haslam, Pinel, Esquirol,
  Georget, Bayle, Calmeil, Foville.

  Few diseases appear to be  connected  with a  greater variety  of
necroscopical phenomena than  insanity.  Such phenomena have been 
158              NECROSCOPICAL RESEARCHES
sought principally in the head, but morbid changes have been found
likewise in other parts of the body ; and there are some pathologists
who regard the  latter as not less important  in  connexion with the
disease than the alterations of structure discovered within the cranium.
This is  a consideration on which, at present, we have no business to
enter ;  it is the office of the anatomist, or the collector of anatomical
facts, to record all the phenomena observed, and to regard those as
most essential to any given  disease which are most generally found
to have been coexistent with it.  We shall  begin with  a  survey of
the morbid appearances discovered in  the  heads of insane persons,
and proceed afterwards to those which  have been-found in the thorax
and abdomen.
   The elucidation of this disease, as  of most others, by pathological
anatomy, may be said  to begin  with  Morgagni.   That  celebrated
writer has, however, related the details of but  seven or eight dissec-
tions referring to cases  of insanity.  In these he  remarked several
facts which later observations have confirmed.  He found the  sub-
stance of the cerebral hemispheres more firm, and that of the cerebel-
lum softer than  natural.  In one instance the white substance of the
cerebrum was hard and of a brownish hue, and its bloodvessels, as
well as those of the  plexus choroides, much distended with blood : in
another there was hardening of the hemispheres and softening of the
fornix,  fulness of the cerebral vessels, adhesion of  the pia mater : in
a third, injection of the meninges.
   The  first author  who recorded an extensive series of observations
on the appearances  of the brain in  cases of insanity was Dr. Greding,
physician to  a public hospital at Waldheim,  where a  considerable
number of lunatics and demented persons are congregated.   The fol-
lowing are the most important of the facts which he has noted.
   1.  In the cranium.—" Experience  has proved," as he says, "that
the skulls of almost all insane persons have a natural shape." In 16
cases only of the whole number examined, viz. nearly 220, the  fore-
head was contracted, the temples compressed, and the occiput large
and expanded.  In a few the head was elongated and compressed  at
the temples.   Some had a head almost round, or of a square shape:
these were epileptic idiots.  Two had small  heads, quite circular:
these were epileptic madmen.   Of 216 cases, including those of mad-
men, idiots, and epileptics, the skull was  unusually thick in 167 : this
fact was observed in 78 out of 100 cases of raving madness, and in 22
among 30 of idiotism.  In  many cases the  cranium was remarkably
thin.   Holes were observed in the inner table in 115 out of 216 cases:
in other instances bony projections from  the inner surface.
   2. Membranes.—Dura mater firmly adherent to the skull in 107
out of 216 cases ; in a few instances of a blueish black colour, thick-
ened and partially  ossified.   Pia mater thickened  and opaque,  more
 or less, in  86 out of 100 cases of mania;  beset with  small, spongy
 bodies, in 92 out of 100 : these bodies were often united to the sur-
face of the  brain,  and were in some instances the  seats of ossific
 deposits. 
OF GREDING AND HASLAM.
15&
  3. Brain.—Cerebral substance softer than usual in 118 out of 216
cases :  soft and pulpy in 51 cases of mania out of 100, as likewise in
19 out of 24 cases of melancholia, in 8 out of 20 epileptics, and in 16
out of 30 idiots.  Those maniacs who had the  cerebrum softened had
the cerebellum still more soft and pulpy.
  4. Effusions.—Between the dura and pia mater in 120 out of 216
cases ;  in 58 out of 100 maniacs.  Between  the pia mater and the
surface of the brain  in 28 among 100 maniacs.  Lateral ventricles
in 29  very  full of serum, in 23 ready to  burst ; in 10 among  24
melancholies astonishingly distended.   Third ventricle quite full in
57 out of 100 maniacs, and in 16 of 24 melancholies.   Fourth ven-
tricle ready  to burst in  80 out  of 100 maniacs, and quite  empty in
only 3 : completely distended in every one of 24 melancholies.
   Other appearances.—Plexus choroides  in a nearly  healthy state
in only 16 out of 216 cases, thickened and full of hydatids in 96 out
of 100 maniacs.  Lateral ventricles  either larger  or  smaller than
natural in many cases.   Softness of parts of the brain, as of the tuber-
cula quadrigemina in some cases.
   Dr.  Haslam has given the histories of 37 cases  of madness with
the appearances discovered on dissection.   In not one of these cases
were the  brain and its membranes  free from morbid appearances.
In almost all either the membranes bore marks of former inflamma-
tion, or the vessels which they contained were distended with blood :
in 16 cases there was an effusion of serum between the membranes,
and in the lateral ventricles in 18.  In 9 cases the consistence of the
brain was firmer  than  usual; in 7 it  was softer, but in 20 not per-
ceptibly altered.   In  3 cases  the cranium  was thicker, and in  3
thinner than the natural state.   In several  cases a peculiar looseness
of the  scalp was observed.
   M.  Georget has recorded with great precision the facts which he
has himself observed.   The following are the most remarkable.  Ir-
regular conformations  of the cranium, the prominences of which are
developed irregularly, those of the right side being generally larger
than those of the  left; some skulls  having the lateral diameter of
equal  extent with the antero-posterior, and the cavities of the base
irregular in extent; some  skulls, 1  in  20,  thickened paitially  or
generally ; n.ore frequently the bones hard,  white, with diploe, resem-
bling ivory ;  some very light.   Dura mater  rarely changed ; some-
times  adherent to  the skull, thickened, containing deposits of bone.
Arachnoid displaying  in places additional  laminae of a red or grey
colour ;  sometimes thickened  but smooth.   Pia mater injected ; or
thickened and infiltrated with  serum, giving at first the appearance
of a gelatinous deposit.  Volume of the  brain sometimes less than
the cavity of the cranium  seems to require.  Some brains very hard,
cut with difficulty ; the white substance glutinous, elastic, and suffer-
ing distension ; more  frequently the brain is soft, the grey matter
being  pale and yellowish, and  the white substance discoloured, of a
dirty  white, the colour and consistence of these portions almost con-
founded.   The convolutions separated by serosity and the pia mater 
160
NECROSCOPICAL RESEARCHES
 thickened.   Interior cavities of the brain appearing in some instances
 Very large, in  others small, often filled with a serous fluid remark-
 ably clear  and limpid;  plexus  choroides exsangueous, containing
 hydatiform vesicles.  Partial softenings of the brain; erosions, ulcera-
 tions of the surface of the ventricles.  Cerebellum generally softer
 than the cerebrum ; sometimes  partially  softened.  Mesocephalon,
 medulla oblongata, and  medulla spinalis  rarely displaying morbid
 changes of structure.
   M. Pinel, after  observing that the phenomena displayed by dis-
 section in the heads of  lunatics are similar to those which occur in
 other cerebral  diseases, seemed to give up the hope of elucidating
 the pathology  of mental derangement by necroscopical researches.
 M. Esquirol was inclined, on the  whole, to participate in this opinion,
 although he carefully noted the appearances which were discovered
 in numerous examinations.   His enumeration of these phenomena is
 in general similar to that of  M. Georget.   But in  the report given
 by M. Esquirol of  the Royal Hospital of Charenton, the mature opi-
 nion of this able writer  is expressed, and it is by no means calculated
 to encourage sanguine expectations.  He  says, " The inspection of
 bodies of lunatics offers numerous varieties as to situation, number,
 and kind of morbid appearances.   The lesions of the encephalon are
 neither in relation to the disorder of the   mind nor to  the maladies
 complicated with it.  Some lunatics whose mental and bodily disease
 had given suspicion of  extensive organic lesions, have presented but
 slight changes of structure in the brain, while others whose symptoms
 had been less severe have been the subjects of great and numerous
 alterations.   But what disconcerts all our  theories is that not unfre-
 quently, even in the instance of  patients  who have passed through
 all the stages of insanity, and have lived many years under  derange-
 ment, no organic changes whatever have  been traced either in the
 brain or its containing membranes.
  " However important may have been the researches of anatomists
 made during our days into diseases which  affect the  mind, we may
 venture to  repeat that pathological anatomy is yet silent  as to the
 seat of madness, and  that it has  not  yet  demonstrated  what is  the
 precise alteration in the encephalon which gives rise to this disease.
 What shall we, then, think of the rash  pretensions  of those who as-
 sume that they can  fix upon the diseased portion of the brain, judg-
 ing merely from the character of the disease ?  But these inquiries
are  foreign to my purpose, and I shall at present  only specify the
 number of organic  lesions which  have  been discovered  in  different
 cavities in  199 bodies examined  at Charenton.  In  these  we have
 found 263 organic lesions of  the brain and meninges, 46 alterations
 in the lungs, the heart, or in their coverings, 113 lesions of the abdo-
minal viscera.  Thus it  appears that morbid phenomena have been
much more frequent in the brain than elsewhere."
  M. Esquirol  avows  that this  conclusion  is different from  that
which he had formerly obtained in the examination of bodies at the
Salpetriere.   In that hospital females only are the subjects of obser- 
OF MM. BAYLE AND CALMEIL.
161
vation, who, being less subject  to  general paralysis  than  men, are
likely to afford fewer morbid phenomena  in  the examination of the
brain.   M. Esquirol, however, candidly admits that a great part of
the difference in the result of these researches may arise  from the
greater  care with which the brain is now dissected, and the slightest
changes observed.  " Hence," he says, " few bodies of lunatics are
now examined in which  they are not  proved to  exist at  the  same
time injections or adhesions of the  meninges, softenings, and tuber-
cles in  the brain, serous effusions in the cavities, &c.  while at the
period when we made our earliest  investigations, we only kept ac-
count, of obvious and manifest alterations."
   Since the publication of M. Georget's works on insanity, minute
and laborious researches into the morbid changes connected with this
disease  have been prosecuted by various writers.   M. Bayle availed
himself of the opportunities for observation afforded by the hospital
of Charenton, and on the  phenomena which he  traced founded his
new doctrine of mental  diseases.   According  to M. Bayle, the
proximate cause of insanity is seated, not in the brain itself, but in
the meninges.  From the inflammation of these membranes effusions
follow, and the phenomena usually dependent on compression of the
brain.   " The cessation or  diminution of maniacal violence, the  great
loss of  power observed in the intellectual faculties, and  the  com-
mencement of general paralysis, which take place at the transition
into the last  period  of the disease, result from compression  of the
brain, owing to the exhalation of serosity into the cavity of the arach-
noid, the serous infiltration of the pia  mater, and  an effusion of the
same kind  into the lateral ventricles."  " The progress of  paralysis
and of dementia indicates," according to the same  writer, " a corres-
ponding increase of  cerebral compression.  A state of stupor  with
obliteration of the faculties and ideas, and  the existence of general
paralysis in its most aggravated form, are  the effects of compression
of the brain, resulting from serous effusion now attaining the greatest
degree.*
   The opinions of M. Bayle have been directly opposed by M. Cal-
meil, who has availed himself of the same resources with remarkable
ability and success.  His researches into the morbid changes connected
with general paralysis are  highly valuable in their results.  It  must
be observed that this last disease, and not insanity, was the object of
M. Calmeil's investigation.  The combination of these two diseases
necessarily occasions ambiguity as to the inferences deduced from the
phenomena, since  it  is scarcely possible to determine how far  these
appearances are connected with  either morbid state;  and  certainly
most of the phenomena traced by M. Calmeil in the paralysis of in-
sane persons are similar to those which other anatomists have regarded
as connected with  mental derangement, without  reference  to the
existence of that disease in its simple form, or as  complicated  with
paralysis.

        * Bayle, Nouvelle Doctrine des Maladies Mentales.   Paris.
  May, 1S37.                  15 
162
NECROSCOPICAL RESEARCHES
      I shall give as brief an abstract as I can from M. Calmeil's observa-
   tions.
      1. Bones of the skull sometimes very full of blood, which fills the
   spongy tissue, reddening  it, and  exudes  from the surfaces of the
   cranium when denuded and separated from the dura mater.   This is
   mentioned  merely as indicative of vascular turgcscence  often  con-
   nected with it in the encephalon.
      2. Vegetations  or excrescences arising from the  pia mater, with
   absorption of corresponding parts of the inner table of the  cranium.
   These are  granulations growing up from the surface of the pia mater,
   penetrating the dura mater, and causing absorption of the inner bony
   surface.  As for the pathology  of this appearance, it is remarked that
   infiltrations and thickenings of parts are found almost constantly under
   these excrescences of the pia mater.
      3. Effusions of serosity in the great cavity of the arachnoid, in the
   ventricles of the brain, and in the cavity of the rachis.   This is one
   of the  most striking and uniform symptoms in persons who have died
   of general  paralysis.  The quantity of serosity varies.   Six or eight
   ounces are often  found in the cavity of the arachnoid.   M. Calmeil
   attaches less importance to this phenomenon than many  have done.
   The following are his reasons.   1. He has observed it to be wanting
   in some strongly marked  instances  of  the disease.  2. He has fre-
   quently discoveied similar effusions in the heads of individuals who
   had perished under dementia, without any symptom of paralysis, even
   to the  last.  3. In cases in which effusions were found of five or six
   ounces of serosity, the symptoms of general paralysis  had been not
   less intense, or even more intense,than in others displaying  effusions
   of twice that extent.  4. If the compression of the brain was so con-
   siderable as many have thought,  the structure of its  parts would
   display disorganization  of some kind, but the structure of the convo-
   lutions, commissures, septum, &c. is uninjured.   5. In casesof chronic
   hydrocephalus of long duration, the deposit of serosity has been enor-  '
   mous,  without loss of locomotive  power till the disorder reached its
   last degree.  6.  If compression from such a cause acted mechanically,
   we should  expect paralysis depending on it to affect all nerves equal-
   ly or indifferently ; no  reason  could be  perceived why  the motive
   faculty should be impaired first in  the tongue, then in the muscles of
   the lower members, and lastly  in the upper,as the fact is observed to
   be in general  paralysis.  7. We certainly  cannot imagine that, such
   a cause acting, the upper extremities  would  still retain its  mobility
   unimpaired, after the total  palsy of the lower limbs.   For these and
)  other  reasons M. Calmeil  concludes that the symptoms  of general
   paralysis are not, as M. Bnyle supposed, dependent on compression
   of the  brain, the result of effusion,  but on the state of the encephalon
   which gives rise  to such  effusion, and  chiefly to  inflammation, of
   which the thickenings, adhesions, and vascular lurgescence of the pia
   mater, and the peculiar  condition of the cineritious substance other-
   wise afford sufficient proof.
      4. Other morbid  phenomena occurring in general paralysis with 
OF M. CALMEIL.
163
relation to the state of the membranes are, false membranes, sometimes
organized, at others unorganized, between the laminae of the arach-
noid ;  encysted concretions  with hemorrhages  between the same
laminae : these phenomena are referred in like manner to inflamma-
tory action, or to erethism in the capillaries of the meninges ; simple
hemorrhages in the great cavity of the arachnoid ; serous infiltrations
of the  pia mater and the cerebral  arachnoid, a phenomenon found in
many  diseases, but rarely to such a degree as in the paralysis of de-
mentia ; thickenings of the pia mater and  the cerebral arachnoid ; a
high state of vascular injection of the same membranes.
   5. Adhesions, either general or local, of the internal surface of the
pia mater to the cineritious portion of the brain.  This is not univer-
sally observed  in cases of the disease described, although strongly
marked.   It is important as giving an indubitable proof of inflamma-
tion affecting the surface of the brain.
   6. A curious and  no doubt important series of observations refer
to the  state of the grey and white substance.
   The grey substance  contiguous to the pia mater is softened, and has
the consistence of  the  pulp of a rotten  apple.  This ramollissement
extends to the depth of a quarter  or half a line.   This appearance  is
accounted for by the observations of M. Lallemand, who remarks that
permanent accumulations of  blood diminish the cohesion of any pa-
renchyma ;  even muscular parts, spleen, lung, can easily be crushed
when gorged with blood.   In brains of persons destroyed by intense
cerebral  congestion, the corpus  callosum, the septum lucidum,  and
other  parts are found relaxed, and  their consistence  gives  way to
slight pressure ; it is to accumulation of blood that the loss of consis-
tence in the superficial grey  substance in  general paralysis is to be
ascribed.   The same state  is further manifested by  a  violet or  red
coloration of the pulp and injection of vessels ; varieties of colour
resulting from  inflammation,  the only cause that can be imagined to
maintain in the brain a  continued vascular plethora.  "We conclude,"
adds M. Calmeil, " that the want  of  cohesion in  the  grey substance
is the result of inflammation."  To  phlegmasia, under different  cir-
cumstances, and in  a different modification, he likewise ascribes the
hardening of the convolutions observed  in some rare instances of the
same disease, although he does not agree with MM. Bouchet, Casau-
vieilh, and Bouilleau,* in maintaining that this hardening is the first
degree of inflammation.
   This softening of the grey substance peculiar to general paralysis,
in which it is separated into lamina?, and the external adheres to the
pia mater, is, however, strongly distinguishable from ordinary ramol-
Iisement of the brain, in which its substance is really diffluent, and its
component particles have lost all their organic texture and relation.
Whatever affinity there may be in the pathological causes of these two
states, they are distinguishable in appearance and different in results.
  The consistence  of  the  white substance is  generally normal or

* Bouilleau, Traite de l'Encephalite, et Archives Generates de Medecine, t. viii. 
164              NECROSCOPICAL RESEARCHES
 natural; in some few instances, as above hinted, it is harder than usual
 in the convolutions.
    Besides  the appearances resulting from high vascular  injection,
 there is a discoloration of the grey substance, which is a peculiar phe-
 nomenon.  This  appearance has been  observed by M. Lallemand.
 It is attributed by M. Calmeil, as connected with  general  paralysis,
 to inflammation of the cortical  substance, which he considers as the
 proximate cause of the disease.
    7. This inflammation extends, as it would appear, to the ventricles,
 as the rugous or roughened state of the internal membrane, owing to
 subjacent villosities, indicates.  These villosities, and the membrane
 itself, are often of a bright red colour.  The appearance of inflamma-
 tion is generally more marked  in the fourth than in the lateral ven-
 tricles.
   8. Local and particular lesions in the substance of the brain, such
 as apoplectic cysts, and  likewise partial ramollisement, sometimes
 found in the medulla spinalis, are considered by M. Calmeil as merely
 accidental and peculiar to the  occasional disorders complicated, in
 particular instances, with  general paralysis.
   The conclusions resulting from these observations are very clearly
 deduced and expressed by the author.  He  says,
   "The changes discovered in the heads of persons who have perished
 under general paralysis,  viz. injection  and  absorption  of the  bony
 structure ;  injections of the dura mater ; separation of its fibres ; ef-
 fusions of serosity into the cavity of the arachnoid ;  false membranes,
 organized  or without organization ;  cysts filled with blood between
 its two laminae ; simple  hemorrhages in the arachnoid ; cedema of
 the meninges ; injections and thickenings of the membranes ; vege-
 tations of the pia mater ; development of their vessels ;  adhesions be-
 tween the pia mater and the convolutions ;  disappearance of the grey
 substance ;  softening, hardening, and discoloration of the same  sub-
 stance ; consistence and  injection of the white substance ; redness
 and tumefaction of the ventricular villosities ; serosity in the ventri-
 cles, apoplectic cysts, erosions of the convolutions ;  ramollisement of
 the brain, or of the spinal marrow ;—these  phenomena do  not suffi-
 ciently explain the symptoms  observed during life.  The changes
 enumerated are so various in their appearance, and so far from uniform
 in occurrence, that they cannot on this account be immediately  con-
 nected with the results."  M. Calmeil considers them all to be evi-
 dences of inflammation.   This he infers to  be the  identical state of
 thebrain, of which the several appearances are diversified signs, only
 varied manifestations of one and the same disease.  " Nearly all these
 disorders," as he says, " indicate a chronic phlegmasia in the brain,
producing an identical modification of which the morbid appearances
are only symptoms."*
   The observations of M. Calmeil must be  compared with those of
M. Foville,  who has more  recently pursued  the research  into the
* Calmeil, p. 416. 
OF MM. CALMEIL AND FOVILLE.
165
 state of the brain in cases of insanity.*  It will be seen that in many
 leading particulars they agree, but that  M.  Foville  connects  with
 mental derangement appearances  which  M. Calmeil  regards as re-
 stricted to  general paralysis.
    It was a part of M. Foville's plan to compare in every instance on
 the spot, healthy brains with  those which were the particular subjects
 of examination.  By this method some minute peculiarities of struc-
 ture seem to have been  detected which might otherwise have escaped
 notice.   M. Foville's inquiries were carried on at the Salpetriere in
 conjunction with his colleagues.   MM.  Delaye and  Pinel Grand-
 champ, when  that  hospital was  under the superintendence of M.
 Esquirol, and  subsequently by himself at the extensive hospital of
 St. Yon, in the department of  the Lower Seine, which has been for
 some years under his immediate care.  His observations are arranged
 under the  following heads: 1, morbid  changes in the cortical  sub-
 stance ; 2,  changes  in the white or fibrous substance ;  3, changes in
 the nerves  of  sensation ; 4, changes in  the membranes ; 5, observa-
 tions on the skull and hairy scalp ;  6, changes observed in  idiots.  I
 shall abstract the most remarkable observations made by M. Foville
 under several  of these divisions.
    1.  Changes in the grey substance.—In the most acute cases the
 surface of the cortical portion presents,  on the removal of  the mem>
 branes, a most  intense  redness, approaching  to  that  of erysipelas.
 This is still more marked in the substance of the grey matter itself;
 it is more striking in the frontal region than on the temporal lobes,
 and in the higher regions than in the posterior parts of the  brain. In
 brief terms the morbid  changes observed  by M.  Foville in acute
 cases of madness are nearly confined to the following : " Red colour,
 uniform and very intense ; numerous mottled spots, varying from a
 bright to a violet red, bloody points, minute extravasations  of blood ;
 diminished  consistence  in  the  thickness  of the  cortical substance,
 coincident mostly with a slight increase  of consistence in its surface ;
 dilatation of the vessels, resistance of their parietes."  In acute cases
 M. Foville  has never observed adhesions of  the membranes to  the
 cortical  substance.  Such  adhesions are  very frequent in chronic
 cases, and hence, as he conjectures,  may be explained the curable na-
 ture of recent   maniacal  affections,  and  the hopeless and  incurable
 state of those patients who have long laboured under madness or de-
 mentia.
   Among the  chronic changes of the cortical substance, the most
 frequent is a very perceptible increase of firmness and density in the
 superficial part, extending to  no great depth, but uniform, constitut-

  *  M. Foville's original and highly interesting Researches into the Structure
 of the Brain were presented to the  Academy of Sciences in March, 1828.  They
 were consigned in an unpublished memoir, of which Dr. Hodgkin has given a
most valuable extract in his Catalogue for the anatomical museum of Guy's  Hos-
pital.  M. Foville's observations on the mordid changes connected with insanity
are to be found in his article Folie,  contributed to  the " Dictionnaire de Medecine
Pratique et de Chirurgie."
                                15* 
166
NECROSCOPICAL RESEARCHES
ing a distinct lamina, smooth externally, but internally irregular, of
lighter colour than usual, which, when torn off, leaves the remainder
of the cortical  substance  red, soft, and mammillated, somewhat re-
sembling granulations.  Something like this external pseudo-mem-
brane  of  the cortical  substance  has  been noticed in wild  animals
which have  died in  a state of confinement, by M.  Foville, and is
conjectured by him to denote a cerebral disease in them.  The pale
and almost bleached hue of the  surface  of the cortical  portion is al-
ways connected with this increased density in its substance.   Some-
times the surface is rough and granulated, containing small grains of
a yellowish white.
   In conjunction with these changes  the volume of the convolutions
remains natural, or is less than usual.   When it is lessened, there are
sometimes linear depressions or  irregular  pittings on the surface of
the convolutions, and  in the cortical  substance itself there are small
yellowish lacunae filled with a serosity of the same tinge.   These
lacunae are  supposed to correspond with the minute extravasations
observed in  acute cases.  In other instances, the diminution of vo-
lume is a real  atrophy of the convolutions, which appear thin and
 angular, as if  pinched up towards their extremities.   This morbid
 change corresponds  with  what MM.  Gall and  Desmoulins have
 termed  atrophy of the  convolutions.  It is very frequent in the
 frontal regions of the hemispheres.  It often comprises particularly
 three or four convolutions on each side of the sagittal suture, a chasm
 filled with  serosity occupying the place  left by absorption of the
 cerebral substance.   Coexistent with this  appearance is that species
 of atrophy in   the cranium  in which the diploe  disappears, and the
 external lamina approaches the internal, leaving a superficial depres-
 sion on the  head.  In these cases of atrophy of the convolutions, the
 diminution of substance is confined frequently to the cortical or grey
 matter. What remains of the cortical substance is harder than natural,
 and sometimes presents, when  carefully examined, a really fibrous
 structure ;  it is of darker colour, or seems to separate  into layers, of
 which the exterior is pale and the interior of a rose colour.
    Another  state of the cortical  substance observed  in chronic oases
 of  madness is  that of ramollissement ; this is entirely distinct from
 the softened state of  the external  portion  already described.   The
 whole thickness of the grey substance is  equally altered  in  these
 cates ; its colour is  more  brown  than  usual;. its consistence almost
 iiquefied.
    This extreme and general softness of the cortical substance  does
 not necessiirily accompany a similar state in the white substance ;  it
 is spmetimes conjoined with a hardened state of the medullary por-
 tion.  In such instances the grey may be separated from the  white
 matter by pouring water upon it.  Appearances of this kind seem to
 belong to, cases of the last degree of dementia, with general paralysis
 and merasmus.  M.  Foville mentions cases apparently of the same
 nature, in. which limited portions of the grey substance had disap-
 peared previously to, death.  M. Calmeil, in his work  on the paraly- 
OF M. FOVILLE.
167
sis connected with insanity, had related two instances  of a similar
description.
  It seems that the grey substance in other parts of the brain is  not
subject to a similar change ; its morbid alterations coincide  with
those of the medullary portion.  From this remark must be excepted
the cortical substance of the cornu ammonis, which is sometimes soft-
ened, and at others of a scirrhous hardness.
  2. Morbid changes of the white substance.—Morbid  alterations
of the white or fibrous substance in deranged persons are in relation
to its colour, its density, and its texture.
   The white substance is often the seat of vascular injections; some-
times vessels of a certain size  being affected,  the appearance of
bloody points is produced on the section of the white substance.  In
other instances a finer injection gives rise to a mottled appearance of
a deep red or violet colour.   A magnifying glass is required in order
to discover the vascular injection which produces this appearance.
These injections of the white fibrous substance do not always coincide
with similar injections of the surrounding cortical  substance.
   It is not rare to find in lunatics the fibrous substance  of a splendid
white; this particular aspect generally corresponds with an increased
density of  the parts.   The  hardness of such parts of the brain is
sometimes almost fibro-cartilaginous.  The induration of the medul-
lary substance is, however, not always connected with this remark-
able whiteness ;  sometimes the hardened medullary substance has  a
yellow tinge or a grey leaden colour.   M. Foville attempts to
account for this hardening of the fibrous portion of the brain by the
supposition that  each cerebral  fibre has contracted morbid adhesions
with the surrounding fibres, so as to render their separation impos-
sible.  This opinion  is  offered as more  than conjectural with respect
to  the different planes of medullary substance, of which  it is consi-
 dered as proved  that the white substance of the brain consists.   The
 fibrous mass  of  the  hemispheres results, according to this writer,
 from the super-position of several distinct layers or planes, applied
 one upon the other, and  connected  by means of a very fine cellular
 tissue.   These planes are easily separable  in the healthy  state, but
 in the state of maniacal induration they are inseparable.
   Among  lunatics affected  with general paralysis, M. Foville has
 found these adhesions wanting in only two cases ; and in these two
 instances  the  cerebral  nerves, the annular protuberance, and  the
 medulla  oblongata  presented an  extreme hardness.   The  same
 alteration has been found in the brains of old men whose voluntary
 movements have become uncertain or vacillating ; it has never been
 seen in lunatics whose  muscular powers had remained unimpaired.
   The  brains of some  lunatics are so full of serous fluids, that an
 abundant serosity flows from the surface of incisions ; sometimes
 this serous infiltration is so abundant as to  deserve the name of
 cerebral  cedema.  A  change more rare,  which M.  Esquirol has
 remarked, was  the  presence  in the  brain of a  multitude of small
 cavities, from the size of a millet-seed  to that of a  nut, containing a 
16S
NECROSCOPICAL RESEARCHES
 limpid fluid.  The section of a brain  thus changed is  compared  to
 that of a porous cheese.  The cavities are supposed to be the sequelae
 of extravasations.
   The changes  in  the structure of the cerebellum are  analagous  in
 kind to those of the cerebrum, but much more rare.
   Tubercles and other tumours in the brain are considered by M.
 Foville as accidental in their connexion with insanity.
   3. Morbid changes in the nerves.—M. Foville is persuaded that
 he has traced morbid alterations in the nerves corresponding with
 peculiar phenomena of sensation.  In a female lunatie, tormented by
 hallucinations of sight, the optic nerves were  found  hard and semi-
 transparent through a great part of their thickness.
   4. Morbid changes in the membranes.—In acute cases, the only
 morbid appearance discovered in the meninges is for the most part
 injection of the pia mater.   This injection is generally proportioned
 to the degree of inflammation in the cortical substance of the convo-
 lutions.  The small arteries and veins, passing from the membrane
 and  penetrating the grey matter, are seen distended with florid or
 black blood : the arachnoid  in  the mean time preserves its natural
 aspect.
   The chronic  changes in the membranes consist for the most part
 in opacity, increased  consistence, thickness  of  the  arachnoid, the
 formation of granulations and pseudo-membranes on its surface, and
 the effusions of serosity into  the cellular tissue of the pia mater and
 the ventricles.
   The arachnoid membrane displays either extensively or in patehes
 a pearly whiteness.  The opacity never exists without  thickening;
 and in those places where the arachnoid and pia mater are naturally
 contiguous, they are found to be adherent.   These opaque patches,
 as M. Foville supposes, result  from  the  deposition  of albuminous
 layers upon the arachnoid.
  The observations of the same writer on the peculiarities observed
 in the skulls of lunatics add little to our previous knowledge  on this
 subject; and his remarks on the conformation and  texture of the
 brain in cases of idiotism do not necessarily belong to the inquiry in
 which  we  are  now engaged.   I shall conclude this  abstract of his
observations by briefly citing his general inferences.
  " The morbid changes which  we have surveyed present many of
the anatomical characters of inflammation ;  intense, general, diffused
 redness; in many  cases tumefaction ;  and  lastly, in  passing to the
 chronic state, the formation of adhesions between the  cortical sub-
stance  of the convolutions and  the contiguous membrane ;  besides
this, adhesion of the different planes or layers of the cerebral sub-
stance to each other in a certain number of cases.
  " If the simple redness, the perceptible tumefaction—if the general
and partial  softenings, the increased resistance which we have noted
in acute cases,  left any doubt  of the  true  nature  of  the organic
disorder, the adhesions observed so often  in  chronic cases certainly
admit of none ; and we are  forced to allow  that there exists in the 
OF M. FOVILLE.                     169
 brains of lunatics  a state of true  inflammation, unless we cease  to
 regard adhesions observed in other parts as undoubted traces of such
 a state, and refuse to admit that adhesions of the pleura, peritoneum,
 and pericardium afford evidence of the former existence of pleuritis,
 peritonitis and pericarditis.
   " As the different traces of inflammation are  more constant in the
 brain  than  in the membranes, it is  necessary to conclude that the
 essential change has taken place in  the brain,  and that the change
 produced in  the membranes is  only accidentally complicated with
 it."   In  his  remarks on this subject M. Foville  plainly means  to
 express his dissent from the  opinions maintained by M. Bayle, who,
 in his treatise on affections of the brain, attributes insanity to disease
 of the membranes.
   Among the morbid appearances of the  brain, the varied changes
 of  the cortical substance are the most constant in connexion with
 symptoms of mental derangement.  Although M. Calmiel maintained
 a different opinion, and was  inclined  to ascribe paralysis or the loss
 of  muscular power to disease of the cortical substance, the facts on
 which he  founded  this inference  do  not, as M. Foville  contends,
 warrant such  a conclusion.   In all  instances of the  general paralysis
 of  lunatics which he has examined by dissection, there was, besides
 the change  in the  cortical substance, some alteration, either harden-
 ing, serous  infiltration, or softening of the white substance ; and  in
 most cases,  in addition to these appearances, there were adhesions  of
 the principal planes of the cerebral substance to each other. A very
 remarkable case which occurred  in the clinical course of M. Esquirol
 in 1823, affords strong evidence  in favour of M. Foville's argument.
 The  cerebrum  of  an idiot  displayed the grey substance of both
 hemispheres in  the last stage of atrophy and disorganization, while
 the white portion of the brain remained  perfect on one side.  In
 this person  the  intellect  had  been entirely  defective,  but the
 muscular power on  one side  only had failed.  From this and similar
 observations M. Foville concludes that the function of the cineritious
 portion of the brain  is essentially connected with the intellectual
 operations, and  that of the fibrous or white structure with muscular
 action.   His two principal inferences are expressed in the following
 terms:
  1st, Morbid changes in the cortical substance are directly con-
 nected with intellectual derangement.
  2d,  Morbid changes in the white substance are directly  connected
 with disorders in the motive powers.
  It has been further remarked by  M. Foville, that in some  affec-
 tions of the maniacal  class, succeeding the action of debilitating
 causes, as in the puerperal state,  nothing has been discovered in the
 brain more striking than  its  extreme and general paleness, and that,
although there are in these instances some mottled appearances of a
light  red or rose colour in the cortical substance,  such changes are
too  slight to be considered as idiopathic.  The same writer adds that
in the small number of cases  of this description  which he has had  an 
170
NECROSCOPICAL RESEARCHES
opportunity of examining, the disorder in the brain has appeared to
him to  be sympathetic and the result of some deeply seated disease
of the uterus or abdomen.
 Section II.—Of morbid Appearances in the thoracic Viscera.

  1. Lungs.—It is commonly imagined that madness is much more
nearly related to diseases of the abdominal viscera than to those of
the thoracic ; but this opinion  is scarcely borne out by  necroscopy.
M.  Esquirol found in 168 melancholic lunatics only two,instances of
disease in the liver, while in the same  number there were 65 cases
of disease in the lungs.   The same writer has computed that, in two
cases out of eight, mental derangement  is accompanied with disease
in the  thoracic  viscera ; and M. Georget declares that he has found
in more than three-fourths of the bodies of insane persons examined
by  him, organic affections of the lungs,  such as chronic pnueumonia,
suppuration, or a tuberculated state.  The same writer,  in his work
on  insanity, reports that phthisis  is the  cause of death in more than
half the lunatics  of the Salpetriere.  The disease, he says, is never
acute, and it is often so  obscure that it is not discovered until the body
is opened.   In such instances there exists not the slightest indicative
sign of pulmonary irritation :  the patient neither coughs nor spits,
and he makes no  complaint; he  wastes,  gets weak ;  looseness or
constipation succeed : he dies :  these changes take place slowly. The
most remarkable fact is, that, although no expectoration is perceived,
cavernous excavations are found in the lungs after death.*
  2. Disorders  of the heart.—Disorders of the heart have  fre-
quently been discovered on  examining the bodies of lunatics ; it has
not been supposed that such phenomena are connected with madness.
Such facts were generally looked upon as accidental coincidents until
a contrary opinion was maintained by Nasse, in his " Zeitschrift fur
psychischen aertze."t  This writer, in support of his opinion  that
disorders of the heart exercise  a morbid influence on  the cerebral
functions, has cited the  following case.  An individual, with a pulse
of  forty  strokes  in a minute,  had scarcely any appearance of  life.
When his pulse rose  to fifty, he is said to have been melancholic ;
when  to seventy he was perfectly rational  ; and with eighty pulsa-
tions he became maniacal.  Nasse has also  referred to dissections
made by Dr. Romberg of Berlin, who, in five out  of seven bodies
examined by him, found softening of the heart, and in  one a com-
plete atrophy of  the  aortic ventricle.  The same writer has main-
tained that insanity results in  some instances  from inflammation of
the heart; and he brings forward in proof  of this assertion observa-
tions made by some  anatomists, who have discovered  in  cases of
madness traces of such disorder in that  organ, while  no morbid

        * De la Folie, par Dr. Georget, p. 474.
        f Zeitchrift, ann. 1818.  Guislin sur 1'Alienation, p. 7. 
IN THE ABDOMINAL VISCERA.
171
appearances have  been found by  them within the  cranium.   He
likewise mentions the case of a  young  man who during  six years
laboured under the signs of disease in the heart, and at the end of that
period became affected with melancholia.*
  The fact last mentioned admits of a different explanation.   Hy-
pochondriasis or nervous excitement often produces disorder in the
function  of the heart which is  mistaken for  organic disease ; and
such a state is in frequent instances a prelude to insanity as well as to
other affections of the nervous system. I have observed two strongly-
marked cases of hypochondriasis  accompanied and  chiefly marked
by disordered function  of the heart.  They occurred in young men
who had grown rapidly.  In both  auscultation gave evidence of dis-
ease :  there was the " bruit de soufflet," with too strong impulse, and
the sound accompanying contraction of  the cavities was heard  over
the whole  chest.   Both these individuals were supposed  by myself
and others to labour under hypertrophy.  Mania in both supervened
on hypochondriasis,  and the symptoms of disease in the heart in a
great measure disappeared.
   According to the observations of M.  Foville, diseases of the heart
must be considered as very frequent attendants  on  insanity.   That
accurate anatomist has stated that in  the bodies of lunatics examined
by him after death during three  years, five out of six  displayed 6ome
organic affection of the heart or  of the  great vessels.  He adds that
this was frequently hypertrophy of the heart.
   If it should be  established as the result of general observation that
organic affections of the heart are coincident with insanity in a pro-
portion of cases nearly  as great as the fact just  mentioned would lead
us to suppose,  it could no longer be doubtful  that some  connection
subsists  between  these disorders.   This connection may be either
that of cause or  effect.  M. Foville supposes that disorders  of the
 heart, when complicated with mental  derangement, are  more fre-
quently  the results of continued agitation and of the violent efforts
 and cries,  which  in  lunatics appear likely to  bring  on  disorders of
 the thoracic viscera, than predisposing causes  of insanity.  Perhaps
 this is the most probable conclusion.  It is the inference which par-
 ticular facts and the succession of symptoms have led me to adopt in
 those cases which have fallen under  my own observation, displaying
 morbid states of the heart in connexion with mental  derangement.


 Section III.—Of diseases  in the Abdomen  discovered in cases of
                            Insanity.

   Vestiges of diseases in the abdominal viscera have  often been found
 in the bodies of  lunatics.  Perhaps  the most frequent morbid phe-
 nomena discovered in  the abdomen, in individuals who have died
 insane, is  the appearance of  inflammation in the mucous membrane

       *  Nasse, Archiv. fur Med. erfahr, 1817.  Guislain, Alienation, t. i 
172
NECROSCOPIC RESEARCHES
of the alimentary canal.   It has been reported by M. Scipion Pinel
that in 269 bodies of lunatics examined, gastro-enteric inflammation,
or phlegmasia of the mucous membrane lining the intestinal tube,
was discovered in 51.  Among these 269 cases there were only 13
of organic disease of the abdominal viscera.   M.  Guislain has cited
some cases from Prost in which the gastro-enteric inflammation above
mentioned was strongly marked.   Such an appearance, according to
that writer, has been many times observed, and is  a frequent accom-
paniment of insanity.
  A singular displacement of the  transverse  colon  is  one of  the
most  remarkable changes yet observed in the abdomen  in  cases of
insanit}'.   This was first pointed out in a  distinct  and particular
manner by M. Esquirol, who discovered the fact in  several instances.*
One of them was the case of the  famous Teroigne de Mericourt
a female  who  performed  a celebrated part in the tragedy of the
French revolution.  This woman,  after exciting.the populace  and
occasioning disturbances, became insane on the suppression of popular
ferment by the Directory.   She was sent to the Salpetriere  in 1810,
in a state  of agitation, raving about " liberty, the public safety, and
committees."   She died, and among other morbid phenomena  dis-
covered in her body, the transverse  colon was found "perpendicu-
larly precipitated" behind the pubis.
  This perpendicular position of the transverse  colon, descending
into  the pelvis behind the os pubis, has been  minutely described by
M. Esquirol in several other cases ; and he affirms that it was found
in not less than  33 out of 168 bodies of individuals who had laboured
under  melancholia.  It does not appear to have been the immediate
cause of death in these instances.  The colon  itself was healthy in all
the cases alluded to.  This appearance has not been satisfactorily  ex-
plained.   It is attributed  by M. Esquirol to augmented weight either
from increased density, or from repletion of the colon acting mechani-
cally.   M. Georget thought it was owing  to  a relaxed  state of  the
peritoneal folds which support the intestines in  their position.!
  Nasse's Zeitschrift  contains dissections of thirteen bodies of luna-
tics by Bergman, in which very considerable contractions were found
in the colon.   In some of these the colon was contracted to a very
small calibre through a great part of  its length ; in others it was in
parts contracted and dilated  ; in some it was likewise displaced nearly
in the manner described by  M. Esquirol.   In combination with  this
state of the colon, Bergman found the following morbid phenomena:
—plethora of the abdomen and the encephalon ; hemorrhoidal disease;
tumefaction of the spleen, liver, and uterus ;  distention of vessels in
the brain.  The symptoms during life were in these instances pecu-
liar, viz., hardness and tumefaction, and tenderness of the abdomen ;
slow and difficult progression in a bent forward position ; anxiety in
the praecordia ; obstinate constipation with vomiting ; coldness and a

  * Journal General de Medicine, 1818.  Guislain, de 1'Alienation, t. i. p.  10*.
  f Georget, art. Folie, in Diet, de Med. 
IN THE ABDOMINAL VISCERA.
173
 blue colour of the skin ; trembling and agitation ; convulsion* rigor,
 diarrhoea, ushering in the final catastrophe.  The mental phenomena
 in such  instances are chimerical ideas ; the patient  thinks he has
 frogs or serpents in his bowels ; mania and dementia ensue.  To these
 cases of Bergman's, M. Guislain has added others of a similar, de-
 scription from Hufeland's Journal, and from the report of Dr. Muller
 of Wurtzburg.
   ^ M. Guislain attempts to account for the contraction as well as the
 displacement of the colon in these instances, by attributing them to
 inflammation.  This solution cannot be admitted in the instances of
 the displacement observed by M. Esquirol, because the intestine is
 expressly affirmed by that writer  to  have  been  in a  healthy  state.
 The contraction  of  the canal, however, may be well imagined to re-
 sult from a  chronic inflammation between the planes of fibres which
 form the muscular coat  of the intestine, comparable, as M. Guislain
 contends, to the  chronic phlegmasia which in rheumatism brings on
 gradually a disorganization and contraction with wasting of the  mus-
 cles of the  limbs.
  ^ The question,  which is the primary disease in cases displaying mor-
 bid phenomena in the abdomen  in connexion with insanity, without
 excluding the usual vestiges of mental derangement as discovered in
 the encephalon, belongs to a later department of this inquiry : in the
 present I am chiefly intent upon a collection of facts.  It must be
 stated, however,  that insanity, in most of the instances now cited, in
 which disease was traced in the abdominal viscera, had been apparent-
 ly the result of moral causes, agencies which exert their influence in
 the first instance  on the brain and nervous system.   This  must be
 concluded to be the fact in nostalgia, of which several instances  with
 dissections  have  been  reported by  Larrey, Laugier,  Devaux, and
 Guislain.   Although the causes of the malady were mental emotions,
 different phenomena, indicative  of disease in various  tissues, were
 found after  death, and among the  most prominent of these was in-
 flammation  of the mucous coat of the stomach or intestines.
   Medical writers formerly attached great importance to the liverin
 disorders affecting the mind ; later researches have by no means con-
 firmed this prejudice.  Esquirol  found only two instances of diseased
 liver in 168 melancholies, while in the same number there were sixty-
 five morbid  changes  of the  lungs.  In sixty cases of dementia, there
 were only two diseases of the liver ;  and Scipion Pinel reports only
 five organic lesions of that organ in 259 cases of insanity, accompa-
 nied with alterations of structure in various parts.*
   Notwithstanding the infrequency  of connexion between  organic
 disorders of the liver and insanity, there are yet facts on record which
seem to prove that disease originating in  the liver has given rise to
mental derangement.  One strongly marked instance of this kind has
been recorded by  M. Scipion Pinel.  A man received a violent blow
on the  right hyppchondre, which was followed by loss of sense,

                         * Guislain, p. 138.
  May, 1837.                16 
174                     PATHOLOGY OF
vomitino-, and afterwards by all the signs of hepatitis, jaundice, severe
inflammatory symptoms, &c.   The disorder terminated in melancho-
lia and death.  The brain was found in a natural state ;  the liver
greatly diseased.
  The rare  occurrence of organic diseases of the liver  in cases  of
mental derangement is  no proof, as M. Guislain  has remarked, that
pathologists have been always in  error when they have conjectured
or inferred, from circumstances, that the functions of the same organ
have been in a disordered state, and even that such disorder has had
a considerable share in evolving the train of morbid phenomena which
refer to the mind.
                        CHAPTER  VI.

     THEORY OR PATHOLOGY OF MENTAL DERANGEMENT.

Section I—General Remarks  on Opinions maintained by dif-
  ferent Writers: Opinions of Heinroth and others, that Insani-
  ty is a Disease of the Mind properly so termed.

  From noticing the changes of structure found in the bodies of per-
sons who have died insane, the usual progress of investigation would
lead us, considering  these changes as causes of  the symptoms which
had been observed during life, to inquire in what  manner the symp-
toms may have resulted from the morbid states discovered.  But here
we are stopped by  an obstacle arising out of the  nature of the sub-
ject.  In other instances of disease, as in affections of the heart and
lungs, a discovery of morbid changes often accounts for the impedi-
ments which had arisen to the healthy function of organs of which
the operation is to a certain extent understood.   It is not  thus with
respect to disorders in  the brain giving occasion  to derangement of
the mind.  As we know not by the aid of what organic processes the
mental  faculties  are exercised, we are  at  a  loss  to discover a con-
nexion between  defects in  the structures to the instrumental opera.
tions of which they are referred, and the disorders recognized in the
exercise of these faculties.  And here, if we follow a cautious method
of inquiry, doubts interpose themselves, whether the phenomena of
insanity are really the results of changes discovered  in  the  brain.
May it not be supposed that these changes are  the effects of mental
disorders rather than their cause?   In this latter  point of view the
subject has been considered by several practical writers, as by Crich-
ton, Cox, and Arnold, who  have observed that hardenings of the
brain,  adhesions, opacities of  membranes, and  other phenomena  of
disorganization, have been  discovered  chiefly  and  almost solely  in
protracted cases of  insanity, and have been wanting in recent exam-
ples of the disease, that is, the bodies of those who have died  during
its early stage.   The inference to which these considerations have led 
MENTAL DERANGEMENT.
175
is, that such morbid appearances have been effects produced by long-
continued derangement of the mind on the state of the brain, and that
the real proximate cause of insanity, or the condition from which its
characteristic phenomena in the first place arise, may be some, devia-
tion from the healthy state of a very different kind from that which
anatomy displays.
  In this point of view the morbid  appearances connected with in-
sanity have been contemplated  by one class of writers, who admit
this disease to be essentially an affection of the organized body, but
deny that conclusive evidence has been  furnished of the fact that its-
principal seat is in the brain.   Others, also, avail themselves of the
same argument, who maintain that madness is a disease of the mind
in the strict sense of  that expression.  This last opinion, although  it
has been abandoned by most enlightened physicians in England,  is
still prevalent among the  public,  as we  know from the frequent in-
quiry, whether such or such an example  of insanity is the result of
bodily disease or an  affection of the mind itself.   The same notion
has found strenuous  advocates  in Germany, even among  celebrated
writers ; and the arguments adduced by them in its support, although
inconclusive, are not without some appearance of reason.
   These writers insist strongly upon the  evidence  which they de-
duce from the want of any peculiar and distinctive phenomena mani-
fested by anatomy as uniformly connected with insanity.   They as-
sert, and adduce many authorities to support the  observation, that
instances of this disease have occurred  in which  no disorganization
has been discoverable in  the  brain  or in any other structure of the
body.  They remark that many lunatics have the external appear-
ances of health, that they live  for many years with their bodily
vigour slightly  or in no degree impaired, while their minds are in a
state of the utmost disorder.
   " The causes," as they further remark, " which are chiefly pro-
 ductive of madness are circumstances which influence the mind.
 Violent passions, anxieties, grief, joy, the cares of life,  are the princi-
 pal causes of insanity.
   " Insanity is cured by moral treatment, or by remedial means suited
 to a disease of  the mind, often without any measures  adapted to the
 removal of physical or bodily disorder.
   " The predisponent  causes of insanity are, in many instances at
 least, moral or mental  influences.  Faulty  education, an  habitual
 want of self-control, a fickle over-sensitive  character unaccustomed
 to and incapable of steady pursuits, the dominion  of passions, vices
 of various kinds, are  among the  circumstances which experience
 every  day proves to be  most influential  in  laying a  preparation  for
 this disease."   Professor Heinroth, who carries to the utmost this
 line of argument, insists on the assertion that moral depravity is  the
 essential cause of madness.*   According to  him,  sin and guilt, evil

   * " Aus der schuld entspringen alle seine uebel, auch die stoerungeft des seel-
 enlebens."—HeinrotWi Steknstoerungen, torn. i. \ 179. 
176
PATHOLOGY OF MADNESS.
    conscience,  is  the real origin of  mental derangement.  Violent
    passions, sinful indulgences, want of mental discipline, give  a pre-
    ponderance to all the evil tendencies of our nature, and render them
    so impetuous as to destroy all power of restraint.   In the total loss
    of restraint, even over the actions of the mind itself, consists that
    subversion of the understanding which, according to Professor Hein-
    roth, constitutes insanity.*
      This doctrine has been supported  by the author with  a most im-
    posing array  of arguments  and  learned researches.   The  whole
    theory and the grounds on which  it rests have been examined by
    Dr. Jacobi in his last work, entitled " Beobachtungen iiber die Patho-
    Iogie  und Therapie der mit Irreseyn  verbundenen Krankheiten,"
    in which the reason for entering so  fully into the discussion of this
    singular hypothesis,is alleged to he  the influence which it has exer-
    cised over the public  opinion in Germany.t  In referring to Hein-
    roth's dogma, that insanity  is the result of moral depravity, Jacobi
    has taken occasion to record the case of one individual, selected from
    many others, whose history affords sufficient proof that mental de-
    rangement is a calamity that  may befal the most pious and excellent
    persons.  Absurd as the opinion  of Heinroth  will appear to most
    English  readers, and superfluous as it may  be to enter seriously into
    a refutation of it, I shall yet insert Jacobi's account of this case, which,
    as related by the author, is not without interest.
     "  The wife of John Caspar Lavater, of  Zurich, was  a  person re-
    garded, by all  who knew her, with respect and love.   Her mind
    was  endowed with the highest  principles, sensible  and intelligent;
    her  disposition was cheerful, pious, and  benevolent.   She had been
    tried and proved by misfortunes  and  sorrows,  was the  friend, the
    counsellor, and  the comforter of many.   She was induced, by the
    sole  desire of doing good to her suffering fellow-creatures, to under-
    take the  chief care of several  insane persons.   It pleased Divine
    Providence  that, in an advanced period  of her life, this excellent
   person should herself become insane, and continue for a long time to
   be a  victim  to the deepest melancholy.   Towards the close  of her
   life she recovered from the disease, and her friends had the gratifica-
   tion  of knowing that the  last few months of her existence were passed
   in a state of mind resembling that  of her earlier days, and in  that
   state she died.   Now let  Professor Heinroth direct his attention to
   the character of this excellent individual, and from the point of view
   which he assumes, explain how the state of mental darkness to which
   she was reduced can be regarded as the result of guilt  and evil con-
   science, connected as it was with long-continued  ill-health, and in all
    }>robability depending on  a  chronic bodily  disease under which she
    lad for a long time laboured."

    * Heinroth's doctrine is. set forth in the first part of his " Lehrbuch der Stoer-
N ungen des Seelenlebens," and it is maintained in the annotations subjoined by
  the same writer to Hill's German translation of M. Esquirol's treatises.
    f Heinroth's doctrine has likewise been criticised by M. Guislain, in the work
  which  I have repeatedly cited, on mental alienation. 
OPINIONS OF MM. GEORGET AND FOVILLE.       177
   It would be no difficult task to multiply instances of a similar de-
 scription, but it is scarcely necessary to contend seriously against the
 docrine of Professor  Heinroth.   Yet  it cannot be denied that this
 opinion has, in a limited view, some foundation in truth.   Vices, in-
 ordinate passions, and the  want of mental discipline tend in two ways
 to increase the prevalence of insanity.   In the first place, vicious in-
 dulgences, intemperance, and other depraved  habits have an imme*
 diate tendency to  bring on diseases of the brain and nervous system of
 that kind of which madness is a result or manifestation ; secondly,
 irregular mental excitement produces a state of the moral constitution
 which renders the mind more  subject to perturbations, violent pas-
 sions and agitations, and these are known  to be frequent precursors
 and causes of derangement.  In the former instance, the injurious in-
 fluences above mentioned come under the head of physical agents ; in
 the latter they must be referred to that of the moral causes of insanr-
 ty.   Minds well disciplined by self-control, and brought by habit to
 a sedate  and  moderated state  of feeling,  are protected against the
 eauses of violent emotion and distraction, which in persons of differ-
 ent habits of mind and conduct tend to increase the natural excitabi-
 lity of the moral constitution,  and break down the feeble  powers of
 the understanding.  This  line  of observation can,  however, only be
 carried to a certain extent.  A great proportion of the cases of insanity
 which occur arise from causes independent of any moral weakness or
 defect.
   Several writers have entered at large into the discussion, whether
 insanity is a disease of the mind or of  the organic structure of the
 body.  MM. Franck, Nasse, and Guislain have brought forward  a
 variety of arguments in defence of the latter opinion.  They conclude
 that this disease has its seat in the  organized body,,and that it con-
 sists sometimes in a modification  of the vital properties or  functions,
 and sometimes in an alteration  of the tissues or textures themselves.*
 I shall have occasion hereafter to  add some  further remarks upon this
 subject.
   If we consider the fact  to be  admitted, that insanity is always  a
 disease of the body, an  affection of the organized  structure or the
 functions of organized parts, we shall still find it necessary to advert
 to some contradictory opinions as to its nature and particular seat.


 Section  II.—Of the  Opinions of MM. Georget,  Foville,  and
   others., that Insanity is an  idiopathic Disease of the Brain.,

   Many writers of celebrity, both  in Britain and on the continent,
have regarded madness as an idiopathic  disease of the brain.   Of this
opinion are Cullen,  Cox,  Haslam, Foville, and many others.  M.
Georget  is perhaps the most decided and unconditional advocate for
 his doctrine.

  * See Nasse, Zeitschrift, 1824. Guislain de 1'Alienation, torn. i.,p. 3L40.
                              16* 
178
PATHOLOGY OF MADNESS.
  He says, " Insanity is a disease of the brain ;  it is idiopathic ; the
nature of the organic alteration is unknown.
  " The first proposition results from the following considerations.
  " l. The essential symptom, intellectual disturbance, depends upon
a lesion of the cerebral functions.
  " 2. It is always preceded, accompanied, or followed by other im-
portant  cerebral or nervous disorders.
  " 3.  The disturbances of the  other functions are neither constant
nor severe : they are, besides, precisely similar to  those  which ac-
company  any sudden lesion of an important organ : such are loss of
appetite, irregularity of bowels, suppression of catamenia, &c. : they
are transient, subside after the period of excitement has passed, and
leave the essential symptoms yet subsisting.
  " 4.  The causes are  such agents  as are known to act directly on
the brain and nervous system.
  " 5.  The natural terminations of insanity are permanent disease of
the brain."*
   The peculiarity of  M. Georget's  doctrine  respecting insanity is,
that he  considers all the disorders of physical functions and of parts
remote  from the brain as  only connected accidentally with the idio-
pathic cerebral  disease, or at least  as but its  consequences  ; while
other writers maintain that these disorders are of much greater im-
portance, that they lay  the foundation for mental derangement, that
the disturbance of the brain is merely sympathetic  or  secondary.
Some term the disorder manifested  in the state of the mental facul-
ties a symptom of the primary disease.  In this class of pathologists,
who, however, differ very much from each other in particular views,
we must reckon Pinel, Esquirol, and Broussais,t and their followers,
as well  as Nasse, Guislain, and Jacobi.

Section III.—Of the Opinion of Pinel, that the cerebral Disease
                         is sympathetic.

   It seems to have been the opinion of Pinel  that the primary seat
of disease in  cases of insanity is in the region of the stomach-and in-
testines :  thence, as from a centre, the disorder was supposed by him
to propagate itself, until, reaching the head, it  deranges  the under-
standing.   The meaning of this is not very obvious, but  it has been
exemplified  and illustrated  by the phenomena of some remarkable
cases, and particularly by facts recorded by Pinel himself.  The first
symptom of an attack of furious delirium, according to this writer, is
in some instances a strong sense of he.at in the abdomen :  the bowels
are confined, and the  patient^complains of thirst;  the sense of heat
ascends from the epigastrium to the neck and face : the countenance
reddens, the eyes become  sparkling, the features  are agitated, the
temples throb, arid the mind is excited into delirium or raving madness.

              *■ M. Georget, De la Folie, p. 74..
              t M.,Broussais, De Irritation et de la Folie. 
OPINIONS OF PINEL AND GUISLAIN.           179
  These observations lead us directly  to the opinion which was
admitted by Guislain, that the state of the brain on which madness
immediately depends, whether the causes have primarily affected that
organ or have reached it through the medinm of the viscera of physi-
cal life, is a kind of sanguineous orgasm or erethism, a sudden injec-
tion of  the cerebral  bloodvessels.   This is regarded as a temporary
condition.   Hence the remark of M. Pinel, that we can hardly ex-
pect to  discover the actual cause of this disease unless by examining
the heads of individuals who expire under the paroxysm of raving
madness.   But this opportunity, as he says, can seldom be obtained,
since lunatics sink under diseases of various kinds.
  This state of sanguineous orgasm is nearly allied, as Guislain re-
marks, to nervous excitement: it is  more transient than inflamma-
tion,  but  leads to it.*   Primary inflammation, as the  same writer
thinks, rarely subsists in insanity.  " When  I discover,"  he adds,
"in  cases of mental derangement resulting from the  influence of
moral causes, the symptoms or the traces of cerebral inflammation, I
am convinced that the causes have not operated immediately on the
vessels of the brain,  but that they have in the first instance acted on
the nerves,  whence this nervous modification, or if you prefer so to
term  it, this irritation has been communicated to the bloodvessels."
The brain is in a state of functional activity in the process of think-
ing, and it is in this action, when madness is excited by a moral cause,
that the disorder has  its sphere of existence:  the disturbance of the
circulation is only a  consequence, the result of a change more recon-
dite."  He continues, in opposition to the opinions of other writers,
to say, " I  consider insanity to be a disease which  has its seat in the
brain ; but when I place it in that organ, I refer to the disease itself,
and not to its cause.   It has been held  by some  that insanity may
have  its local seat in  the liver, in the heart, or in any other organ ;
but can it be said with  propriety that the seat of the disorder is in
such organs ? and is  it not rather the cause of the disorder which has
been  discovered in such various situations ?   To  be in a state of de-
rangement is to  have the understanding disturbed, and  no person
imagines the understanding to be seated in the breast or in the abdo-
men : the  viscera may, however, undergo  morbid changes which
react  upon the brain, and  give rise  to madness.   I therefore hold
that mental derangement is always a  disease  of the brain, but that in
many cases it has for its cause an  irregular condition of some other
organ, and  in such  instances the  disorder  is termed 'sympathic
insanity.'"
  Jacobi has. made objections to some of the positions maintained by
Guislain.t   When madness arises from moral causes, as from violent
passions, the first morbid action  is, according to his opinion, much
more frequently  seated in remote organs than in the  brain.  The
morbid changes in parts remote from the brain have been generally

          * Guislain, Traite de l'Alienation IVlentale, torn. i. liv. 2.
          ft Beobachtungen.:. driUer abschnitt. 
180
PATHOLOGY OF MADNESS.
looked upon as less essentially connected with: the disease than they
really are ; and, according to this writer, the only way of throwing
additional illustration on the causes and nature of insanity is to make
a diligent study of all the organic affections which accompany it, and
of which, in the view of Jacobi, insanity is merely a symptom. This
writer objects still  more strongly to the opinions of  Georget, who
regarded the concomitant diseases of the viscera as results of the dis-
order in the brain.   These writers,  MM. Georget and Jacobi, hold
the two extremes of opinion in respect to the nature of insanity. The
former  considered it as in every instance idiopathic  inflammation of
the brain : the latter views  the cerebral disorder as  the least essen-
tial in the train of morbid changes.   Madness, according to him, is,
to chronic diseases of the viscera, what delirium is to fevers, in which
the main object of attention is often a gastro-enterite or an inflamma-
tory disease of some organ in  the abdomen, or perhaps in the chest,
and in  which the delirium  is relieved only or chiefly by remedies
directed to the state of the parts  originally affected.

Section IV.—Inferences collected in relation to the Pathology*
                           of Madness.

   Such a review as I have now taken of the theories maintained by
medtcal writers as to the nature of insanity, and the relations which
the disordered states of different  organs bear to the derangement of
mind, seemed  requisite  in  order to illustrate the  present state of
opinions with respect to this disease. From considering the diversity
and contradictory tenor  of these speculations, we might be induced
to regard the subject as one beyond  the reach  of satisfactory elucida-
tion.   Yet the nature of  the inquiry is not such as to  lead us  to this
conclusion.   The writers who have treated on it have  perhaps failed
at arriving at certainty,  owing to the too discursive  way in which
they have entered upon  the investigation, and the too  general points
of view in which they have contemplated it.   By proceeding in a
more analytical way, or by beginning from particulars, we are more
likely to arrive at some  tolerably certain inferences, and at least to
perceive how far we can advance on sure ground, and what yet re-
mains in the region of conjecture.
   I shall remark in the first place, that in cases such as those described
by M.  Calmeil, in  which not only the brain and its investing mem-
branes  display after death the signs  of long-continued inflammation,
but affection  of the power of voluntary motion is combined with  the
disorder of intellect, and  is often either coincident with  it in origin or
shortly supervening on it, there arises from the alterations, observed,
and from a comparison of this with  other cerebral diseases, sufficient
reason  for concluding that the whole train of morbid phenomena de-
pends from its commencement to inflammation of the  parts in which
the appearances described are discovered.  We have no reason for
hesitation  in  setting down  cases of this description as instances of
chronic cerebral or meningeal inflammation. 
PROOFS OF CEREBRAL INFLAMMATION.          181
   When again, the intellectual faculties are affected in nearly a simi-
 lar manner and degree,  without disorder of the  motive powers, as
 in cases of mania or monomania complicated with  or  passing into
 dementia, or in examples of dementia occurring under other circum-
 stances, we have strong  reasons for presuming on the existence of a
 similar morbid state, since in these cases we find after death the results
 of long-continued inflammation in the encephalon, and because these
 cases bear a close analogy in many respects to those which belong to
 the class above described.
   There are many cases of madness in which the nature of the ex-
 citing causes, or the circumstances  preceding the appearance  of the
 disease,  when viewed in connection with its ultimate results, give no
 room for doubting that the whole disease from its commencement to
 its termination has been  of an inflammatory nature.  If we take, for
 example, an attack of mania,  supervening immediately on an  injury
 of the head, or  on exposure to a coup de soleil, or to excess in the
 use of stimuli, or a violent fit of  intoxication, which is known in
 other instances to induce phrenitis ; and if the individual is  found,
 after surviving a longer or shorter period, to display in his brain the
 phenomena before described,  nothing  seems to  be wanting  to  the
 chain of evidence supporting the conclusion.
   It  must be admitted that in the generality  of cases  of mania and
 monomania the existence of  inflammation is only a matter of pro-
 bable inference.  The arguments which present  themselves in sup-
 port of this inference may be summed up briefly under the following
 heads.
   1.  Analogy with cases in which  the  evidence  of such a diseased
 state  is stronger.   If such examples of mental derangement as those
 above described admit of a tolerably certain inference, it may  be ex-
 tended by analogy to other cases in which the morbid  phenomena are
 similiar,  though the causes and results of the disease may be*not so
 clearly marked.
   2.  The morbid changes found in  the encephalon, after the termin-
 ation of protracted cases, being such as  inflammation induces, afford
 an argument, which, when the subject is properly considered, cannot
 be set aside by any method of evasion.   On  this  subject I shall add
 nothing further to what has already been said.
   3.  The physical causes which excite madness bring us to the same
 conclusion. These are  principally of a description likely to give
 rise either to inflammation  in the  brain, or to a full and distended
 state in the vessels of that organ.  Exposure to severe heat or cold,
 insolation, concussion or  other injuries of the head, intoxication, and
 generally excess in the use of stimuli, are all of this class ;  the con-
 dition of the brain, which it is the tendency of these agents to pro-
mote, is either inflammation, or something bordering upon it.
   The metastatis of inflammatory diseases from  other parts  of  the
body, among which is included the recession of gouty or rheumatic
inflammation, or of cutaneous eruptions, is well known to  be followed
not unfrequently by the  appearance of maniacal  symptoms.   Sup- 
182
PATHOLOGY OF MADNESS.
pressions of catamenia and other discharges, giving rise to similar
diseases, strongly confirm the same pathological principles.
   This argument does not apply fully to cases of insanity induced
by moral causes.   But many of the moral causes of insanity are cir-
cumstances of excitement giving rise to excesses in the action of the
brain.
   4. The connection of insanity with other diseases known to de-
pend on cerebral congestion or inflammation, the mutual conversions
of such diseases  and of madness into  each other,  affords a strong
presumption that the immediate causes  on which they depend are
analogous.
   The instances  of mental disorder which leave  the greatest doubt
with respect to the presence of disease in the brain are those of moral
insanity, or disorder affecting merely the moral character, the  pro-
pensities, habits, temper, and feelings, without involving any notable
lesion of the understanding.   In such cases what  proof  have we that
the brain is disordered ? The complaint is often brought on by moral
 causes alone ; it  lasts for a time, and disappears  without  the aid of
 physical remedies, through the effect of time, and  by the influence of
 circumstances which act upon the mind alone.
   If we were assured that the brain is what some  German physicians
 term it, the  "seelenorgan" or instrument in all the manifestations
 of mind or the attributes of the soul, we might be at liberty to con-
 clude that disorders in the affections and feelings  imply, not less than
 intellectual  disturbances,  some disorder  in the brain.  But this pre-
 liminary step has not  been  gained.   However  probable it may be
 thought by some persons that the passions and propensities are seated
 in the brain, or that modifications which the mind undergoes in
 respect to these phenomena are connected with instrumental changes
 in the brain, the fact has never been proved.   Variations in the state
 of the temper and feelings are experienced in connexion with bodily
 disorders : the  fact is  one of daily observation.  Disorders of the
 alimentary canal,  dyspepsia with flatulence, a  torpid state of the ab-
 dominal  viscera with scanty and  unhealthy secretions, are accom-
 panied by lowness of spirits amounting often to despondency r this
 state  constitutes hypochondriasis. An opposite state of feelings, hope
 scarcely to be depressed, a  sanguine expectation of recovery, often
  with unusual vigour of intellect, prevail almost uniformly in the most
  severe diseases of the lungs. A highly sensitive state,, with excitement
  of the feelings,  in some cases, according to Nasse and others, accom-
  panied by an irascible  disposition  and even a proneness to commit
  acts  of violence, is attendant on diseases of the heart.  All medical
  practitioners are well aware that disorders of  the urinary system are
  connected with a peculiar anxiety of disposition, a restless and irri-
  table state.   Particular conditions  of  the  uterine or genital systems
  are likewise denoted by particular phenomena in the mind or dispo-
  sition.  In all  these instances are we authorised in assuming  that
  particular conditions of the brain are intermediately and  instrumen-
  tally co-operative, and interposing themselves between the disorder 
AFFECTING THE MORAL FEELINGS.
183
of the organ primarily affected,  and then the state of the mind or
temper which is traced as its manifestation or  accompaniment ?*
  But without  attempting  a solution of this general question of
physiology, we may collect some facts  which render it probable
that moral insanity depends, in some  instances at least, on disease of
the brain.
   1. The  characteristics  of moral insanity, obliquity of character,
perversion  of  the  natural  temper and   disposition  without  any
aberration of intellect, occasionally supervene on manifest  cerebral
disorders.
   2. Similar phenomena, with eccentricity of conduct and  habit,
belong sometimes  to individuals in  families  in which  intellectual
madness and other cerebral  diseases are hereditary.
   3. Some cases  of moral  insanity are  manifestly connected with
diseases  affecting the bodily constitution, and  particularly the brain.
Instances, for example, of homicidal propensity will  be  mentioned
in  a succeeding chapter, in which this connexion was so  manifest
that it could not be mistaken.
   Cases in which such a connexion is apparent and may be demon-
strated are probably by no  means the majority among the instances
 of disordered propensity, but from these we  may draw an inference
 by  analogy to the remainder,  and  this, I  apprehend, is all  the
 evidence that can be furnished of the existence of cerebral or other
 bodily disease in many examples of moral insanity.
   I shall close  these remarks on the proofs of cerebral inflammation
 in mental  derangement  with  one observation which  will  be  found
 important in a  practical point  of view.   If it were allowed that the
 proximate cause of this disease, or the state of the brain on which it
 depends in its origin or first accession, is not  proved to be,  generally
 speaking, of the  nature of inflammation, still we  know  sufficiently
 from  necroscopy that the  results of inflammatory action take  place
 in cases which have any considerable duration, and  that the disor-
 ganized state of the brain which renders recovery impossible, or
 generally precludes it  in the advanced stage, is  produced by inflam-
 mation.   We have, then, in practice nearly as strong inducement for
 treating the disease on  antiphlogistic principles as if we  were sure
 that cerebral inflammation, in the strict  sense of the terms, was its
 proximate cause.
    What has been  said in the preceding part of this section refers
 most obviously to those  cases of insanity which are produced by
 causes  acting  immediately on  the  brain, and exciting  idiopathic
 disorder  in that  organ.   I shall  now  make a few remarks  on  the
 instances of sympathic  or secondary affections of the  brain, which
 are manifested by derangement of the mind.
    It would appear, from  the  great proportion of  cases in  which
 disease of the thoracic or abdominal viscera are discovered  in  the

    * There seems to he a remarkable want of evidence in support of this opinion,
  which is often so confidently assumed. 
184
PATHOLOGY OF MADNESS.
 bodies of lunatics, that cases of the description last mentioned are
 much more  important by  their frequency  than it  is  commonly
 imagined.  Pinel seems to have referred nearly all cases of insanity
 to this class,  and Jocobi, though he has  stated his  opinion  in very
 different terms from those of Pinel, may be considered as an advocate
 for a similar doctrine.  I shall take the liberty of observing that a
 great part of  my work " On Diseases of the  Nervous System" was
 devoted to  the development of the history and relations of diseases
 of the brain, originating  from  primary disturbances in different
 parts of the system,  and giving rise  in some cases to maniacal, in
 others to convulsive  phenomena.  On the present  occasion I shall
 treat this subject very briefly.
   M. Scipion Pinel has reported in his Inaugural Dissertation some
 cases which clearly  prove the influence of the stomach  upon  the
 brain in producing  mental  alienation.   A young  man swallowed
 some cigars :  gastritis followed, which, after being relieved, became
 again severe : melancholia  ensued, which terminated  in suicide.
 A soldier in an ague swallowed  a glass of brandy containing gun-
 powder : the consequence was a  violent  attack of mania, which
 lasted for some  months.   The  same  writer declares that in  two
 hundred  and  fifty-nine necroscopical examinations which he  has
 either seen  or collected from the reports of MM. Esquirol, Louyer-
 Villermai, and others, there  were fifty-one cases  in which chronic
 inflammation  was  discoverable in the mucous membrane  of  the
 intestinal canal.
   It is not difficult to imagine that  similar states of disease  in  the
 alimentary canal should produce disturbance in the  brain,  when we
 observe  how much that organ is  liable to  be modified in its func-
 tions by slight causes acting through  the medium of the stomach.
 A full stomach promotes sleep;  various  substances taken into  the
 stomach occasion  sleep or  wakefulness ;  others intoxication and
 temporary madness.   On  this subject M. Guislain has  collected
 observations from various authors in the first volume of his valuable
 work on mental alienation.
   The theory of mental disorders arising from morbid states of other
 viscera  is more obscure than  what regards  the  stomach, because
 these instances are more removed from immediate observation and
 experiment; but that diseases of the  liver,  the  lungs, and  other
 viscera are connected  under a similar  relation  with affections of  the
 brain and consequent disturbances in  the  exercise of the mental
faculties, is a position  which scarcely admits of doubt.   In all these
 instances the morbid  state  of the  brain, which, though a secondary
or sympathic  affection, is the immediate cause of derangement  in
the mind, is probably of the  same nature  in itself as the morbid
condition which arises primarily from causes acting immediately on
the cerebral  and nervous system. 
TREATMENT OF INSANITY.               185
                       CHAPTER  VII.

                   TREATMENT OF INSANITY.

  It is usual to divide, under two heads, the various measures which
suggest themselves  to our consideration as likely to promote reco-
very from mental derangement.  The moral  treatment of the insane
comprehends all the means which are known to exercise immediately
on the mind an influence tending to restore the  healthy and natural
state of its  operations.   The medical  or  therapeutical  treatment
includes the use of remedies which act upon  the body and  are
designed to remove the disorder  of cerebral or other  functions,
known or believed  to be the cause of derangement in the mind, or
at least to  be intimately connected  with its manifestation.  As this
mode of arrangement is attended with some advantages, and as no
practical  objection  has arisen against it, I propose  to follow it in
considering  the various subjects  connected  with the treatment of
insanity.

       Section I.— Therapeutical Treatment of Insanity.

  The proximate or immediate cause of mental  derangement is so
much concealed from our research, the phenomena of the disease are
so complicated, and  the morbid states of the constitution with which
they are connected  so  various, that we might foresee no ordinary
difficulty in the attempt to lay down, with respect to  this disorder,
any general principles or indications of cure.   In reality this task has
been found  to be a  more arduous  one than even  the circumstances
adverted to would have  led us to anticipate ; and hence many writers
have given  it up, and  rest satisfied with  stating as merely experi-
mental results  the effects  which  particular remedies  have been
thought to  produce.  We are not driven, in my opinion, to  this
necessity.  The medical treatment of insanity may be referred  in a
great measure to two indications or principles, which in  many cases
may be followed  more or less fully, and will  at least serve the pur-
pose of associating in the mind the different curative attempts which
may be made with some hope of success.

                           article  i.

First practical indication in the medical treatment of insanity.
  The first indication is to remove or lessen  that  diseased condition
of the  brain on  which we have reason to believe that insanity depends
as its immediate cause.
  In the preceding  chapter on the theory of mental derangement, I
have collected various facts of which the consideration appears likely
to throw light on the nature of insanity, or rather on the physical
conditions of the system on which it depends.  I shall not recapitu-
  May, 1837.                 17 
186
TREATMENT OF  INSANITY.
late what has been said, but refer my readers to the arguments which
have appeared to establish the inference, that the state of the brain
immediately giving rise to the phenomena of  madness is in general
one of increased vascular excitement or fulness, a state which, if it
does not really constitute inflammation, is  at least closely bordering
upon that morbid condition, and liable to pass into it,—that from it,
in fact, all the usual consequences of inflammation arise if it continues
for a considerable time.  ,This inference, as a pathological one, may
be deduced with much gi aater confidence than any practical conclu-
sion that may be founded upon it.   From the fact that the proximate
cause of madness is nearly allied to inflammation, it does not follow,
with certainty, that the disease is to be cured by the simple use of
antiphlogistic remedies.   The physician who would  proceed  to treat
cases of madness as instances simply of inflammation in the brain, and
who would expect to cure it at once, like any other  local inflamma-
tory disease, by the direct operation of antiphlogistic means, would
very often find himself greatly disappointed.  He would meet with
many  cases in which  no perceptible benefit arises from bleedings,
and  evacuations of all kinds generally or locally applied, and com-
bined  with the whole series of remedies supposed to be required by
the existence of organic inflammation.   Many patients would  sink
under such a course of treatment if carried on incautiously : it would
leave the disease undiminished, and exhaust the powers of life.   This
depends, perhaps, on the influence of diseased states in other struc-
tures and organs, or on disordered functions of other parts which are
complicated with, and in some instances give rise to, the disturbance
existing in the brain.   Inflammatory excitement is a part of the dis-
ease, but does not entirely constitute it.
   Perhaps, however,  I  may venture on the assertion that there are
few instances in which the practical indication arising from the view
which I  have taken of the pathology of madness will  not be found
applicable  during some periods of the case, though in many its ap-
plication is very limited.  'The degrees in which it is admissible are
various.
   In recent cases of mania, properly so termed, and  of  incoherence,
particularly in young and plethoric  subjects, and where the disease
has made its attack suddenly, and  is accompanied with signs  of con-
siderable vascular excitement, much  may be  hoped from the anti-
phlogistic treatment, at least from certain parts of it judiciously modi-
fied.   I shall now consider the different means of which it consists,
and  advert to  the  opinions of  some of the  most eminent practical
writers with respect to their use in cases of insanity.
   1.  Of bleeding.—Dr. Cullen recommended bleeding in the early
stage of madness.   He says that it has been common to employ this
remedy in all cases of recent mania, and, as  he thinks, with advan-
tage.   He observes that when the disease has subsisted for some time,
he has seldom found bloodletting to be of service.  " It is," he says,
" a proper and even a necessary remedy in those instances of mad-
ness in which there is fulness and frequency of pulse, and when marks 
OF THE PROPRIETY OF BLEEDING.
187
are observed of  increased impetus in the vessels of the head."  He
prefers bleeding from the arm, while the patient remains in some-
what of an erect posture, and  bringing on a  degree  of deliquiurn,
which, as he thinks, is a pretty certain mark  of diminished fulness
and tension in the vessels of the encephalon.
   Pinel, whose  authority could not fail to produce an impression, is
in this respect decidedly opposed to Cullen.   He considers the signs
of vascular plethora in the head, or of determination of blood thither,
as  very deceptive ; and although he allows bleeding to be in some
instances  capable of averting attacks of recurrent madness when they
are anticipated, he carefully abstains from the use of the lancet after
the disease has actually broken out.   Care is always taken, he says,
to question the relatives of patients admitted into  the hospital over
which he presided, whether bleeding has been  practised,  and if so,
what were its results.   " The reply  always proves that the state of
the patie.t has  changed for the worse immediately after bleeding."
Pinel held very firmly the opinion that  bleeding, even in maniacal
cases which are accompanied by circumstances supposed to Indicate
plethora and local determination to the head, tends to retard recovery,
to  render it more doubtful.   He was  persuaded that  bleeding gives
to  the disease a tendency to degenerate into  dementia.   The facts,
however, which this distinguished author adduces as proofs of his
opinion, afford,  as M. Foville has remarked,  but very equivocal evi-
dence.   " Two girls, nearly of the same  age and temperament, were
admitted into the hospital—the Salpetriere—on the same day :  one
of them, who  had not been bled, was  cured in the space  of two
months ;  the other, who had undergone a copious bleeding, sank into
a state  of idiotism, or  rather of  dementia, and did  not recover the
faculty of speech till the fifth month.   Her perfect restoration took
place at the end of the ninth month."  Now, as most authors fix the
 mean duration of madness at the period of several months, and some
at  more than a  year, this case of  recovery at the  end of the ninth
 month, cannot afford a strong condemnation of the practice pursued.
Another case, which the same author has adduced as affording evi-
dence against bleeding, is not more conclusive in respect to the influ-
ence of  remedies on the ultimate  event of the  disease.  Yet the
 opinion of such a writer, founded as it was, at least  by himself sup-
posed to  have been, on extensive observation, ought not to be en-
tirely disregarded because he happened to select but dubious illustra-
tions,  l^ bleeding occasions a state of collapse in the system, and is
 carried beyond what  is necessary to reduce an over-excitement, a
 fatuous dejection of mind is likely in some cases to be the result.
    M. Esquirol  coincides with  Pinel in the opinion that the diseased
state on which  mental derangement  depends, is sometimes changed
 for the wors« by bleeding.   He  says that he has  seen madness  in-
creased after an abundant flow of the catamenia, and  likewise after
one, two, or three bloodlettings.   In such cases melancholy dejection
 has passed  into  furious madness.   Yet M. Esquirol approves of
moderate bleeding in  plethoric eases, and where some habitual san- 
188
TREATMENT OF INSANITY.
 guineous evacuation  has  been suppressed.   He has often with ad-
 vantage applied leeches behind the head or to the temples of patients
 who are subject to sudden determinations of blood towards the head.
 His favourite remedies in such cases were the use of a few leeches at
 a time,  repeated as often as necessary, and cold  applications to the
 head.
   To outweigh the authority of these writers who either condemn
 the practice of bleeding  in madness, or  allow of its adoption in so
 sparing a degree, strong evidence is required.
   Dr. Haslam says that bleeding  is the most beneficial remedy that
 has been employed  in madness, and  that it is  equally beneficial in
 melancholic as in  maniacal cases.   He  limits its use to recent cases
 and plethoric habits,  and  directs it to be performed by the application
 of six or eight cupping-glasses to the shaven scalp.  The quantity of
 blood to be taken must depend on  circumstances.  " From eight to
 sixteen  ounces may be drawn, and the operation repeated as circum-
 stances may require."   When a stupid state has succeeded to one of
 high excitement,  Dr. Haslam considers bleeding as contra-indicated.
   But Dr. Rush is the most strenuous advocate for bleeding in mania-
 cal cases.   He lays the greatest stress on this remedy, and has perhaps
 carried its use to a greater extent than any other medical practitioner
 of high repute.   The arguments  which he has  given  in support of
 the practice of large depletion in madness are the following :—1. The
 force and frequency ,of the pulse, the sleepless and  agitated state of
 maniacal patients.  2.  The appetite being unimpaired in lunatics, and
 sometimes even  stronger than usual, a plethoric state of the vessels
 easily arises in such habits.  3. The importance of  the  diseased  or-
 gan, the delicate structure of the brain, which prevents it from long
 supporting morbid action without being exposed  to the  danger of
 permanent disorganization.  This danger, he says, is much increased
 by the want of sleep, the cries and exclamations, and  the constant
 agitation of mad  persons.  4.  The  vvant of any natural channel of
 discharge from the brain, by which the ordinary results of inflamma-
 tion might be averted or got rid of, in that way by  which serous
 discharges in other parts relieve the  inflammatory  state.   5. The ac-
 cidental  cures which  have followed the loss of  a  large quantity of
 blood.   Dr. Rush  has seen several lunatics who had attempted self-
 destruction by cutting their throats or opening the great vessels, cured
 by the abundant hemorrhages which have followed these attempts.
 6. Lastly, he says that  bleeding is  indicated  by  the extraordinary
 success which  has  resulted from its use in  the United States, and par-
 ticularly at the hospital  for lunatics in Pennsylvania.
   Dr. Rush advises large bleedings at the first attack of mania.   If
 the patient bears  it without syncope, he ought to  lose, according to
this physician, from twenty to forty ounces of blood.  If possible, it
should be taken from  him while standing erect.   Free bloodlettings
practised early in the disease have, as he says, a surprising effect in
calming the patient, and in many instances are sufficient for the cure,
unaided by any  other remedies.   In most cases, however, bleeding 
OF THE PROPRIETY OF BLEEDING.
189
from  the arm  is  to  be  followed  by the application of leeches or
cupping-glasses to the head or nape of the neck, by low diet, anti-
phlogistic remedies, refrigerants applied to the head, and  the use of
warm or tepid baths.
   Dr. Rush was of opinion that the evacuation of blood ought to be
carried  to a greater extent in madness than in any other acute disease
whatever.   From a patient, sixty-eight years of age, he caused  two
hundred ounces  of blood  to be  drawn in  less than  two  months.
Another patient of Dr. Rush lost four hundred and seventy ounces by
forty-seven bleedings  in the course of seven months.
   I shall conclude this survey of the conflicting opinions of practical
writers  on the expediency of bleeding in madness, by citing the ob-
servations of M. Foville, which arc deserving of  the most attentive
consideration, and which place the subject in the true point of view.
He says, "Without ever  having  pushed the  employment of this
remedy so far as Rush and Joseph  Franck, I confess  that it appears
to me to be one of those on the efficacy of which the greatest reliance
may  be placed.   MM. Pinel and  Esquirol  have proved  that the
i expectant method,' assisted by a few simple rules, and a moral treat-
ment wisely directed, have succeeded  in a great many  cases ; but
although it is better to confine ourselves to the use of simple means,
patiently continued, than to employ unadvisedly the method of inter-
ference, I believe  that the  physician devoted to the study of patho-
logical'anatomy can draw from the results which it furnishes, compared
with the observation of symptoms, valuable inductions for practice ;
that he  may place reliance on their efficacy, and  recommend them
with confidence when experience shall have demonstrated their good
effects.   Are not the  anatomical characters which  so constantly  pre-
sent themselves in acute cases, and the adhesions which are so frequent
in chronic ones, evident proofs of inflammation, and are we not by
this consideration authorized to hope for advantages from the use of
antiphlogistic means?
 ^  ilU it be added," says M. Foville, "that in several hundred luna-
tics, whose bodies my situation  for nearly ten years has given me an
opportunity  of examining, 1 have  never found adhesions  in acute
cases, while they  have been very common in chronic ones ; if, with
these  facts, the results related in the works of MM. Bayle  and Cal-
meil are compared, we may conclude, on seeing these adhesions so
frequent in chronic cases, that they are incompatible with the regular
exercise of an organ  so  delicate as the brain, and consequently in-
compatible with the return  of reason.  We ought, therefore, in every
acute  case, to choose the  most active means, in order to prevent this
melancholy termination of cerebral disease.
   "These  are some of the reasons which have led me, with several
physicians who have  been placed  in circumstances favourable for
making observations,  to conclude that bleedings ought  not 1o be en-
tirely  proscribed in the treatment of mental diseases.   In the greatest
number of cases of recent insanity which have been placed under my
                              17* 
190               TREATMENT OF INSANITY.
 care,* I have employed evacuations of blood, local or general, rare or
 frequent, abundant or in moderation, according to the strength of the
 patient, and the state of the pulse, the redness of the  eyes, the heat
 of the head, the agitation and want of sleep.  I have always preferred
 general bleeding, when  there existed a state of plethora, which the
 force and frequency of the pulse evinced.   In opposite circumstances,
 leeches on the neck,  the temples, behind  the ears, copping upon the
 same parts, and upon the shaved head, have produced decided benefit.
 Local bleeding having appeared to me  to  produce  a marked effect
 upon the brain, I have often prescribed it at the same time with general
 bleeding whenever the intensity  of the  general symptoms has impe-
 riously demanded the latter remedy ; but I have never rested exclu-
 sively upon the efficacy of sanguineous evacuations,  although in many
 cases I have seen all the morbid symptoms disappear, as if by enchant-
 ment, under their use.
   " I have under my care several patients subject for some years to
 attacks of intermittent madness, which, left to  nature, would  last
 three or  four months, or longer.
   " During three years, that is, since they  have been confided to my
 care, they have not experienced a single attack of a month's duration.
 Often  in the space of five or six  days  all  the symptoms  have been
 dissipated.  General or local bleedings,  proportioned to the intensity
 of the symptoms, warm baths,  with cold applications to  the head at
 the same time, are the means by which  I have treated such attacks.
   " I have several times prevented the return of these attacks by em-
 ploying the same treatment, as soon as the redness of the eyes,  the
 heat of the head, and  wakefulness, manifested themselves, even when
 there had been no delirium."                  ,
   My own experience has  afforded me  sufficient opportunities of
 forming opinions on the effect of remedies in insanity, since for twenty
 years I have never been without patients labouring under that disease
 who were more or less under my care and observation.   Long before
 Dr. Foville's remarks were known to me, and long, indeed, before they
 were written,  I had pursued the practice which he has recommended,
 having been led to adopt it by similar considerations^ and I entertain
 no doubt of its practical advantages.   I  am very far from approving
 or wishing to  recommend such detractions of  blood as those which
 appear to have been practised by Dr. Rush ; but I have been  con-
 vinced by the evidence of numerous facts, with respect  to which I
 could not be mistaken, that bleeding, both local and general, is, under
 due limitations, serviceable in casesof insanity.   To what extent the
 use of these measures  ought to be carried it is more easy,  after a long
 practice, to determine in particular instances, than it is to lay down
 general rules which  may be of service  to  students  or young practi-
 tioners ;  and perhaps  all the remarks which I can offer on this sub-


  * M. Foville has been for several years physician in chief to one of the most
extensive lunatic asylums in France, that of St. Yon, near Rouen.
  f Treatise on Diseases of the Nervous System, chap. i.  London, 1822. 
OF THE PROPRIETY OF BLEEDING.           191
ject are only such as common sense and discretion would  scarcely
fail to dictate.
   The circumstances which render bleeding most advisable  in the
treatment of madness are  those which indicate an approach  in the
disease to the character of phrenitis.  The age and  constitution of
the patient must be taken into the account:  if young and plethoric,
he will more easily bear depletion ;  if the attack has  been acute and
sudden, it will more decidedly require it.  If the vessels, especially
the carotids and temporal arteries, pulsate strongly and rapidly, and
there is heat of the skin, and principally of the head, much redness of
the face and conjunctiva, a contracted pupil, intolerance of light and
of sounds, total want of sleep, and much agitation, symptoms of dis-
ordered sensation, as  spectral appearances, in such  cases bleeding
from the arm will be practised beneficially ; and  it should be  done
before excitement shall have produced collapse and exhaustion.  The
abstraction of twelve or  sixteen ounces of blood under the circum-
stances above described  is often followed by a mitigation of all the
symptoms.   It may be repeated with advantage if the good effect is
only temporary, or may be followed, if this  be  incomplete, by the
use of cupping-glasses, or leeches applied near the head.
   Less frequent are the indications, of which even M. Esquirol ad-
mits the evidence as proving the necessity of bleeding.  I allude to
circumstances connected  with the origin of the attack, such as its fol-
lowing the suppression of catamenia, or of some morbid, though per-
haps also salutary discharge, the sudden disappearance of eruptions,
its coming on after the disappearance of erysipelas or of dropsical
effusions.   All these observations point to the propriety of bleeding,
but they do not authorise it unless  the arterial  circulation  and the
heat of the skin  be considerable.   I have seen mischievous results
from bleeding in cases of madness which followed the disappearance
of eruptions, when the vigour and excitement of  the  arterial system
were not sufficient to support the consequent collapse.
   Insanity occasioned  by blows or  injuries  of the head, as well as
madness resulting from  intoxication,  is relieved by bleeding, and
many cases of these kinds require antiphlogistic remedies, including
the use of the lancet ,•  but care must be taken  to distinguish  insanity
the effect of intoxicating liquors or of blows on the head from deli-
rium tremens, and from that species of delirium so much resembling
it, which is occasioned by wounds.  I know that  patients labouring
under delirium tremens have been killed almost  instantaneously  by
practitioners  who were unaware of the nature of such cases ; and
traumatic delirium is a disease which confessedly  requires the great-
est caution.   The latter affection, which has  been so  well described
by M. Dupuytren* and by Dr. Crampton, is known to appear shortly
after severe injuries of  the extremities and compound fractures: in its
phenomena it bears a  close analogy to delirium tremens.   It is ac-

  * Gazette Medicale de Paris, Mars 1832.  Fodere sur les diverses especes de
Folie Vraie.   London Medical and Physical Journal, 1833. 
192
TREATMENT OF INSANITY.
companied by profuse  sweats, a pale countenance, quick tremulous
pulse, great insensibility of external impressions ;  while the preva-
lent state of the mind is terror and agitation.   In this disease bleed-
ing is highly dangerous, and the appropriate remedies are stimulants
and frequent opiates.
  Mania is the form of insanity which most frequently requires ab-
straction of blood : but I have in many instances found  a decided
benefit to arise in cases of melancholia from one  or two  moderate
bleedings, either general or local.   This has been  the fact in cases
accompanied with headach or a feeling of oppression referred to the
head, with a full state of the bloodvessels, and generally with confined
bowels.
  The circumstances which chiefly preclude the use  of evacuant re-
medies, and particularly of bleeding, are the indications of weakness
and irritability without strength.  All approximations to the state
characterizing delirium tremens are decidedly in this class: a weak
and small, or a frequent, very compressible pulse, with  throbbings
without strength in the carotid, while the circulation is feeble in the
extremities ;  a clammy, cold skin, especially in the  hands  and feet,
or  profuse though warm perspirations ; a tremulous state  of the
tongue or voice ; tremors and agitation in the limbs, are symptoms
which should render the practitioner very  cautious in ordering de-
pletive measures, though they do  not  in all cases preclude at least
local bleedings.  In puerperal cases it is  now allowed by all that
venesection is to be  rarely attempted.
  In many individuals of weak constitution, when  the indications of
plethora and general excitement of the circulation were wanting, I
have observed the best results to follow the  use of leeches to the head
after it has been shaved, or the application of cupping-glasses to the
nape of  the neck.   I have observed instances in which melancholy
dejection accompanied by sleeplessness and  want of appetite has been
relieved or removed by the use of this remedy in a few days,  after it
had continued for several months.
  I have stated my opinion on the subject of bleeding with the con-
fidence which appears to myself to be the result of  long and repeated
experience of its  beneficial effect  ; but I must not omit  to remark
that, although a majority of physicians who make  insanity an object
of study coincide with me, unless I am greatly mistaken, in this  re-
spect,\there are others who hold an opposite opinion.  Among these
are some  who' have the very best claim to the  confidence  of the
public, namely, that of more than ordinary success in the treatment
of  insanity.   I  am  informed by Mr.  Hitch, that  at the Gloucester
Lunatic Asylum, which is under the superintendence of Dr. Shute
and his own immediate care, the use of the lancet, leeches, cupping-
glasses, blisters, drastic purgatives, the practice of shaving the head,
are totally proscribed.   Yet among the patieuts admitted to this hos-
pital, a very  large proportion  of  recoveries,  as  I  have already ob-
served, take  place, and no cases of sudden apoplexy or hemiplegia
have yet happened. 
OTHER  ANTIPHLOGISTIC MEANS.             193
    Experience has afforded in this instance a strong evidence against
 the necessity and propriety of bleeding, and of other antiphlogistic
 measures in insanity ;  but it is here obvious to  remark that circum-
 stances probably exist connected with the general condition and the
 state  of  constitution of the patients admitted  into the Gloucester
 Asylum, which may prevent the  inference hence arising from  becom-
 ing universally applicable.
    2.  Of abstraction of heat from the head: regulation of tempe-
 rature :  bathing.—The head should always be shaved when there
 is much vascular excitement and heat about the scalp.  By the cool-
 ness afforded on the removal of the hair, more  benefit and a  greater
 degree of tranquilization is often  produced than is anticipated. Cut-
 ting the hair short is not sufficient: the head should be shaved once
 or twice  in a week.
    Cold shower-baths, r.nd  affusions of cold water administered in va-
 rious  methods, have been extensively tried.'n maniacal o'seases.   Dr.
 Rush considered them  to  constitute a very '.ih^iuK. *oAudy, and
 recommended, in  order to obtain the greatest advantage from them,
 that they should be repeated two or three times in a day.  M. Es-
 quirol used this remedy with  advantage in  some  cases : he  chiefly
 prescribed it for young subjects.   M. Foville says that he was a wit-
 ness to an almost immediate cure of a maniacal girl of delicate con-
 stitution and nervous temperament, who was subjected by M. Esquirol
 to the affusion of cold water at the degree fourteen of  the centigrade
 thermometer.   She was placed, with a garment covering  her, in an
 empty bathing-tub, and water was poured in small quantities  on her
 head till  it covered her body, and shivering ensued.   On  a  second
 application of this method, which was for some time resisted, it was
 followed by deep sleep, accompanied by copious sweating ; and when
 the patient awoke, she  was found to  have recovered  her reason.  I
 have witnessed the application of this remedy by M. Foville in  the
 manner described, and can add my testimony of its greater  conve-
 nience and efficacy, when  compared with the ordinary methods of
 applying  cold affusions.
   The use of the shower-bath is often  followed by reaction, when  the
 patient, if excitable, becomes violent.   In old cases, attended  with a
 disposition to congestion of blood in the head, its use is precluded by
 the danger of producing paralysis.  It is chiefly serviceable in  young
 persons; when the constitution is relaxed, and when it is predisposed
 to hysteric affections.
   A method  of bathing adopted by M. Foville in the hospital under
 his management is free from the inconveniences and occasionally
 injurious results attendant  on  cold affusions.  He places  a cap or
 bonnet, containing ice and  closely fitting, on  the head of the patient,
 and keeps the body immersed in a warm-bath for two or three hours,
 and renews this proceeding twice  or three times in a day, according
 to the  intensity of symptoms.  On adopting it, as he was accustomed
to  do at first,  only once in a day,  he found the tranquillity produced
by it followed not  unfrequently by increased agitation ; but on re- 
194
TREATMENT OF INSANITY.
peating the bath, with the ice constantly applied to the head, he has
frequently succeeded far beyond his expectation.   It  has  been the
apparent means of recovery in many acute cases, and  has  produced
sleep and tranquillity in frequent  instances of obstinate restlessness
and agitation.
   Applications of ice, or, when more convenient, of cold water, are
very generally serviceable in  cases attended  with heat of the head
and irritability.
   Warm or tepid bathing has been found advantageous in the treat-
ment of madness under a variety of circumstances.  A cold state of
the skin, languor of the general circulation indicated by coldness of
the extremities, a tendency to chronic eruptions, are among the phe-
nomena which suggest its adoption.  Sometimes  it produces  sleep
after long-continued agitation.  If the degree of heat  be not such as
to occasion too  much vascular excitement, it is generally a  useful
and safely applicable remedy.
   3. Counter-irritation.—Counter-irritation, established by various
means, such  as blisters to the shaved head or nape of the neck, issues
or setons in  the neck or on the scalp, caustics, actual cautery, irritat-
ing ointments, is found to afford in some instances a powerful method
of reducing  inflammatory disease, or relieving a state of congestion
in the brain.  The  various remedies which belong to this class have
 been tried in every modification in cases of insanity, but the general
 result of experience is not favourable to  their use.   They afford
 little benefit in  ordinary maniacal cases, and often  appear to  be in-
jurious.
   Irritating ointments have been applied in. many instances, particu-
 larly since  their use was strongly recommended by the late Dr.
 Jenner.  Medical practitioners have been  generally disappointed in
 their expectation of benefit from this attempt.
   There are, however, instances of mental disease in which these
 remedies are beneficial, but some care is requisite in order to distin-
 guish them.
   M. Esquirol has  remarked that blisters, dry cuppings, and other
 irritating applications, are used  successfully in cases which  follow
 metastasis ;   in  monomania accompanied  by  stupor; in puerperal
 madness ; and  in dementia  when not complicated with convulsions
 or paralysis.
   I believe  that the cases  of disease affecting the exercise  of the
 mental  faculties in  which  counter-irritation is principally and perhaps
 exclusively  of  service, are those in which torpor and  insensibility
 prevail, instead of excitement  and  intensity of feeling,  or  morbid
 activity.  In almost every case of paralysis with a tendency to coma
 and lethargy in which such  remedies have  been tried within the
 sphere  of my observation, and these  cases have been very numerous,
 I have  witnessed the most  decided advantage  from  their use.  In
 disorders of a chronic form, when means  of  slow and gentle opera-
 tion are sought, setons in the neck  are  most advisable ; but  when
 there is great intensity of disease  and a state of the  brain threaten- 
USE  OF PURGATIVES AND EMETICS.
195
ing a fatal increase, issues made by a long incision in the scalp over
the sagittal suture are particularly useful.  This remedy is not found
in experience to be more painful than the more usual application of
setons, and it is incomparably more efficacious.   In cases of stupor"
and of dementia following attacks of apoplexy or paralysis, or severe
fevers, this method is, according to my observation, more beneficial
than any other.   I  should not advise it with much hope in dementia
the result of insanity.
 0 The  general  paralysis of insane  persons, or the " paralysie des
alienes," is so deplorable a disease that it almost  precludes  expecta-
tion of recovery.    I  have not had  an  opportunity of prescribing
issues on  the scalp  in cases  of this description, but the pathology of
the disease so manifestly indicates the  propriety of such an  attempt,
and it has been so successful in disorders in many respects analogous
within  my observation, that I  should not fail to adopt it in any in-
stance of the kind, nor should  I absolutely despair of the result until
the experiment had failed.
   4. Purgatives.—No fact in medical practice has been longer es-
tablished than the utility of purgatives in madness j witness  the fame
of Anticyra and hellebore.   To confirm a maxim so well supported
 by the result of constant experience, it seems  almost  superfluous to
adduce pathological facts.   It  is not, however, difficult to  find this
 species of evidence in its favour.  Many authors have  remarked that
 spontaneous cure of madness  has resulted from a supervening diar-
 rhoea, in  which the  intestines have discharged in great quantities  a
 variety of morbid  secretions.
    M.  Esquirol has well observed that purgative medicines ought not
 to be used indiscriminately in  all  cases  of madness,  and that  they
 are injurious when the mucous membrane of  the intestinal canal  is
 in a diseased state.   This is the case in  many instances of insanity.
 I shall, under another indication for medical treatment, consider the
 method of practice which  is advisable in  different states of  intesti-
 nal irritation, as they occur in madness.   At present  it will be suffi-
 cient to observe that, unless any signs exist of disease in the structure
 of the alimentary canal, such as inflammation or ulceration of the
 mucous coat of the intestines, the use of purgative  medicines is one
 of the  most important and generally available means in the  treatment
 of maniacal patients.  The mildest cathartics are preferable to others
 in most instances,  because  their use can  be  long continued without
 injury to the structures on which they immediately act.   The neu-
 tral  salts,  infusion of senna, rhubarb, jalap, castor-oil, are  in the
 majority of cases  sufficiently powerful, and may be used daily  or
 frequently according to circumstances.   When there  is decided ten-
 dency to constipation, or the alvine evacuations are morbid, calomel,
  scammony, colocynth, or  croton  oil, may be added, due attention
  being  paid to the  cautionary circumstance above pointed out.
    5.  Emetics.—Emetics  have been strongly recommended by some
  practical writers.   M. Esquirol says that he has found them useful
  in most cases of melancholy accompanied  by a torpid  state of the 
196
TREATMENT OF INSANITY.
 system.   Dr. Rush considered them to be chiefly indicated in hypo-
 chondriasis, or lowness of spirits connected with  dyspeptic disease.
 Dr. Haslam confirms their  utility in cases attended with disorder of
 the stomach, merely  with  a view  to the  relief  of that  particular
 symptom ; but he declares that,  " after the administration  of many
 thousand emetics to persons who were insane, but othenvise in good
 health, he never saw any benefit derived from their  use."  " Per-
 haps no one," he says, " has enjoyed a fairer opportunity of witness-
 ing the effects*of remedies for insane persons than  myself; and when
 emetics  are  employed in Bethlem  Hospital, they  have the best
 chance of effecting all the  relief they are  competent to  afford, as
 they  are  given by themselves,  without  the intervention of other
 medicines ; and this course of emetics usually continues six weeks."
'" It has been for many years the practice of Bethlem  Hospital .to
 administer to the curable  patients four or  five emetics in the spring
 of the year ; but on consulting my book  of cases, I have  not found
 that such patients have been particularly benefited by the use of this
 remedy.  When the tartarized  antimony given with this intention
 operated  as  a purgative,  it generally produced beneficial. effects."
 The most strenuous advocate, in  late times, for emetics in madness
 is Dr. Cox,  whose work on that disease contains many excellent
 practical observations.  This author goes  so far as  to say,  that, "in
 almost every species  and degree of maniacal complaints, from  the
 slightest aberration of intellect that accompanies hypochondriasis, to
 the extreme of mania furibunda, emetics have proved a most valuable
 and efficacious remedy."  Dr.  Wake, physician to the York Lunatic
 Asylum, has assured me, that, after extensive experience in the use
 of different remedies  on  the patients of  that hospital, he has found
 no other class of remedies so frequently efficacious as emetics.
  The use of emetics in madness requires caution.  Dr. Haslam says,
that, "in many instances,  and in  some where bloodletting had been
previously employed, paralytic affections have within a few hours
supervened on the exhibition  of  an  emetic,  more  especially where
the patient has been of a full habit, and has had the appearance of an
increased  determination to the  head."  The possibility  of bringing
on attacks of apoplexy or paralysis  ought always  to  be taken into
consideration in the prescribing of emetics to maniacal patients. The
use of medicines of this class is precluded by the signs of a  plethoric
habit and cerebral congestion ; but,  as  MM.  Esquirol and Foville
have well observed, they are likely to  be  of service, and this proba-
bility is confirmed by ample experience,  in  cases  of melancholy or
hypochondriacal  dejection attended  with  stupor, and where the lan-
guid state  of the functions,  both animal and  physical, appears to
require the use of remedies which are fitted to excite new actions,
and to stimulate  the secretions of  the abdominal viscera.  It may be
added, that emetics are sometimes useful during a state of furious
excitement, and produce  calmness and a mitigation of  violence..
Sometimes under these circumstances their exhibition is followed by
a restoration of sleep and tranquillity. 
USE  OF DIGITALIS AND OPIUM.             197
   Insane patients often require large doses of tartarised antimony, as
 from six to ten grains, before vomiting is excited ; and this is espe-
 cially the case when the remedy is given during a paroxysm of vio-
 lent excitement.  It is, however, better to begin with moderate doses,
 and to combine ipecacuanha with the preparations of antimony.
   The use of antimony in nauseating doses  is generally safe, and very
 frequently  beneficial in  controling maniacal  excitement and  the
 febrile state of the system which accompanies it.
   6. Digitalis.—Digitalis has been much  extolled both by English
 and foreign writers as a remedy in cases of insanity.  In this country
 it has been more  especially recommended by Dr. Cox, and  abroad by
 Dr. Muller, of Wurtzburg, and  Dr.  Guislain.  Continental  physi-
 cians have  given this  medicine in large  doses, so  as to produce
 vomiting,  and they have witnessed decidedly good  effects from its
 administration in this mat.ner.   Muller gave five grains at night and
 morning, or two  grains every  second hour.   Guislain has reported a
 remarkable cure, the patient having taken only one grain and a half,
 which, however,  had produced such vomiting and prostrations, that
 recourse was had to the ceremonies of the catholic church, under the
 opinion that the individual was moribund. Dr. Cox began with small
 doses, and gradually increased them.  He relates the  case  of a man
 who was kept under the influence of this remedy, the state of  the
 pulse being always in relation to the degree of morbid excitement in
 the  mind : when the pulse was at ninety, he was  furious ; when at
 seventy, rational  ; at fifty, melancholic ; and at forty,  half-dead.  He
 was perfectly  cured by keeping his pulse steadily at seventy.
   The cases of insanity in which digitalis is most likely to be useful
 are those accompanied with great arterial action, and  displaying the
 phenomena of high  mental excitement.   M. Foville has expressed
 an opinion that little benefit is to be expected from this remedy  ex-
 cept in those instances in which  hypertrophy of the heart  is compli-
 cated with  insanity.   Such instances, as we learn from necroscopic
 researches, are by no means infrequent.   We might probably be  not
 far from the truth in comprehending within  the  number of cases in
 which the trial of digitalis is advisable, those in which  the circulation
 is preternaturally increased, though no manifestation of disease may
 appear in the organic fabric by which it  is  carried on. In other in-
 stances the same remedy, if given so as to produce full vomiting and
prostration, may be of use in breaking through a train of morbid ac-
tions, and by the great changes which it  induces in the general state
of the system, in the determinations of blood, and the relative activity
 of particular organs.
   Having mentioned the use of digitalis  in this department of cura-
tive recommendations, I shall proceed to consider that of  the other
narcotics, though there may be some doubt whether, in strict pro
priety, this is the most proper  place for mentioning them.
   7. Of the use  of opium.—Opium  is  far  from being a remedy
generally admissible  in cases of insanity ; yet there are instances in
which it is decidedly  useful.   Its adoption  requires  care and  dis-
  Mat,  1837.                18 
198
TREATMENT OF INSANITY.
crimination.  We are not possessed of any precise rules by which
the effects which may arise from it can be with certainty predicted.
   Opium is always a very doubtful  remedy in  disordered  states of
the brain, and is generally injurious when the vascular system of that
organ is over-loaded with blood.  I have seen  apoplexy supervene
on a moderate dose of opium in such a condition of the system ; and
I well remember an instance  of acute phrenitis occurring in a man
who had swallowed a poppy-head fomentation intended for his legs,
and who with difficulty recovered after  large depletion.   The first
effect of opium is undoubtedly accompanied by increased arterial
excitement; its action is in a  great degree analogous to that of alco-
hol and wine :  it brings on delirium, and is known to aggravate it
when previously existing.  Nothing can be more contrary to pro-
bability than that  a  remedy of this description should be service-
able in a state of the brain such as we have inferred to exist generally
in madness.  It is only under  particular circumstances that we find
an exception to this conclusion.  There is a condition  of the living
body,  produced by long-continued  excitement or stimulation,  when
the powers of re-action are beginning to be exhausted, and  what the
Brunonians term indirect debility ensues, in which the sudden ab-
straction of stimuli gives  rise to extreme prostration.   This, for
instance, is nearly the state of the system in delirium  tremens, the
disease of the habitual and worn-out drunkard, marked by occasional
fits of violent delirium, in the intervals of which excessive weakness
ensues, with tremblings of the limbs, tremulous movements of mus-
cles, paleness, cold perspirations, a rapid and feeble pulse.  In this
disease opium is well known to be a  most important remedy ; and in
analogous conditions of the body occurring under other circumstances,
it may be beneficial by sustaining the vital actions in a certain degree
of energy until the restorative  powers of the constitution can  come
into play, and exert their usual influence.  A state more  or less of
this description exists in some  cases and periods of insanity, and it
is probably under such circumstances that opium has been found use-
ful ; but it is not an easy matter to make the necessary discrimination.
   The state of the vascular system, as M. Guislain has well observed,
is a principal guide in determining as to the propriety of administer-
ing opium in insanity. In cases of high excitement, strong full pulse,
heat of skin, fulness of vessels in the head, opium is  injurious; it
tends to  increase the symptoms and aggravate the severity of the
disease.  It is more likely to be of service in delicate and attenuated
persons,  of feeble constitution, pale, cold, relaxed skin, frequent,
small, weak pulse.  " If the disease  has been of long duration,  if the
circulation has  been losing its force and activity from day to day, if
the attack of mental derangement has not been a sequel of suppressed
cutaneous eruption o*r suppressed hemorrhage,  causes tending in a
high degree to produce an inflammatory  state of the brain ; if  there
are only  nervous symptoms to  be contended with, I should have no
hesitation." says M. Guislain, " in having recourse to opium."*

         * Guislain, Traite sut 1'Alienation Menfale, torn. i. p. 350. 
USE  OF HENBANE AND  CAMPHOR.
199
  The circumstance which most plainly indicates the propriety of
using opium is long-continued restlessness, a want of sleep bringing
on dangerous exhaustion.  Cullen declares  that he  has  frequently
employed large doses of opium in  maniacal cases, and that, when
they had the effect of inducing sleep, it was manifestly an advan-
tage.*   Esquirol  has given it with advantage to individuals of great
sensibility, in that state of the constitution which he terms excessive
tension of the nervous system.
  It is generally  agreed  among practical writers  that opium should
be used, when it is given to deranged persons, in considerable quan-
tities.  Van Swieten and Cullen gave it in large doses : the former
relates the case of a female maniac, who swallowed by mistake a
scruple of opium  dissolved  in vinegar, and was cured of her disease.t
Darwin has reported an example in which he declares that two scru-
ples of solid opium were given in a dose, and  one scruple after four
hours ; the patient is said to have been cured.   Dr. Kriebel, of Berlin,
recommended that one grain should be given every hour until sound
sleep should be produced ;  he is said to  have administered twenty-
six grains in the course of twelve hours.  These facts are interesting
as showing what may be expected under extraordinary circumstances,
but they are too much out of the usual course of experience to fur-
nish an example for imitation or a rule of  practice.   It would be more
prudent, in all cases, in the use of an ambiguous remedy, to proceed
cautiously, to give moderate doses at first, and larger ones afterwards,
if the results of such trials  and the circumstances of  particular cases
appear to warrant the" proceeding.   Two grains may perhaps be the
maximum of a first dose.
  8. Hyoscyamus.—The use of hyoscyamus  was recommended by
Dr. Willis as a substitute for opium, and it has been very generally
adopted, but with uncertain success.   Five  or ten grains of the ex-
tract, or a drachm of the tincture of henbane, will often  succeed in
producing  sleep.   This medicine is certainly devoid of many of the
injurious  qualities which belong to opium.   It has  no stimulating
influence, but diminishes sensibility and irritability without any pre-
vious excitement; it diminishes not  the  secretions, nor does  it pro-
duce constipation, but it  often leaves a  greater degree of languor,
want of appetite,  and of  the general  uneasiness which ensues on the
use of narcotic remedies  than does opium.  It is likely to be useful
under nearly similar circumstances  as opium, but may be adminis-
tered  without requiring so much caution.   I have repeatedly given
it to patients who suffered for want of sleep in different modifications
of mental disease with some  advantage, but  do not  consider it to be
a remedy of great importance.
  9. Camphor.—Camphor has been  recommended by  Hufeland,
Awenbrugger, and other  German physicians, for the cure of insanity ;
but it  has  been most extolled by Perfect.^   This writer appears to

  * First Lines, 1571.        f Comment, in Boerhaav. Aph. torn. iii. p. 533.
  % Perfect's Annals of Insanity.—Guislain, Traite sur 1'Alienation. 
200
TREATMENT OF INSANITY.
have given it in very large  doses  to many  patients, who recovered
after taking it, though no other remedies were  administered ; at the
same time it is not clearly  apparent to what means the prosperous
result  is to  be attributed.  These  remarks apply to the following
case :—« T. B----, a  married woman, of leucophlegmatic habit, be-
came melancholic ; her  complexion was  pale, urine  high-coloured,
tongue dry, pulse contracted,  hard, irregular.   After bleeding her
and giving an emetic, Perfect prescribed two scruples of camphor to
be taken every night and morning.  An eruption appeared over her
whole body ; the catamenia, which had been suppressed, became re-
stored ; and she recovered."
  Practical  physicians, whose testimony is  deserving of the fullest
confidence, Dr. Cox, Muller of Wurtzburg, and Guislain, appear to
have given a fully sufficient  trial to the use of camphor in insanity, in
various doses and under various forms of the disease.   The result is
such as to convince us  of its inefficacy.
  The journals of Hufeland and Nasse contain various accounts of
cures obtained by means of stramonium and of belladonna.  Theformer
of  these narcotics was used  by Dr. Schneider with  great success in
the form of a tincture, made by infusing two ounces of the seeds in
eight ounces of Spanish wine with one of  spirit of wine, of which
the dose was from six  to  twenty drops.  Franck has  recommended
belladonna, especially  in mania combined with  epilepsy.  Muller of
Wurtzburg is said to have cured mania by giving the powdered root
of this plant in doses  which reached the quantity of thirty-six grains
in a day, taking care to desist when dilatation of the pupils or any
other specific effects of the poison were discovered.*
   10.  Mercury.—The use  of mercury has been highly recommend-
ed  in  madness by several  writers, and particularly by Dr. Rush.
Mercury is by no means a general remedy for maniacal diseases ; but
in cases of torpor, with suppression of a very scanty state of any of
the secretions, mercury is frequently employed with great advantage.
It should be used in mild alterative doses, and  discontinued as soon
as the  gums become slightly affected.
  11.  Rotatory motion.—Rotatory motion has been proposed long
ago, and frequently brought into use as a  method of reducing the
force of circulation, by occasioning vertigo and nausea with  some de-
gree of faintness.   The first suggestion of this attempt  is to be traced,
as M. Guislain has pointed out, in the works of Cselius Aurelianus.
Darwin, in modern times, made the proposal known.   A rotatory
coach,  in which  the patient  was to be turned round with rapidity in
a horizontal position, was the plan recommended by the last  men-
tioned  writer.  Dr. Cox, who brought the suggestion into actual use,
improved also on the scheme.  He used a swinging or rotatory chair,
in which the patient remained  seated during the operation.  Halla-
ran  and Von Hirsh have recommended a ship-bed or hammock.  In

  *  Hnfeland's Journal.—Nasse's Zeitschrift, 1823.—Guislain,  ouvrage cite
t. i. p. 368. 
           ROTATORY MOTION.—RESTORATIVE MEANS.       201

the hospital of la ChariU at Berlin, rotatory machines on both prin-
ciples are constructed ; one for horizontal and the other for perpen-
dicular rotation.  The application of this remedy has been still fur-
ther varied by Dr. Hoven and by Hayner.
  In whatever manner rotation may be  applied, the effects of the
process  are nearly similar.  Whoever has  experienced sea-sickness
must be aware of the strongly sedative  influence which this state
exerts on the nervous system and the voluntary powers.   That it
must be advantageous to a medical practitioner who has the care of
maniacs to  have within his reach the means of reducing occasionally
the morbid activity of such  persons by thus lowering the energy of
the physical  powers, could  scarcely admit  of doubt.  Experience
confirms this presumption.   Some  writers  have, indeed,  ridiculed
the idea of attempting such a remedy, and  others have thought it
difficult to imagine on what  principle it can be of any service ;  but
those practitioners who have put the proposal  to the test of experi-
ment have, if 1 am not mistaken, in  most instances been convinced
of its utility.  It was used by Dr. Cox in cases of violent maniacal
excitement, and was found by him to be a powerful sedative.   The
nausea and sickness  induced were  found  to tranquilize the patient
and put  a speedy termination to his paroxysm.  It was not found
requisite in all  cases to bring on vomiting.  Quiet sleep often folT
lowed the trial of this process.  Many other physicians who have
made use of the same remedy have assured me  that they  have  de-
rived similar advantages  from it, and  consider it  as a resource of
great value in the treatment of madness.  Among them, I shall men-
tion Dr.  Bompas, the relative  and  successor of Dr. Cox,  who  now
superintends the same establishment, and Dr. Wake, physician to the
asylum at York.
  The rotatory swing is also  useful as a method of moral  restraint.
Its effects are  so  disagreeable that the threat  of a repetition  has a
salutary influence upon turbulent and untractable patients.

                          ARTICLE II.

Second practical indication in the medical treatment of insanity.
  The principle of medical treatment hitherto considered, which has
respect to the physical condition of the brain  in cases of  maniacal
disease,  is chiefly applicable  to the  acute stage and early  period of
its duration.  The pathological fact  on which it is in part founded,
may be  usefully borne in mind in  the subsequent progress of the
complaint, and acted upon more or less when circumstances allow or
require  it, but it cannot, when the disorder has become confirmed,
be the chief guide of the practitioner.   The  marks of determination
to the head have generally,  under  such  circumstances, in a great
measure  subsided.  In these  instances inflammatory action  in  the
brain has probably given way to a state of relaxation bordering on
serous effusion, or to  other  changes which  imply rather the conse-
quences than the existence of increased vascular action.
                              18* 
202
TREATMENT OF INSANITY.
  The second indication for the medical treatment of insanity, which
has relation chiefly to the more advanced period and chronic aspect
of the disease, is to restore and maintain, as far as it can be done, a
healthy condition of the physical or natural functions, and to obviate
or remove disorders in other parts of the system, which may be con-
nected or coincident with the diseased condition of the brain.
   I have already  observed that in a great proportion of maniacal
cases there are symptoms of disturbance in the natural functions, and
that diseases of the thoracic and abdominal viscera co-exist with  that
morbid state of the  brain  on which madness  immediately depends;
—that the former are in fact often the immediate  causes  of death.
The relation in which these diseases stand to the cerebral disorder
may be doubtful  in  many instances ; in some  it is the relation of
cause, in  others  that of effect: even  in the last instance there is a
reaction of the secondary upon  the primary parts  in  the series of
morbid changes, and the original  disease is aggravated by its compli-
cation  with an accessory one.  By relieving the  latter  we obtain a
 proportional mitigation of the  former.   It is indeed a fact that many
 lunatics have been cured by a course of remedies adapted to the res-
 toration  of their  general health.   I  have repeatedly  seen persons
 who had laboured  for  some  months, or even years,  under mental
 derangement, brought from poor-houses in the country, or from their
 private dwellings, in a state of emaciation and squalid  wretchedness,
 suffering under  various disorders which had  become complicated
 with insanity, or had in some instances  preceded it.  These persons
 have been placed under medical  treatment; care has  been taken to
 relieve the disorders arising from exhaustion, to restore the functions
 to a healthy state, to afford good and  nutritious diet, and  to remove
 complaints which occurred  from time  to  time by occasional reme-
 dies.  In  many  cases of  this description, as the general health im-
 proved, the mental  disorder has  gradually lessened, and has finally
 disappeared.  In the course of four, five, or  six months from the
 period of the\r coming under  medical treatment,  very  many patients
 of this description  have  been restored to their usual  state of health,
 and to  the exercise of their customary occupations, after having
 undergone the operation of few remedies except such as are adapted
 to the indication or principle  of practice now pointed  out.*
    * This is the indication which some practitioners follow from the first  in the
 treamerit of insanity.  Mr. Hitch informs me that the plan adopted at the  Glou-
 cester Asylum is very simple.  He says, " We first secure the free evacuation
 of the bowels, and  cleanliness of skin  and clothing.  We assure the patient that
 we consider him to be mad, and shall treat him accordingly.  We allow  him a
 generous and  nutritious diet, bread,  meat, and ale, &c. and  if there is great
 anxiety and restlessness, we give him ether (Sp.  seth. s. c. 5ss or 5i)  every
  fourth hour, conjoined with carbonate of ammonia, and camphor, and other stim-
  ulants.  We enjoin living as much as'possible in the open air ;  and if the excited
  state is unyielding to this treatment,  we use the douche. For acts of violence,
  occasional moral delinquencies, &c. we use with remarkably good effects the
 bath of surprise."   Mr. Hitch assures me that when this plan of treatment has
 been adopted during the stage of incubation, the disorder has never proceeded to
 actual mania. 
RESTORATIVE MEANS.
203
  The mode of treatment required in following this indication must
vary according to the state of the constitution  and the modifica-
tions of disease which particular cases may present.
  In  examples of madness complicated with intestinal disorder,
care must be taken to relieve the latter by the  various remedies and
modes of diet and regimen which the  condition  of the intestinal
canal or of its function requires.  A torpid state of bowels must be
overcome by the use of mild aperients, continued daily, or  given
occasionally according  to  circumstances.  When  constipation has
given way to diarrhoea, with tenderness, abdominal distention, with
or  without occasional  symptoms of dysentery, with  emaciation,
coldness of the skin, general debility, a  disposition  to eruptions
resembling those of scurvy or purpura, the cure  can only be pro-
moted by a careful attention to a variety of particulars.  The  action
of  the bowels should be restrained by absorbent medicines, com-
bined  with slight  opiates  and mercurial alteratives.  The  use of
leeches and the warm bath, warm  clothing, and a warm atmosphere,
a mild and  nutritious diet, should be  enjoined  at the  same time.
Bitters, tonics, and aromatics  may afterwards  be given  to  support
the strength of the stomach and promote digestion : a liberal  allow-
ance of animal food, and sometimes malt liquors, and even wine,
are given with advantage in cases of debility  and exhaustion when
the digestive powers will bear their use.
   When the actions of the intestinal canal are irregular in chronic
cases of madness, without giving rise to so great a degree of disease
as in the instances above indicated, a healthy state of their function
is sufficiently promoted by giving mild aperients, with tonics and
neutral salts, two or three  times in a week, and  occasional doses of
calomel.
   When madness has been the result  of, or has been accompanied
by, diminution or loss of any other natural function or habitual pro-
cess, an effort should be made to restore it.   If we were possessed
of any certain emmenagogue, it  is highly  probable that its success-
ful application would in many cases promote  the  cure  of maniacal
diseases connected with the suppression of the  catamenia.   When
habitual discharges  from hemorrhoidal veins  have been coerced, or
have ceased spontaneously, derangement of the health  has ensued
similar to that occasioned  by uterine  suppressions.  The  want of
this latter process seems to be more easily supplied by the powers
of art than that of the uterine function.  M. Foville has mentioned
a case which occurred to M. Esquirol,  in  which  paralysis  became
complicated with madness in  consequence  of  the  suppression of an
 habitual hemorrhoidal discharge.   The application of a single leech
to the hemorrhoidal veins every day during a month was followed
 by a restoration of the  flux, and the patient was cured  of his com-
 plaint.
    Attempts to restore  the catemenia  when defective  in maniacal
 patients, as they very frequently are, seldom  produce  in a speedy
manner the desired result.  If any effort is perceptible  at particular 
204
MORAL TREATMENT.
times to set up the periodical discharge, it should be promoted by
small bleedings ;  by the application  of  leeches to the inguinal
region or the thighs, or by cupping at the loins, together with the
use of the hip-bath, pediluvium, general  warmth of clothing and
atmosphere, warm drinks, with doses of castor, camphor, and other
odorous stimulants.   At other times  aloe, rhubarb, and aromatic
bitters should be given daily by way of preparation.
   Attention  to  diet and regimen are fully as important for the ful-
filment of the last-mentioned indication as any remedy whatever.
In exhausted subjects, as before hinted, great advantage is obtained
from the use  of a liberal diet.   A  plentiful allowance of  animal
food of the most wholesome and digestible kind, is required.  The
adoption of a liberal diet is  not only free  in  such cases from any
exciting or too stimulant influence, but even appears  to  calm the
irritation  which previously existed.  But no rule respecting diet
can be laid down that must not  be subject to modification in particu-
lar circumstances, and according to the peculiarity of the case and
the state of  the constitution.
   Fresh air and exercise, for those  patients who  are in a condition
that renders them fit for it, are among the most important restora-
tive means.   Every asylum for the reception of lunatics  ought to
be provided with the means of affording regular employment in
the open air  to all the patients  who are able to undertake it.  Gar-
dening and  various  agricultural works should as much as possible
occupy their time at stated periods  of the  day, and by system and
judicious management a great majority among the inmates of these
receptacles may be brought  into  the habit of devoting themselves
mechanically to such employments.   M. Esquirol remarks that the
best effects have resulted from the employment  of these  methods.
They are  followed  with the greatest advantage  in several  lunatic
asylums, both public and private,  in different parts of England.  I
shall return  to the consideration of this topic under the head of the
moral treatment of insanity.

          Section II.—Moral Treatment of Insanity.

   The state of individuals is so very different in  the several forms
and  varieties of insanity, that no  rules  referring  to the moral
treatment or personal management of the insane can be of universal
application.   Any remarks  that may be made  on this subject will
either  have reference to particular  classes of deranged persons, or
will require modifications if they are adopted  in a  more general
point of view.  Maniacs, for example, who are under strong  excite-
ment,  during  paroxysms   of  raving  madness,  require  personal
coercion and even strict confinement of body and limbs in order to
prevent mischief to themselves and others.  Such treatment would
be quite improper for other  classes of lunatics, or even for the same
individuals at different periods.
   In order to render the remarks I  shall  offer on the moral treat- 
PROPRIETY OF SECLUSION.               205
 ment of insanity more  distinct  and easy of apprehension, I  shall
 arrange them under  the following  heads : these will be found to
 comprise,  if I am not mistaken, all  the most important considera-
 tions to which it is necessary to  advert.
   1. Of the  propriety of secluding or  confining the  insane, and
 separating them  from society.
   2. Of other means of abstracting  them from the morbid impres-
 sions and associations which may have excited and may foster their
 mental disease.
   3. Of the moral discipline and personal control under which they
 ought to be placed.
   4. Of the treatment of their understandings in relation to their
 illusions or the morbid impressions on their minds.

                           ARTICLE I.
   One of  the most  important considerations relating to the treat-
 ment of the insane turns upon the propriety of secluding them and
 separating them  from their  families and  from society.  This may
 be taken up, and, in  fact, requires to be  treated  both as a medical
 and as a legal or medico-legal question.  Legislatures have provided
 for the arrest of insane persons who disturb or endanger the public
 tranquillity :  they have ordained the confinement of such  indivi-
 duals in receptacles which are appropriated to their detention ; and
 they have  enacted a  suspension of the rights which those who are
 sane possess, and can alone with propriety exercise in disposing of
 person and property according to their  inclination.   Of all these
 arrangements the maintenance  of  public order  is the  principal
 object, and the second is the preservation  of the property belonging
 to the lunatic, and the interest of his family.   It belongs to medical
jurisprudence to determine under what  circumstances  such  pro-
 ceedings are required for the objects above mentioned:  the inquiry
 comprehends  what are  termed medico-legal discussions.   I  shall
 advert to the topics belonging  to this inquiry on a future occasion.
 My present engagement is  with a  consideration  strictly medical,
viz.  under  what  conditions and  in  what  manner confinement  or
seclusion is required in order to promote the recovery of insane
persons, or as means of restoring their health.
  M. Esquirol has observed that all  English, French, and German
physicians, who have devoted themselves to the  study of mental
diseases, recommend the confinement of the  insane, and are unani-
mous as to  the utility of this proceeding as means of cure.
  " Cullen  has pointed out the necessity of confining lunatics, and
separating  them  from their relations and  friends.   Willis,  who
acquired so great celebrity by having assisted towards the  happy
termination of the first attack of madness experienced by George III.,
unfurnished the  king's  apartments, dismissed  his  courtiers and
domestics, and had him attended  by strange servants.  Willis asserts
that insane  persons from the continent, who came to seek his advice,
got well more frequently than his countrymen. 
206
MORAL TREATMENT.
  " M. Pinel, in his Treatise on Madness, his best title to the admi-
ration and gratitude of mankind, has pronounced seclusion to be
the foundation of all rational treatment of mental diseases."
  We here find this statement made in very general terms ; whe-
ther any and what limitations are required or were  intended  will
be apparent, when we shall have considered the reasons which have
been assigned for having recourse to such a proceeding.
  The reasons which indicate the necessity of secluding  and  con-
fining  insane persons are briefly stated by M. Esquirol  in the
following heads.*
   1. The insane ought  to  be confined  for  their own security, for
that of their families, and for the maintenance of  public order.
This consideration is not within the scope of our present inquiry.
   2. To remove them from the influence of external circumstances
which may have  produced their disorder,  and may be  likely to
protract it.
   3. To overcome their resistance to curative means.
   4. To subject them to a regimen appropriate to their situation.
And
   5. To cause them to resume their moral and intellectual habits.
   That the second of these objects, which is  the foundation of all
curative proceedings, can only be obtained  by withdrawing insane
patients from their homes, and secluding them from their families
and society,  becomes apparent on considering the prevalent state of
the  feelings  and affections of lunatics, and  the results arising from
the erroneous impressions which cloud their understandings.
   " The sensibility of the insane," says M. Esquirol, " is perverted:
they no longer have any relation with the external world but those
of  a disordered and consequently  painful  nature.   Every thing
irritates them, distracts them, and excites their aversion.  In con-
stant opposition to all that  surrounds  them, they  soon persuade
themselves that persons are combined to injure them  ; and  neither
understanding  what  is said,  nor being able  to comprehend the
reasonings that  are addressed to them,  they misinterpret the most
affectionate expressions and the wisest counsels ; they mistake the
most candid, serious, and tender language for insults,  irony, and
provocations, and  the most attentive kindness for  contradictions.
The regimen and  the prohibitions  which are called for by their
situation, and  to  which their attendants wish to  subject them,
appear to them  cruel persecutions.
   " The heart of the insane cherishes no feeling but  mistrust; he is
irritated to anger  by every thing he sees, and is so timid and fearful
that he is troubled as soon  as  any one approaches him.  Hence
arises  the conviction  that every one tries to vex, defame, ruin, and
destroy  him.   This conviction  puts the  finishing  stroke to the

   *  Observations on the Illusions of the Insane, and upon the Medico-Legal
 Question of their Confinement, by M. Esquirol; translated by W. Liddell, Esq.
 Mr. Liddell has conferred a benefit on English  readers by his translation of this
 valuable work, and by many useful notes which he has appended to it. 
PROPRIETY OF SECLUSION.
207
moral perversion of his mind, and from it arises that symptomatic
mistrust which is observed in all the insane, even in maniacs who
appear so bold and audacious.
  " From mistrust these patients soon pass to fear or hatred ; and
in these new moral situations they repel their relations and friends,
and welcome stangers, throwing themselves into their arms, calling
them their  protectors or liberators, with whom they are ready to
fly, and abandon their home and family.
   " With these moral dispositions, if left in the bosom of his family,
the tender son, whose happiness used to  consist in living near his
mother, and in following his father's  counsels, persuaded that they
wish to disgust  him with his home in order to drive him  from  it,
falls  into the deepest  despair,  or  escapes to  destroy himself."*
" Another unhappy person becomes, all at once, lord of the world,
dictates his  sovereign commands to all that surround him  ; he ex-
pects to be  blindly obeyed by all those who have been accustomed
to yield  to his will through respect or affection.   His wife, his
children, his friends, his servants, are his subjects ;  they  have hi-
therto always submitted to his will  ;. how dare they resist him now ?
He is in his own territory ; his commands are despotic ; he is ready
to punish with  the greatest severity  whoever shall  make  the least
remonstrance.   What he requires may be impossible—that is of no
consequence : should the commands  of the all-powerful  meet with
obstacles ?  The affliction of his family, the chagrin of his friends,
the anxiety of all, their deference to  his will and  caprices, and the
repugnance that each evinces to oppose him from the fear  of exas-
perating his fury, contribute to confirm  him in his  imaginary pos-
session of power and dominion.  Withdraw him from his preten-
sions, transport him far from his house, from his empire,—removed
from  his subjects, surrounded by new scenes, he will collect his
ideas, direct his attention to himself, and place himself on an equal-
ity with his companions."!
   " Very often the cause of mental  derangement is to be found in
 domestic causes.  The malady takes its rise from  chagrins, from
family dissensions, from reverses of fortune, from privations ; and
the presence of relations and friends increases the evil, often with-
out their suspecting that they are the first cause of  it.  Sometimes
an excess of  tenderness seizes the patient;  a husband persuades
 himself that he cannot make  his wife happy ; he forms  the resolu-
 tion  of flying from her, and threatens to put an end to his existence,
 since it would be  the only means of  securing her happiness.   Her
 tears, her melancholy  countenance, are  so many new reasons  for
 persuading this unfortunate person to commit suicide."
   "  Sometimes the first disturbance given to  the moral and intel-
 lectual faculties has arisen in the home of the insane person, in the
 midst of his relations and friends.  All these external circumstances

              * Observations, before cited.
              f Dictionnaire des Sciences Medicales;  art. Folie. 
208
MORAL TREATMENT.
 being associated with the first attack and the disorder which follow-
 ed, will often contribute to keep alive and foster the hallucination,
 __a phenomenon which easily explains itself, since ideas  recur si-
 multaneously with certain impressions, when these  impressions and
 ideas have often been associated, or even when they have been con-
 nected, only once, but  with  remarkable  force and energy.  It is
 generally remarked that insane persons feel  an aversion  towards
 certain individuals, without the possibility of diverting  them from
 this feeling.  The object of  their hatred is  almost invariably the
 person who before the  attack possessed their tenderest affection ;
 hence it is that they are so indifferent to their relations, and often-
 times so dangerous ;  while, on the other hand, strangers are agree-
 able to them.   The presence of strangers suspends the delirium of
 the insane, either by the influence of new impressions, which is ah
 ways useful, or  from  a secret  feeling of self-respect,  which in-
 duces lunatics to conceal their state of mind.  I have seen patients
 appear quite calm before their physician and strangers, while they
 were at the same time abusing their  relations or their friends in an
 under voice."
   M. Georget, one of the most acute and intelligent writers of our
 time, who long devoted his attention to disorders which affect the
 mind and the  nervous system, has  in a similar manner urged the
 necessity of adopting the course which  is advised by M. Esquirol.
 He says that " all physicians who have habitually the cure of insane
 persons have recommended their seclusion  in almost every case as
 the most essential condition  and one of the  first  measures to be
 adopted in their treatment."   " Lunatics," he adds, " ought to be
 separated from  the  objects which have excited their  disease, or
 which foster or aggravate it ;  from relatives or servants whom they
 dislike, whom they pretend to command, and to whom they would
 never submit; from busy-bodies, who only irritate them by useless
 arguments or misplaced  ridicule ;  they ought to be  separated from
 society, and placed in an appropriate habitation, to ensure both the
 safety of the public and  their  own preservation.  Their friends are
 always  repugnant to put this plan  into execution ; a mother, a wife,
 or a husband, can with difficulty believe that the object  dearest in  „
 the world to either of them can be  better  placed  in the hands of
 strangers  than under the influence of those who are eager to devote
 the most affectionate cares ; they fear likewise that in lunatic asy-
 lums the sight of the patients will have a bad  effect, and aggravate
 the disease ; that constraint, severity, and all kinds of ill treatment
 will be  employed to manage the patient, and that, if once cured, he
 will preserve a horrible  impression  of his  abode, and resentment
 against his relations who have  consented to his confinement.   These
 last considerations induce rich families to place their deranged rela-
tives in private houses destined to receive  a single lunatic, who is
surrounded by servants  and inspectors whom he does  not know.
Besides that  these private establishments are very expensive, they
rarely answer the end proposed ; either some relation chooses to 
PROPRIETY OF SECLUSION.
209
 remain near  the invalid, or  the latter  soon perceives that every
 thing by which  he is  surrounded is destined for his service :  in
 either case the objects of seclusion are imperfectly attained.   Lastly,
 many things are  often required which are only to be found in public
 establishments.  This imperfect separation, however, is all that can
 be adopted  in some families, and we must make as much advantage
 of it as we can.   In  public asylums the  seclusion is complete; the
 patients soon know that they  are under  the  authority, and even at
 the discretion  of the director ;  they are watched and constrained
 without difficulty, under the care of regular attendants.   They find
 powerful sources of  occupation  and of distraction in  associating
 even with the other patients.  The greater number of lunatics never
 discover that they are in the midst of mad people, and find nothing
 to complain of in this circumstance.  When  their reason begins to
 return, they are removed  into the department destined  for the re-
 ception  of  convalescents, and hence are  withdrawn from  sights
 which might make unpleasant impressions upon them.  As long as
 the  disease  continues, they are angry with those who have deprived
 them of their liberty ;  but as soon as they have recovered their
 reason, resentment is  changed into  gratitude.   On  this account,
 then, the friends of  the  insane  incur no  risk.   We do not pre-
 tend to deny that this separation  and abode  among other  lunatics
 has  occasionally aggravated the disease, when of recent occurrence,
 in some individuals :  on  the  other hand, we affirm that the same
 means have cured many lunatics almost immediately.  Besides it is
 next to impossible to preserve and take  care  of  maniacs or mono-
 maniacs in the midst  of their families ;  and  all the inconveniences
 of separation  disappear under the absolute necessity of its adop-
 tion."*
   The preceding observations  on the propriety of secluding de-
 ranged persons from  society, and confining  them  in mad-houses,
 will be found applicable,  perhaps, to  all maniacs, and to many of
 those who labour under monomania.   In mania or raving madness,
 indeed, the  condition of the patient is such as to render the neces-
 sity of strict confinement obvious to common sense, both on account
 of the safety of  the individual and that  of his family, without ad-
 verting to the advantages  resulting from  such a measure in the pro-
 motion of recovery, and in the facility of applying remedies.  In a
 great proportion of the  cases of monomania the propriety of adopt-
 ing the same course is almost equally evident.  The understanding
 is in this disease  so disturbed, and the moral affections of the indi-
 vidual so perverted, that no alternative seems to  be left.
  But when the disorder of the understanding is so restricted as to
 leave the patient, according to appearances, the exercise of a great
portion of his reason,  it  is  more difficult to come to a determination.
It is often feared  that  the  opposition which the individual is about
to experience will deprive him of that portion of intelligence which

    * M. Georget, De la Folie,  1820: also art. Folie, in Diet. deMedecine.
  May, 1837.                 19 
210
MORAL  TREATMENT.
remains.   It seems cruel to  deprive him, of the attentions of his
family, and to separate a miserable being oppressed with grief from
the objects of his affections ; to remove an individual morbidly prone
to terror and alarm from the friends and relatives whom he regards
as his natural protectors.   We dread the shock which the feelings of
such patients may sustain when they see themselves in the midst of
lunatics.
   M. Esquirol, who is so strenuous an advocate for the seclusion of
deranged persons, candidly admits that  he  cannot assert  it to have
been never prejudicial.   He frankly owns that its effects  are some-
times injurious : he says tbat it  partakes  of the nature of  those
things, the best  of which are not always  free from inconvenience ;
he draws the conclusion "that the measure of confinement should
not be adopted too generally, nor too exclusively, and that it should
be prescribed only by the experienced physician."*
   It was long ago observed by this highly informed and  judicious
writer, that the necessity of confining madmen depended principally
upon the state  of their moral affections.  He has lately explained
more fully the meaning  of this remark, and has furnished us with
suggestions for following it out to its particular applications.t When
thepredominantfeelingsof the monomaniac are such as are calculated
to estrange  him  from  and to set him at enmity with his relatives;
when he is  actuated by  pride and misanthropy, by jealousy, hatred,
malice, confinement is absolutely necessary.  If, on  the  contrary,
the illusion of the insane relates to objects of indifference, and ex-
cites no strong emotions ;  if he has no  aversion  to his home and
the persons with whom he lives, although confinement may be
sometimes useful, it is not absolutely necessary. " But if the patient,
retaining a large portion of his intellect, has a strong attachment to
his relatives, it is to be feared that confinement might aggravate the
disease."
   If the disorder of intellect displays itself in connection with the
domestic habits  of the individual ; if the real or imaginary causes
of excitement are to be  found in the bosom of his family, there is,
on this account an obvious reason for removing him from his home,
though  it does not follow that confinement is necessary.
   Those lunatics whose propensities are dangerous to themselves or
others,  individuals who are prone to self-destruction, as well as the
malevolent and mischievous, ought always to be confined and closely
watched. They are cunning, and know how to elude the most active
superintendence.
   In moral insanity nearly the same observations are applicable as
in monomania.   The state of the feelings in these forms of insanity
is the same, and  monomania is only moral insanity with the addition
of disorder affecting the understanding or the rational powers.
  In that variety of moral insanity which consists in undue excite-
ment, a disposition to boisterous mirth,  wildness of conduct and

      * Diet. des. Sc. Medicates.       ,f Observations,  before cited. 
PROPRIETY OF SECLUSION.
211
   deportment, confinement is necessary.  It is the only remedy for
   this disease, and it often succeeds in bringing about the recovery of
   the individual.   Quiet,  seclusion, even  solitude, are obviously the
   most applicable means of bringing him to sober reflection, and en-
   abling the mind to subside into a state of tranquil composure. These
   means cannot be obtained except by having recourse in the first in-
   stance to compulsory seclusion and confinement.
      Where the disease is manifested  by dejection of spirits, gloom,
   and melancholy, the propriety of  confinement is much less certain,
   and it must depend upon the particular disposition and character of
   the individual.   Some  melancholies, when they are brought  into
   mad-houses, derive benefit from the effect which new external cir-
#  cumstances and the various habits of the inmates have in exciting
   their attention, and withdrawing it from their own internal feelings.
   A  few are shocked, and experience a sense of degradation.   If a
   patient labouring under  melancholia in the early stage, and while it
   is  not complicated  with  illusions,  can  be safely taken care  of  in a
   private abode, where inducements to exercise and beneficial recrea-
   tions can be administered, it will often be advisable  to adopt such
   a method rather than that of confinement in a lunatic asylum ; but
   if  the dejection of mind is  very great, it is necessary to be on the
   watch in order to anticipate any attempt at suicide. I was consulted
   some years ago with regard to a case of this description.  The
   patient was a gentleman who had  been an officer in  the army : he
   lived with  a friend in the  country, where he became melancholic,
   and gave himself up to despondency.   I strongly urged the imme-
   diate necessity of confinement : it was neglected, and  the next in-
   telligence that reached me respecting the individual was that he had
   shot himself.  In  every case of melancholy  it  is  requisite that a
   keeper should be constantly with  the  patient, who  should  be en-
   joined never to  lose sight of him.  Yet even  such precaution is not
   always sufficient when the disordered  person is otherwise at large.
   I know  a vigilant active woman who had once the care of a female
   lunatic under such  circumstances, and who for greater security slept
   in  the same bed with the patient.  The latter took an opportunity
   when her keeper was asleep, got out of bed, and cut her throat with
   a pair of scissors,  which she had contrived to  secrete on the pre-
   ceding day.
      A very troublesome description of cases are those in which there
   is  an invincible propensity to  drink  intoxicating liquors,  and in
   which fits  of drunkenness are followed by accessions of mania.
   Such persons, when brought into  lunatic houses and debarred from
   the use of fermented liquors, are soon  restored to a state of compo-
   sure : they demand their liberty, and after obtaining  it soon return
   to  the habit which occasioned their disease, or  rather the aggrava-
   tion of its symptoms.  Confinement in such instances would be the
   only prophylactic.   It is said to be practised in some countries, but
   in  this it is not  sanctioned.   The  consideration  of these cases does
   not, however, belong strietly to the subject which is our chief con-
   cern at present. 
212
MORAL TREATMENT.
   In the early stages of dementia or incoherence, when that state
supervenes on insanity, and the transition is as yet incomplete, con-
finement is not less necessary, from regard to security, than in mania
or monomania, but in the advanced degrees it is no longer required
on this ground, and may be dispensed with, provided that the rela-
tives and family of the demented person be in circumstances which
enable them to pay due attention to his comfort.
   Demented persons, or individuals labouring under incoherence or
fatuity the result of cerebral diseases, constitute a larger proportion
of the inmates  of both  public  and private  lunatic asylums. It
would be much better on  many accounts that such persons, if con-
fined  at all, should be  placed  in separate establishments, and not
mixed, as they now  universally are, with maniacs.  Many reasons #
connected with convenience and propriety may indicate, under par-
ticular circumstances, the expediency of  removing demented  per-
sons as well as idiots from private families,  but these  are different
considerations from  that of their confinement in lunatic houses,
and quite unconnected with the point of view in which we are now
contemplating the seclusion of insane persons, as a measure cal-
culated to promote recovery or a condition essential to any attempt
at cure.
   A very important consideration connected with  the  subject of
seclusion refers to  the period at  which it ought to cease.  On this
matter we may observe that it is the opinion of  all practical men,
an opinion confirmed by the experience of every day, that too much
care and precaution cannot be exercised in setting patients at liberty
who have  been  under confinement on account of mental derange-
ment.  So strong a predisposition to the disease appears  to remain
for some time after its apparent  cure, that convalescent patients are
known to undergo relapses when excited by such  emotions as  they
are almost  sure to  experience as soon as they are  at large, and can
only be protected from by seclusion, continued  as long as this extreme
susceptibility remains.  M. Pinel has given some important remarks
on  this subject,  which I shall  briefly abstract.  He observes that
any sudden alarm, transport of anger, or of grief;  that intemper-
ance, hot weather,  or even a sudden change from  a state of confine-
ment and  restraint to  liberty,  is liable to produce in convalescent
lunatics a disturbance of which they Would  not  be susceptible in
other  circumstances,  -and  to renew the attacks of mania when the
habit has not been  long suspended : that some convalescent patients,
who have been taken away too soon  by their  friends have suffered
relapses, and have  been obliged to return several  times to the  hos-
pitals.  A grenadier  of the French guards, who was one  of the
foremost to mount the Baslile  at its assault, gave  himself up to the
most  unbounded ambition, was  disappointed  in his brilliant expec-
tations, and  fell  into the  most violent maniacal delirium.  He re-
mained  four months in this state of fury and  confusion  after his
arrival at Bicetre.  When  he  became calm,  his mother took him
away  before his reason was confirmed : henee he experienced  a re- 
MEANS OF ABSTRACTION.                213
 turn of his attacks in the midst of his family, and it became neces-
 sary to remove him again to the hospital.  The same imprudence
 was renewed twice with the same results.   His mother, then in-
 structed by experience,  was  no  longer anxious to remove  him
 unseasonably : he passed two years tranquilly and without any at-
 tack, left the hospital at the beginning of the winter, and never again
 experienced a return of his disease.
   Hot weather, and sometimes the return of cold, although much
 more rarely, are liable to produce attacks  of recurrent mania ; it is
 therefore prudent, at such seasons, to employ some  preservatives
 for convalescent patients who have left the hospitals.
   I have no doubt that many  convalescent patients would derive
 great benefit from a plan of treatment similar to that which is insti-
 tuted at the establishment of Gheel, in  Belgium.  Gheel is a large
 scattered village,  where  five or  six hundred lunatics are spread
 among the cottages of the peasants.  Each patient is obliged to la-
 bour in the fields or gardens  for a  certain number of hours each day.
 When  not employed, they are allowed to walk  about  without re-
 straint, and are summoned to their homes  by the  village bell.  The
 peasants are bound to treat  their inmates with kindness, and they
 are remunerated according to a fixed rate for the care they take.
 We are informed that " the patients are considered to  be under the
 especial protection of St. Dymph of Gheel, a holy woman who  was
 there cured of insanity, under whose coffin each  person is made to
 pass with great ceremony at certain times."*

                          ARTICLE II.
 Of other means of abstracting lunatics from morbid impressions
   and associations connected with and fostering  their menial
   aberrations.

   In recent cases of partial  derangement, when the  state of the
 mind is judged to be not such as  requires  absolute seclusion  and
 confinement, much benefit has  often arisen  from changes of scene
 and occupation, from travelling, from  placing the patient amid ob-
jects which may divert his thoughts, and change  the course of his
 reflections.   This, next to the consideration  of confinement, is  the
 most important that can  engage our attention in reference to  the
 moral treatment of insanity.   The measures to be adopted in par-
 ticular cases must depend upon the circumstances of each individual,
 his condition as to pecuniary resources, his personal tastes or incli-
 nations, his susceptibilities of amusement  by  travelling,  or by field
 exercises or sports, his  inclination to society, or habitual fondness
 of solitude.  This last  disposition should be as  much  as possible
 counteracted.
  Journeys into foreign countries have often been recommended as

  * See the account of Gheel in M. Guislain's work, and particularly that of Sir
Andrew Halliday in his General View.
                              19* 
214
MORAL TREATMENT.
affording greater novelty.   Travelling in the south of France, Italy,
and Switzerland, has been enjoined  to melancholies as  well as to
hypochondriacs.  The use of mineral waters has been resorted to
with advantage in both instances : the influence of hope  and confi-
dence  in a new remedy is here presented in aid of other  favourable
external circumstances.  In some instances mineral waters are bene-
ficial by their medical properties, and particularly warm sulphureous
baths in cases complicated with cutaneous affections.* Ferruginous
saline  waters are also of service in some cases, when there is disor-
der and weakness of the stomach and digestive organs.
   Exercise  is  of the  greatest importance among the means of re-
storing the health of lunatics in all curable cases.   Walking or riding
in the open air, during as great a portion of the day as the strength
of individuals will support the fatigue resulting from it,  is often of
great service.   I have known  instances in which both insane per-
sons and hypochondriacs have  been greatly  improved by adopting
this rule, and systematically  adhering to it.   Long walks in fields
or woods, in company  with a suitable guardian, have aided  princi-
pally in the restoration of health  in some instances in  which  the
relatives of patients  labouring under symptoms of mental disorder
have refused to send  them to lunatic houses.   All establishments of
this description ought to beprovided with the means of affording regular
employment in the open air to such patients as  can  be induced to
undertake it.   Gardening and various  agricultural works should as
much  as possible employ their time at stated periods of the day ;
and  by system and judicious management many of the inmates of
these asylums may be brought into the habit of devoting themselves
mechanically to such occupations.  It  is said that a farmer in Scot-
land once  obtained a  high reputation for the cure of mental diseases.
He employed lunatics  in his farm, made them work in tillage,  fas-
tened  them to his plough, and by degrees brought the most violent
to a state of quietness  and submission.  Dr. Horn, of Berlin,  has
constructed at the hospital  of La Charite" a sort of cart  fit to hold
four lunatics, which  is drawn by thirty of their,companions, who
take their  turn  to  ride and  to be pulled along.   This exercise is
performed in the alleys of the gardens, and under the eyes of inspec-
tors.   The course along  which  the cart is to be driven  is marked
out beforehand, and  the greatest  regularity is observed in the per-
formance,  which, according to Horn, has been found a very effica-
cious resource  for  exercise  and  diversion, and  has  tended to  the
improvement of many  patients.t

  * Guislain, Traite de l'AHenation, t. i. p. 265.
  f Guislain, ouv. cit.—M. Fodere cites with commendation Dr. Wendt's account
of the lunatic asylums at Copenhagen, and some others in the north of Europe,
recently established or improved.  In these hospitals we are informed that all the
arrangements of construction are on the most aptly contrived plan, and  that the
principle of gentleness in the treatment of the patients is carried further than else-
where.   " All  violent means of repression are proscribed, such as chains, the
rotatory machine, solitary confinement, harshness of manner, and forced abstinence:
lunatics are treated in such  a manner as to  spare them  as much as possible the 
MEANS OF ABSTRACTION.
215
   Exercise is necessary for deranged  persons in cold and wet wea-
ther, and lunatic asylums should be furnished, and they are often
furnished, with galleries where the patients may walk under cover
and protected from rain, with a free admission of air.
   Female patients and men of sedentary habits should be engaged
as much as possible in some regular occupation.   This rule is fol-
lowed with great advantage in some of the hospitals for lunatics in
France, where the females  occupy  their time  in  embroidery and
working in various ways.   It  is found, as  before  mentioned, that
even in the early stages of dementia,  it is not  impossible to induce
such patients to work steadily at some merely mechanical employ-
ment.  Such habits mitigate the disease, or at least  its manifesta-
tions, and in  curable cases they tend strongly to promote recovery.*
   The  opinions of practical physicians are undecided as to the utility
of music as a means of amusement and of withdrawing the attention
of lunatics from the disordered  trains of thought which constitute
the  phenomena  of their  disease.   M. Guislain says  that music is
useful in two respects ; in the first place, when the patient plays on
a  musical instrument, his attention is  for the time occupied and his
mind beneficially exercised ; secondly, when  another person is the
agent, a train of soothing sensations  are excited  in  the deranged
which tend more or less to tranquilize.  Dr. J. P. Franck is said
to have found music of  great advantage  in  some cases of mania ac-
companied with  violent excitement of anger or rage.  On the other
hand Herberski  mentions a case in which  the sounds of any musi-


conviction of their real state."   It may be doubted whether this is always advisa-
ble.   " Patients, whose attacks abate in violence, are admitted to the society of
the director, take their meals with him; they are allowed free intercourse and
society among themselves, and care is taken to furnish them all with such occu-
pations as are consistent with their habits and education.  The men are occupied
either with military exercises, or they cut wood, or cultivate the soil; the women
wash the linen, knit, spin, sew.  Both sexes are taught geography, drawing, and
music."  " On Sundays" says Dr. Wendt, "they are  allowed to play at cards,
billiards, and in some asylums are made to act comedies.   Convalescents have
at their  use libraries and reading-rooms, where the public journals are put into
their hands."   Essai Medico-legal de M. le Professeur Fodere.
   * These principles have been followed in the establishment of most of the
lunatic asylums founded of late  years in different parts of Great Britain, and it
is  much to be regretted that they are not introduced into the old ones.  In the
Armagh Asylum there are thirteen  acres of ground, which  is cultivated by the
patients, and furnishes vegetables to the  whole establishment.  All the linen
used is woven by the patients, and their clothes made by themselves.  " As em-
ployment," says the  intelligent governor,  Mr. Jackson,  " is now generally
allowed to be one of the best restoratives, every means has been used to promote
it.   Such as are at  all  capable among the females are constantly occupied at
plain work, spinning, &c.  The division in which these works are carried on is
remarkable for its cheerfulness.  The patients with few exceptions seem grateful
and happy."  In the Richmond Lunatic Asylum, out of two hundred and seventy-
seven patients one hundred and thirty are actively and usefully employed, viz.
eighteen in garden labour, sixteen in spinning, twelve in knitting, eighteen at
needle-work, twelve in washing, sixteen in  carrying coals, white-washing the
wards, tailoring and weaving, and  twelve in learning to read—See Halliday,t
General  View. 
216
MORAL TREATMENT.
 cal instrument immediately excited a maniacal paroxysm ;* and M.
 Esquirol affirms that he has seen deranged persons in whom raving
 fits were produced by the same cause.  There  is no doubt that in
 many cases music is too exciting ; it produces too vivid an impres-
 sion on some persons  to be devoid of injury, especially in cases of
 mania with a tendency to strong excitement.  In an opposite state
 of  the  feelings, when the patient has  sunk  into dull apathy or
 lethargy, or is wrapped in gloom and melancholy contemplation
 from which  he is with difficulty  roused, some  advantage may be
 derived from this amusement, and  Dr. Cox declares that he has wit-
 nessed very  beneficial effects from it.
  The good effects of  music in madness have been chiefly extolled
 by  persons  who  were themselves devotedly  fond of it.  A fact
 which tends to prove that it affords no  important resource for  the
 treatment of this disease, is that it was  formerly much used in the
 lunatic asylum conducted  by Dr. Cox, and has been discontinued by
 his successor Dr.  Bompas, who had abundant opportunities of wit-
 nessing the trial, and who has  too much  observation and vigilant
 attention to leave any means neglected which had been found really
 serviceable.
  Dr. Cox has very judiciously observed that when the patient has
 been a  performer, playing on  his instrument should generally be
 allowed, as it innocently employs  both mind and body, and the  in-
 dulgence or  deprivation  may make a part of a  system of rewards
 and punishments.

                         ARTICLE III.

 Of the moral discipline and personal control under which luna-
                    tics ought to be placed.
  It is a great error to suppose  that lunatics are  not susceptible of
 moral discipline, or capable of being brought under  the control of
 motives similar to those which govern the actions of other persons.
 It is very possible to subject them  to such  rule, and this constitutes
 indeed a very important and essential part of the means of cure.
  The influence of fear and physical  force were formerly almost
 the only means by which deranged  persons were kept in control,
 Of  late years it has become the universal  conviction of those who
 understand the treatment of lunatics, that they ought to be managed
 with the utmost kindness.   The mildest methods have been found,
 in point of fact, the most successful in their  cure.   An  union of
 firmness in determination  with the greatest gentleness of manner is
the  sure way of gaining the respect and promoting the welfare, and,
 in curable cases,  the  recovery of lunatics.   "  Nothing is better
 established," says  M. Pinel,  "than the powerful influence  which
 the superintendent of a lunatic hospital exercises, when he sustains
 in his office the sentiment of his  dignity and the principles of a
Guislain, i. p. 274. 
OF MORAL DISCIPLINE.
217
pure and enlightened philanthropy.  I may cite, for proofs of this
position, Willis,  Fowler, Haslam  in England ;  Dicquemare, Por-
tion, Pussin in France ;  and in Holland the  steward of the lunatic
house'in Amsterdam."*  " Ignorant persons," he cohtinues, " per-
ceive only motives of provocation  in the  cries,  the outrageous
expressions, and violent actions  of maniacs.  Hence  the extreme
harshness, the blows, and brutal  treatment  which  the attendants
have allowed themselves to  use, unless when they have been per-
sons well chosen, and restrained by severe  discipline.   A sensible
and enlightened  superintendent, on the contrary, views these ex-
plosions of madness as the  impulses of an automaton,  or rather as
the necessary effects of nervous excitement, by which he ought no
more to be provoked than by the shock of a stone falling by its own
specific gravity.   He allows to lunatics all the liberty that is recon-
cilable with their own safety and  that of others, conceals from them
the means of constraint which  he  is obliged to employ,  and treating
them with indulgence,  leads  them to suppose  that they are  only
submitting to the laws of necessity.  At the  same time their incon-
siderate  entreaties  must be resisted  by strength or  eluded  with
address.   The  time during which the violent  exacerbations  of
mania continue is  thus  passed over amidst well directed measures
for mitigation, while the intervals of  calmness are made use of, to
render by degrees these accessions  less severe and of shorter dura-
tion.!
   It is an important observation  of M. Guislain's, that the  physi-
cian ought as much as  possible  to abstain from  inspiring fear or
dread of himself in  the lunatic, by which he  would become the ob-
ject of  aversion and lose the  confidence of  his  patient.  Another
person should smpear to be the agent in all restraints or punishments
that may be required, and the physician should be regarded as the
protector of his patients, and the dispenser of kindnesses and indul-
gences.:):
   M.  Georget,§ who has condensed, in an  admirable  manner, the
discursive observations  of MM. Pinel and Esquirol, has remarked
that "an active and incessant inspection must be  exercised in every
lunatic asylum over both  patients and attendants.   Patients who
evince a disposition to suicide should never  be  lost sight of  for a
single instant, whatever they  may say or do to  obtain their wish.

  * "A lunatic," says M. Pinel, "in the vigour of his age and of great strength,
who had been seized by his family, tied, and brought bound in  a carriage, so
terrified the persons that conducted  him, that no one dared approach to untie him
and conduct him to his  cell ; the steward sent all the keepers away, talked some
time with tbe invalid, and gained his confidence.  After being unbound, the lat-
ter permitted himself to be conducted quietly to the new abode which had been
prepared for him.  The steward  gained every day more  influence over the pa-
tient's mind, became his confidant, and  succeeded in restoring him to reason,
and to the bosom of his family, of which he constitutes the chief happiness."
  | Traite  Medico-Philosophique sur 1'Alienation Mentale, par Ph. Pinel, Mede-
cin Consultant desa Maj. PEmpereuret Roi, &c.2d edition. Paris, 1809, p.264.
  ± Guislain, ouvr. cite, torn. i. p. 328.        § Diet, de Medecine, art. Folie. 
218
OF MORAL DISCIPLINE.
It is often necessary to confine violent patients with  the  strait-
waistcoat.  Those who  are addicted to  indecent practices,—a cir-
cumstance by no means unfrequent,—should be restrained by similar
means.   Occasionally it is  better to confine them by straps round
the legs, fastened down  in  an arm-chair, or shut up in their rooms,
according to circumstances.  The use of chains  is almost entirely
abandoned, and we are  indebted to the noble efforts of our venera-
ble Pinel for this improvement in  the condition of lunatics."  It
may be observed that M. Foville ascribes to the Quakers who have
managed the Retreat the credit of  having been  the first to discard
these inhuman  instruments of restraint.*  " At the time of the abo-
lition of chains at Bicetre, M. Pinel observed that the diminution of
the number of furious lunatics, and the accidents which they suffered,
was very remarkable.   The only measures of punishment that ought
to be put into practice are the  strait-waistcoat, seclusion in a cell,
removed from one division to  another, the shower-bath, and some
occasional privations.  A violent or wicked lunatic, who all at once
puts on a menacing appearance, or  even commits reprehensible ac-
tions, should be immediately surrounded by a number of attendants,
approached and seized at the same  time on  all sides, particularly by
those who are behind him.  Sometimes  great advantage has been
obtained by suddenly enveloping the  patient's  head  in a napkin,
which completely bewilders him.   In other cases, while persons
placed before the patient endeavour to occupy his attention, others
advancing from behind  easily lay hold of and  secure him.t
   All means of punishment or of intimidation should be used as
sparingly as possible, and be of the most harmless kind.  Solitary
confinement with restriction in the strait Waistcoat is sufficient in
ordinary cases.   M. Foville makes great use of cold shower-baths
in the hospital  of St. Yon, where I have seen this  method  put in
practice with great address and management.   A violent maniac is
seized at once  by a number of strong men, who fasten his limbs
instantaneously, and place  him in a tub,  which is  covered with a
lid, having an aperture large enough for the head and neck to be pro-
truded.  In this he is placed  recumbent, and a man standing over
him pours out  pitchers  of  cold water,  which are supplied  by a by-
stander successively, till the lunatic, however boisterous and violent,
becomes completely subdued ;  the  water which falls from the pitch-
ers passes through holes in the cover  of  the tub and  flows over the
patient's body.  Refrigeration thus  produced is a powerful  sedative.
M. Foville employs it occasionally several times in a day, and he
assured me that he has  found it a most efficacious and  at  the same
time safe and  easy way of subduing  the violence,of the most in-
tractable patients.
   The use  of  the  circular swing  has been found  very serviceable
with a similar view, and after it  has  been  once used, a threat of
repetition is frequently sufficient.
         * Foville, art. Folie,  Diet. Pratique de Med. et de Chirurg.
         f Georget, Diet, de Medecine.—Pinel, ouvr. cite, p. 208. 
TREATMENT OF THE MIND.               219
  Intimidation is sometimes necessary in order to induce  obstinate
lunatics to take food.  Persuasion should be  first tried, and if this
fails, threats and harmless  punishments  should  be adopted.   It is
never  impossible, even by force, to  oblige  patients  to swallow a
sufficient quantity of nutritive broths or other fluids for the support
of life.  When  compulsion has been used but a few times, volun-
tary submission generally follows.*

                          ARTICLE IV.

 Of the treatment of the understanding  of lunatics, in relation
  to their illusions or the morbid impressions on their minds.
  It is a general rule, long since  established as a maxim among phy-
sicians who have made insanity  their particular study, not to direct
the attention  of  patients to the subjects  on which their illusions
turn, or to oppose their unreasonable prejudices  by argument, dis-
cussion, or contradiction, in order to bring them to a  correct way
of thinking.  Such  attempts are found to be worse than vain and
useless ; they irritate the temper of the deranged person, whom it
is impossible, under ordinary  circumstances,  to  convince by the
most evident proofs.  I have mentioned the case of a female lunatic,
who declared that her husband was dead, and who, though assured
that she was mistaken, refused to believe, and was not convinced of
her  error  when  he  game  to visit her.  She then averred that the
devil had assumed his form in order  to deceive  her.  There are
some cases on record in which a striking and palpable proof, sud-
denly and unexpectedly displayed, has succeeded in dispelling the
illusions of insane persons  ;  but they are rare, and form exceptions
to a very  general and almost universal rule.
  Other and more numerous instances are likewise related, in which
monomaniacs, and chiefly persons originally labouring under hypo-
chondriasis, have been cured of their  mental  delusion,  and, as it
would  appear, eventually of their entire disease, by some deception
founded upon the strength  of their illusory opinion or hallucination.
I shall recite a few of these examples, which may sometimes afford
useful suggestions.
  A lunatic refused to eat, assuring his  friends  that he was dead.
To the most earnest entreaties he only replied that " dead people
never eat."  After every other  method had been tried, he was left
for a time alone, when persons entered his  room dressed  in  white
shrouds, and after talking in his  presence, to persuade him  that they
were dead  men  or ghosts, sat  down to table  and began to eat.
When  his curiosity was excited by this strange scene, they invited
hint, as one helbnging to their own state of existence, to partake of
their repast.  At first he expressed astonishment, but at length took
his seat among them ;  and  after  eating voraciously fell asleep, and
on waking became convinced that he  was alive and well.
  * Mr. Liddell strongly recommends the use of a stomach-pump, which he says
that he has employed with good effects. See LiddelFs translation of Esquirol
on the Illusions of the Insane, &c. London, 1833. 
220
OF LUNATIC ASYLUMS.
   A celebrated  story is that  related by M. Esquirol, of a lunatic
 who fancied that he could not  let his urine pass without  subjecting
 the world to the risk  of being drowned by a second deluge.   He
 was at length prevailed upon  by being told that the town was on
 fire, and that he could thus save it from being destroyed by flames.*
   Gatianar is said to have cured a patient who fancied she had frogs
 in her stomach, by giving her a purgative and introducing by stealth
 little frogs into the pan that  received  the alvine  evacuations.!  A
 similar case occurred to Ambrose Pare.J
   Dr. Muller of Wurtzburg  cured a man who fancied that he had a
 demon or goblin in his belly, by the following  contrivance.   He
 covered the abdomen with a large blister, and at the moment when
 the vesicated skin  was torn off, contrived  that a  puppet or figure
 dressed up should be  thrown  out of the bed.   The man fancied
 himself  delivered of his tormentor.  Dr. Jacobi imitated this ex-
 periment, but only with temporary success.§
   Dr. Franck cured a woman  who  fancied  her bones  were lumi-
 nous and ready to take fire, by rubbing her skin with oil containing
 phosphorus, and pretending to  extract the light.
   I  have seen many cases not unlike some of the  above-mentioned
 as to the character of the illusion or hallucination,  but have not had
 an opportunity of making similar experiments, which, however, I
 shall certainly attempt  whenever  it  may be in my power, though
 without sanguine hopes of success.
   With  the exception of such  singular cases, it appears to be the
 uniform  result of experience that monomaniacs are  injured by all
 attempts to adyert or  in  any way to direct their attention to the
 subject on which their  illusions turn.   It is always better to draw
 them out from themselves, and  to  engage them as much as possible
 on external objects, and to excite interest in connexion with things
 remote from the morbid trains  of thought.

                          article  v.
   On the arrangement and management of lunatic asylums.

  MM. Pinel, Esquirol, and Guislain have discussed at great length
the various subjects connected with the arrangements and manage-
ment of lunatic asylums.  As it is my design to  present my readers
with  a short and compendious treatise  rather  than  to compile a
large and voluminous work, I shall beg to refer those who wish for
extensive and particular information on  the  construction and the
mode of  conducting  these establishments to the  authors  above-
mentioned, and on the present occasion I shall merely translate the
abstract which M. Georget has  given us from the extensive disqui-
sitions of Pinel and Esquirol.
  " 1.  M.  Pinel  has  particularly  insisted  upon the necessity  of

   * Esquirol, Diet, de Sc. Med.
   f Franck, Prax. Med.  Guislain,  i. p. 286.
   1; Esquirol on Illusions of the  Insane.
   § Jacobi's Sammlungen fur die heilkunde der gemiithskrankheiten, bd. i. 
OF LUNATIC ASYLUMS.
221
 classing lunatics, of separating such as are liable to injure themselves
 or others, and  permitting  those  to  associate together  who  may
 contribute to each other's  cure.  A lunatic  asylum ought to  be
 composed of several parts more or less insulated.   There should be
 a quarter appropriated to each sex, a  division  for violent lunatics, a
 second for those that are tranquil, a third for convalescents, a fourth
 for lunatics who labour under accidental disorders.  It will be  very
 useful  to  have a division for  those who are of melancholy habits,
 and  in  a  state  of  dementia,  and another  for furious and noisy
 patients, and for some lunatics who are of an untameable character,
 and  are confined by way of punishment.   It is above all things
 necessary  to separate  the sexes, the convalescents,  and likewise
 those patients  who  have depraved habits and indecent manners.
 Each division  ought to  have a court planted with  trees, and, if
 possible, a garden for the patients to walk in.
   " 2.  M. Esquirol, who has devoted his attention  to the arrange-
 ments which these establishments require for the  convenience of
 the patients, to facilitate vigilant superintendence and protection,
 and to prevent accidents, is of opinion that  such houses should  be
 built on level ground ; that the cells  destined for violent  patients
 should be  spacious,  with  a door and  window  opposite each other,
 and opening  from without; that they should  be boarded and not
 paved, furnished with a bed firmly fixed in the wall ; that all the
 cells  should communicate with  covered galleries or corridors,  in
 which the  patients may walk in  bad weather, and  by  means  of
 which the  inspectors and servants may easily traverse the different
 parts  of the establishment; that all the rooms should be warmed
 by pipes of hot  air ; that abundance of water should be furnished
 by fountains  to wash the dirty cells ; that  the privies  should be
 separated in such a manner as  to occasion no  inconvenience to the
 patients ; that there should be  places appointed for a general work-
 room, for a common dining-room,  for baths and showerbaths.   In
 the plan of M. Esquirol there are dormitories only for convalescents,
 melancholic  patients, idiots, and individuals who are debilitated.
 For others little cells, with one bed are  preferable in almost every
 case : during the day the patients can go out and  associate with
 others, and in the night they do not require companions.
   " 3. Beings deprived of reason, who  fancy  themselves rational,
 who  incessantly desire and demand things that cannot be granted
 them, and  who are nevertheless  sensible to  kind  as well as to
 bad treatment, must needs be difficult to influence,  to govern,  and
 to cure.  As long as each person continues  insane, he looks upon
 the director and inspectors of the establishment  as accomplices in the
 power which has deprived him of liberty, and  upon the attendants
as inhuman jailors.   Even  after his  cure he  is not always very
grateful.   The  director,  the inspectors,  and  the attendants will
invariably  be objects of  prejudice, suspicion, and  hatred  to  the
patients ; they will receive abuse and  often blows from them.  On
the other hand,  it is impossible for  one who has  not had for  a
  May,  1837.                20 
222
DESCRIPTION OF
long time the care of them, and studied  their disease, to know the
mental  disposition of lunatics.   Without  such  preparation vve
should attribute to wickedness what is the effect of disease, or look
upon  lunatics as beings deprived of all  sensibility.   In either case
we might be induced to treat them  with severity.  It is almost
impossible to make servants understand that mad persons have the
use of some of their faculties, with the exception of those servants
who have been themselves  attacked by the disease.  At the Salpe-
triere and at Bicetre great advantage is derived from  employing
persons who have  been  cured to  take  care of the patients.   The
physician of a  lunatic asylum ought  to  be particularly careful to
instruct  the individuals  who  are  to  have the management of the
patients."
   " 4. It is absolutely necessary that a judicious  arrangement of
authority and subordination be established in  lunatic asylums, and
that the physician be invested with  a power superior to all with
regard to every thing that concerns the patients."
                      CHAPTER VIII.

                   OF- PUERPERAL MADNESS.

 Section I.—Description and general Account of the Disease.

  Puerperal madness  is a form of mental derangement incident
to women soon after  childbirth.  This is  the proper sense of the
term, but by some writers it has been extended in its meaning, and
made to include cases which occur both before and after the puer-
peral period.   Symptoms of  insanity occasionally display them-
selves during pregnancy, and  under circumstances which indicate
that they are  dependent on that state.   These cases  are  rare in
comparison with  those which occur after  delivery.  M. Esquirol
mentions the  instance of  a young  woman of very sensitive  habit
who had attacks of madness on two  occasions, each of which lasted
fifteen  days,  having commenced  immediately after  conception,
The same writer observes also that several women at the Salpetriere
have become maniacal during  the time of their pregnancy.  Many
females likewise  become deranged  during the advanced period of
lactation, especially  those  of irritable temperament, and  such as
attempt to suckle  their children too long in reference to the strength
of their constitutions.
   Cases of puerperal madness properly so termed, that is, coming
on  after childbirth, are by no  means infrequent.  M. Esquirol  has
related  that among 600 maniacal women  at the Salpetriere, there
were 52 cases of this description.   In another report  by the same
writer, there  were  92  similar cases among 1119 insane females
admitted during four years into the above-mentioned hospital.  M. 
PUERPERAL MADNESS.
223
Esquirol is of opinion that the proportion  is still  greater in the
higher classes of  society,  since  out  of 144  instances  of mental
disorder occurring in  females  of opulent families, the  symptoms
had  displayed themselves, in 21, either soon after childbirth or
during the period of lactation.  Dr. Haslam enumerates 84 instances
of puerperal mania in  1644 cases admitted at Bethlem.  Dr. Rush,
however, reckons only five such cases in seventy received into the
hospital for lunatics in Philadelphia.
   There is no peculiarity in the phenomena  of puerperal madness
by which this disease is distinguished from other examples of insa-
nity.  Dr. Gooch has remarked that " if a physician was taken into
the chamber of a patient whose  mind had become  deranged from
lying-in or nursing, he could not  tell by the mere condition  of the
mind that the disease had originated in  these causes."
   Those cases which are more properly termed puerperal, as occur-
ring in the first period after childbirth, are generally of  the charac-
ter of mania, attended with excitement of  the feelings  and  mental
illusions ; while the disorder  which displays itself in women ex-
hausted by suckling is most commonly  connected with melancholy
depression, a tendency to which may generally be perceived in fe-
males who  nurse their  children too  long  with reference  to the
strength of  their own constitutions.  Cases of the former descrip-
tion occur within a short period,  and most frequently within a fort-
night after delivery.   They appear sometimes to be occasioned by
fright or other accidental causes of disturbance ; sometimes by error
in diet, or  by premature exertions  or excitements : in other in-
stances they take place independently of any discoverable external
cause.  The patient passes one or two restless nights,  appears un-
usually excited and irritable, talks loudly and incessantly, and very
soon betrays a disturbed intellect.  The attack  is often attended
with febrile  symptoms.  This is the case especially, as Dr. Burrows
has  observed, if  it takes place about the fourth or fifth day, when
the  secretion of milk is producing a new excitement.  The state of
the  pulse is  the most important symptom in  reference to the nature
and treatment of the case, as  well as to the prognostic which is to
be formed of its result.  Dr. Gooch has laid particular stress on this
circumstance, and he has extracted  a valuable passage  which bears
 upon it  from the manuscript  lectures  of Dr. Hunter.   " Mania,"
said this eminent practitioner, "  is not  an uncommon appearance in
the  course of the month, but of that species from  which we gene-
 rally recover.   When out of their senses, attended  with fever,
 like paraphrenias,  they will in all  probability die  ; but when
 without  fever it is not  fatal, though it (i. e. fever) generally takes
 place before they get well.   I have had several private patients, and
 have been called in when a great number of stimulating medicines
 and blisters have been  administered, but  they have gone on as  at
 another time, talking  nonsense, till the  disease has gone  off, and they
 have become sensible.  It is a  species of  madness they generally
 recover from, but I know of nothing of any singular service in it." 
224
TERMINATIONS OF
   Dr. Gooch's comment upon this passage is the remark, supported
 by his own observation, that there are two forms of puerperal ma-
 nia : one of them is attended by fever, or rather by a rapid pulse ;
 the other is  accompanied by a  very moderate disturbance of the
 circulation.   Cases of the latter kind, which happily are by far the
 most numerous, terminate in  recovery ; the former are generally
 fatal.

       Section II.— Terminations of Puerperal Madness.

   Puerperal madness terminates, in a great proportion of cases, either
 in death  or in  the  recovery of  reason.  Few instances, compara-
 tively, become cases of permanent  insanity.  It is, however, very
 difficult to obtain accurate information on this subject.   Dr. Gooch
 has  observed that the records of hospitals contain chiefly accounts
 of cases which have been admitted because they had been unusually
 permanent, having  already disappointed the hope, which  is gene-
 rally entertained and acted upon, of relief by private care : the cases
 of short duration, which last only a few days or weeks, and which
 form a large proportion, are  totally overlooked or  omitted in the
 inspection of hospital reports.   This remark accounts for the unfa-
 vourable  nature of the results which are obtained from such tables
 as those given by M. Esquirol and others.  By this writer ninety-
 two cases are enumerated, of which  fifty-five recovered,  and six
 died, leaving thirty-one as the number of incurables, that is, one in
 three.  Of the fifty-five recoveries, thirty-eight took  place within
 the first six months.   Of eighty-five cases admitted at Bethlem,
 under Dr.  Haslam, only fifty recovered, leaving  thirty-five as the
 number of incurables.   Dr. Burrows mentions fifty-seven cases, of
 which thirty-five recovered, and eleven remained uncured ; of the
 recoveries, twenty-eight  took place  within the  first six months.
 These tables, as Dr. Gooch observes, throw but little  light upon
 the real proportions of recoveries, and  present a prospect unneces-
 sarily gloomy and discouraging.   He adds, " Of the many  patients
 about whom I  have been consulted, I know only two who are now,
 after many years, disordered in mind, and of them one had already
 been so before her marriage."
   The question, on the solution of which there is the greatest reason
 for anxiety in reference to any particular case of puerperal madness,
 is, whether it is likely to be fatal, because, if not fatal, there is great
 probability  of ultimate  recovery.  The most satisfactory way of
 coming to a conclusion on this inquiry in any individual case, is by
 the prognostications which the particular  symptoms afford, and on
 this subject  I can add  little to what has already been said.  The
 principal  danger which  menaces life in cases of this description
 arises from  extreme debility ; the excitement  of the  vascular as
 well as of the cerebral  functions is  so great as  to wear out the
strength, already at a low ebb, and neither recruited by nutrition
nor by sleep, and the patient sinks from exhaustion.  Experience 
PUERPERAL MADNESS.
225
 has proved that a rapid circulation  is  the  principal  circumstance
 which tends to bring on this state.   A very frequent pulse is the
 most unfavourable  symptom.  Long-continued resistance to sleep,
 and a state of complete restlessness, and the appearance of great
 weakness and inanition, give likewise reason for apprehension.   If
 these signs are not found, the  mental derangement of the patient
 need not give occasion  to very serious alarm.
   Medical authors  have sought to found a prognostic in puerperal
 madness on the estimate of the proportions which deaths bear  to
 recoveries.   This cannot afford evidence on which so much reliance
 may be placed as on the symptoms of individual cases.  Out of the
 ninety-two cases mentioned by M. Esquirol, of which fifty-five ter-
 minated in recovery, there was, as I  have observed, six deaths, and
 in  Dr. Burrows's table  of fifty-seven cases  there were ten deaths.
 The  former calculation gives  one death in fifteen  cases, and the
 latter one in six.   But the patients in the Salpetriere are probably
 removed thither after the period in which the disease is most danger^
 ous to life.   There must have been some circumstances tending  to
 explain the discrepancy in the above-mentioned results.  The pro-
 portion of deaths given by M. Esquirol's table is probably some-
 what too low, but the result afforded by that of Dr. Burrows gives
 perhaps a greater mortality than the average number afforded by
 general experience.

  Section III.—Causes and Pathology of Puerperal Madness.

   The inquiry into the  causes of puerperal madness  comes within
 a narrow compass.  The principal question which suggests itself in
 relation to this subject is,  whether the  disease is the  result  of de-
 livery, or arises, according to common  opinion, from  the irritation*
 accompanying the flow  of milk.
   Sauvages and other writers have recognized two different forms
 of  mental derangement  incident to lying-in women.   One of them
 has been termed " paraphrosyne puerperarum," and is observed
 to succeed  labour, immediately or within a day or two, before the
 secretion of milk can  disturb the system, and independently of any
 lochial suppression,   " These attacks," says Dr. Burrows, who as-
 sents  to the above distinction of varieties in the disease," will some-
times gooff under the operation of a smart purge and an opiate, and
may then be considered  as merely accessions of delirium : in other
 instances they are more  permanent, and become fully developed in-
 stances of  puerperal insanity.  Sauvages  second species  is termed:
 < mania lactea:' and  Dr. Burrows is of opinion that maniacal  symp-
 toms in reality make  their appearance  most frequently about the
 third or fourth day after childbirth, which tends to confirm the
 notion that they are  connected  with the lacteal secretion.   This
 writer, however, has very candidly referred to the evidence deduci-
 ble from the tables  published by M. Esquirol, although it is  rather
 opposed to the opinion above stated.   From these tables it appears
                              20* 
226
PATHOLOGY OF
that in the years 1811, 1812, 1813,1814, eleven hundred and nine-
teen insane women were  admitted  into  the  Salpetriere, of whom
ninety-two laboured under puerperal madness : of these—
16 became delirious from the first to the fourth day.
21 from the fifth to the fifteenth  day, which generally includes the
       termination of the lochia.
17 from the sixteenth to the sixtieth day.
19 from the sixtieth to the twelfth month of lactation.
19 after forced or voluntary weaning.
  The result seems to be, as Dr. Burrows allows, that the disease is
more frequently a consequence of delivery than of suckling.
  On the whole it appears evident that some cause more general in
its influence than any one  particular process must be referred to, if
we would explain the frequent occurrence of  madness in pregnant,
puerperal, and suckling females.
  The only attempt to  explain  the theory of puerperal madness
which deserves much consideration,  is that which was suggested by
Dr. Ferriar.  I shall cite his opinion in his own expressions.
  " I am inclined to  consider the puerperal mania as a case of con-
version.   During gestation, and after delivery, when the milk be-
gins to flow, the balance of the  circulation  is so greatly disturbed
as to be liable to much disorder from the application of any exciting
cause.  If, therefore, cold  affecting  the head, violent noises, want
of sleep, or uneasy thoughts, distress a puerperal patient before the
determination of blood to the breasts is  regularly made, the impetus
may be readily converted to the head, and  produce either hysteria
or insanity, according to its force and the nature  of the occasional
cause."
  That new determinations in  the vascular system should ensue on
the removal of one so long subsisting as that to  the uterus during
pregnancy, is  in accordance with a well-ascertained principle in
pathology.   The natural  and  healthy determination under these
circumstances is to the lacteal glands, but owing  to various causes,
either external  or  of predisposition, morbid  determinations  occa-
sionally take  place  Some women become  phthisical at  a  very
early period after childbirth, or  rather the symptoms of phthisis
develope themselves  at that time in  a  manifest form.  Other con-
stitutional complaints are apt to arise at the same period, according to
the prevalent tendency of  the habit. When  the  brain is suscepti-
ble, it is likely to suffer in its  turn, and  become the seat of local
disorder, the manifestations  of which  are  affections of the mind.
If we consider the frequent changes or disturbances  occurring in the
.balance of the circulation from the varying and quickly succeeding
processes  which are carried on  in the system  during and soon after
the periods of  pregnancy and  childbirth, we shall be at no loss to
discover circumstances  under which  a  susceptible  constitution
is likely to suffer.  The  conversions or successive changes in the
temporary local determinations  of  blood which  the constitution
under such circumstances sustains and  requires, appear sufficiently
to account  ftu? the morbid susceptibility of the brain. 
PUERPERAL MADNESS.
227
  The cases of mental disorder which occur in the later periods of
lactation are, as it is evident from M. Esquirol's table, of two kinds.
In one  the disease supervenes on weaning, and probably has its
origin in the subsidence of the lacteal secretion.  There  are other
instances  which appear to arise from the continued excitement and
exhaustion of the system consequent  on suckling.   This state of
exhaustion takes place at different periods in different constitutions.
Some women can continue to give milk  without injury for years,
but by others morbid feelings are experienced in the  space of a few
months or even of  as  many weeks, and  do not subside  for some
time after weaning.  I have observed very numerous instances of
melancholy dejection  with symptoms  of insanity  more  or  less
strongly marked, which have displayed themselves in  the protracted
period of nursing,  and in  females who were evidently suffering
from  exhaustion.   In  one case a lady, who on former occasions had
complained of feelings termed nervous, and had  been much  in-
disposed when giving milk, was persuaded to continue suckling a
child until  the thirteenth  or  fourteenth month.  She was  then
attacked by a maniacal disorder, which, though of a mild character,
was very  decided in its nature.  Nearly a  year  passed before her
mind was perfectly restored.

       Section IV.— Treatment of Puerperal Madness.

  If we consider that the greatest  danger to be apprehended  for
patients labouring under puerperal madness arises from a state of
extreme exhaustion, that many Women  die from this cause within
a short interval from the commencement of the disease, and that, if
they survive this  period, the healthy state of the  mind is in  most
instances restored, it will be evident that our chief endeavours must
be directed to the present support of life.   If we can maintain and
restore the general health, and keep the  natural functions  in a state
compatible with continued existence for a time, the disease of the
animal system will  in  all probability subside.  Antiphlogistic and
particularly evacuant  remedies must  be used very  sparingly and
with great caution.
  1. Bloodletting, as  a general remedy for puerperal  madness, is
condemned by all practical  writers on whose  judgment much  reli-
ance  ought to be placed.   M. Esquirol is  decidedly opposed to
it.  Dr. Gooch's observations on this subject contain the best expo-
sition of the rules which ought to guide medical  practitioners  as to
the use of the lancet in cases  of puerperal madness.   He  says,
" The result of my experience is, that in puerperal mania and me-
lancholia, and also in  those cases  which more resemble delirium
tremens, bloodletting  is not only seldom or never  necessary, but
generally  almost always pernicious.  I do  not say that cases never
occur which require this remedy ;  no man's experience extends to
all  the  possibilities of disease, but I have never met with  such
cases, and I would lay down this rule for the employment of blood-
letting—never to use it as a remedy for disorder in  the mind, unless 
228
TREATMENT OF
that disorder is accompanied by symptoms of congestion or inflam-
mation of the brain, such as would lead to its employment though
the mind was not disordered.  Even  here, however, great caution
is necessary ; local is safer than general bleeding.  In  one  case
the head was hot, and the face red, and the pulse was said to have
become somewhat hard, yet a bleeding of eight ounces was followed
by extinction of the pulse within three  hours, and death in less  than
six.   The only cases  attended by a  quick pulse which I  have  seen
recover were those in which no  blood  was taken.   In  the really
inflammatory diseases of the brain, bloodletting  of  course is essen-
tially necessary, but these, I think, can  never be mistaken for puer-
peral insanity ; they are febrile headachs, more  or less acute.  Pain
of the head with fever is a much better indication for bloodletting
than disorder of the mind without these symptoms."
   2.  In cases attended with much heat about the scalp, flushing of
the face, and strong pulsation of the temporal  and carotid arteries,
it will be proper to shave the head and keep  it cool  by  means of
cold lotions,  or an oil-skin cap filled with ice or iced  water, or by
evaporating lotions.  If the symptoms above mentioned are very
acute, and the debility of the patient is not in an alarming degree, a
few leeches may be applied with  advantage. Blisters to the occiput
or nape of the neck are often serviceable ; they are much recom-
mended by practical writers.  When the scalp is not hot, and the
tendency of the disease is rather to  stupor than to a high  degree of
excitement, blisters are usefully applied over the top of the head.
  The lower extremities, which are often cold, should be frequently
immersed in hot water.  Dr. Burrows recommends bathing the legs
and feet in a warm infusion of mustard or horse-radish.  Heat should
be applied in the most convenient form, and the circulation in  the
extremities promoted by other obvious means.
  3. Purgatives and emetics are among the most useful remedies in
this disease.   The alimentary  canal is frequently in a disordered
state, the tongue  furred, the breath fetid, the skin discoloured,  the
evacuations dark and  offensive.  A few brisk purgative doses, calo-
mel, followed by castor-oil or rhubarb and magnesia, should be given
in such cases.   Emetics of ipecacuanha, with small doses  of tartar-
ized  antimony, are very valuable remedies in this state of the alimen-
tary  canal.   Dr. Gooch has remarked that they should be used with
caution when the face  is pale, the skin cold, and the pulse quick  and
weak ; and in general he prefers ipecacuanha to  antimonials.
  4.  After these  evacuant remedies have been premised,  great ad-
vantage is frequently  derived from  the  use of opiates.  Full doses
are generally attended with the best success.  Ten grains of Dover's
powders may be given at night, or a grain and a half of solid opium,
or thirty drops of the tincture.   Several writers recommend Batt-
ley's solution of opium  in preference to the tincture ; perhaps  the
acetate and muriate of morphia are the best preparations of opium;:
they may be given  in doses of a quarter or half of a grain, and re-
peated every third  or fourth hour until sleep is procured.  When
opiates disagree,  Dr.  Gooch recommends  the  use of byosciamus,. 
PUERPERAL MADNESS.
229
  mixed with camphor.   He says that five grains of each should be
  given every sixth hour, and a double dose at night:  a dram of the
  tincture will answer the same purpose.  This writer is  of opinion
  that narcotics are the most valuable remedy in the cure of puerperal
  mania ; he says that " they often produce nights of better sleep and
  days of greater tranquillity, and this calmness is followed  by some
  clearing up of the disorder of the mind."  He says that these reme-
  dies produce salutary effects much more frequently in the mania of
  lying-in women than in maniacal disorders occurring under other
  circumstances ; if, however,  there is heat  in the head, flushing in
  the face, and  thirst, their use ought to be postponed until such symp-
  toms shall have been removed.
    5.  In the more protracted cases  of puerperal  madness, tonic and
  stimulant medicines are sometimes  requisite, especially when the
  appetite has failed.   Ammonia is much recommended.   It may be
  given with infusion of cinchona, or any bitter infusion.   When it is
  not offensive  to the  stomach, the rectified oil of turpentine is one of
 the best stimulants, especially if it can be taken in the dose of a dram
 three times in a day with cinnamon water,or any other aromatic fluid.
    6. A rule of great importance refers to the diet of women in puer-
 peral madness.  It may, perhaps, be safely asserted that the greatest
 risk which patients in this  disease incur is  that of being starved
 through the mistaken notions of their attendants, who are too often
 disposed to consider the excitement of maniacal  disease a reason for
 withholding food, when this very state, owing to the exhaustion
 produced by  its long continuance, renders it especially necessary
 to support the strength more carefully.   Farinaceous fluids  of a nu-
 tritive quality, milk, rice, and other such matters should be given at
 short intervals, when  febrile symptoms preclude the  use of animal
 food.  In most instances broth  may be allowed and ought,  to be
 given.   In the more protracted periods solid meat, with malt liquors,
 should be taken.   I have seen very many maniacal  patients labour-
 ing under great weakness and exhaustion, with  cold extremities,  a
 clammy skin, passing sleepless nights, and under continual agitation,
 begin to improve as soon as their diet was changed, and meat with
 some ale or porter given daily.   The pulse has  become fuller and
 less frequent,  the extremities warm, sleep has  been  restored, and
 convalescence has taken  place in a surprisingly short period after
 such a system has been adopted.
   7.  The last observation to be made refers to the management of
 such patients.   We must here advert to the remarks to be found in a
 former chapter on the management and moral treatment of insane
 patients  in general.   The general rules only require modification in
 some particulars in relation to the peculiar circumstances of puerpe-
 ral women.   The latter for obvious reasons cannot be soon removed
 from  home.  They require in other respects  similar management.
 They should be separated from  relatives and friends, and carefully
 attended by persons who are  fitted for the occupation by habit. It
 will not so often be necessary to send puerperal maniacs to lunatic
asylums as deranged persons of a different description. 
230
IDIOTISM, OR
                       CHAPTER IX.

            OF IDIOTISM AND  MENTAL  DEFICIENCY.

  Section I.—General Description  of Idiotism and Menial
                          Deficiency.

  Idiotism is a state in which the mental faculties have been want-
ing from birth, or have not been manifested  at the period  at which
they are usually developed.  Idiotism  is an original defect, and is,
by this circumstance, as well as by its phenomena, distinguished from
that fatuity that results  from disease or from protracted  age:  the
latter, as we have seen, is dementia, or incoherence, and it is impor-
tant that this affection should not be confounded with idiotism.  The
distinction was pointed out by M. Esquirol, and it has been gene-
rally adopted.  By the same writer, idiotism, or original deficiency
of  understanding, is likewise divided into two stages  or degrees,
viz. absolute idiotism, and the condition approaching to  idiotism ;
which last is denominated imbecility.  Imbecility is a state in which
the intellectual faculties are not wholly deficient, though manifested
in a lower degree than according to the ordinary standard.
   Idiotism, however, itself is not the same in all instances : it  dif-
fers in particular cases, and has a variety of forms.   One of the most
strongly marked of these is termed Cretinism, a species of idiotism
connected with personal deformity, which  is well known and  fre-
quent in  the Valais and in some other parts of Switzerland.  This
disease has been described by many  writers,  and particularly by
M- de Saussure and  Professor Fodere.*  Cretinism discovers itself in
very early infancy.   Josias Simler, the historian of the Valais,  who
wrote in  1574, declares that in his time midwives were able to  pro-
nounce, from the appearance of a new-born infant, whether it would
prove a cretin or not ; but this is denied by M. de Rambuteau, pre-
fect of the department of the Simplon,  who, in  1803,  addressed a
memoir on the subject of cretinism to the minister of the interior,
from which M. Georget has published  some  very interesting ex-
tracts.  According to M. de Rambuteau, cretinism can very rarely
be recognized in newly-born infants.
   According to M. Fodere, who has given a  very able  and, as  it
appears, an accurate account of the characteristic phenomena of this
affection, " cretins  often  show  in the earliest infancy what they, are
destined  to  become : they have sometimes in their first years in-
cipient goitre,  a puffed, swollen countenance ; their hands and  head
are large, and out  of proportion to  the rest  of their bodies ;  they
evince insensibility to atmospheric impressions, an habitual state of
6tupor and sloth ;  difficulty in sucking, as  if through weakness  of

   * M. de Saussure, Voyages dans les Alpes. Geneve, 1826.—Traite du Goitre
et  du Cretinisme, par F. E. Fodere, ancien Medecin des Hopitaux civils et
militaires.  Paris, an  8. 
MENTAL DEFICIENCY.
231
instinct connected even with the first wants ; very slow and very
imperfect development of the faculty of articulating sounds ; often
they are only capable of learning to pronounce vowels without con-
sonants.   As their bodies attain bulk, they even display more and
more clumsy  and  stupid awkwardness in all their  movements ;
the same deficiency or  absence of intelligence continues to the age
of ten or twelve years, since little  cretins of that age are unable  to
take food into their mouths and masticate it, so that it is even neces-
sary to put their aliment down their throats.   As they grow up,
they still go with an awkward tottering gait, when they can be in-
duced to move at all : they have never a cheerful  countenance, are
always stupidly obstinate, with a resisting, mutinous temper, which
is only tolerated by maternal  tenderness : they show a dispropor-
tioned smallness of the  head  in relation  to the body ;  their heads
are flattened at the summit and at  the temples, and the tuberosity
of the occiput is less projecting than is natural; their eyes are small,
sometimes deeply sunk, at others prominent ; their look fixed and
stupid ;  their  chests are flat ; their fingers  thin and long, with small
articulations ; the soles of their feet flat, and sometimes bent; their
feet often turned inwards or outwards ; puberty comes very slowly,
but with  enormous size of the genital organs, obscene and inordinate
propensities.   It is not until this epoch that cretins generally walk
about;  their  locomotion is yet  very limited,  and only excited  by
the desire of  getting their food  or of warming themselves by the
chimney-corner or in the rays of the sun.   His litter is to the cretin
the term of  his longest and most fatiguing journies, and to it he
comes tottering, with his arms hanging,down and his body reeling
about.   In seeking his  object,  he goes forward, without shunning
dangers or obstacles ;  he can  take no other road than  that to which
he is familiar.  When  he has  attained his  full  stature, which is
generally from thirteen to sixteen  decimetres,  the  cretin's skin
becomes brown, his sensibility continues  obtuse; he is indifferent
 to cold, heat,  or even to blows and wounds ; he is generally deaf and
 dumb ;  the strongest and most revolting odours scarcely affect him.
 I have seen a cretin eat with  avidity raw onions,  or even charcoal,
 which  proves that the organ  of taste is gross or imperfect.  Still
 more so are sight and touch,  which are modes  of discernment and
 intelligence,  the powers of  which must be very limited or very
 imperfect.  The affections of cretins  seem to be still more dull ;
 they have often no  sort of gratitude  for the good offices rendered
 to them ; they show scarcely any sensibility at the  sight of their
 relations, and evince neither  pain  nor  pleasure in respect  to their
 physical wants. Such is," says Fodere,  " the physical and moral
 life of the cretins during  a  long career  ; for, reduced to a sort of
 vegetation and automatic existence, they  arrive without difficulty to
 an extreme old age."*
    The observation  that cretins attain old  age is contradicted by

       * Fodere Traite, du Goitre, &c.—Pinel sur 1'Alienation Mentale. 
232
IDIOTISM—CRETINISM.
other writers.   Cretins in  general  die  before  they have attained
thirty years of age.  The goitre and  the other external  deformi-
ties above described are not  universal among them, though very
general.*
   The causes of cretinism form a very interesting subject of inquiry,
but one as yet but little elucidated.  The opinion that it arises from
the drinking of snow-water has been long abandoned.   This notion
was refuted  by M.  de Saussure, who observed that cretinism is
peculiar to certain  local  situations : cretins are  found only in deep
valleys and on the lower  parts of mountains,  and do not exist in
places of considerable elevation.   The cause of cretinism  is appa-
rently some congenital defect of organization depending upon the
physical circumstances of families in which it is engendered, but
of what precise nature this may be it is as yet unknown.  Some
very curious  particulars, however, have been collected by M. Ram-
buteau.  Cretinism  seems to be  nearly connected with the causes
which give  rise to  goitre  or the  bronchocele of  mountaineers.
Wherever there are cretins, goitres are also found ; but goitres exist
in  some places  where there are  no cretins.   In approaching the
countries where cretinism exists, one meets first with a few goitres
only : these  afterwards are found  more frequently, and at length
cretins make their appearance.   Women  of the Valais are much
more apt to have cretin-children when married to  Savoyards, who
are commonly drunken and debauched men, than those who marry
Frenchmen,  or mountaineers from the higher Alpine country. The
latter are sober and active in their habits.   Parents of healthy con-
stitution and sound  organization  of body seldom  have cretins in
their families.   Stammering is common  in the Valais ;  and parents
who have this  defect have more frequently cretin-children than
others.  It is generally observed that  if the first child in  a family
is a cretin, those who are born subsequently partake of the same
infirmity.  Cretinism seems,  therefore, to  be a congenital disease,
and to depend upon some defect in the race propagated in certain
situations in  mountainous countries.  Like other congenital pecu-
liarities, it depends chiefly on causes which exert their  immediate
influence principally on  the  parents.   In these particulars it is
analogous to other forms of idiotism ; a defect which is observed to
be more  frequent in mountainous than  in other regions, owing like-
wise, as  it may be presumed, to local influences.
   The idiots of other countries, though not  cretins, are deforrried in
person, and have the external marks of imperfect organization. They
are often, as  M. Esquirol remarks, scrofulous,  or  rachitic, or par-
tially paralytic, or subject to epilepsy : their heads are  either too
large or too small, ill-formed, flattened laterally, behind  or before  ;
their features are ill-shaped  ; their chests narrow, contracted ;  their
eyes are  blinking and deeply set: they have thick lips, wide-gaping
mouths : their organs of sense are  imperfect; they see imperfectly,
* M. Georget, Diet, de Medecine. 
IDIOTISM.                       233
are deaf or hard of hearing, dumb or drawling and lisping in their
speech :  their taste and smell are also imperfect, and they eat with-
out selection of food.   Their limbs are ill-formed, and their gait
awkward and unsteady : their movements and attempts at muscular
action of any kind are imperfect.   Their reflective faculties are still
more imperfect than their powers of sensation: they are incapable of
directing their attention to  anything.  Though sensations take place.
through the organs of sight  or hearing, they are scarcely followed by
any perception of objects :  they have scarcely any traces of memory,
judgment, or imagination :  their power of speech, if it exist at all, is
extremely limited, and they are only capable of expressing the most
urgent physical wants.  Many idiots have even the instinctive faculties
in a defective  state, and appear to be far below the brutes in the scale
of  animal existence ; for brute animals have in perfection all those
impulses to action which  are necessary for  their individual well-
being and that of their tribe, and they are endowed by nature with
powers adequate to the pursuit of the objects to which  these im-
pulses direct them. It is otherwise in both these respects with idiots,
which, as  the writer before cited has observed,  are monsters  or
imperfect beings, who appear destined to a  speedy  extinction, if the
tenderness of  parents or the compassion of others did not interfere
to prolong their existence.  Yet  idiots have the  bodily appetites,
sexual desires :  they are likewise subject to anger and rage.  Con-
genital idiots!  have large heads,  imperfect features, with difficulty
take the breast, and have a feeble physical life ; are long before their
eyes follow the light, and they often squint.   They are puny, lean,
of  bad complexion, incapable of  instruction, do not learn to walk
till six or seven years  of age, or  sometimes not till they attain  the
age of puberty : they articulate  imperfectly, and learn but a few
words.   There  are  some  idiots who  display faint glimmerings of
intelligence :  their attention is  sometimes excited by impressions
made upon their senses : " they appear  to look at  certain objects
with a sentiment  of pleasure mixed  with  curiosity :  they show
appetency for certain objects, go  to their food and  take it : they
come to  know the persons who habitually take care of them : they
indicate  sometimes, by means of cries or gestures, the  objects of
their desires, and manifest the pleasure or pain which they expe-
rience :  yet it is necessary to dress them,  to put them in bed, and
to place  them where they are to remain."* Idiots of a higher grade
of  development are capable of moving themselves voluntarily from
place to  place.  These individuals display  very remarkable pheno-
mena : they resemble, as M. Esquirol observes, machines made for
the purpose of repeating ever the  same movements, and habit takes
with them the place of understanding : they move their arms in a
particular way, as if to facilitate their progression,  laugh mechani-
cally, utter inarticulate sounds, as if to amuse themselves:  some even
are capable of catching tunes of a simple kind, which they repeat:

              * M. Georget, art. Idiotisme, Diet,  de Medecine.
   May, 1837.                21 
234
OF IMBECILITY.
they become attached to particular places, and grumble and appear
ill at ease if they cannot get access to them.
  There is no exact line of demarcation between idiotism  and a
degree  of  weakness which is  generally  termed imbecility ; they
pass by insensible shades into each other, as imbecility likewise ap-
proaches gradually to  perfection of  understanding ; there is no
possibility  of saying where precisely one stage of mental deficiency
ends and the other begins, or where the latter ceases and sound un-
derstanding has its place.  Imbecile persons are, according to the
distinction laid  down by M. Georget, those who have some  use,
though a limited one, of  speech, who display some indications of
mind, of intellectual  faculties,  and of  feelings or affections : these
individuals show the same varieties  of  character and inclination as
persons of stronger understanding : the senses of some give rise to
dull and feeble impressions, in  others  to  more lively perceptions;
the power of recollection  is tolerably strong in some,  in  others
scarcely exists, or is confined in its range to the  most ordinary and
frequently-repeated ideas.   Some have a limited capability for  par-
ticular actions ;  a disposition and some degree of facility in certain
acts or performances, which they get through tolerably well, while
to other modes of exertion they are quite incompetent.   "Custom
or habit has a great influence on all their proceedings, and this gives
to the manner of existence of some imbeciles an appearance of regu-
larity  which might be mistaken for the result of steadiness and  per-
severance."'*  All, however, are deficient in power of thought and
of attention.  Left to themselves, they are careless, slothful, filthy,
lazy, timorous.   At the age of  puberty, they display the effects of
animal instinct in the  most offensive  gestures and habits.  Some
become subject to fits of capricious  violence, to hysteric attacks, to
nymphomania or satyriasis ; others grow dejected, melancholy, and
sink under a gradual  decay of physical health.
   In idiots and imbecile persons in general, the physical functions
are in a comparatively perfect state.  They eat and digest food, and
females have the catamenia :  they are, however, generally short-
lived, and  anatomy sometimes displays, as M. Georget has observed,
 great and unsuspected  anomalies in the viscera of natural and  vital
functions; but these are by no means so  constant as deformities in
the shape of the head and  defects in the organization of the brain.
   Some individuals, who yet come under the denomination  of im-
becile persons, display  glimmerings of talent in  particular pursuits.
 Some are fond of music, and  cultivate with  success this  aptitude.
 An instance of this kind has fallen under my observation : a young
 man, otherwise very  weak, has a decided  talent for music, and can
 compose  extempore in  a  way  that has astonished many persons.
 Some have even very retentive memories, learn languages, or are
 capable of other particular acquirements, while in all other respects
 they are defective in mental power.   Many facts of this description
* Esquirol. 
CAUSES OF IDIOTISM.
235
have been collected by Dr. Gall and his followers, as favourable to
the doctrine of phrenology.

       Section II.—Causes of Idiotism and Imbecility.

   M. Georget has given a brief statement of the morbid appearances
in the brain connected with idiotism.  Faulty conformation of the
head  has already been mentioned : from it arises deficiency in the
volume of the  brain  either general or partial.   A  similar conse-
quence results from preternatural thickness of the cranium, which
has sometimes been observed.   Chronic hydrocephalus is not a fre-
quent cause of idiotism.   When the brain is small, the convolutions
are less thick, less deep, and often less numerous ;  particularly in
the anterior  lobes, when  the forehead is flattened.   Induration of
the medullary substance of the hemispheres is not very rarely found :
it is generally partial.  M. Esquirol has  collected  seven or  eight
cases of atrophy of  one hemisphere in idiots who had been hem
plegical with atrophy of the paralyzed limbs.  The diseased part
was reduced by one-third ; the convolutions were attenuated, com-
pressed, and some of them destroyed ; the cerebral substance was
softened in some parts and hardened in  the  centre.  This  kind of
disorganization extended through the brain of a  deaf  and dumb
 idiot.  Some brains  of idiots  have been found free from  disease,
though contracted in volume.
    Idiotism. depends evidently  upon congenital  disease in  most in-
stances, but in others it is the  result of maladies affecting the brain
 in very early infancy.   It is often occasioned by severe fits of con-
 vulsion during the process of dentition, as are other manifestations
 of cerebral disease.   Hemiplegia, for example, arises from the same
 cause.   In other cases  idiotism has been observed after the sudden
 disappearance of  eruptive diseases of infants, particularly of those
 affecting the sealp, as of porrigo with extensive suppuration.  In
 these instances inflammation from metastasis becomes the precursor
 of a change of structure in the brain.  It is possible that in some
 cases such consequences might be averted by the early use of ap-
 propriate means.
    There  are  different degrees and varieties of mental  deficiency,
 which scarcely amount  to  what is termed  either  idiotism,  or, in
 general  language, imbecility.  Persons so  affected are commonly
 said to be weak in  character,  stupid, or of mean capacity.  When
 the degree of  intellectual weakness is just such as to render indi-
 viduals scarcely competent to  manage business, or to conduct them-
 selves with propriety, it sometimes happens that legal inquiries are
 instituted into the state of  their understandings and the soundness
 of their minds.   It is in such cases that the  vvant of a  criterion of
 the  presence or absence of mental  deficiency is chiefly felt, as well
 as the difficulty of establishing any certain standard.
    In a following chapter, on the legal considerations which are
 connected with unsoundness of mind, I  shall take an opportunity of
 advening to the attempts which have been made to supply this want. 
236
STATISTICS OF INSANITY.
                        CHAPTER  X.

  ON THE HISTORY OF MENTAL DISORDERS AS DEDUCED FROM
                 STATISTICAL OBSERVATIONS.

Section I.—General Remarks on the Opinion  that Insanity is
  an increasing Disease.—Statistics of Insanity in Britain.—
  Concluding Observations.

  Several extensive  inquiries are  comprehended under the title
prefixed to this chapter, such as those which relate to the propor-
tion of  lunatics to the general population of different countries, the
increase or diminution of their relative numbers, their  condition,
and  that of the  classes in  the community to which they belong.
These particulars, and other subjects connected with them,  would
furnish  by themselves matter for a voluminous treatise. The limits
of my work prevent me from entering at large into these  investi-
gations  ; but I cannot pass  them by  altogether, because from them
many general facts are developed which are essential to the history
of mental disorders.  I shall, therefore, take a brief survey of this
subject, and shall refer my  readers to the sources of more extensive
information.
  Two  principal inquiries connected with this subject  relate to the
proportional frequency of mental disorders in different places and
times.  It is hence that we may expect to throw some  light  on the
connexion of insanity with the circumstances of climate and local
situation  on the one  hand, and,  on the other, with  the peculiar
moral condition and the states of society.
  A very general apprehension has existed both in this country and
in France, that insanity has increased in prevalence of  late years to
an alarming extent, and  that the  number  of lunatics, when  com-
pared with the population,  is continually on the increase. Different
opinions have been  held on this  subject by medical  writers, and
much discussion took place in reference to  it before  data existed
that were calculated to furnish any secure groundwork for conclu-
sions. The opinion that mental derangement is an increasing disease
was maintained by Dr. Powell, secretary to  the commissioners for
licensing mad-houses, in a memoir published in  the fourth volume
of  the  Medical Transactions.  The principal  ground  on which
Dr. Powell  argued  was an increase of  numbers  apparent  in  the
London Register of lunatics.  This  register contains an account of
all lunatics confined in  private  asylums in England ; and  in  the
numbers of these  a great  augmentation  was apparent, as  it was
shown by a table containing the numbers in the eight quinquennial
periods or lustra from 1775 to 1814, the aggregate nnmber in the
first lustrum being 1783, and that of the last 3647.  But Dr. Bur-
rows, who has examined this subject with attention, proved that the
conclusion is by no means supported by the data  ;  for in the first
place the Register has no  account  of  the  numbers of lunatics in 
NUMBERS IN ENGLAND AND WALES.          237
 public asylums, or of those who exist elsewhere, and not confined
 in licensed houses ;  its contents may, therefore, vary according as
 it may be the custom  to  send patients either to public or private
 mad-houses, or to keep them at home or in unlicensed receptacles :
 and, secondly, the increase in Dr. Powell's table is not regular and
 progressive, but subject to such variations as plainly invalidate the
 inference drawn from it by the author, while the augmentations ob-
 served at particular times admit of a different explanation from that
 which he has  adopted.
   An opinion opposite to that of Dr. Powell has been  maintained
 by other writers, as  by Dr. Willan, and afterwards by Dr. Bateman,
 in their reports on the diseases of  London, published in 1801 and
 1819 ; and this side of the question had been taken by Dr. Heber-
 den, in his Observations on the Increase and Decrease of Different
 Diseases.   But to establish any general and satisfactory conclusions
 on the subject, more extensive data  were evidently required than
 those of which the writers above mentioned could avail themselves.
   The first attempt to estimate the  proportional number of lunatics
 in England was  made by Dr. Powell.  The  author had no other
 resources for his computation than a comparison of the  number  of
 lunatics entered on the register with the  census of the population.
 By comparing the number registered in 1800 with the census of
 the same date, Dr. Powell deduced  the conclusion that the propor-
 tion of lunatics in England is one to seven thousand three hundred
 persons, an estimate which only shows how  vain it  was to  make
 such an attempt with means so inadequate.
   The public attention was drawn to this subject, and to the  neces-
 sity of obtaining further information, by the exertions of some active
 individuals ; and in 1806  a select committee of the House of Com-
 mons was appointed for the purpose.  In  the report  of this com-
 mittee we have the first attempt to obtain an  official  return  of the
 number of insane poor in England.   This return stated the number
 of lunatics and idiots in England and Wales to be only 2248. The
 numbers were more  than double by returns which were  called  for
 by a new committee in 1815 ; but this augmentation appears refera-
 ble to the incompleteness of the former account rather than to an
 increase in the number of lunatics.   Even the last-mentioned  re-
 turns were found to be very unsatisfactory, and much larger num-
 bers have been obtained, as we  shall observe, on later occasions.
   Dr. Burrows pursued the inquiry into  the  slatistics of insanity,
availing himself of the returns made to the House of Commons in
 1819, which he corrected  by inserting the numbers contained in St.
 Luke's and some other hospitals. He found the aggregate number
of lunatics confined  in public  asylums, hospitals, and gaols  at the
above date to be 1456, and that of  individuals  resident in private
asylums 2585, making a total for all  England and Wales of 4041.
To this ascertained number the author added conjecturally, for the
number not included in the return, that is, for those existing at
large or in private receptacles not registered, one half of the  num-
                              21* 
238
STATISTICS OF INSANITY.
ber ascertained.   He thus increased the aggregate number to 6,000,
which he regarded as the nearest approximation that could be made
to the total number of  lunatics in  Great Britain, and which gives,
on a probable estimate  of the population at the time, one lunatic to
2000 people.
   We have the results of later  and more extensive  researches in
two works published by Sir  Andrew Halliday in 1828 and 1829.
In the first of these the author proved, by a calculation founded on
the returns printed in  1826, that the number of lunatics in South
Britain  was at that time considerably above Dr. Burrows's estimate.
The number of lunatics stated to be in confinement in the different
private  and public asylums, as  well  as in gaols, in  England and
Wales, amounted, in 1826, according to the data obtained  by Sir
Andrew Halliday, to 4782.
-   " But there is a number," says the same writer, " if not equally
great, at least nearly so, of whom the  law takes no cognizance, and
whose existence is only known to their relatives and friends.  These
consist of individuals  placed  in solitary confinement with persons
who only take one patient.  I have been persevering and strict in
my inquiries; I have laboured unceasingly now for twenty-five years,
and I give it as the result of the information I have  obtained, that
the aggregate  number of persons actually in confinement in public
and private asylums, and with  their relatives, or  with  individual
keepers, in  England and Wales, exceeds 8000."   "Yet great," he
adds, " as this number  may  appear, and I  am aware that it  greatly
exceeds the average given by some late writers on the subject,  I do
not think that the disease has  increased among us ;  and I have good
authority for what I say on this point, from the returns I have col-
lected at various periods during  the last quarter of a century."*
   The same writer has added  a computation of the number of luna-
tics in Scotland, deduced from parliamentary returns and other pub-
lic documents.  From these it appeared, as he says, that the public
and private asylums of that country, in 1826, contained 648  indi-
viduals, and the public gaols 10,  a collective number bearing  a small
proportion to  the aggregate of insane persons in the kingdom.  "On
this point," he adds, " I can speak with absolute certainty, for there
are now on my  table  distinct returns from 800 of the 900 parishes
into which Scotland is divided, all carefully made up and signed by
the respectable clergyman  of  each  parish.  From these it  appears
that there are about 3700 insane persons and idiots in this kingdom.
Of these 146 are  in  private asylums, 50 in the public asylum, and
about 60 in Bedlam, in the county of Edinburgh, and 387 in other
public asylums and  workhouses ;  1192 are  confined with  private
individuals, principally with small farmers and cottagers, and 21 are
in  gaols ; making the  number of persons actually in a state  of con-

   * General View of the state of Lunatics and of Lunatic Asylums in Great Bri-
tain and  Ireland, and in some other Kingdoms, by Sir A. Halliday, M. D. & K. H.
London, 1828.  p. 15-16. 
NUMBERS IN ENGLAND AND WALES.
239
finement 1861 ; while upwards of 1600 are allowed to be at large,
most of them wandering over the  country and subsisting by beg-
ging."*
  Returns of the numbers of persons in confinement in lunatic asy-
lums in Ireland were likewise made  up for the same year ;  in these
the aggregate amounts nearly to 1600.  This number, according to
Sir A.  Halliday, bears a small proportion  to the actual  number df
insane  persons and idiots in Ireland.   We have no certain data, says
the same writer, from which we can calculate what that number is ;
but I do not exaggerate when I state it at 3000.
   In the year 1829, Sir  A. Halliday  published further  researches
in the  same subject, in which  he was induced to estimate the  total
numbers of deranged persons in England and Wales considerably
above his former computation.  After going through a careful exami-
nation  of all the English counties separately, he states the total num-
ber of  lunatics at 6806, and that of idiots at 5741, being altogether
12,547 insane persons ascertained, beyond all doubt, as existing in
England.t  This, however, is by  no means  the whole  number.
Considering the towns  which are counties in themselves, and the
great number of parishes in some counties which  had made no re-
turns  when the reports  were made  up, which are the basis of this
calculation, we shall  have, as Sir A. Halliday says, on the  most
moderate estimate,  to add about 1500 to the  number above stated,
which will make the whole  number of insane persons in England
above  14,000.
   From a summary of the insane population of different counties in
Wales, we have 153 lunatics and 763 idiots,  collectively 896 de-
ranged persons ascertained to exist  in the principality.   From the
facts that so great a proportion of these are idiots, and that very few
are in  any place of refuge, and that many parishes  have made  no
returns, it is very reasonably supposed that the  true amount may be
fairly  estimated above 1000 persons.
   To  the numbers  actually ascertained, by adding 155, the number
of lunatics in the Naval Asylum at  Haslar, and  122 in the  Military
Asylum at Chatham, the aggregate  number of 15,720 will be afford-
ed. Having thus ascertained that very nearly 14,000 insane persons
exist in South Britain, Sir A. Halliday concludes that it will be no
exaggerated estimate to  state the  numbers not  returned at 2500,
 which will give 16,500 as the entire number of deranged persons in
the whole of South Britain.
   The same writer estimates the proportional  numbers of lunatics
 to the entire population  in different parts of Britain, separately, as
 follows.
    The population of England in 1821 was 11,261,437 persons.  In
 ten years an increase of nearly two millions had taken place beyond

   * General View, p.  28.
   f A  Letter to Lerd Robert Seymour, with a Report of the Number of Lunatics
 and Idiots in England and Wales, by Sir Andrew Halliday, K. H. & M. D.
 London, Underwood,  1829. 
240
NUMBER OF LUNATICS
the number existing  before  that interval ; it is, therefore, fair to
allow one million and a half  for the increase of  the  population of
England since the last census, that is, from 1821  to 1829,  and this
will make the number  of people in England at the latter period
amount to nearly 12,700,000, and the proportion of insane persons
to the entire population about 1 in every 1000.  This refers to as-
certained numbers, and is obviously below the reality.
   On a  similar principle, the population of Wales is estimated at
817,438  in 1829 ;  and as the ascertained number of insane persons
amounted then to 896, and  the returns are known to be very in-
complete, the proportion of the deranged to the entire population of
Wales is calculated by Sir A. Halliday at 1 to 800.
   Sir A. Halliday states the  number of insane  in Scotland as ascer-
tained at 5652, which, as he says, gives  1 to 574 of the population.
   Some curious facts develope themselves in regard  to the compa-
rative frequency of madness  and  idiotism in different ranks of the
community.   Of the 14,000 insane  calculated  to exist in England,
or  of the 12,547 ascertained, not fewer than 11,000 are paupers,
maintained principally at the expense of parishes.   A most remark-
able  difference  is found in the proportional number  of lunatics in
agricultural and  in manufacturing districts.  Previous  to  inquiry,
we should conjecture that the causes of insanity  would have more
influence, and the  disease be more prevalent,  in a manufacturing
than  in an agricultural population ; but the contrary  is the fact.
Thus, in twelve counties in England, of which the inhabitants are
chiefly employed in agriculture, the entire population being 2,012,979,
the insane amount to 2526, giving about 1 lunatic to 820 ; while in
twelve counties where the majority of the inhabitants are otherwise
employed, including Cornwall, where  a great  number are miners,
the entire population  being 4,493,194, the insane amount to 3910, or
nearly as 1 to 1200.  In Scotland and in most of the Welsh counties
the population is chiefly agricultural, and this may, perhaps, account
for the greater proportion of  lunatics in the population of those parts
of the island.  In Scotland and Wales, it appears that a great pro-
portion of the insane, or of those  included under that denomination,
are idiots.   In six of the maritime counties of England, the propor-
tion of idiots to  lunatics is nearly as 2 to 1 ; and this is likewise the
case in the Scottish counties  of Inverness and  Nairn, Argyll  and
Bute, and Moray ;  but in the six counties of North Wales there are
about 7 idiots to 1 lunatic.
   A survey of the statements which I  have collected suggests  two
remarks, which place  the subject of  mental  derangement  in its
relation  to the community in a  particular point of view.  In the
first place, it may be observed that this  affliction appears to fall in a
great proportion upon the  lowest classes of society, since, in Eng-
land,  eleven out of fourteen  thousand  lunatics  and idiots are stated
to be paupers.   Hence it appears that mental derangement must be
looked upon not merely as an individual  calamity, but as a serious
public burden,  for such  must be the  permanent  maintenance of 
IN ENGLAND, WALES, AND SCOTLAND.
241
11,000 paupers  in a state requiring more than ordinary care and
expense.  It may be remarked, secondly, that mental derangement,
considered generally, or with respect to the great aggregate number
of cases, may be looked upon  rather as a congenital imperfection
than as a disease resulting from external impressions.  This appears
in part  from  the large proportion of idiots comprehended  in the
collective number.   Idiots  are not so  numerous  in  England as
lunatics, but  their number  is not greatly inferior, the statements
published by Sir A. Halliday giving 5741 of the former, and 6806
of the latter.  In  Wales, as we have seen, idiots  are to lunatics
almost as 7 to 1  ; and  in Scotland they are very numerous.  The
morbid  state of  lunatics cannot properly  be said  to be innate, but
the predisposition is original and  in-bred  in the constitution.  In
those cases in which it has  not been inherited, it is an individual
peculiarity of organization, which  is  ready to become hereditary in
the next generation.  The relation which cases of insanity bear to
those of idiotism, the  proportional  numbers  varying under par-
ticular circumstances, indicate  some analogy in their nature.  On
the whole it would appear that both  idiots and lunatics are persons
born  with a  defective structure  of brain, though  manifested in
different ways.  These defects are  generally prevalent in various
degrees in different  parts of the island, and in different classes or
castes in the community.  The  numbers of both  are such as to
render them important to  the public when viewed in connexion
with  their remarkable prevalence among the lower orders.
  In  adverting to the inquiry, whether any means could be adopted
that would tend  to diminish the  extent of this evil, we are struck
by the obvious consideration that the numbers of  deranged persons
in the community might be  very much lessened if it were possible
to regulate or establish  any  surveillance over  the marriages of the
lower orders, or if some measures could be adopted  to prevent the
propagation of idiotism and an hereditary tendency  to madness.
Idiots who are at large  wander about the  country, and the females
often  bear children.  I  have  frequently seen,  in Herefordshire, a
female dumb idiot, who was said to have borne several children by
unknown fathers.  Sir Andrew Halliday has made similar observa-
tions.  We should hear without surprise of the permission of such
things in Turkey or Kafferland,  but  in  a country having police
regulations  it would  not be  expected.   All pauper  idiots and
lunatics ought to be kept  in proper  asylums, where every possible
alleviation of  their calamitous lot should be afforded them, and the
public should thus be  protected  against such evils as those just
pointed  out.   But, perhaps, the  propagation  of  mental disorders
might be prevented in other ways  by some restrictions  on mar-
riages.   Intermarriages  between near relations should be prohibited,
and the  known prevalence of idiotism or madness in  a family should
be made, if  possible, what at present it is not, at least among the
lower classes, a bar to its propagation.
  The fact that  insanity prevails so much  in agricultural countries 
242
STATISTICS OF INSANITY.
indicates that its development is  favoured by some of the circum-
stances connected with the condition of agriculturists.   The labour-
ing of women in the field during pregnancy is, perhaps, as Halliday
suggests, one  cause.  Hard labour and low  diet, to  which males
may be subjected, may, perhaps, have an influence on the offspring
propagated  by them ; and in Wales  and Scotland particularly this
may enter into the number  of causes which render idiotism so
prevalent.
   The congenital  nature of these diseases, when considered on an
extensive scale, renders  it, perhaps, less probable  than the notions
generally entertained would persuade us, that  any great increase in
the prevalence of  mental derangement, beyond an average propor-
tion to the population, has taken place of late years.   It is not easy
to conceive that ordinary causes of temporary influence can materially
affect the frequency of any congenital predisposition.   But although
congenital predisposition  is so important a circumstance, still it
does not include the whole of the productive agencies, and tempo-
rary changes  in the prevalence of the exciting causes may doubtless
affect  the  frequency of  insanity at  particular  times, though the
whole influence of such causes is very much overrated when they
come to be regarded  as the principal  foundation of the disease.   It
is still a matter of great interest to determine whether the propor-
tion of lunatics to the population is actually on the increase.  Not-
withstanding all that has been written on  this subject,  I believe
that we yet  want sufficient means of arriving, on this question, at
any positive  result, owing to  the. still  remaining doubt  as to the
completeness of our latest estimates of the number of lunatics.   It
is exceedingly improbable that  Scotland contains proportionally
nearly  twice as  many  deranged persons as  England.   Can the
difference be  ascribed to the greater accuracy of  the returns from
Scotland ?  This  opinion will, perhaps, be thought the  most pro-
bable one, if  the remarks formerly suggested by Mr. Take's state-
ments are  well considered.   But although our information is  yet
imperfect, there is no reason, in the nature of things, why it should
so remain.   If the proper care and  attention were devoted to  the
subject, all the questions connected with this inquiry might in a few
years be fully elucidated.

    Section  II.—Statistical History of Insanity in France.

   Similar apprehensions have been entertained in France as to the
increase of  insanity, and as far as we  can  depend upon evidence
furnished by  registers of hospitals, these apprehensions are too well
established.   The facts  leading to  this conclusion  were brought
before the public in the  official  memoir drawn up by M.  Desportes,
which was published in  1823.*   From the data adduced it appears,

   * Rapport fait au Conseil-general des Hospices civils de Paris sur le service
des Alienes.   4to.  Paris, 1823. 
INCREASE IN FRANCE.
243
as the Duke de la Rochefoucauld remarked, that the " general aggre-
gate of lunatics existing in the different receptacles of Paris, at the
beginning of 1801, amounted to 1070 persons, and at the beginning
of 1822 to 2493.   The table which affords proofs of this result is
divided by the author into five periods.  The mean term  of admis-
sions  during the three first periods was only 2699, and in the fourth
period 3769."*   This increase seems to have been nearly progres-
sive, as appears by the following numbers : —
    In Jan. 1, 1R01, the hospitals contained  .....  1070 lunatics.
            1806,.............,1-225
       „    1816,..............  1800    „
            1821,.............2145
            1823,.............2493

   M. Desportes observes that if the same ratio of increase should
continue to prevail, the hospitals must contain at the end of 1825
about 2900 persons.  These facts induced the compiler of the report
to request  M. Pariset and M. Esquirol, physicians at that time  to
the hospitals of Bicetre and the Salpetriere, to communicate their
opinions on the causes  which  had led  to  the  increase, and he has
inserted the.replies of these celebrated physicians.
   M. Pariset, in his memoir, on this  subject,  observed that in all
parts of France, where  insanity is principally treated, there is a per-
ceptible increase in the numbers of  lunatics.  The houses destined
to their reception are everywhere  found insufficient.  " The same
remark," he says, " has been  made in  other parts of Europe.  I
can affirm  that it is true in  respect  to various provinces in Spain."
" Is this augmentation real in regard to the  whole of France, or
only  apparent ?  We may presume that before the revolution a
great number of lunatics existed in religious houses, in private fami-
lies, in hospitals, and even in prisons.  A sentiment of shame, or of
self-interest, induced convents or families to conceal their lunatics :
the deplorable state  of hospitals prevented many from  removing
thither their deranged relatives:  those  whom  their destitution
brought to such wretched abodes found there  dungeons and chains,
or were  confounded with other inmates  and  escaped  attention.
Many lunatics suffered from the hands of justice the penalties due
to crimes !  How many demonomaniacs were  burned for  witch-
craft.  ' C'etaient  de pauvres fous condamnes par d'autres  fous.'
Thus was  insanity neglected, dissimulated,  or mistaken, and hence,
 in reality so extensively spread, it was supposed to be so rare.
   " During the great tumult of revolutions, while  all the  elements
 of social  life were  confounded and  agitated, it is probable that a
 thousand cases of derangement took place without being recognized.
 Reverses of fortune, sudden  changes which elevated or depressed
 individuals, so many sources of calamity opened at once  inundated
 our country with unexampled calamities, that madness must have

   * Rapport fait au Conseil-general par M. le Due de la Rouchefoucauld, sur le
 travail presente par M. Desportes. 
244
STATISTICS OF INSANITY.
been the result in examples without number, but they have  been
lost sight of in  the  mass of more general evils.  Those who are
aware  to what a  degree the habitudes,  the diseases, the infirmities
even of the mind, are  transmissible, will not deem it rash to con-
clude that even children born during that era of sorrow and terror
must have felt in their mother's wombs the baneful influence.  The
wars of a subsequent period have  added to these afflictions, since
nothing is more fitted to extinguish every social feeling, to pervert
the understanding and  the  will, than the disorderly habits which
are the result  of a state of war.
  " In general, every great  and rapid change, whether in the phy-
sical or moral order  of things, is pernicious to the health and to the
reason.  The  sight of wealth and  power, raised and thrown down
by accidents equally unexpected, has excited not only astonishment,
but in rude minds the  most dangerous hopes and illusions.  Uni-
versal reformers, founders of empires and republics, creators of in-
stitutions, have arisen on every side ; simple artisans or even opera-
tives, have thought themselves destined to overturn thrones or to
mount into them. Such illusions  have engendered the most obsti-
nate of all mental aberrations.  Pride and ambition produce incura-
ble forms of madness ; I may add that they are most widely spread,
since the diabolical pleasure of  ruling over men  is, as it would ap-
pear, the most fascinating  among the guilty delights to which the
human race abandons itself.
   " Even if it should be demonstrated, what nobody can  affirm for
want of positive  data for calculation, that the number of lunatics in
France is, cseteris paribus, more considerable now than  formerly,
it would appear that the increase  must be attributed chiefly to the
two orders of events above indicated.  But will the augmentation
continue to be progressive.   The solution of this question will de-
pend  on  the movements of  society.  I  shall conclude  with one re-
flexion.  The more there is of liberty in any country, the more nu-
merous are the chances of derangement ; but this does not prevent
Our allowing that liberty is favourable also to the expansion of hu-
man reason."*
   M. Esquirol has expressed his opinion that the causes of increase
in the number of lunatics in the Salpetriere are both general and
local : the first class are principally as  follows.   Formerly opulent
persons deranged were shut up in  convents, or in their own estates.
The poor, when monomaniacs,  imbecile, or old and demented, re-
mained at home, and raving or mischievous madmen alone were sent
to asylums.  Since the time when Pinel revealed the true principles of
treatment for insanity, that disease is no longer considered  as incura-
ble, and most rich families send  their relatives to  asylums in the hope
of cure ; while the better management of hospitals encourages per-
sons of the lower class to follow a similar practice, and even public

  * I have given but a short abstract of this report, which will afford the reader
of the original a specimen of the eloquence and brilliant conception of the author. 
INCREASE IN FRANCE.
245
opinion would condemn them if they were not to have  recourse to
it.  Lunatics are more the objects of care :  they are kept longer in
the asylums, and being more the objects of attention, they are more
in evidence.   We ought, perhaps, likewise to take into account the
increase in  the  population of Paris.   Among the local causes are
the high reputation of the asylum  of La Salpetriere, to which many
constantly apply for admission from distant departments.  Hence in
the ten years from 1803 to 1813, the  average number of admissions
was annually 280, and during the six years from 1816 to 1821, the
average has been 409.  Besides this increase in the admissions, the
number of cures not equalling  that of the entries, the number of
permanent inmates has been ever on the increase.   The high repute
of the Salpetriere and of other improved hospitals has drawn to them
great numbers of the  most severe and incurable  cases, just as, in
general, physicians of great celebrity are consulted on a large pro-
portion of diseases, for the cure of which ordinary skill has been
found unavailing.
   M. Desportes, after considering the reports of the physicians, and
comparing the facts which had fallen  under his observation, came to
the inference that the causes of increase in the fullness  of Parisian
hospitals were the following.   First,  the  improvement  of regimen
and treatment whicb have overcome repugnance to admission into
the hospitals.  This, he says, is really  a fact, and to  such a degree
that indigent persons, and even old ecclesiastics, occasionally simu-
late madness or epilepsy in order to gain  entrance.  Secondly,  the
admission of great numbers of persons who are considered to be in a
state of senile dementia, and  who  in reality are only  old persons
nearly in their  ordinary  state, but having  their  faculties slightly
weakened by old age, or  apoplexy, or  paralysis.*  Thirdly,  the
blending of cases of acute mania, such as were formerlyvsent to  the
Hotel Dieu, with examples  of chronic  insanity, and  the caution
against dismissing, as cured, individuals whose condition is still in-
secure,—the mean term of residence  of lunatics who are dismissed
cured being  now, in the two great hospitals, considerably more than
double the space of time during which  such persons were  formerly
retained in the Hotel Dieu.
   M. Desportes concluded this part of his memoir by  strongly re-
commending the establishment of separate hospitals for the treatment
of curable and incurable cases.     »
   The  considerations adduced  by MM.  Pariset and Esquirol  cer-
tainly explain to a considerable  extent the comparatively greater
number of lunatics in the Parisian hospitals, and materially weaken,
if they do not destroy, the evidence which at first sight appears so
strong in  proof of the increase of insanity.   But the question is still
left in uncertainty ;  and a  general  suspicion  has  remained on  the

  * Before the year 1790, among411 cases of admission only 19 individuals were
above  fifty  years of age.  In 2451 admitted between 1816 and 1821, one-third,
or 880, were beyond that age.  This sufficiently proves the increased admission
of the old and demented.
  May, 1837.                22 
246
STATISTICS OF INSANITY
minds of many that such an increase exists.  These doubts can
be dispelled in no other way than by means of general  returns
of the real  numbers of lunatics  in  different departments, and of
their proportion to the entire population  obtained  for a series of
years.   Unfortunately no satisfactory sources of information on this
subject exist, and  France is much behind England  and some other
countries in  all the materials for statistical  researches on  the fre-
quency of mental  derangement.   Some  means  were adopted to
supply this defect  in 1812.  It was then  ascertained that2100 in-
sane persons existed in the department of the Seine.   The attempts
made to estimate the proportional number  of lunatics in  France on
this ground, were founded on error, because,  as  M. Esquirol ob-
serves, lunatics are constantly  sent to Paris from all parts of the
country.  In 1818  M. Esquirol addressed  a memoir to the minister
of the interior, on the state of lunatics in France ;*  and a commission
was appointed for the purpose of  improving the condition of these
persons.  By this commission a series of questions were addressed
to the prefects  of the different departments, the majority of which
were never answered.  M.  Esquirol  has made such researches in
this subject as  the  extant documents enabled him to pursue.  By
collecting the statements of the different establishments for  lunatics
in France, and  by inquiries as to  the number existing in several de-
partments, he has been enabled to draw the conclusion that the total
number in the whole kingdom is about 50,000, which, taking the
population at 30,000,000, whereas it  is said to  be  32,000,000, gives
1 to  every  1000.t   This proportion is  less than that believed to
exist in Britain and some  other countries.

Section III.—Statistics of Insanity in other Countries: General
                         Observations.-

   Most of the information we possess as to the statistics of insanity
in the  Dutch and  Belgian states has  been communicated by M.
Guislain.£  This writer has collected all the materials that could be
obtained for  calculations of various kinds  from the lunatic asylums
of the Belgian kingdom ; but he complains greatly  of their insuffi-
ciency, and in many instances of the obstacles that were thrown in
his way in the attempt to make inquiries.   He appears  to have
despaired of collecting data adequate to a calculation of the propor-
tional  numbers of lunatics in reference to the general population.
   In the provinces of North Holland, or the Dutch states, the returns
of lunatic asylums give the following  numbers  :—From  1820 to
1825 there were resident in the lunatic asylums of this country 2157
male lunatics, 2363 females : total 4520.

  * De FEtat des Alienes en France, et des Moyens d'ameliorer leur sort.  Paris,
1818.
  f Statistique de6 Alienes, par M. Esquirol, in the Annates de l'Hygiene Pub-
liquefor 1829.
  X Traite de l'Alienation, par M. Guislain, 2 tomes. 
             IN THE BELGIC AND DUTCH STATES.          247

  For the lunatic asylums of the Belgian  states, M. Guislain has
given tables including the numbers resident at those establishments
in 1810 and 1812, and the numbers of admissions during succeeding
years down to 1823 inclusive.  They are as follows :—

    Gheel, from 1810  to  1823 (including 113 previously resident)  .  401
    Maastricht (including 18 previously resident) in the same years   115
    Tournay and Mons, from 1812 to 1821 (including 22)   ....   86
    Louvain, from 1810 to 1823.............177
    Antwerp...................482
    Ghent...................608

                                                        1869

   In reference to the inquiry whether insanity has increased in the
 countries to which  his documents relate, M. Guislain makes the fol-
 lowing observations :—
   " We deduce from the subsequent table a progressive augmenta-
 tion in the number of admissions into our asylums for lunatics. Th'\
 would seem to depend partly on the general increase in the popula-
 tion  which has  taken place since the cessation of war, and partly
 from some universal cause ; since the augmentation to which we
 refer only began to show itself in 1816, a time of trouble, of famine,
 and of misery.  After that period  the  number  of  cases began to
 diminish, or at least has undergone no  perceptible increase."
   The table gives  for the asylums, of  Gheel, Maestricht,  Louvain,
 Termonde, Gand,  Velscique,  Bruges,  and Amsterdam, which, for
 brevity, we include collectively  in the following terms of years :—

          From 1810 to 1815.......627 admissions
          From 1816 to 1819.......972     „
          From 1820 to 1823.......792     „

   We are thus brought nearly to the same conclusion, with reference
 to the state of insanity in  the Low Countries,  as that which Dr.
 Burrows and Sir A.  Halliday  were inclined to adopt with respect to
 this disease  in  the  British isles, viz. that there is  no ground for
 apprehending a progressive increase; that temporary augmentations
 are owing to the pressure of  circumstances and  causes which  give
 rise to unusual distress and misery in the population; and that, when
 such causes have ceased to operate, the proportional number of luna-
 tics becomes nearly what it previously was.
    There is, perhaps, no other country on  the continent of Europe
  where  our information  on the  statistics  of insanity is founded on
 data so satisfactory as in the  Prussian provinces on  the  Rhine.
 Documents have  been  published by Dr. Jacobi, furnishing  results
 of great interest."6  The following are statements  of the general
 population and  of the numbers of lunatics of several states, in the
  year 1824 :—
  * Jacobi's Beobachtungen iiber die Pathologie und Therapie der mit Irreseyn
verbundenen krankheiten. 
248
STATISTICS OF INSANITY
t»   i t-        Number of
Population.     T   .-
  r           Lunatics.
Diisseldorf.......641,213
Aix-la-Chapelle.....331,960
Treves   ........ 301,505
Cologne........323,283
Coblentz.......250,613
798
312
221
336
348
2,067,104        2,015
   The estimates of the number of lunatics in each province are not
 taken from collective statements of asylums, but from documents
 collected with the greatest possible  care by order of the Prussian
 government.   Yet they are considered by Jacobi as far  from per-
 fect ; and this accurate writer is of opinion that the estimates of some
 districts omit not less than half the number of lunatics actually there
 existing, and that the deficiency  may amount to scarcely less than
 one-third for the whole computed aggregate.  He thinks the actual
 number of lunaties in the whole of the Rhenish provinces should be
 reckoned as  greater by nearly one-third part than  the  sum  total
 above  given ; a circumstance which, as he  says, renders it still
 more  remarkable that  this number is already so great when  com-
 pared  with the population.  The proportion is very nearly 1 to
 1000 without augmentation ; and with this increase  it becomes, of
 course, 1 : 666].
   Qne of the most complete  statistical accounts that exists of the
 deranged persons of any country, is that which was drawn up  some
 years  since for the kingdom  of Norway.   It was ordered by the
 government, in 1825, that returns should be made of the number,
 age, sex, situation of all the insane in that kingdom.   The statistical
 account was drawn up by Dr. Fr. Hoist, and published by order of
 the king of Sweden  in 1828.  M. Esquirol has given an analysis of
 this document.   This writer confesses his  surprise  in discerning
 from it that deranged persons are more numerous in  Norway  than,
 proportionally to the population, either  in England or in France.
 The physical circumstances of the inhabitants  are, perhaps,  most
 like those of the Scots.   The  people are chiefly employed  in agri-
 culture and in rearing cattle : they are herdsmen, whose sustenance
 is cheese, salt-fish, and the milk  of their cattle.   Their country is
 mountainous :  it has no  large,  populous  manufacturing cities : in
 that respect it differs from Scotland, as well  as in the inferiority of
 intelligence and civilization of its people.  The facts which relate
 to the  proportional number of  lunatics when compared with the
 entire  population, as well  as those which refer to  the comparative
 frequency of  insanity and idiotism, are  very similar in the two
 countries : In  Scotland lunatics and idiots are  to  the entire popula-
 tion  as 1 to 573 : in  Norway they are as one to 551, there being in
all 1,909 deranged persons in the  kingdom, and the population being
 1,051,318.  Of the whole number of deranged, 680 are reported to
be idiots. 
IN DIFFERENT COUNTRIES.               249
  Our information is very defective as to the number of lunatics in
most other northern countries.   A  report which M. Esquirol  ob-
tained  from Dr. Remann of St Petersburgh gives the number of
1,437 lunatics treated in the asylum of that city from 1814 to 1821.
From all the accounts collected by M. Esquirol from the north of
Europe, it would appear that insanity is  by no means so frequent as
in the southern parts of Germany.
  No writer has  attentively suryeyed the state of lunatics in  the
north of Germany without expressing a  sentiment of abhorrence at
the cruelty with  which these unfortunate beings are treated in  the
dominions of  Hanover.   A frightful and disgusting account of  the
prison of Celle, where lunatics and idiots are confined together with
thieves and murderers, may be found  in Sir  Andrew Halliday's
work before cited.
  The southern and less civilized countries  of Europe  present a
contrast to the northern, where  the intellect of the people is more
cultivated.  In Spain, according to  the  information communicated
to M. Esquirol by Dr. Luzuriaga, there  existed, at  the end of  1817,
in the asylums of Toledo, Grenada,  Cordova, Valencia, Cadiz, Sara-
gossa, and Barcelona, but  509 lunatics.   Only  50  lunatics were in
the hospitals of Cadiz, 60 in  that of Madrid, and there  were 36 in
the kingdom of Grenada.
  The receptacles for  lunatics in Italy have been visited lately by
M. Brierre.   In twenty-five establishments of this  description,
among which were those of Turin, Genba, Milan, Brescia, Verona,
Vienna,  Venice,  Parma, Modena, Bologna,  Ferrara,  Florence,
Sienna, Lucca, and Rome.*  M. Brierre found 3441 patients.   The
population of those parts of Italy which  were visited by him is said
to be about 16,789,000  inhabitants, which gives 1 lunatic  to 4879
persons.!
   It has been remarked that in  Spain and Portugal, where insanity
is comparatively rare, malformation of the  brain and  consequent
idiotism are very frequent!  Parallel observations have been made
elsewhere.
   It appears,  from an  extract given  by M. Esquirol from a publica-
tion of  Dr. Beck on  the number and condition of  lunatics in  the
American United States, that the  proportion which deranged per-
sons bear to the entire population in the state of New York is very
similar to that which obtains  in Great Britain.  It is given as fol-
lows :—
        Population of the state of New York  ....  1,616,458
        Number of the deranged........     2,240
        Proportion.............    1 : 721

  * At Rome iron rings, armed with chains and fixed in  the wall, serve to  con-
fine the furious and turbulent maniacs, who are  fastened by their necks and  feet.
There is no garden nor any particular walk for convalescents, nor any work
rooms.  Quiet patients have always before their eyes the spectacle of turbulent
and furious madmen. More than 300 lunatics are shut up in this frightful prison.
  | Annales d'Hygiene Publiqueet de Medecine Legale, t. x. part 1.
  t Sir A. Halliday's General View, p. 62.
  v                            22* 
250
PREVALENCE OF INSANITY
   It has often been observed that insanity is  comparatively rare in
 semibarbarous countries, but it is not immediately obvious to what
 countries this term applies.  Where the people are industrious, and
 have the arts of life and motives to  exertion of mind and body, and
 the cares and anxieties which are  consequent on  such a  state of
 society, casesof insanity appear to multiply.   In India it seems that
 there are many lunatics.  Numerous asylums have been established
 in various parts of the Anglo-Indian empire, of  which an account
 may be seen in Sir A. Halliday's  work.  In  China, M. Esquirol
 believes madness to be of rare occurrence ; but our accounts of that
 country are defective.   In Turkey  and in Egypt it is probable that
 there are few lunatics in proportion to the  number of people. M.
 Desgenettes is said to have found only 14 in the hospital of Grand
 Cairo, a city containing 300,000 inhabitants ; but it must be remem-
 bered that it  is not the custom in such countries to confine all luna-
 tics in hospitals.  M.  Hamont declares that  lunatics  are by no
 means unfrequent in Egypt  He says that those who are dangerous
 are chained and conducted to Cairo, where they are kept in a horri-
 ble receptacle ; they eat, sleep, and  satisfy the calls of nature in the
 same spot, of which  the stench  is  intolerable.  The only attempt
 made to cure them is by giving broth of serpent's flesh at every
 new moon.   Lunatics  who are harmless wander about the country,
 some of them quite naked :  they are looked upon  as saints and pro-
 phets, and held in the highest veneration.*
   In savage countries, I mean among such tribes as the negroes of
 Africa  and the native Americans, insanity is stated by all scientific
 travellers, and by naturalists or other persons who have had means
 of correct  information, to  be  extremely rare.  Dr. Winterbottom
 declares that  among the African tribes near Sierra Leone, "mania
 is a disease which seldom if ever occurs."  He adds, that he could
 not make the natives of that country comprehend the meaning of
 the term, though they  were not unacquainted with the delirium of
 drunkenness.  Idiotism was, likewise, a  rare  phenomenon among
 them.t   Among the negro slaves in the West Indies, it has been ob-
 served  by  many that insanity  is  scarcely known.J  It scarcely
 exists in the native races of America.  This observation was made
 by Von Humboldt, and it has been confirmed by travellers who in
 late times have made the most accurate researches into the history
 of the tribes in the interior of the continent, and particularly by the
 scientific men who were sent by the government of  the  United
 States,  in 1819, on the expedition  from Pittsburg to the Rocky
 Mountains.§
   I have brought before my readers the  most  prominent and im-
 portant facts connected  with  the statistical  history of mental dis-

  * Lettres de M. Hamont sur 1'Egypte, Annales d'Hygiene Publique, &c.
Janvier, 1830.
  f Winterbottom's Account of Sierra Leone, vol. ii. p. 25.
  X Sir A. Halliday's General Account.
  j Expedition to the Rocky Mountains. Guislain, torn. i. 
IN DIFFERENT COUNTRIES.
251
 eases, from which, if from any thing, inferences may be formed as
 to the various points  of inquiry before  suggested, and  if, on  this
 groundwork, it is still difficult to construct any system of positive
 opinions, the difficulty is still such as time and more continued ob-
 servation may dispel.   The period is so recent from which accurate
 knowledge has been obtained in  any country, that we are scarcely
 authorized  in determining that insanity  is, or is  not, anywhere an
 increasing evil ; and the reasons pointed out  by MM. Pariset and
 Esquirol in France, and suggested by Halliday and Burrows in this
 country, explain the apparent increase, or at least prevent our taking
 the multiplied number of lunatics and of lunatic establishments as a
 full proof that there has been a real augmentation  in the numbers of
 deranged persons.  Yet the apparent increase is every where so
 striking, that it leaves on the mind a strong suspicion, and this  sus-
 picion, that cases of insanity are far more numerous than formerly,
 can only be removed by a series of observations that may prove the
 negative.  It is encouraged by the reflection that the state of society
 is, in most countries, such  as appears likely to multiply the exciting
 causes of madness.
   From the facts which we have surveyed, sufficient evidence has
 arisen to confirm in a  great measure the remark made, many years
 ago  by  M. Esquirol,  that  insanity belongs almost  exclusively to
 civilized races of  men : it  scarcely exists  among savages, and is
 rare in barbarous countries.*   To what principle of explanation are
 we to refer this general fact ?  Is it because the exciting causes of
 madness are not present in  the savage state ?   Passions  and anxie-
 ties, doubtless, find their sphere of action wherever men are.   We
 might rather conjecture that congenital  predisposition  is wanting
 in the offspring of uncivilized races.   If  there were as great a pro-
 portion of individuals  predisposed to insanity in a  nation  of negroes
 or Americans as in England or France, it is difficult to suppose  that
 the disease itself would either not exist or be a rare phenomenon :
 nor could the  existence of idiots have escaped the observation of
 travellers,  who were  scientific men  and physicians, if  there  had
 been  as many in Guinea  or Louisiana as there are in Wales and
 Scotland.  It  is an obvious and  probable conjecture that the cir-
 cumstances of the  civilized  state of mankind, as  they give rise to
 other  variations of structure, so, likewise, produce or multiply
 morbid varieties of organization.   Hence a great  number of con-
 stitutional diseases are common in civilized nations which are rare
 among savages.   The brain receives a  different development in
 the progeny of uncultivated races, or of  those whose mental facul-
 ties have been  awakened:  it has a more ample  expansion, as the
 countenance  itself, and the shape  of  the  skull, often testify :  with
 greater variations of .structure it has new morbid varieties,  and
 while, perhaps, in the  majority of persons  its organization attains
  * The series of observations  from which this general result follows is stated
in an extensive and striking way by Professor Fodere, " Essai Medico-legal sur
les divers especes de Folie, a Strasbourg, 1832, pp. 116 et seqq. 
252
UNSOUNDNESS OF  MIND.
greater  perfection  and  completeness of  development,  in some
the efforts of nature, if we may use the expression, are  not fully
successful.  I offer  these remarks merely as a conjectural solution
of a difficult problem, which seems  to me probable from its coinci-
dence with many facts  in  the  physical history of mankind ; but I
do not attach any importance to it.
                        CHAPTER  XI.

 OF UNSOUNDNESS OF MIND IN RELATION TO  JURISPRUDENCE.

Section I.—General Observations :  three Sources of Unsound-
                             ness.
  Mental  unsoundness is a disordered or a defective state of the
mind, impeding in such a manner the exercise of its faculties as to
render an individual  incapable of performing correctly the duties
of life, and of maintaining over himself those restraints which are
necessary for the intercourse of society.   Unsoundness of mind
impairs or destroys moral responsibility, and calls for  interference
in the exercise of personal rights.  Various questions connected
with this subject have been discussed among writers  on  medical
jurisprudence, such as, " what  constitutes  soundness and unsound-
ness of mind ?"—in other words, by what distinguishing  circum-
stances are we led to  pronounce on the presence or absence of  such
a state of the understanding as renders a  man incompetent to the
management of his affairs, and  absolves him from moral responsi-
bility ?—Is  this  state of the understanding absolute, or when it
exists at all, extending to all cases and varieties  of  circumstances,
or does it admit of degrees and modifications ?  In furnishing a
solution to these and  similar inquiries, both lawyers  and physicians
have their part   It belongs to the latter,  as observers of nature, to
take note of the phenomena displayed by the human constitution
under disease, and from  the relations of these phenomena to deduce
such results as common sense, aided by the habit of reflecting on
similar  subjects, may enable  them satisfactorily to  establish.   On
these results, which are the conditions given, legal regulations are
to be constructed. They must be made to  accommodate themselves
to the conditions, and they doubtless will be so accommodated when
the latter shall have been set forth in a manner unexceptionable, and
commanding general  assent.   These arrangements and  the elucida-
tion of their principles belong to lawyers and the framers of law.
Physicians are expected  to supply to them information as to the
nature of those causes on which unsoundness of  mind  depends, as
to their extent  and  duration, their distinguishing characters, and
ultimate results.  The entire assemblage of such facts, including the
practical  regulations  which are founded on them, constitutes  a
branch, and by no means an uninteresting one, of medical jurispru-
dence. 
GENERAL OBSERVATIONS.
253
   Writers are not  wanting  who have treated on these subjects in
 different countries.   Germany has  produced the most numerous
 and the most voluminous ;  of whom Metzger, Pyl, Hoffbauer, and
 Heinroth are the  most  celebrated.  In  this  country the able and
 well-known works  of Dr. Haslam and Dr. Conolly are principally
 devoted to the same subjects.*   The French have  no systematic
 writer on the whole theory of medical jurisprudence as applied to
 persons  of unsound  mind,  for the  commentaries  of  Professor
 Fodere, and the laler occasional publications of MM. Marc, Georget,
 and Esquirol, can scarcely be looked upon  in this light. An attempt
 has been made to supply the  defect  by means of a  translation of
 Hoffbauer's treatise, to which  notes  and  illustrations have been
 appended  by  M. Chambeyron, the  translator,  and  by MM. Itard
 and Esquirol.   This work has not been  very well received among
 the French, who complain of its want of clearness  and precision.
 Notwithstanding  this objection, which has  not been alleged alto-
 gether without reason, the work of Professor Hoffbauer is of great
 value.   It  is the most  comprehensive in  its scope, and the most
 systematic of any that  are known to  me, and displays at the same
 time the results of much reflection and accurate  observation on the
 subjects to which  it relates,  and  to  which the author is known to
 have long devoted his attention.!  In  going through the different
 articles which belong to this part  of my work, I find that I cannot
 pursue my object in a better method than by following the steps of
 Hoffbauer, and, considering  the various topics which offer  them-
 selves  for  discussion,  nearly in  the  points of view  in which that
 writer has  surveyed them.
   Professor Hoffbauer  observes that  various defects and disorders
 of  the mind are incidentally  specified in the Roman  law and  in the
 legal code  of Prussia, and that  in the latter the terms adopted are
 in some instances defined.  In the French code a course has been

  * To Dr. Conolly's work I have not made so frequent references as might be
 expected, considering its high value and importance, and the just celebrity of the
 able and accomplished author.  It is a work that does not admit of analysis or
 condensation, and in the brief essay which I have to give on this subject I have
 preferred to survey it under a different arrangement.
  f Herr Hoffbauer was a doctor of laws and professor in the University of Halle,
 who made psychology and diseases of the  mind the particular subject of his
 studies.  He is the author of several  works  on insanity and the inquiries con-
 nected with it.  The first, entitled  " Untersuchungen iiber die krankheiten der
 Seele, u. s. w. was published in 1802-1807.  He  afterwards published,  in con-
junction with Reil, the celebrated author of Researches into the Structure of the
Brain and Nerves, a work entitled " Beytrage zur Beforderung einer Kurmethode
auf psychischen Wege."  His  most popular work, entitled " Die Psychologic
in ihren hauptanwendungen auf die Rechtspflege nach den allgemeinen Gesicht-
spunkten," &c. has  been translated into French, with notes by the editor, M.
Chambeyron, and  additional comments by MM. Esquirol and Itard.  Hoffbauer
likewise translated the work of  Crichton on Insanity into the German language.
Professor Hoffbauer shows, in many instances, a want of practical knowledge of
insanity, but  he has discussed admirably the legal relations of mental deficien-
cies.  A critical analysis of his works has been given by Professor Heinroth,
in his "Lehrbuch der Storungen des Seelenlebens,'* th. 2. 
254                 UNSOUNDNESS OF MIND.
followed which in  the opinion of this writer indicates the correct
judgment of the legislator ; occasional references are made to va-
rious classes of persons whose states are distinguished respectively
by the terms madness, dementia, and  imbecility;  but  the law no
where determines  the  precise import of these expressions.   "In
fact, all legislation  ought to proceed on the ground that the objects
to which it refers are well known and understood ;  but this know-
ledge failing, it is  much  better that the law should leave things
undefined  than that it should define erroneously, and thus introduce
mistakes which would be perpetuated by its authority."
   The triple division recognized by the legal code of France cor-
responds with actual facts or with the distinctions established by the
observers of nature.  Among the disorders and defects of the under-
standing we discover three very different states, all  of which imply
mental incapacity.  These are, first, idiotism or congenital defect,
depending on an originally imperfect formation  or  development of
the brain,  under which article must also be  comprised the different
degrees and modifications of weakness of mind or imbecility, though
 the latter  may be  distinguished  from absolute  idiotism ;  secondly,
 madness or insanity in its various forms; thirdly, dementia, intellec-
 tual  decay, or, as  I  have termed it in the preceding pages, from its
 characteristic feature, incoherence.
    The English law is less accurate in the distinction of mental dis-
 orders than the Roman jurisprudence and the modern systems which
 are founded on its principles.  The only classes of incompetent per-
 sons recognised by the former are idiots, who  are  properly idiotz
 ex nativitate, idiots from  birth, and lunatics or  madmen, styled
 " non compotes mentis."  The latter are " persons who have had
 understanding, but by disease, grief, or other accident, have lost the
 use of their reason."   " A lunatic," says Blackstone, " is  properly
 one  that  hath lucid  intervals ; sometimes enjoying his senses, and
 sometimes not, and that frequently depending upon the  state of the
 moon."   This indeed would reduce the classes of incompetent per-
 sons recognized by law  within  very narrow limits indeed.   " But
 under the general  name of non compos mentis, which Sir Edward
 Coke says is the '  most legal name' for a madman, are comprised not
 only lunatics but persons under frenzies, or  who lose their intellect
 by disease ; those that grow  deaf, dumb, and blind, not being bom
 so ;  or such, in short, as are judged by the Court of Chancery inca-
 pable of conducting their own affairs.*  To these as well as to  idiots
 the king is guardian."  It seems  from this  that demented persons,
 including dotards, or  individuals labouring under  senile decay and
 loss  of memory and intellect, are, by the English law, comprehended
 under the class of non compotes mentis, or lunatics.
    An idiot in the  English law, to be considered  as  such, must be
 "punts idiota," a mere or absolute idiot   By the Roman law, if a
 man by notorious prodigality was in  danger of wasting his  estate, he
* Blackstone, Comment, book i. cap. 8. 
REGULATIONS OF THE LAW.
255
was looked upon as non compos, and committed by the prseter to the
care  of curators, or tutors.  "But in England, when a man on an
inquest of idiocy hath been returned an unthrift, and  not an idiot, no
further proceedings have been had, and the propriety of the practice
itself," says Blackstone,"seems to be very questionable. It was doubt-
less an excellent method of benefitting the individual and of preserving
estates in families ; but it hardly seems calculated for the  genius of
a free nation, who claim and exercise the liberty of  using their own
property as they please.   " ' Sic utere tuo ut alienum non  laedas,' is
the only restriction our laws have  given with regard to economical
prudence."   The  propriety of acting on this principle with respect
to the imbecile and those morally insane would  be less subject to
doubt, if such  individuals suffered only in their  own  persons and
interests, and were not liable to involve their families  and  relatives
in misfortune and disgrace.
   Whatever may have been the decisions of courts  of judicature or
the opinions of lawyers on this subject, certain it  is, as a  matter of
fact, that idiotism, or mental  incapacity depending  upon congenital
formation, is not  a thing to  be pronounced absolute and  complete
within a definite degree.  It exists in  various shades and  modifica-
tions, from the last stage  of fatuity which  places  human beings far
below the brutes in regard to the manifestations of  mind,  up  to an
 almost imperceptible inferiority in comparison with the  ordinary
 powers of understanding.  There are some idiots whose degradation
 is of so decided a character, and whose defect is  so strikingly dis-
played by their expression of countenance  and manners, that no per-
 son could hesitate for a  moment to pronounce upon their state, but
 the number is much  greater of those  whose  affection  is  of such a
 kind as to leave room for doubt, and  to require attentive  examina-
 tion ; yet it is not less really the  fact that these  individuals are by
 nature incompetent to govern their conduct by their own  wits, or if
 left to themselves amid the collisions  and accidents of life, to  pre-
 vent the ruin of their families  or  relations.   Whatever the law  of
 prescript or of custom may be with respect to such  unfortunate per-
 sons, common sense and humanity indicate  most plainly  that they
 ought to be protected, and that the provision of the Roman law and
 the laws of the most enlightened nations on the  continent are  wise
 and humane in this respect, and also  in accordance  with justice and
 propriety.   The course which  the Roman law has adopted is doubt-
 less that to which the legal regulation in this particular, of all  coun-
 tries, will be ultimately brought, and to which they would speedily
 arrive,  if only the  indefiniteness and ambiguity connected with the
 existence and  degrees of mental deficiency could  be removed, and
 some clear and distinct principles recognized, which might guide  or
 assist the opinions of arbiters in pronouncing judgment in particular
 cases.  The want of some rule by which  the various degrees of in-
 capacity may  be measured, and the exigencies of each stage and con-
 dition  determined,  has  long  been felt.   Professor  Hoffbauer has
 made an attempt to  supply this desideratum.  He has divided the 
256
UNSOUNDNESS OF MIND.
 defects of the understanding into several stages, and has endeavoured
 to describe each by its appropriate  phenomena.  His arrangement
 has met with great approbation among his  countrymen ; by foreign-
 ers it has been  variously estimated.   I believe  that it will be found
 useful as furnishing a scale to which approximations may be made in
 particular instances, though it may sometimes be  found difficult  or
 even  impossible to refer individual cases to the description  of any
 one particular stage in the series.
    The scheme of Hoffbauer seems originally designed  to distinguish
 the varieties of ment3l weakness in persons who are by nature defi-
 cient, and who  have  sustained no loss of reason  by disease.  The
 state of these individuals is different from that of demented persons,
 or those who have become incoherent and fatuous.   In a  medical
 point  of view, and for purposes of nosological accuracy, this distinc-
 tion ought carefully  to be maintained, but as  both  imbecile and
 demented persons are liable to be examined as to the powers Of the
 understanding and  the extent to which the fault Or  disorder in either
 may reach, and as  the decision to be formed will  depend in either
 case on nearly similar considerations, there seems to be no reason in
 propriety why  both should not be referred to the same scale.  De-
 mented persons in  the last degree are as completely beyond all doubt
 or question as to their incapacity as the merest idiots :  in the lower
 or less strongly characterized stages their cases admit, like those of
 idiots, of a variety of degrees.  For these reasons it seems  not im-
 proper to comprise the degrees of congenital weakness, or approaches
 to idiotism, and  those of dementia under the same scale.

 Section II.—Of mental Deficiency in its different Modifications
   and Degrees.  Hoffbauer's Stages of Silliness and Stupidity.

   Mental deficiency includes all the  degrees  of intellectual  weak-
 ness, from the slightest appearance of inferiority  in understanding to
 absolute fatuity.    Different modifications of mental weakness are
 comprehended under this head, whether arising from natural imper-
 fection in the organ of intellect or the consequences of disease; they
 are arranged according to the degrees in which the mind is found to
 be defective in its operations.
   But though I include at present under one head kinds  of deficiency
 different in  respect to their causes and their pathological nature, I
 must, before I prwceed to the  arrangement  of gradation established
 by Hoffbauer, distinguish, with that writer, two marked varieties in
 the character and phenomena  of mental weakness.  One of these
 modifications of defective understanding is termed bloedsinn, or im-
 becility, and the other  dummheit, or dulness :  I  shall adopt the ex-
 pressions silliness and stupidity, as  the most appropriate glosses for
 these German  words which I can find.   The former, in Hoffbauer's
phraseology, is said to consist in a defect of intensity, the latter in a
want of extensity.  By intensity M. Hoffbauer describes the energy
with which a sound mind applies itself to judge with accuracy on the 
HOFFBAUER'S DISTINCTIONS.
257
objects of reflection, or on the  data already furnished by the senses
and by perception ; extensity is a similar energy directed externally
to sensation and apprehension, or to the acquisition  of ideas.  The
former defect renders the intellect unable to examine with sufficient
exactness the data on which judgment is to be exercised ;  the latter
renders it liable to suffer some-of these data to escape.   There is in
fact, if I am not mistaken, a marked diversity among men as to  the
relative degrees of energy in  their internal  and external faculties,
meaning by the former the powers of judgment  and  reflection, of
reason, the faculties by which  the mind decides on  truth  and false-
hood, right and wrong, and in general of relations ; and by the latter
the ability for  external  perception and apprehension.  When  the
whole constitution of the mind  is weak so as to render the individual
barely competent  to the  business of life, these differences  are  the
more striking  and conspicuous.   Many  persons  whose  power of
judgment is very deficient  have a tolerable share of quickness in  ap-
prehension ; others, on the contrary, and  these often  appear much
more defective than the former class, are slow of perception, and let
many things escape them  which  would  be  observed  by ordinary
men, yet they make occasionally shrewd remarks, and give tokens in
their conduct which indicate a sagacity much  beyond the measure of
intellect which common observers ascribe to them.  M. Hoffbauer
is correct in  distinguishing two classes among weak  and half idiotic
persons.  One  of these may be  described as  silly  or defective in
judgment, in the powers of reason and discrimination, while the other
or stupid class show their deficiency chiefly in obtuseness or slow-
ness of perception and apprehension, and  in a consequent  ignorance
of external things and relations.*
   That form of intellectual weakness which is distinguished by  the
term silliness or imbecility differs in several respects from stupidity
or obtuseness of the mental faculties.
   " In reference to the faculty  of judgment, it may be observed that
the stupid or obtuse person is  more liable than the imbecile  to form
erroneous decisions ; the latter experiences great difficulty in bring-
ing himself to  any conclusion.   Secondly, the stupid person some-
times judges very correctly on subjects to which his  attention  has
been strongly applied ; occasionally he comes even more directly to
a right conclusion than those who are  possessed of superior  intelli-
gence.  When he errs,  it is through neglect of some of the considera-
tions which ought to have  formed the groundwork of his judgment,
and he will say, in order to excuse himself, that 'he should never
have dreamt of this  or that circumstance.'  To the silly the most
simple  act  of judgment is difficult:  for  instance, a lady who  said
that she was twenty-five years of age, and  had been married  six
years, could not, after many efforts, tell  how old she was at  the period
of her wedding.   Thirdly, the stupid man may often be induced to

   * Hoffbauer has explained his ideas on the nature of*bhodtinn' and«dummheiV
more fully in his  Untersuchungen, th. i. 8. 9.
   May, 1837.                 23 
258
UNSOUNDNESS OF MIND.
correct his mistake, some particular circumstance being suggested to
him which leads to its detection.  The imbecile man  can  scarcely
rectify his error, being unable sufficiently to concentrate his atten-
tion on any particular subject   The  stupid man has not this defect,
but he views every subject on one side only, and is  embarrassed by
every complex idea.
   " In relation also to memory, there  is a decided difference between
stupid and imbecile or silly persons.  The latter appear to be almost
entirely  defective  in this faculty :  the former recollect  after a long
interval  of time some insulated circumstances or transactions.  The
reason of these peculiarities is the total want of attention to present
objects which is characteristic  of  the one state, and the partial but
concentrated attention to them  which is observable in the other.
   " Weakness of  intellect displays itself in both these classes of per-
sons, when their defect is in  a  high degree, by a propensity which
they have to talk  to themselves.  This is most  observable when the
affected  individual is alone or supposes himself to be so.  In reality,
we employ words not merely for purposes  of intercourse, but as an
instrument of thought, and the weakest intellects  require their aid
in the  most perceptible manner.    When  the mind is  morbidly
weakened, the silent and unperceived or the mental employment of
words is insufficient : they must be  repeated more or less audibly.
This practice is not uncommon  with  imbecile and stupid persons, but
when in society they generally perceive its incongruity and abstain
from it.   If, however, such individuals talk to  themselves, knowing
themselves to  be  in the presence  of  other  persons, it  is a proof of
greater deficiency.
   " Another distinction  between the stupid and the silly is that the
former imagines himself to  be  at least equal to other men in intelli-
gence, whereas the imbecile is ever conscious of his state, and even
exaggerates his defect.
   " This difference between them  is easily explained, as well as the
results which it induces in their conduct.   The stupid act rashly and
without reflexion  ; the imbecile can never come to a determination.
 Hence,  also, the imbecile become cautious, timid, and even misan-
thropic, unless when assured of their security by finding themselves
 under the protection of persons  of whose kind  intentions towards
 them they are well convinced : to the guidance of such persons they
 give themselves up with blind  confidence.
   " The pusillanimity and  misanthropy of the imbecile  lead them
 to a species of devotion, if such it may be termed.   Supposing them-
 selves to be despised and ill-treated by men, they are led to apply
 for support to  the common resource  of the unfortunate.  The stupid,
 more confident in themselves, fancy  that they acquire merit by their
 devotions, or confer a favour on the  divinity."
    This  account of the phenomena of mental weakness might suffice
 for ordinary purposes, but the deficiency exists to different degrees,
 and one stage  in the approach to  idiotism  has  results, in  respect to
 social relations, which do not belong to a different grade in the same 
HOFFBAUER'S DISTINCTIONS.               259
scale.  M. Hoffbauer has for the first time made the attempt to de-
fine the gradations of mental deficiency as a basis for suggestions on
the legal bearings of this state in particular degrees.   It  was hardly
to be expected that he should accomplish this undertaking at once in
a manner wholly free from error, and  requiring  no correction or
improvement.   The  outline which  he has sketched is drawn with
great ability, and  is evidently the  result of extensive  observation,
assisted by no ordinary talent for generalising phenomena and tracing
their connections.   The subject is so important that I shall incur the
risk of being thought somewhat prolix, and give an abridged extract
of this author's  description of the five  stages or degrees into which
he  divides the  affection of  bl'odsinn, imbecility or silliness, and the
three degrees of dummheit, or stupidity.
   " The first degree of imbecility or silliness manifests itself in the
incapability of  forming a  judgment respecting any new object, even
when  the necessary data are furnished, and the question is one which
in itself presents no difficulty : in  this degree  of the affection the
individual can very well judge respecting  objects to which he is daily
accustomed, and in familiarity with  which he may be said  to have
grown up ; he often shows, in the  pursuit of his  daily concerns, a
minute exactness which appears to him a matter of absolute neces-
sity.  His memory is very limited : not  that he absolutely loses the
remembrance of things, but because  he cannot apply his recollections
according to  his  wishes.  He scrupulously  observes whatever he
thinks becoming in his situation, because he fears to give offence  in
 neglecting it.   When he gives himself up to avarice, there is ob-
served in him rather an apprehension of  losing than a desire of ac-
cumulation.   The propensity to talk alone, and the species of devo-
 tion to which we have alluded, is  seldom  to be met  with  in this
 instance, the former because the  routine  of daily occupations, above
 which the individual seldom raises himself, makes but small demands
 on his intelligence; the latter because his infirmity is not so remarka-
 ble in society as to render  it a subject of general  observation, and
 entail upon  him  frequent annoyance, and  thus make him  feel the
 necessity of seeking support elsewhere.  He is very subject to gusts
 of passion, which nevertheless are as easily appeased  as they are
 excited."
    The preceding description will  be found  to  coincide accuratelv
 with  many cases  of mental defect arising from original or congenital
 weakness of the intellectual faculties. I  could furnish instances from
 my own observation which strikingly exemplify it.
    " In the second degree of imbecility  the patient still  judges and
 acts consequently with respect to subjects that are  familiar to him,
 but even on those subjects it often happens that he is deceived,  be-
 cause, through a  distraction  which is  a second  nature to him, he
 forgets places,  times, and circumstances.   He observes so little what
 takes place or  what passes around  him,  that he often fancies himself
 in a different spot from that in which he really is, mistakes strangers
 for persons of  his acquaintance, confounds the present with the past, 
260
UNSOUNDNESS OF MIND.
 but more often with the future, and believes himself at home when
 he is at the house of another person.
   "The individual effected with imbecility in the third degree is
 unfitted for all matters which require more than a mechanical mode
 of action, but he preserves sufficient intelligence to be aware of his
 weakness and the superiority of others with respect to the mental
 faculties.   We may likewise remark in  him that propensity to devo-
 tion and to misanthropy which we have mentioned above.   His mind
 is not completely inactive, although it cannot raise itself to any high
 pitch ; hence he has the propensity to talk to himself.  He  has not the
 power of seizing any idea so clearly as to impress it on his mind ;
 hence a very marked  defect of memory,  and a propensity to pass
 rapidly from one topic to another. He is  very irritable and suspicious,
 fancies a design to insult him where it is impossible, because his state
 yet permits him to feel and resent injuries ; of which susceptibility
 those around him often take advantage to his annoyance.
   " The fourth degree of imbecility is marked by a clouded state of
 the understanding and the memory, with a  great insensibility, which
 nevertheless leaves the patient a confused idea  of his weakness.   He
 eagerly seeks excitement by various stimuli.
   " In the fifth degree of imbecility there is a nullity of intelligence;
 the attention cannot be  directed  to  any object : all the faculties of
 which the activity depends upon  the intellect are destroyed or  op-
 pressed.   The phenomena which depend upon attention are wanting,
 and those which  imply its absence take  their  place.   The imbecile
 in this degree is insusceptible of passions, of joy, of grief, of pleasure,
 in  a word, of  every kind of moral  feeling.  He  is even but little
 sensible of pain and other physical inconveniences.  He  only takes
 nourishment  because it is given to him, like an  infant ;  the natural
 wants, such as hunger and thirst, have no effect upon  him.  He has
 no memory, he has neither deArotion nor the desire of talking to him-
 self, which is  observed in other imbecile persons, but  which implies
 in  them to a certain degree of consciousness of their state."
   The fifth stage  of  imbecility thus characterised by Hoffbauer is
 precisely the last degree of dementia, or the fatuity which is the con-
 sequence of cerebral diseases.
   " Stupidity, generally speaking, is a defect less severe than  imbe-
 cility, according to the definition which we  have given of both.  The
 slightest degree, however,  of imbecility indicates an imperfection
 of  the intellectual powers  less severe  than the greatest degree of
 stupidity.
   " We admit in stupidy three principal degrees.
   " In the first, the individual is incapable of judging and  of self-
 determination, only when it is necessary to weigh opposing motives.
 Then he feels his incapacity, and  has recourse to the intelligence of
others, unless pride happens  to prevent him, which is often the case.
If he  acts  absurdly,  it is often  because he applies to his actions a
rule good'in itself, but the application of which requires  other con-
siderations. 
HOFFBAUER'S DISTINCTIONS.
261
  "The subject of the second degree of stupidity forms a judgment
accurately and often promptly upon things by which he is daily sur-
rounded ; but he  commits serious errors whenever it is necessary to
exert a certain vigour of judgment:  he embarrasses himself  in any
train of reasoning, however simple it may be.   His memory is per-
haps faithful, but it  is slow ; he cannot, without great difficulty,
express a complex idea, if it is the result of his own reflections, and
has not been  received from  another.  When his faculties have been
somewhat developed by education, he is an obstinate partisan of any
thing which is, as we  say, good  in  theory but  useless  in practice ;
because he cannot observe the circumstances which distinguish par-
ticular cases,  and appreciate them according to their just value. These
two conditions are, however, indispensable, in order to make with
propriety the application of general rules.
  "In the  highest degree  of stupidity the individual cannot go be-
yond one  single  idea ;  and he must completely lose that one before
he can pass to another.  He is hence less capable of judging than the
imbecile, because  the comparison of several ideas is necessary to form
a judgment.   Individuals who are afflicted in  the  third degree of
stupidity often express themselves in half-uttered words, return in-
cessantly to the same subject, make known their ideas by sentences,
short, incoherent, and unfinished, like children who can retain words
but do not know  how to connect them together ; they express often
the subject and the attribute without connecting the one to the  other
by an affirmative  or negative.  If they wish to say ' the rose is beauti-
ful,' they will say' rose beautiful,' or only rose, or beautiful, according
as the subject or the attribute strikes them most Often they reverse
the natural order of words, and say, for example, ' rose beautiful is ;'
and when  they perceive an omission which they wish to repair, they
become still  more perplexed.
  " With  respect to legal relations, the first degree of imbecility may
be  assimilated to the second  degree of  stupidity, and  the  highest
degree of  the latter to the third degree of the former."
   M. Esquirol has made objections to the minuteness and attempted
accuracy of these distinctions.   He thinks it difficult,  if not impos-
sible, to determine the exact limits of each stage.   The endeavour to
lay down  rules with accuracy scarcely attainable in  practice may
sometimes impose unnecessary difficulties. This is undoubtedly true,
and perhaps  it may be admitted that the modifications and degrees of
which Hoffbauer's arrangement  consists  are more numerous than
they ought to be.   Yet the necessity of adopting some method  of
this kind is obvious, unless we determine to regard mental deficiency
as an absolute state, and admitting of no gradations ; and experience
proves more and  more the error of such a proceeding.
  I proceed  now to the practical application of these distinctions.
  " In matters of criminal accusation all legal culpability is annulled
when it is proved that the party labours under  imbecility amounting
to the third degree, or even nearly approaching it.  Imbecility in the
first and  second degree may either annul or weaken culpability, or
                               23* 
262
UNSOUNDNESS OF MIND.
leave it unaffected under different circumstances.   Ignorance of the
law and of the illicit nature  of actions may sometimes be alleged as
excuses in criminal accusations in the instance of imbecility amount-
ing to the first degree.   But this plea can only be allowed to be valid
under one of  the two following conditions:—1st, when the law
which has been violated by the imbecile neither forms part of general
relations which concern himself as well as other members of society,
nor  belongs  to his  own  particular  habits  or circumstances : 2dly,
when the action forbidden by the legislator is not contrary to the law
of nature.
  " The second degree of imbecility may lessen  or destroy culpa-
bility in cases in which the first degree leaves it entire.
  " In the first degree of imbecility, inattention or absence of mind,
vvant of foresight, &c. are not considered as excuse when they have
regard to objects universally known, as to.fire, or  to those which are
familiar in use to the imbecile, as the tools, &c. of his profession.  In
all other instances his fault loses the degree of culpability which be-
longs to it, according to the expression of jurists, in abstracto.  This
is also the case when the act is the result  of sudden anger or  fear,
to which persons are prone.
  "The imbecile  in the second degree has less  responsibility  than
in the first.   His  incapacity is  greater, as likewise is his proneness
to sudden emotions.
  " Similar considerations affect the responsibility of persons labour-
ing under stupidity, when it passes the middle  degree above de-
scribed. In fact, the latter being incapable of extending their thoughts
to several objects at the same  time, must omit many considerations
of which intelligent persons  never lose sight  Such an individual is
so much the  less responsible for his  actions,,as he is known to be in-
capable  of the reflection  which  might lead  another to rectify his
mistakes.
  "  The principles established in  reference  to criminal law, on the
ignorance of the parties, are applicable  in civil law to the question—
whether an individual is in a condition to recognize the illicit nature
of an act by  which he  has trespassed on the right of another.  In
imbecility in the first or second  degree, ignorance of the  law may
be pleaded as excuse under  circumstances  analogous to those before
alluded to.
   "  All the arrangements which the 'law authorizes or prescribes in
regard to imbecile persons are founded either on   their own interest
or on that of others, and have for their object the personal security
of either party.   These arrangements  refer, 1st,  to the appointment
of a  tutela  for the administration  of  the  property of .the weak or
idiotic man,  and  of a curatela for the care of his person ;  2dly, to
seclusion, when it is required for preventing dangers likely to accrue
to society or to the individual from his unrestrained enjoyment of
personal freedom.   All the  measures judged necessary for his secu-
rity and for  the protection of society must  be taken with as much
mildness as possible.
   "  An imbecile person, whose affliction  reaches the  third degree, 
PRACTICAL APPLICATION.
263
can no longer be judged competent to the care of his own property :
this may be observed a fortiori, if his disorder passes that degree.
But in the appointment of a tutela, regard must be had to the neces-
sity greater or less of such protection, and especially to the particular
character, habits, inclinations, &c of the individual.   It must be con-
sidered whether he is likely to commit actions which, though indif-
ferent in themselves, may occasion  public  offence, or whether  an
excessive liberality or ruinous prodigality may not expose him  to
dissipate the property that may be left at his disposal.
   " The administration of his property should be left to the imbecile
in the second degree, and a curator should only be appointed for him
under particular  circumstances, as for example, when his character
calls for such an  arrangement, and when some interests are at stake
which require practical intelligence, and especially constant attention.
With  such exception it is unjust to deprive him of the management
of his affairs.  The inconveniences to which he may contingently be
exposed cannot be compared with the certain annoyances connected
with  a tutela, and  some  reliance may be placed in general  on the
vigilance which self-interest calls forth even in defective minds.  •
   " Persons imbecile in  the second  degree  are  more subject to act
without reflection than those whose defect belongs to the first or the
third stage.  The former are rather irresolute and  timid than pre-
cipitate in action, and the latter too negligent and inactive.   Hence,
though in the second degree imbecility does not generally authorize
the appointment of a tutela it often requires that individuals should
 be subjected to an especial surveillance.
   "The imbecile  whose infirmity-does not exceed the first degree
 cannot justly be subjected to  a  tutela, or to  any  particular surveil-
 lance, except under circumstances in which his inclinations or habits,
 his family, relations, pr fortune, or the affairs under his management,
require such an arrangement
   "What has been observed in respect  to the degrees of imbecility
 may be applied to stupidity, on the principle above laid down. Only
 it must be remembered  that this last infirmity renders individuals
 more liable to rash and hasty actions  than does imbecility.
   " Imbecile persons in the third degree are evidently incapable of
 making wills ; as their state renders them competent only to actions,
 which, if not unreasonable, are without reflection.   The case is  not
 so in the instance of imbeciles in the first and  second degree, even
 though  under certain  circumstances, before adverted to, they may
 occasionally be subjected to a  surveillance  or  even to a curatela.
 The object of this curatela  is to protect them from  injuries which
 they might bring upon themselves if left to their own discretion,  and
 to-prevent engagements which they  might contract and be unable to
 fulfil.   These considerations are not, however, reasons for depriving
 them of the power of making a will.  By a testament  they might
 deprive those who would inherit ab  intestato, but they prejudice no
 formal right.  Besides a testament does not require the same intel-
 ligence as the administration of property ;  it only depends  upon a 
264
UNSOUNDNESS OF  MIND.
 single arrangement, for which the testator has sufficient time for de-
 liberation."
   To this last opinion of M. Hoffbauer it is objected by M. Cham-
 beyron, that by the simple appointment of a tutela the imbecile per-
 son is assimilated to a minor and declared incapable of any civil act
 except under some particular circumstances, and when  the authentic
 consent  of the tutor  may authorize  him to contract.  Why then, it
 is inquired, should there be any exception for the right of testating?
 The author has given a satisfactory  reason why this right should be
 preserved inviolate in certain instances, namely, that individuals may
 and do retain the requisite  degree of intelligence for entering into
 the arrangements in  question, though  in other respects in a  state
 which renders the appointment of a  guardian  or some especial sur-
 veillance advisable.  The incongruity pointed out by M. Chambey-
 ron has respect to positive  institutions, and the observation of M.
 Hoffbauer is founded on general principles.
   I shall here terminate the consideration of mental  weakness or de-
ject, and now proceed to the second  division of the subject, namely,
 disorders of the mind.

 Section III.—Of Disorders of the Mind considered in relation
                        to Jurisprudence.

   1. Of intellectual derangement  or mental  illusion.  Mono-
 mania  and  Mania.—Professor Hoffbauer adopted  an  ingenious
 though erroneous idea as to the nature of these  diseases.  On this he
 has founded some practical conclusions, of which the validity is very
 doubtful;  they deserve, however, for reasons  which will appear, a
 few moments' consideration.  Mental illusion  (wahnsinn) consists,
 according to  him, in a loss of that due proportion which, in the sound
 state of the mind, the  powers of  sense and perception bear to the
 influence of imagination.  The influence of imagination may become
 excessive in two  ways ;  first, by increased intensity or exaltation of
 this faculty, the other powers remaining the same ; or, secondly, by
 depression of the latter, while the faculty of imagination remains un-
 changed.   The former is monomania, in which, as  the author  sup-
 poses, the mind is not destroyed or generally affected.   The latter is
 mania, and in this the powers  of  the understanding, perception,
 apprehension, are greatly impaired.
   No practical error is likely  to arise from this opinion, as far as it
 respects the nature of mania.   Persons who are generally deranged
 or in raving madness cannot be supposed by any one to be accounta-
 ble for their conduct, or capable of managing their affairs.  No dispute
exists among jurists or physicians on  this subject   The state of ma-
niacs is in general too manifest to admit of any doubt.   The lunatic
perceives the objects and persons  who surround him, but his imagi-
nation transforms them, and  they  are  mistaken by him as to  their
nature and identity.   " Hence in civil  law the acts of such an  indi-
vidual manifestly lose all their consequences, and can neither convey 
OF MENTAL ILLUSIONS.
265
 any right to another, nor place the agent himself under obligation.   In
 criminal law he is discharged from all responsibility, and consequently
 from all culpability ; since what he wills to do in his  imaginary situa-
 tion is not what he would do in his real situation, were he only aware
 of the latter.  This state of disease fully justifies the  placing an indi-
 vidual under a  tutela, and the disposing of his person  in that  way
 which  shall r.ppear most conducive to  his recovery, or in hopeless
 cases, to his security and comfort."
    It will be apparent to those who entertain a correct opinion as to
 the nature  of monomania or partial derangement of the understand-
 ing, that a great part of this reasoning applies almost equally to persons
 affected by that form of disease.   But here we find  Professor Hoff-
 bauer's theory leading him into error, an error which is not peculiar
 to him.  As his opinion  is common to many, and the  inference to
 which it has led  him is by  no means a matter of indifference, I shall
 cite some of his observations, and presently add the comments of a
 practical physician, the powers of whose acute and penetrating mind
 have been directed to this subject.
   Hoffbauer supposes that, in partial insanity characterized by hallu-
 cinations, the representations of unreal objects, or the illusory trans-
 formations  of existing  ones, such illusions  can only  pervert  the
 judgment when the affected train  of ideas is brought into play ; and
 that on matters unconnected with this illusion  the individual is to be
 considered  as a sane man.  " In this relation, therefore, insanity can-
 not be recognized by the law.   In civil law all the acts of the party
 preserve their validity, and in  criminal law their culpability."   In
 fact, there is no  reason  why a man who thinks he has legs of glass,
 and in other respects is in  possession of all his faculties, should  not
 be capable of contracts, and responsible for illegal acts which have no
 connexion with the subject of his madness.   Such a species of  in-
 sanity seldom prevents a  man  from managing his  own  affairs,  or
 undertaking any legal relations  for others.   Swedenborg, so cele-
 brated by his visions, who was confessedly  a  madman,  fulfilled  the
 duties of his office  in  so  distinguished a manner, that  the king of
 Sweden ennobled him.   The author knew a doctor in laws who had
 taken it into his head that all the freemasons had entered into a league
 against him.  This person, who in other respects was perfectly sane,
 held with high credit a chair in a university.
   In genera], in  relation to the insane, the  ruling idea or illusive
 opinion characteristic of their disease, considered with respect to the
 imputability of their actions, ought not to be regarded as an error,
 but as a truth ; or, in other words, their actions ought to be considered
 as if they had been committed under the circumstances in which the
 patient believed  himself to be.   At Brieg, a  soldier  killed a child
 because he thought he saw the Deity near him commanding him to
 do it.  Dr.  Glanwitz, in his report, came to the conclusion that the
 man should  be confined in a lunatic asylum.
  " When the question relates to consent to some particular matter,
regard must be had to the prevailing idea, inasmuch as upon its truth 
266
UNSOUNDNESS OF MIND.
or falsity depends the reality  of the  consent  If, for example, in a
civil affair, as a contract, we suppose that the contractor would not
have given his  consent without a previously existing illusion, this
idea is looked upon as an error, not imputable to the person concern-
ed.  As to the question whether the results of the act are cancelled
or not, this must depend upon what the laws have decided with re-
spect to involuntary errors.
   "In practice it  is difficult to decide whether an affair undertaken
by a person labouring under madness with a fixed illusion is valid or
not, on account of errors likely to result from this fixed illusion.  For
as long as  this  person  enjoys his  rights, it  is not  the business of
another to examine if his act is valid  or not.  And besides, the per-
son himself neither could nor would acknowledge his  error."
   "From what has preceded, we apprehend how important it is to
determine, in cases of permanent  illusion, the paramount idea; to
know whether  it brings on a derangement more or  less complete of
the intellectual  faculties, or only prevents the perfect use of the judg-
ment in relation to certain objects ;  to discover what influence it has,
on one side, upon the notion which the patient has of himself and of
his relations with his equals, and, on the other, upon his actions in
general.  When the prevailing error draws with it a total incoherence
of ideas, the case approaches to one of imbecility.
   " When a patient attacked by madness with one fixed illusion has
a false notion of himself and of his relation to others, this circumstance
ought to be taken into consideration.   For in criminal justice actions
ought to be regarded as if  the person really was in the state and in
 the circumstances in which he believed himself to be.   Thus the
crimes committed by madmen fancying themselves kings and princes,
 ought not to be punished according to their nature and heinousness;
 the culpability  is lessened  or destroyed.
    " We ought  above all to have regard to  the illusion under which
 the patient is carried by his paramount idea to commit actions which
 he considers as matters of duty.   In religious madness, for example,
 the acts which a  person afflicted with this form of the disease com-
 mits, ought still less to be punished ; because no kind of  human suf-
 fering could have any effect upon a lunatic of this description ; divine
 punishment,or the hope of eternal reward, weighs much more strongly
 upon his mind than the fear of any thing within the power of man."
    Similar opinions have been advanced in a manner less restricted
 by a high legal authority in France.   The following observations are
 understood  to convey  the sentiments of the advocate-general, M. de
 Peyronnet, as they were delivered in a process on the " Affaire de
 Papavoine."*   " The advocate-general," says the report, " proceeds
 to examine whether  every  kind  of insanity ought to absolve from
  culpability, and after  distinguishing in  the clearest manner partial

    * Discussion Medico-legale sur la Folie, &c. par le Docteur Georget. Paris,
  1826.  See, also, Examen Medical des Proces criminels des nomme3 Leger,
  Feldtman, Lecouffe, Jean-Pierre, et Papavoine,  &c. par le docteur  Georget.
  Paris, 1825. 
IRRESPONSIBILITY OF MADMEN.             267
from total derangement, sustains and demonstrates that the last can
alone extricate a criminal from the penalty of the laws.  This reason-
able distinction thus laid down by the public  authority, throws the
strongest light upon the questions of mental alienation, the most in-
tricate question in medical jurisprudence, which some physiologists
have solved in a manner as unfavourable to accusation as injurious to
morality, and alarming to society.  M. de Peyronnet here cites some
passages from Lord Hale.  Of these I should prefer to cite the En-
glish text, but as the advocate-general has given to  some of the ex-
pressions a more definite turn, in a  manner which displays fully his
own way of thinking, I shall crave permission to deviate from  my
usual course, and cite the exact words of M. de Peyronnet.
   "'II est une demence partielle  et. une demence totale ; la premiere
est relative a tels ou tels objets.    Quelques personnes qui jouissent de
leur raison pour certaines choses sont sujettes a des acces d'une de-
mence speciale,  a telles discours ou tels sujets, ou bien elle est par-
tielle dans ses degres ; telle -est  la condition d'une foule d'insenses ;
st surtout des personnes melancoliques dont la folie consiste la plupart
du temps  a. temoigner  des  craintes, des chagrins  excessifs, et qui
cependant ne sont  pas entierement  privees de l'usage de la raison.
Cette demence partielle  sernble ne pas excuser les crimes que com-
mettent ceux qui en sont atteints, meme  en ce qui en fait I'objet
principal; car  toute personne qui s'arme contre lui-meme ou contre
d'autres, est jusqu'a  un  certain  point dans un etat de demence par-
tielle, lorsqu'elle se rend coupable.................Je suis en
 outre force d'admettre  qu'il est une importante distinction entre  les
 cas civils et les  cas criminels.  Dans les premiers, des qu'il est prouve
 que la raison de 1'homme est alteree, la loi annulle ces actes, quoiqu'ils
 n'aient aucune relation avec les circonstances  qui causent sa de-
 mence, et qui auraient pu influer sur la conduite.  Mois lorsqu'il
 s'agit de decharger un homme de la responsibilite'  de  ses crimes,
 et surtout de crimes atroces, on ne peut point riclamer I'applica-
 tion de cette regie, incontestable pour une question depropriltL'
    "After having laid down  principles so precise, so positive, so satis-
 factory to the jury," continues  the reporter, " the advocate-general
 applies them to the cause."  The same writer cites  further the follow-
 ing passage, which leaves no doubt as to the views  of M. de Pey-
 ronnet.  " The pretended insanity of the accused is a pretext  had
 recourse to  in despair of the cause ; certain it is that this derange-
 ment cannot have been total:  it is likewise proved that  it could not
 be partial, and  in this last supposition, if even allowed, it could not
 serve for an admissible excuse."
    M. Georget, possessing much more correct knowledge  of the real
 nature of monomania or partial  illusion, considered the joint opinion
 of these lawyers as highly objectionable.  He expressed his aston-
 ishment at the sentiments of  Lord  Hale. " This writer," he says,
 " appears professedly to consider property of higher value than human
  life !  There is then no excuse for an  unfortunate lunatic, who in a
  paroxysm commits a  reprehensible action, even  although it should 
26S                 UNSOUNDNESS OF MIND.
 appear to be the result of his particular illusion !  And yet the civil
 acts of this same individual are to  be annulled, although they have
 no relation to the insane impressions which  might have influenced
 his conduct!  And even M. de Peyronnet could cite such maxims
 as these with approbation; we do not at least  find he has objected to
 any part of them.   All monomaniacs, according to this statement
 are liable to become  criminals in spite of the sixty-fourth article of
 our penal code, and may undergo the penalties recorded for atrocious
 offences."
    M. Georget has refuted these opinions on grounds which must be
 conceded by the jurists of all countries, viz. on those of experience
 and correct knowledge as to the real state  of monomaniacs.  Such
 persons, as he has  clearly proved, though they reason correctly on a
 variety of subjects remote from the particular one on  which their
 illusion  turns, are yet  more fully deranged than they appear to be,
 and are ever liable to display perversities both in feeling and action.
 Cases like those of Swedenborgand the German professor mentioned
 by Hoffbauer, very rarely occur.   Even in these instances, had we
 been enabled to follow the individuals  affected into private life and
 to observe their personal  deportment, it is almost certain that some-
 thing  would have  been discoverable in their moral character and
 habits different from.those of ordinary men.   M. Georget's observa-
 tions have led  him to form nearly the same  opinion  as to the nature
 of monomania or partial derangement as that which I have expressed
 in a former part of this work.
   The facts of a remarkable  case  of this description which  came
 out in evidence some years ago before an  English court, confirm in
 a striking manner the character here ascribed to this disease.   For a
 full account of this I must refer to a "Report  of the judgment in
 Dew vers. Clarke and Clarke," delivered by the Rt. Hon. Sir John
 Nicholl, in  the  Prerogative  Court- of Canterbury. It was there
 proved that the individual " in the ordinary transactions  of life con-
 ducted himself and his affairs rationally ; was  a sensible, clever man;
 amassed a  considerable fortune by his profession ; took good care of
 hispropert}7; and that several of his friends and acquaintance, some of
 them medical persons, never even suspected that he was deranged in
 mind."  It was stated by those who wished to prove his sanity, that
 " he was a man of irritable and violent temper, of  great pride and
 conceit, very precise in all domestic arrangements, very impatient of
 contradiction, entertaining high  notions of parental  authority, rigid
 notions of the total and absolute depravity of  human nature, of the
 necessity of sensible conversion, and of the necessity or expediency
 Of confessing to other persons the most secret thoughts of  the heart."
 It was proved that this person, such  as he is above described, having
 a daughter " amiable in disposition, of superior talents, patient under
 affliction,  dutiful  and affectionate, modest  and virtuous,  moral and
 religious," was in the habit of " tying this daughter to a bed-post,
flogging her with the most unmerciful severity, aggravating her suf-
ferings by the  application of  brine, flogging her  repeatedly with a 
OPINIONS OF ENGLISH JURISTS.
269
horsewhip, pulling her hair out by the roots, and compelling her to
perform the meanest drudgery.  It is scarcely necessary to add that
the able and enlightened judge before whom  the investigation of
this  case was brought, declared  the  individual to be " non compos
mentis."
  If such is in  general the real character of partial  insanity, and if
cases which come near to the idea  usually entertained of this disease,
are, when and  if they occur, rare  exceptions to  the general fact, it
will  be allowed that criminality should be  attached with extreme
caution to any individual in whose case  the existence of insane illu-
sion  has been proved, however limited  in its extent this particular
phenomenon of the disease may appear  to be.  The  same consider-
ations ought to  weigh in an equal degree in questions which respect
the exercise of  personal rights.
  The only remaining topic connected with illusion which I shall at
present consider, is the subject of lucid  intervals.
  Hoffbauer has well observed that much depends upon the duration
of lucid intervals.   In some instances these intervals are very short;
in others they  are of equal length with the  periods of disease, and
sometimes they last much longer than these periods.   In the former
case  the individual has consciousness of  his actual state with relation
to external circumstances, but not  with relation *o his former periods
of existence.   His life is only, in  his view,  in insulated fragments;
his knowledge  of himself is inaccurate and  confused.   This obser-
vation  can only be applied in a more  limited manner to cases in
which  lucid intervals are nearly of equal duration to the periods of
disease.  I cannot follow M. Hoffbauer into the inferences which he
founds upon this observation.
  We  must likewise take into consideration  the  circumstances that
repeated attacks of disease  weaken the understanding, and that, when
they are frequently recurrent, the  individual generally falls  into a
state bordering on dementia, in which the  remembrance of persons
and relations becomes very defective.   In  such instances  it must
become a subject of inquiry to what form  and  degree of mental
deficiency, as before distinguished, his particular case belongs.
  In all examinations respecting insane  illusions,  it will be necessary
to bear in  mind the well-known fact  that  many  lunatics display
great artifice in evading questions  relating to their morbid impres-
sions, even while these impressions are strongly fixed in their minds.
Hoffbauer is incorrect  in attributing this dissimulation to  the sup-
posed fact, that  the lunatic  during a lucid interval has perceived his
hallucination to be  absurd.   I  know  that such dissimulation  and
evasion has been practised  in cases in which  no lucid intervals have
occurred, especially when  the lunatic has  been  frequently  interro-
gated  upon the subject of his erroneous convictions.   A striking
fact,  exemplifying this observation, is mentioned by M. Chambeyron.
  The statement of what the English law has positively determined
with reference  to insanity comes within a comparatively short com-
pass.   Lunacy, when proved to exist, absolves from guilt in criminal
  May, 1S37.                 24 
270
UNSOUNDNESS OF MIND.
cases.  " For," as it is observed by  Sir Edward Coke, "the execu-
tion of an offender is  for  example,  ' ut  posna ad paucos, metus ad
omnes perveniat;'  but so it is not when a madman is executed; but
should be a  miserable spectacle, both against law and  of extreme
inhumanity and cruelty, and  can be no example to others.  But if
there be any doubt whether the party be compos or not, this shall be
tried by a jury.   And if he be so  found, a total idiocy or absolute
insanity excuses from  the guilt, and of course  from the punishment
of any  criminal  action  committed under  such  deprivation of the
senses : but  if a lunatic hath lucid  intervals of understanding, he
shall answer for what he  does  in  those intervals, as  if .he had  no
deficiency.   Yet, in the case of absolute madness, as they are not
answerable for their actions, they should not be permitted the liberty
of acting, unless under proper control ; and in particular they ought
not to be suffered to go loose to the terror of  the king's subjects."*
The question is, what  will be considered as lunacy ?   In the penal
code of France, it  seems, from  M. Georget's  statement, that partial
insanity is a sufficient plea against responsibility for  offences :  this
we rest upon the  sixty-fourth article.   It would  appear,  however,
from the passages  cited above from Lord Hale, (which, however, the
reader ought to compare with the original text of that lawyer,) that
partial insanity is  not considered in English law as entirely cancelling
responsibility for  actions,  or consequently culpability, or what  the
Germans more correctly term (strafbarkeit) punishability.
   It is observed by Professor Hoffbauer, that  in case  of partial illu-
sion it is extremely difficult to ascertain how far the influence of the
insane error extends, and what trains of thoughts and acts of the un-
derstanding  are within or without the limits of its sphere.  If  this
be borne in mind,  and it  be  also  fully made  known  to juries that
monomania generally involves a morbid  perversion, and  sometimes
occasions a  total  change  of  the moral character of the individual
affected, the  cases of punishable criminality occurring under circum-
stances of mental  disease will  probably be reduced to a very small
proportion.
   The exercise of civil rights is suspended when a lunatic is proved
to be such :  he is  neither capable of entering into marriage, nor of
any other contracts.   These disqualifications,  however, only subsist
during actual derangement:  in  a lucid interval a lunatic resumes the
exercise of personal rights.
   The chancellor, on receiving  information as to the  state of a de-
ranged person, issues a writ " de lunatico inquirendo," and  on lunacy
being established  by  the verdict of  a jury, appoints  committees to
take care of the individual  as  to  his  person, and to administer  his
estate.!

   * Blackstone, book iv. c. 2 and 3.
   f For further particulars as to the modes of proceding respecting lunatics, see
the Appendix to Dr. Cox's work on Insanity, and Paris and Fonblanque's Medical
Jurisprudence, vol. i. p. 289 & seq.: also Blackstone, book i. c. 8, s. 18.  Item,
c. 15, 4-  Book ii. c. 19, 1.  Book iii. c. 27.  Book iv. c. 2, 2. 
MORAL INSANITY.
271
Section IV.—Of Moral Insanity, in its Relation to Criminal
  and Civil Law: Observations on the  Criterion of Insanity
  according to English Physicians and Lawyers.  Statement of
  a different Opinion.

  In the preceding pages of this work I  have described a form of
mental derangement, under Ihe title  of moral insanity, consisting
in disorder  of the  moral affections and  propensities, without  any
symptom of illusion or error impressed on the understanding.  The
question whether such an  affection really exists or not  is very im-
portant in connexion  with medical jurisprudence, and  I  think  it
indispensable to make some remarks  on this  subject on the present
occasion.
  I must first observe that no such disorder has been recognized in the
English courts of judicature, or even admitted by medical writers in
England.  In general,  it has been  laid down that insanity consists
in, and is co-extensive with, mental illusion.  English writers admit
only that form of insanity which the Germans term wahnsinn ; they
know nothing of moral insanity either as requiring  control in the
exercise of civil rights, or as destroying or  lessening culpability in
criminal ones.  Thus in a report of judgment issued not many years
since by one of the must distingushed lawyers in this country, it is
laid  down that " insanity is deluded  imagination,  the  substitution
of fancies for realities."   In the same report I find the following
remarks:—
  " As far as my own observation and experience can  direct  me,
aided by opinions and statements I have heard expressed in society,
guided also by what has occurred in these and  in other courts of jus-
tice, or has  been  laid  down by medical and legal writers, the  true
criterion is—where there is delusion of mind there is insanity ;  that
is, when persons believe  things to exist which exist only, or at least
in that degree exist only in their own imagination, and  of the non-
existence of  which neither argument  nor  proof can convince them,
they are of unsound mind ;  or, as one of  the  counsel accurately ex-
pressed it, ' it is only the belief of facts which no rational person
would have believed, that  is  insane delusion.'  This delusion may
sometimes exist on one or two particular  subjects, though generally
there are other concomitant circumstances, such as eccentricity, irri-
tability,  violence, suspicion, exaggeration, inconsistency, and other
marks and  symptoms which may tend to confirm the existence  of
delusion, and to establish its insane character."*
   The  right honourable and learned  judge  afterwards cites some
authorities, both medical and legal, in support  of his opinion.   The
former are principally  the sentiments of Dr. Battie and Dr. F Willis.
Dr. Battie says that " deluded imagination is not only an indispensa-
nle,  but an essential feature of madness7."

  * Report of the  judgment in Dew v. Clarke  and  Clarke, delivered by the
Right Hon. Sir J. Nicholl. Lond. 182G. 
272
UNSOUNDNESS OF MIND.
    Dr. F. Willis, in his treatise on mental derangement, which was the
 substance of the Gulstonian Lecture delivered before the College of
 Physicians in 1822, thus pointed out the difference, according to his
 apprehension, between an unsound and a sound mind :—
    "A sound mind is one wholly free from delusion.   Week minds,
 again, only differ from strong ones in the extent and power of their
 faculties ; but unless they betray symptoms of delusion, their sound-
 ness cannot be  questioned." " The man of insane mind from disease,
 having  been once compos mentis, pertinaciously adheres to some
 delusive idea, in opposition to the plainest evidence of its falsity, and
 endeavours by the most ingenious arguments, however fallacious they
 may be, to support his opinion."
    Lord Coke and  Lord Hale are referred to for a similar opinion.
    It seem, then, to have  been the prevalent judgment  both of medi-
 cal and  legal  writers in this  country,  that delusion,  or as medical
 writers express themselves,  illusion and  hallucination constitutes the
 essential character of insanity, and hence, unless the existence of this
 characteristic phenomenon should be proved, it would be very diffi-
 cult to maintain a plea on  the  ground  of  insanity in  this  country,
 with a view to  the removing culpability in a criminal accusation.
   It would be doubtless of advantage to have an opportunity  of
 resorting at once to a  criterion  so  decisive and intelligible, and in
 general so easily brought into evidence, if it were only true in point
 of fact  that  insanity always involves that particular  circumstance
 which is supposed to be characteristic of it  Unfortunately the reality
 is otherwise.   I am  fully persuaded that the time is not for distant
 when the existence of  mental disorder unaccompanied  by illusion or
 any lesion whatever of intellect, will be  generally recognized.' I
 shall not recapitulate the  evidence which I have already adduced on
 this subject  in  the second  chapter of the  present work,  but shall
 merely refer my readers to it, and observe that the conclusions which
 I have there endeavoured  to establish will be confirmed and illustrated
 by facts to be cited in the following pages.
   I have already considered the  subject of moral insanity in a patho-
 logical point of view ;  I  have now  to offer some remarks  upon it in
 its relation to moral delinquency and to criminal jurisprudence.
   The precise limitation  of insanity and eccentricity of character is
 very difficult to discover, and I shall not attempt to sift this matter
 to the bottom on the present  occasion.   My readers will find many
 excellent observations upon  it in the work of Dr. Conolly.  Some
 remarks  have been offered upon it in the  preceding  parts of this
 volume.   I shall not attempt to refer all examples of extreme oddity  |
 or eccentricity to mental  disease, but am satisfied with maintaining,
 as I am fully persuaded, that some instances of this kind really con-
 stitute cases of madness.  It is perhaps sufficient, in ordei to prove
 this position, to remark that such moral phenomena as those which
are designated by these terms, actually arise  in  many instances, and
make their appearance for the first  time, after an attack of insanity
of a most decided character, from  which recovery has been supposed 
HOMICIDAL PROPENSITY.
273
to have taken place ; secondly, that the same  traits frequently are
met  with in families  predisposed  to  insanity ;  thirdly,  that they
often take their rise  from obvious  and even from  physical causes.
Eccentricity of character, in order to become at all the object of
medical  or  legal consideration, must assuxe an  aspect threatening
evil  to society,  or at least  to the affected individual himself, and his
family.  Even  when such persons are complete pests to  society,
which sometimes happens, it is, under the present arrangements of
the law,  very difficult,»if not impossible, to interfere with them.
  The conclusion  that eccentricity of habits or character is not, as
implied  byr common  expressions,  allied  to  madness, but actually
constitutes in many instances a  variety of  mental  derangement, is of
some consequence  in respect to  one  point of criminal legislation.
Various cases are on record in which homicides and other atrocious
acts  have  been committed by persons of morose and  wayward
habits, given up to  sullen  abstraction, or otherwise differing in their
propensities and dispositions from the ordinary character of mankind.
In the investigation whether such acts of violence are attributable to
insanity  or not, it  will be  important to note the fact that the pecu-
liarities of conduct  for which the perpetrators had  been  otherwise
remarkable are sufficient to afford  in themselves a  strong suspicion of
insanity.
  This consideration, had it been fully entered  into, would have led
to an  important result  in the case of John  Howison, who was
executed  for the murder  of Widdow Geddes, at King's  Cramond.
No well-informed  person  who reads the account of this unfortunate
man's trial, as given in Mr. Simpson's late work " On the Necessity
of Popular Education," will entertain  a doubt that he was mentally
deranged.  His case  constitutes a very characteristic case of moral
insanity.   He fell a victim to ignorance.
  The principal consideration in which the subject of moral insanity
is important  in  criminal jurisprudence, is that of  insane propension
to such acts of  violence.   Homicide, infanticide,  suicide  have  been
committed in numerous cases under circumstances which gave room
for suspicion as to  the sanity of the agent.  This plea has been set
up in many trials, and has often been rejected by  juries, while it has
been the  opinion of medical persons that there were ample grounds
for maintaining it.   The questions connected with homicidal insanity
require all the elucidation  that  can  be afforded to them, and I  shall
devote the next section to this subject.

  Section V.—General Observations on Homicidal Madness.

  Homicidal madness isof two very different kinds.  Cases are well
known to take place in which lunatics, under hallucinations,  without
any malignant or destructive  propensity manifested  in their temper
or dispositions,  have attempted  to put men  to  death for the sake of
conferring on them some  great fancied benefit, or under an impres-
sion  that they are  fulfilling  the  commands  of an  angel  or of the
                              24* 
274
UNSOUNDNESS OF MIND.
 Deity.  M. Esquirol mentions the case of a military officer confined
 at  Charenton, who talked reasonably on various subjects, but  was
 often intent on inflicting mortal wounds  on those who conversed
 with him.  He used to invite them  to approach him  in a tone of
 calmness and even of kindness, and say, " Let me cut off your head ;
 I will immediately make you alive again, and you will  be purified.
 I will perform the same office for every  body."  This individual
 gave no sign of anger or malice, and  only  testified his regret in the
 privation of liberty, because  it  prevented  him from performing the
 commands laid upon him by the Almighty.
   In this and in a great number of parallel instances evident halluci-
 nation has  existed, and the disease has been  intellectual  insanity or
 monomania according to the sense in  which that term was first used
 by M. Esquirol ; but there have been many cases of a different kind
 in which no lesion of intellect has been discovered :  the individual
 affected has experienced no  other mental  change than a powerful
 impulse to commit  an act destructive of life on  some  particular
 individual,  against whom,  even at  the time of commission, it  has
 sometimes  appeared  that he  has entertained  no  malicious feeling.
 The  fact  seems  improbable, but  it  is established  by ample and
 unquestionable evidence.  I shall cite  some strong examples.
  The following instances were published  by M. Marc, and have
 already been alluded  to by several writers.  The facts display, as  the
 author observes, a contest in thq mind  of the individual between  the
 instinctive  desire which constitutes the whole manifestation of dis-
 ease,  and  the judgment  of the understanding still  unaffected and
 struggling against it*
  " In a respectable house  in Germany, the mother of  the family
returning home one day, met a servant, against whom she had  no
 cause of complaint, in the  greatest agitation ;  she begged to speak
 with her mistress alone, threw herself upon  her knees, and entreated
 that she might be sent out of the house.  Her mistress astonished,
inquired the reason, and learned that whenever this unhappy servant
 undressed the little child which she nursed, she was struck with the
 whiteness of its skin, and experienced the most irresistible desire to
tear it in pieces.  She felt afraid that she could not resist  the desire,
and preferred to leave the house."   " This circumstance occurred
about twenty years ago in the family  of M. le Baron de Humboldt,
and this illustrious person permitted me to add his testimony."
  "A young lady,'? continues M. Marc, " whom I examined in one
of the asylums of the capital, experienced  a violent  inclination to
 commit homicide, for which she could not assign any motive.  She
was rational on  every  subject, and whenever she felt the approach of
this dreadful propensity, she entreated to have the strait-waistcoat put
on, and  to  be carefully watched until the paroxysm, which  some-
times lasted several days, had  passed."

  * Consultation Medico-tegale pour H. Cornier, femme Berton, accusee d'homi-
cide, par M.  Marc, &c.  Chez Roux. 
HOMICIDAL PROPENSITY.
275
  "M.  R----,  a  distinguished chemist and  a  poet, of a disposi-
tion naturally mild and sociable, committed himself a prisoner in one
of the asylums of the Fauxbourg St Antoine."  " Tormented by
the desire of killing, he often prostrated himself at the foot of the
altar, and implored the divine assistance to deliver him from such an
atrocious propensity, and of the origin  of  which he  could  never
render an account.  When the patient felt that his will was likely to
yield to the violence of this inclination, he hastened  to  the head of
the establishment, and requested to have his  thumbs tied together
with a  riband.   This slight ligature was  sufficient  to  calm the
unhappy R.,  who, however, finished by endeavouring to commit
homicide upon one his friends, and perished in a violent fit of ma-
niacal fury."
  " A servant maid, twenty-six or twenty-eight years of age, whose
bodily functions  were perfectly natural, nevertheless experienced at
each period of the catamenia  a sort of excitement which did not
apparently affect her judgment, but which rendered  her extremely
dangerous,  since, without provocation, she  menaced every person
with her knife ;  and  one day having realized her menaces, she was
sent to a lunatic hospital."
  The following instances of propensity to infanticide are  given by
Dr. Michu.   In both cases the individuals were afflicted by the
consciousness of their state, confessed it, and  recovered  without any
sinister event
  " A countrywoman, twenty-four years of age, of a bilious sanguine
temperament, of simple and regular habits, but reserved and sullen
manners, had been ten days confined with her first child, when sud-
denly, having her eyes fixed upon it, she  was seized with the desire
of strangling it.   This idea made her  shudder ;  she carried the
infant to its cradle, and went out in order to get rid of so horrid a
thought  The cries of the little being, who required nourishment,
recalled her to the house :  she  experienced  still more  strongly the
impulse to destroy it  She hastened away again, haunted by the
dread of committing a crime of which she  had such horror ;  she raised
her eyes to heaven, and went into a church to pray.
  "This unhappy mother passed the whole day in a constant strug-
gle between the desire of taking away the life  of her infant, and the
dread of yielding to the impulse.   She concealed, until the evening,
her agitations from her confessor, a respectable old man, the first who
received her confidence, who, having talked to her in a soothing man-
ner, advised her to have recourse to medical assistance.
  " When we arrived at the  patient's house, she  appeared gloomy
and low, and felt ashamed of her situation.   Being reminded of the
tenderness due from a mother to her child, she replied, < 1 knovy how
much a mother ought to love her child ; but if I do not love mine, it
does not depend upon me.'
  " At Bures, the wife of a butcher, forty years  of age, of a nervous
constitution, the mother of several children, of a mild amiable charac-
ter, endowed with good sense, who had always enjoyed good health, 
276
UNSOUNDNESS OF MIND.
experienced anxiety of mind in consequence of the derangement of
her affairs, of which her husband was a chief cause.
  " One  night she had  a  dream, and thought she perceived a cord,
which she tried to seize in order to hang herself.   On awaking, she
was silent, and had confused ideas which soon fixed themselves in a
project of strangling her children.  She mentioned to her husband,
shedding tears, this dreadful design, and requested that her children,
and even the knives belonging to the trade, might be put out of her
way."
  M. Esquirol has repeatedly declared his conviction that there ex-
ists a species of homicidal madness, in  which " no disorder of intel-
lect can be discovered;"  the murderer is driven, as it were, by an
irresistible power ; he is under an influence which he cannot over-
come, a blind impulse without reason :  it is impossible to divine the
motive which induces him, without interest or disorder of the intel-
lect, to commit acts so atrocious and so contrary to the laws of nature.
  The preceding examples are sufficient to prove the reality of this
singular phenomenon in the mental economy.   It is an important
point to establish the  connection of the impulse with certain physical
states of the constitution.   The facts which I shall now recite will be
sufficient for this purpose.
  The following case occurred under the care of Dr. Hawkins at the
Hitchin Dispensary ; I extract the account of it from Dr. Johnson's
Medico-Chirurgical Journal.*
  "E. B., a young and hitherto healthy woman, the mother of two
children, in  humble life  but not indigence, applied at the  Hitchin
Dispensary, in consequence of  the most miserable feelings of gloom
and despondency, accompanied by a strong and, by her own account,
an almost irresistible  propensity or temptation, as she termed it, to
destroy her infant  This feeling  first came upon  her about a week
before, when the child was a month old, and she was now sunk into
an extreme state of dejection.   She begged to be continually watched
lest she should  yield  to this strange propensity.   The appetite  is
bad ;  bowels loose ; stools dark and  offensive ; has occasionally dis-
charged portions of tape-worm from  the bowels.   Pulse natural ;
sleeps ill.  This  account is taken  from the Dispensary report-book,
October 1824 ;  and the treatment  need not be  mentioned as the
symptoms continued without alteration until March 1825, when the
patient took the small-pox.   During the eruption the  mind  was
serene and happy, and she was  free from the dreadful temptation by
which she had been previously harassed : but upon the subsidence
of the small-pox,  the  disease  returned  with its  former horrors.
About the middle of April, the disease, without any apparent cause,
began to decline, and she  was  at the end of the month  discharged
from the dispensary by  her own request  Her child was now six
months old.   She nursed it herself from  its  birth, and continued  to
do so until it was twelve months old.   She remained free from any
« Vol. x. p. 474. 
HOMICIDAL PROPENSITY.
277
 disorder till the spring of this  year (182S), when  she had another
 child, and about a month after the birth of it she was assailed by this
 propensity to destroy it.  The symptoms continued until the child
 was half a  year old ; and from that time  have  gradually declined.
 Occasionally, for a few  days, a sort of  metastasis  takes place ; the
 propensity to destroy the  infant entirely subsides, and the place of
 it is supplied by an  equally strong  disposition  to  suicide.  It  is
 worthy of remark, that  during the most distressing periods of her
 disease, she is perfectly aware of the atrocity of the deed she is so
 powerfully impelled to,  and prays fervently to be enabled to with-
 stand so great a temptation.  She  has repeatedly told Dr. Hawkins
 that the inclination to  destroy her child  has been so powerful, that
 she should certainly have yielded to it, if she had suffered herself to
 use a knife even at her meals  ; for the knife is the instrument which
 she  feels necessitated to  employ  in  the  perpetration  of the act
 Whilst this extraordinary state lasts, the bowels are uniformly relaxed,
 and  the stools of  a dark  colour  and  offensive odour.   She has
 suckled  all her  children  for twelve  months ;  she has  had three
 children, but this dreadful  state of mind has supervened on the birth
 of the  two last  only.  It may be proper to observe  that, when
 suffering from any bodily  indisposition,  the mind is serene and  free
 from any kind of morbid feeling.  This poor woman is by  no means
 deficient in affection for her infant, even  in the most trying period of
 her disease."
   The influence of bodily disease is equally obvious in the  following
 case, which has been cited  by M. Esquirol.
   " A peasant, born at  Krambach  in Svvabia, and of parents who
 had  not  very robust health, twenty-seven years old and unmarried,
 was  subject, from nine  years of age, to frequent fits of epilepsy.
 Two years ago his disease changed its character without any appa-
 rent cause ;  instead of a fit of epilepsy this  man found himself from
 that  time attacked with an  irresistible desire to commit murder.  He
 felt the approach of  this attack  sometimes many  hours, sometimes a
 whole day before it seized him.   From the moment in which he
 felt this presentiment, he desired with earnestness  that he might be
 tied  down,  that  he might be loaded with chains, to prevent his
 committing a horrid crime.  ' When  the fit takes me,' he said, ' I
 am impelled  to  kill or  strangle even  an  infant.'   His father and
 mother,  to  whom  he was tenderly attached, would  be  the  first
 victims of this murderous propensity.   ' My mother,' he cries out
 with a fearful  voice, ' save yourself, or I shall be obliged to murder
 you.'"
  A remarkable case detailed  by M. Pinel as an instance of instinc-
 tive  fury, which has been  cited  by many writers  as  strikingly
 characteristic, is  equally  to  my present purpose  as  evincing the
origination of homicidal  propensity in some evident  disorder as to
the physical state of the constitution.
  " A man who had previously followed a mechanical  occupation,
but was afterwards confined at the Bicetre, experienced, at regular 
278
UNSOUNDNESS OF MIND.
intervals, fits of rage ushered  in  by the following  symptoms.   At
first he experienced a sensation of burning  heat in the bowels, with
an intense thirst  and  obstinate  constipation ; this sense of  heat
spread by  degrees over the breast, neck, and face, with a  bright
colour;  sometimes  it became still  more  intense, and  produced
violent  and frequent pulsations in  the  arteries of those parts, as if
they were going to  burst; at  last the nervous affection reached the
brain, and  then  the patient was seized with a most irresistible san-
guinary propensity ; and if he could lay hold of any sharp  instru-
ment, he was ready to sacrifice the first person that came in his way.
In other respects he enjoyed the  free exercise of his  reason  ; even
during  these fits he replied directly to  questions put to him, and
showed no kind of incoherence in his ideas, no sign  of delirium  ; he
even  deeply felt  ail the horror of his situation, and  was often
penetrated with remorse, as if  he  was responsible for  this mad  pro-
pensity.  Before his confinement at Bicetre a fit  of madness seized
him  in his own house ; he immediately warned his  wife of it, to
whom he was much attached ; and  he had only time to cry  out to
her to  run away  lest he should  put her  to  a violent death.   At
Bicetre there appeared  the same fits of periodical fury, the same
mechanical  propensity  to  commit  atrocious actions,  directed very
often  against the inspector, whose mildness and  compassion  he was
continually praising.  This  internal combat between  a sane  reason
in opposition  to sanguinary cruelty, reduced  him  to  the  brink of
despair, and he  has often  endeavoured  to  terminate  by death this
insupportable struggle.  One day he contrived to get possession of
the cutting-knife of the  shoemaker of  the  hospital, and inflicted a
severe wound upon himself in the  right side of his chest and  arm,
which was followed by a violent hemorrhage   Strict  seclusion and
a strait waistcoat prevented the commission of suicide.
   Another remarkable feature in these cases is the tendency of the
impulse to  spread by imitation.   Tips has  been  noticed by  M.
Esquirol, who cites an observation to the same effect from M. Dela-
place. He says, " In two cases  this affection resulted  from the  change
produced by puberty ; in four the propensity manifested itself  after
the individual had heard the history of  a woman  who  had strangled
an infant and separated  its head from its body.  This principle of
imitation is  one frequent  cause of madness.  ' Some individuals,'
said M. Delaplace, 'possess, from their organization, or from bad ex-
ample,  fatal propensities, which are excited  by the  description  of a
criminal action, when it has become the object of  public attention.
Under  this idea the publicity of crimes  is not without danger.'
   " When the affection  has continued for some time, and the indivi-
duals  possessed with the  desire  of committing  murder have been
observed, we have seen  that this state is, like the delirium of lunatics,
preceded and accompanied by headach and pains in the stomach
and bowels ; these symptoms  have  preceded the impulse to murder,
and  have  become  more severe when this dreadful  propensity is ex-
 asperated." 
CASES OF HOMICIDAL MADNESS.             279
  The influence of imitation or sympathy in exciting this  strange
propensity is illustrated by the  results of Henriette  Cornier's trial.
This was  a very remarkable case of infanticide, which  underwent
much discussion, and became the subject of very general conversation
in France.  Many females of respectable classes, who were strongly
impressed  by the  relation and the horror occasioned by it, were
seized with, a similar propensity.   M. Esquirol has detailed the cir-
cumstances attending several of these cases, on which he was pri-
vately consulted.

Section  VI.—Continuation  of the same  subject.  Allusion  to
  some remarkable Cases exemplifying Homicidal Madness, and
  the character of Moral Insanity.

  Several  remarkable cases of homicide have been brought before
the tribunals  of justice in France  during late years, which have
excited  much discussion.  Among the physicians of Paris  there
are many who  by their great talents, their expanded views, and dis-
interested  attachment to the cause of science, as well as to that  of
enlightened philanthropy, do  honour to  their profession  and  to
humanity.  Some of  them, struck forcibly with the  conviction that
the cases alluded to were examples of insanity, laboured assiduously
to convince the public of this fact.  They could not prevent the
sacrifice of several unfortunate beings, already smitten by the hand
of the Almighty with  the most deplorable of earthly calamities, to the
proceedings of  what  among civilised nations is still  termed justice.
But the discussion which these cases underwent, and particularly the
powerful  writings of the late M. Georget on the subject, have had the
effect of changing public opinion materially in France as to the real
nature  of actions, which are either atrocious crimes, or the dreadful
effects  of disease.  It is almost  certain  that a more rational and
humane proceeding will be followed in cases that may occur here-
after, and that means  will be more generally adopted for the preven-
tion of  similar evils by taking due care of individuals who  indicate
by their conduct such fearful propensities.  The most remarkable of
the cases  referred to were those of Leger, Feldtmann, Lecouffe, Jean
Pierre, Papavoine, and lastly Henriette Cornier, who was spared.
An account of these was published by M. Georget, from which I
shall  abstract a few particulars.
   Antoine Leger,  vine-dresser,  old  soldier, was tried  before  the
assize court at Versailles, in 1824.  In an extract from his accusation,
it is stated that he appeared, from  his youth, "sombre et farouche,"
loved solitude, and shunned females  and boys of his own age.   In
June, 1823, he fled from his home, and concealed himself in a forest,
 where  he lived for weeks, sleeping in a cave, and eating wild fruits.
 He one day caught a rabbit, which he killed  and  devoured raw.   In
his lonely abode a desire seized him, according to his own  account,
to eat human  flesh and to drink blood.  Seeing one day a little girl
near  the margin of the  wood, he seized  her,  murdered  her, sucked
her blood, and afterwards buried her  body.   Three  days afterwards 
280                UNSOUNDNESS OF MIND.
he was apprehended : at first he denied  the  charge, and  invented
absurd stories, but at length, being confronted with the body and in-
terrogated, he avowed the fact   He afterwards acknowledged with
calmness all the horrible details of the accusation.   " Ici Pact retrace
les details,, relatifs au voil, a la mutilation des organes genitaux, et a
l'arrachement du coeur."   Before the audience  his countenance dis-
played profound apathy, even an air of gaiety and satisfaction, but after
hearing the deposition of the mother he was affected, and said, with
tears, " Je suis fachede 1'avoir privee de sa fille ; je lui en  demande
bien pardon."  He then resumed his indifference  : in the same state
of mind  he heard  his sentence of death.  MM. Esquirol  and Gall
examined his head : the former discovered morbid adhesions of the
pia mater to the brain.   M. Georget, after examining the facts of the
case, concludes as follows.  " Leger n'etait done pas, comme on 1'a
dit, un grand criminel, un monstre, un cannibale, un  anthropophage,
qui avait voulu renouveler l'example du festin d'Atree.  Cet  individu
etait, suivant nous, un malheureux imbecille, un aliene qui devait etre
renferme a Bicetre  parmi les fous."
  Feldtmann was a tailor, fifty-six years  old, who, according to his
own account of himself, had been "comme fou" in his youth  from
the effect of an injury of his  head : he was occasionally idiotical or
deranged, but in  general industrious and honest.   After attempting
to gratify an incestuous passion for his own daughter, who had in-
voked the aid of the police to resist his  attacks,  he stabbed her to
the heart, wounded  his  wife and another daughter, and then gave
himself up willingly to a crowd who  surrounded  him,  exclaiming,
in reply to their reproaches, " C'est bien fait."  In this case the ex-
istence of insanity was not  fully established by  facts, but it seemed
evident that the miserable wretch, who suffered for his offence, had
scarcely intellect  enough to comprehend its nature, and to  perceive
the turpitude of his conduct,  though  he foresaw  the destiny which
awaited him.  M. Breschet considered his brain to be in a condition
different from that  of health,  and M.  Georget's  opinion  was that
Feldtmann was a  man whose weak intellect was overwhelmed by a
passion constituting in itself a real disease, which ought  to have
been cured by separating  the unfortunate wretch from  society,
without resorting to the  barbarous expedient  of extinguishing it
together with his life.
  Louis Lecouffe  was an epileptic from  infancy, had often been de-
ranged, had seen visions, and had been  accounted  by all who knew
him to be deranged  or idiotic.   At the instigation  of his mother, he
was induced to rob and  murder a woman against whom he enter-
tained no malicious  feelings.  He was executed. This was a case not
strictly of moral insanity, but of imbecility, which rendered the ac-
cused a victim to the evil  influence  of  other persons  possessed of
greater intelligence.
  The case of Jean Pierre was one of simulated madness.
  L. A. Papavoine  was a solitary, morose  wretch, who was consid-
ered by all who knew him  to be half crazy and melancholic.  Wan- 
CASES OF HOMICIDAL MADNESS.            281
  dering in the wood of Vincennes, he saw a lady walking with two
  young children.  He went to a village and bought a knife ;  returning
  quickly, he accosted the lady with  pale looks and agitation, and
  stooping suddenly, stabbed one of the children :  while the affrighted
  mother attempted to remove it, he killed the other.  He took flight,
  but was overtaken and brought to trial; and  though he  was proved
  to have been insane, and it was manifest that he had perpetrated the
  horrible act without motive, and under the influence of disease, was
  put to death according to  law.  Papavoine afterwards declared that
  he could not assign any motive for his act ; that it arose from a spon-
  taneous  impulse.  The circumstances of the case  were very perplex-
  ing ;  and though the  opinions of physicians  leaned to  the probable
  existence of insanity, they  were not  decided.   M. Georget  says,
  "Comme medecin  nous ne ponrrons que  rester  en  doute sur  cette
  question grave: c'est dire que comme jur6 nous aurions vote pour
  l'acquittement"
    In  a subsequent publication by the same author, we find particulars
  of the trial of Henriette Cornier, which excited so much attention in
  France that many females, by sympathy or imitation, or by the mere
  influence of imagination, became  severely agitated  by the desire or
  the dread of committing similar outrages.  The details of  this hor-
  rible affair are similar in many respects to those of the cases already
  cited, except in the circumstances that Henriette, after  perpetrating
  the act influenced by no imaginable motive but an insane impulse to
  destroy the life of a  child of which  she had  always appeared fond,
  made no attempt whatever to escape or defend herself, but after con-
  fessing that she had determined to kill it, sat down  and awaited her
  arrest with perfect  indifference.   A copious  extract from  this sin-
 gular history has been given in the Cyclopaedia of Practical Medicine,
 under the head of Soundness and Unsoundness of Mind ;  and I shall
 omit to repeat it at present for the sake of brevity.  The woman was
 condemned to  imprisonment with  hard labour, after  the subject had
 undergone much discussion, and the trial had been deferred in conse-
 quence of doubts which the public in France had begun to entertain
 as to the  real nature of similar cases.*
   Professor Fodere of  Strasburg has expressed a very different opin-
 ion from  that of M. Georget on several of  the cases  above  cited, of
 which  he has given a somewhat vague and slight account  in  his last
 work.   His remarks on this subject are scarcely worthy of the high
 and  justly merited reputation of the author, and display the influence
 of strong prejudice.   The discussion was taked up in a very different

  *It is observed by M. Georget that the judges on this trial evinced reluctance
 to suffer a clear investigation by physicians of the actual mental state of the
 accused, and in other respects exerted an unusual influence towards the con-
 demnation.  The public sentiment appears to have been against that of the
 physicians, and M. Georget was treated with ridicule by the journalists of Paris.
 Yet it is impossible to read the account of this trial, which is given from official
documents, without strongly suspecting that the unfortunate woman who was the
subject of it acted under the influence of an impulse which' resulted from disease
  May, 1837.                  25 
282
UNSOUNDNESS OF MIND.
 Spirit  in  this country by  the author of an excellent paper in the
 Edinburgh Law Journal.   In this  the author,  Mr. Simpson, has
 collected  much information on  the subject of  homicide resulting
 from insane  impulse ;  and in addition to several of the  preceding
 cases from M. Georget's first publication, has adduced many instances
 which have occurred in Great Britain.  The most striking of them
 is the case of Howison already alluded to.  Howison, like several of
 the  madmen mentioned by  Georget,  had been a solitary, gloomy
 recluse ; he had displayed moral insanity in his habits, and had been
 subject to illusions of the senses.   He was condemned.   Even after
 the trial additional facts were brought forward in proof of his insanity,
 of which persons who had always known him never doubted.   The
 King was petitioned by the Society of Friends ;  but mercy and even
 further inquiry were refused.
   On the whole it seems fully manifest that there is a form of insan-
 ity, existing independently of any lesion of the  intellectual powers,
 in which, connected in some instances with evident constitutional
 disorder,  in  others with affections of the nervous system  excited
 according to well-known laws of the animal economy, a sudden and
 often irresistible impulse is experienced to commit acts which under
 a sane condition of mind would be accounted atrocious crimes.  Most
 of the French writers  by whom  this affection has been recognised,
 particularly Messrs. Esquirol, Georget,  Marc,  and Michu, have
 termed  it  " monomanie homicide,"  which is assuredly an  erroneous
 designation, unless the  sense of monomania is to be changed. That
 term  is always used  to  express partial illusion, or  intellectual
 derangement affecting only a certain train of ideas ; whereas, in con-
 nection with  the homicidal impulse now under consideration, there
 is confessedly no delusive opinion impressed on the belief, and the
 intellectual faculties are wholly unaffected.
   It must be allowed that instances may and dp occur in which the
 discrimination would be difficult between  manifestations of insanity
 and acts of a criminal  nature, and that this difficulty would be in-
 creased  by the admission of a form of insanity free from hallucination
 or illusion.  The following remarks,  taken chiefly from M. Esqui-
rol's essay on this subject, may tend in some instances to lessen the
ambiguity,
   1.  Acts of  homicide  perpetrated or attempted  by  insane persons
have generally been preceded by other striking peculiarities of action,
noted in the conduct of  the same individuals ; often by a total change
of character.
   2.  The  same individuals have been discovered in many  instances
to have attempted suicide, to have expressed a wish for death ; some-
times they have begged to be executed as criminals.
   3.  These acts are without motive ;  they are in opposition to the
known influences of all human motives.  A man murders his wife
and children, known to have been  tenderly attached to  them ;  a
 mother  destroys her infant.
   4.  The  subsequent conduct of the unfortunate  individual  is gen- 
CASES OF HOMICIDAL MADNESS.
283
erally  characteristic of his  state.   He  seeks  no escape or flight;
delivers himself up to justice ;  acknowledges the crime laid to his
charge ; describes  the state  of mind which led to its perpetration :
or he remains stupefied and  overcome by a horrible consciousness  of
having been the agent in an  atrocious deed.
  5. The murderer has generally accomplices in vice  and crime:
there are assignable inducements which led to its commission, motives
of self-interest, of revenge, displaying wickedness  premeditated.
Premeditated are in some instances  the acts of the madman ; but his
premeditation is peculiar and characteristic.
  To these considerations I  may add that presumptions of insanity
in any particular instance are afforded  by the previous, existence of
that  disease or of epilepsy in the same individual.  Respecting the
latter, it has been shown  by  M. Georget that a very large proportion
of epileptics are particularly subject to violent* agitations of passion ;
that they are rendered by  their physical  state morbidly  irascible,
impetuous, incapable of restraining  the sudden expression and  grati-
fication of their desires, while a considerable number of the  same
afflicted persons are weakened  in  their intellect, if not reduced to
dementia or  incoherence.   In  reference to the  other  point above
alluded to, 1  shall  cite the forcible and  highly judicious observation
of Mr. Simpson :—"There is  so  much evil  in  the very risk that
man's vengeance  should follow God's  visitation, that  all cases  of
crimes of violence, I  repeat, in which  previous  mental  disease  is
unequivocally proved, should have the whole benefit of the presump-
tion that such disease may in a moment  run into irresponsible mania,
and  the unhappy patient be  judged  fit for  confinement, and not for
punishment."
   The difficulties  with which administrators of justice have to con-
tend in distinguishing crimes from the result of insane impulse will
never be entirely  removed, but they will  be rendered much less
important when the good sense of the community shall have produced
the effect of abolishing all capital punishments.   That this will sooner
or later  happen I  entertain  no doubt  Many persons  have begun
already to hesitate as to the  moral rectitude of putting men to  death
in cases  in  which the powerful motive of  self-defence  cannot  be
pleaded,  and  when it is  easy to  keep the offending individual  out of
the way  of committing further mischief.  A single private individual
would scarcely think himself justified  in taking upon himself the
office of  the Almighty, and inflicting moral punishment on a person
whom he knew to have  perpetrated a crime.   If such  an  act would
be, not meritorious, but  culpable, when executed by one individual,
it does not  seem clear  how it becomes more righteous when that
person has any given  number  of  accomplices, or in other words,
what invests any number of individuals, say twelve men, over whom
presides a thirteenth, with the right to put to death a fellow-creature
who has incurred  guilt.   The community is but  an aggregate  of  in-
dividuals.   How  come such an  aggregate  of individuals  to be pos-
sessed, morally, of the right to take away life, the plea of self-defence
bernf precluded by the circumstances of the  case ? 
284
UNSOUNDNESS OF MIND.
                   Section VII.—Of Suicide.

   The question whether the  act  of suicide constitutes a proof of
 insanity was agitated before the parliament of Paris in 1777, but was
 set aside  by some  proceedings  of  form.   The  prevalent opinion is,
 that insanity is not always the cause of suicide, though the verdict of
 lunacy is generally brought in  by juries, owing to the extreme bar-
 barity of the law on this subject
   M. Fodere has expressed long ago the opinion that suicide is always
 the result of madness.   Though every one would  wish to  be of the
 same, sentiment, it  seems  difficult  to  maintain  it  when we consider
 the frequent and almost ordinary occurrence of suicide in some coun-
 tries, as among the Romans, who, as Pliny says, esteemed  it " quod
 homini dedit optimum Deus  in tantis vitas poenis."*
   But in a great proportion of cases suicide is certainly the result of
 physical disease.   The  arguments  on which this opinion is founded
 may  be summed  up briefly under the following heads.
   1.  The propensity to suicide is very often  combined with the im-
 pulse to homicide.  This has  been observed long ago, but the  evi-
 dence adduced by M. Falret puts the fact beyond all doubt, t  These
 impulses are so often conjoined as  to prove  clearly that the condi-
 tions which give rise to one are in close affinity and conjunction with
 those from which the other originates.
   2.  Suicide is in a very marked and  striking manner hereditary ;
 and this is a strong ground for regarding it as constitutional, or  de-
 pending on disorder in the state of organic structure.   Dr. Rush, M.
 Esquirol, and others have recorded instances of the hereditary trans-
 mission of this propensity.  M. Falret has collected a  variety of ob-
 servations on ths subject, and has concluded that, of all the kinds of
 insanity, the  form  distinguished by this  tendency is probably that
 which the most frequently becomes hereditary.
   3. Like other forms of madness, suicidal insanity prevails most in
 certain seasons and  temperatures.  M. Falret  says it is  most frequent
 in the summer and autumn.  MM. Fodere and Duglas observed that
 at Marseilles suicides were most frequent when the thermometor of
 Reaumur was 22  degrees above zero.
   4. Acts of suicide, like those of homicide,  are generally  preceded
 by a morbid change in the character and habits of the agent.   Indi-
 viduals who had  been cheerful, active, animated, taking a lively in-
 terest in the pursuits of life, in  the society of their friends, in their
 families, become  melancholy, torpid, morose, and  feel an  aversion
 towards their relatives  or most intimate associates, become listless
and indifferent.   These  appearances  have often been observed to be
the preludes of some attempts at suicide, and have sometimes  put
the relatives of the  individual on their guard, and have led to a pre-
vention  of the fatal catastrophe.

      * Fodere, Traite de Medecine Legale, t. i. p. 272.  1813.
      | De l'Hypochandrie et du Suicide, p. 170 et seq.  Paris, 1822. 
OTHER MORBID PROPENSITIES.             285
   5.  Suicide is connected in many instances with disease of structure,
 or with disorders of the  functions of physical life, some of which
 have been  detected by  necroscopy, others  by observations  made
 before death.  This general fact is sufficiently established by the ob-
 servations made on the subject by Awenbrugger, Leroy, Fodere, and
 Esquirol, although we  must confess that the  same obscurity yet in-
 volves the physical causes of suicidal as of other forms of insanity.
   6.  Like the impulse to  homicide, this propensity  to suicide is
 simply a moral perversion, and therefore  neither of these affections
 falls within  the  restricted definition of insanity, which has been the
 most prevalent one.  There is  generally no  particular illusion im-
 pressed on  the understanding of the  self-destroyer ;  on the  other
 hand, there is a perversion of the strongest instinct of nature, that of
 self-preservation.   Nature has ordained no law more universal  in its
 influence  than the  desire which all animated beings display, and
 which is  indeed the governing principle in the greater part of their
 actions, to preserve their existence, and to secure themselves from
 the influence of circumstances which bring it into danger.   It  is the
 characteristic of moral  insanity to pervert  the natural instincts  or
 propensities, and suicide displays the  most signal  of  these perver-
 sions.

 Section VIII.—Of other Manifestations of morbid Propensity.

   There are several modifications of moral insanity, and two  most
 decided examples  which require the  arrangements suggested  by
 Hoffbauer in some cases of imbecility : I allude to  the placing of
 individuals under curatela, or  guardianship, for personal security,
 who do not require confinement.  Extreme parsimony has induced
 persons to starve  themselves.  When an individual  would destroy
 himself through this propensity, which  is in  many  instances the
 effect of disease, he is sometimes declared  a  lunatic  and sent to a
 place of confinement  There is no other way of proceeding  by
 which his life can  be saved under the existing regulations.   But con-
 finement is unnecessary for such  a person, who is in  no way dan-
 gerous to society.   If the  management of his property—for  such
 individuals are  generally possessed of  property—could be so settled
 as to ensure his having the usual supports  of life, this would be suffi-
 cient.  Another case is that of profuse  extravagance, and this is the
 most  common.   Individuals  whose moral character is perverted by
 disease often  become profusely extravagant, and the apprehension of
 ruin to their  families is  the motive which  induces the  latter to take
 measures with a view to prevent  such  a calamity.  Confinement  is
 more often requisite with regard  to cases of this  description  than
 those of an opposite one, on account of  other  manifestations of dis-
 order which  are combined with  the leading  propensity : but there
are probably many individuals who are wholly incompetent, through
a habit of thoughtless extravagance resulting from disease, to admin-
ister their own  estates, or manage their domestic affairs, and in whose
                              25* 
286
UNSOUNDNESS OF MIND.
condition  there  is yet nothing that requires confinement in a mad-
house.   Many of these are examples  of extreme difficulty as to the
proceedings which  ought to  be adopted.   It will be advantageous,
however, to the medical persons who  may be consulted in such cases,
to be fully in possession of the  circumstances  connected with them,
and aware of the difficulties with which they are surrounded, although
these difficulties  may be almost  insuperable.*
   Under the head of moral insanity I have adverted  to a form of
disease of  which the  principal  or  sole manifestation is a propensity
to break and destroy whatever comes  within reach of the individual;
in  short, an irresistible impulse  to commit injury or do  mischief of
all kinds.   This propensity  is observed in cases in which it is impos-

   * So much space has been already devoted to the subjects treated  in  the pre-
sent chapter, that I must only allude  to the  curious  and interesting relations be-
tween crimes properly so termed and  cases of insanity which have been pointed
out by late writers on moral statistics. The  following  brief statement of some
results obtained by M. Quetelet in his " Recherches  Statistiques sur le Eoyaume
des Pays Bas," which I extract  from Professor  Fodere's treatise already cited,
will be perused with interest  by such  of my readers as are yet unacquainted with
the works of these writers.
   " Afin d'explorer les causes qui agissent pour developper ou pour amortir le
penchant au crime, l'auteur a passe en revue  l'age, les sexes, les professions, les
saisons, les  climats; apres avoir etabli d'apres des chiffres que dans les deux
royaumes de France et des Pays-Bas, le nombre des crimes contre les personnes
n'est que d'environ le quart de  tous  ceux qui  ont  etejugespar  les differentes
cours de justice, pendant l'intervalle de trois annees  (ce qui est la meme chose
en Angleterre), et que ces  crimes ont principalement 6te commis dans l'age de
la plus grande violence des passions,  M. Quetelet nous apprend qu' il a reconnu
que le developpement du penchant au crime  a un rapport tresdirect avec le de-
veloppement des forces physiques de l'homme, et celui de sa raison ; que c'est
entre 20 et 30 ans que l'homme, pousse par la violence de ses  passions, se livre
d'abord au viol et aux attentas a la pudeur ;  qu'il  commence aussi a entrer dans
la carriere dn vol, qu'il semble suivre comme par  instinct jusqu'a son dernier
souspir ; qu'il est porte ensuite par le developpement complet de ses forces phys-
iques a tous les actes de violence, a l'hornicide, a  la rebellion, aux  vols  sur les
chemins publics; que plus tard la reflexion convertit le meurtre en assassinat ou
en empoisonnement; qu' enfin l'homme, en avancant dans lacarriere de la vie, et
en meme tems dans celle du crime, substitue de plus en plus la ruse  a la  force,
et devient faussaire, plus qu'a toute autre epoque de  sa vie; que c'est commune-
ment l'age de 40  a 50 ans, qui fournit le plus d'accuses de delits contre les pro-
prietes, et le moins, contre les personnes; que d'apres un article que M. Esquirol
a insere dans lies  Annales  d'Hygiene, du mois  d'Avril 1829, les resultats sont
les memes, quant a l'age et aux saisons, pour les alienations  mentales par les
nombres qu'il a reunis a  Charenton, en  182fi, 1827, et 1828;  de l'age de 10 et
de 15  ans, 0;  de 20 ans 24 a 25 ans, 79 ; a 30 ans, 109 ; a 35 ans, 134 ;  a 40
ans, 128 ; a 45 ans, 129 ;  a 50 ans, 131 ; a 55 ans, 108 ; a 60 ans, 51; a 70 ans
et plus, 63 ; or y ayant quant a l'age a peu pres les memes proportions pour les
deux sexes, dans l'echelle criminelle tant contre les personnes que contre les pro-
prietes, il en resulte suivant  M. Quetelet, que  l'age exerce la meme influence
pour faire naitre ou diminuer le nombre des  alienations  mentales  et des crimes
contre les personnes,  en meme tems que le developpement intellectuel et moral
qui s'opere avec plus de lenteur, favorise le penchant au crime contre les proprie-
tes depuis l'age de 40 a 50 ans, bien  plus, il y aurait un connexion suivant l'au-
teur, entre les crimes reflechis,  l'alienation, et l'aptitude  a  la composition des
chefs-d'ceuvres dramatiques laquelle n'aurait presque jamais eu lieu qu' a l'age
de 45 a 50 ans." 
ECSTATIC AFFECTIONS.
287
sible to discover any motive influencing the mind of the person who
is the subject of it.  No illusive belief, for example, can be detected,
that the lunatic is performing a duty in perpetrating that which mani-
fests his disease.   There are, indeed, cases of a different description
in which such an illusion is the groundwork of the proceeding, but
these belong to another class of mental disorders.
  Many lunatics, whose disorder was merely a destructive propensity,
have set fire to houses or public buildings, and it is not to be doubted
that  men have been occasionally executed as criminals for such ac-
tions, who, if they had been kept in confinement, would have proved
to be insane.   Until the existence of moral insanity is distinctly re-
cognized, there will always be a danger of this event ensuing on the
trials of mischievous lunatics.  Popular feeling is generally  excited
in such instances against the perpetrator of a  destructive act, and this
circumstance increases by much the probability of a criminal condem-
nation.
                       CHAPTER XII.

                  OF  ECSTATIC  AFFECTIONS.

     Section I.—General Account—Ordinary phenomena.

  Under the general term of ecstatic affections I purpose to comprise
several states of the nervous system  more or  less analogous to each
other, but differing in various particulars.  The common characteris-
tic which associates them is a suspension either perfect or incomplete
of external sense, while the imagination is in state of activity, and the
individual is not conscious of his real condition, but fancies himself
to exist under different circumstances from those which actually sur-
round him.   Dreaming is one modification of their state, but it does
not afford so great a variety of phenomena as somnambulism, or dis-
play so many peculiar signs of the  real condition of the faculties.
Many forms of delirium, catalepsy, trance or ecstacy, and some other
conditions which have  been regarded as examples of insanity—those
for instance  in  which  the patient on recovery is found suddenly to
have lost all recollection of what had passed during the period of his
disease—belong to  the same class of affections.
  An inquiry  into the real  character and pathological relations of
dreaming and somnambulism will afford us an opportunity of throw-
ing some  light on a variety of obscure phenomena which display
themselves in the state of the system above described, and this inquiry
will prove the more interesting through its bearing on some specula-
tions which have become of late prevalent, especially in France and
in Germany.  I allude to animal magnetism, and the various  hypo-
theses to which the practice of  that art has given rise.  There are
likewise curious facts connected with the histories of trance or ecstacy 
288
ECSTATIC AFFECTIONS.
 and of febrile delirium, and it is probable that phenomena which ap-
 pear so recondite and mysterious, may be rendered more comprehen-
 sible by a comparison with the more ordinary  events  of dreaming
 and somnambulation.
   There is an obvious relation between the state of the faculties in
 somnambulism and that which exists during  dreams.   It is, indeed,
 probable that somnambulism is dreaming in a  manner so modified,
 that the will recovers its usual  power  over muscular motion, and
 likewise becomes endued with a  peculiar control over the organs of
 sense  and  perception.   This power, which  gives rise  to the  most
 curious phenomena of somnambulism, is of such a  kind, that, while
 the senses are in general obscured, as in  sleep, and all other objects
 are unperceived, the somnambulator  manifests a faculty  of seeing,
 feeling, or otherwise discovering those particular objects of which he
 is in pursuit towards which his attention is by inward movement di-
 rected, or with  which the internal operations  of his mind bring him
 into relation.
   The nearconnexion between somnambulism and dreams is establish-
 ed by  the following considerations:—
   1. Sleepwalkers,after they have awakened from the slumbers which
 ushered in  and continued after  somnambulation,  have sometimes re-
 membered  the circumstances or adventures of the period, and have
 correctly related them as the impressions of a dream.  This fact has
 been noticed by Sylvius and by Hoffmann : "Sommantibus et som-
 niorum ratione  obvenire hominibus somnambulorum affectum  patet
 ex ipsorum evigilantium relatu, putantium se somniasse duntaxat,
 quae actu fecerunt"  A striking instance of this kind  is  related by
 Horstius.   A young nobleman  in  the citadel  of Brenstein was ob-
 served by his brothers, who occupied  the  same room, to rise in his
 sleep,  put on his cloak, and, having opened the casement, to mount,
 by the help of a  pulley, to the roof of the  building.   There  he was
 seen to tear in pieces a magpie's  nest, and wrap the young birds in
 his cloak.  He returned to his apartment, and went to  bed, having
 placed his cloak by him with the birds in it.  In the morning he
 awoke, and related the adventure as having occurred in a dream, and
was greatly surprised when he was led to the  roof of the tower and
 shown the remains of the nest, as  well as the magpies concealed in
his cloak.   A similar observation as to the occasional remembrance of
 the impressions  made on the mind during  somnambulism, was made
long ago by  Muratori, to  whose work I shall again  have occasion
to refer.
   2. As in dreams, so likewise in somnambulism the individual is
intent  on the pursuit of objects  towards  which  his mind  had  been
previously directed in a powerful  manner, and his attention strongly
roused ; he is in  both states impelled by habit, under the influence of
 which  he repeats the routine of his daily observances.  A somnam-
bulator is a dreamer who is able to act his dreams.
   Many facts may be cited in proof of this remark.  A man known
to me, who was accustomed to attend a weekly market, rose from his 
DREAMS AND SOMNAMBULISM.              289
 bed, saddled his horse, and actually proceeded on his journey as far
 as a turnpike, which being closed during the night, he was awakened
 by the circumstance.  Another individual who had been in the habit
 ot  frequenting a public promenade, where he  used  to  meet his
 acquaintances, was seen to rise from  his bed at  night and walk in
  f  s "1jf alonS ^he same Path, which extended for a mile on the brow
 ot  a hill, stopping very frequently and greeting different individuals
 whom he had been accustomed to see in the same place.  Hoffmann
 relates the case of a somnambulator who dreamed that he was going
 to set out on a journey, rose  and  put on his clothes, shoes, and spurs,
 and then striding across the sill of an  open window, began to  kick
 with his heels and to exert his  voice, supposing that he  was exciting
 his horse to speed.   Henricus ab Heer  mentions  another  person, a
 student at an university in Germany, who,  having been very intent
 on the composition  of some  verses which he could not complete to
 his satisfaction, rose in his sleep,  and opened his desk, sat down with
 great earnestness to  renew his attempt  At length, having succeeded,
 he returned to bed, after reciting his composition aloud, and setting
 his papers in  order as before.   Martinet gives the case of a  man
 who was accustomed to rise in  his sleep and pursue his  business as a
 saddler.
   M. Bertrand considers it to be a peculiar feature  of somnambulism
 that the individual, though on  waking he is generally found to  have
 lost all recollection of what passed  during his sleep, yet recalls,
 when the periods of this state return, the whole train of obliterated
 ideas.   " Somnambulism," as the same writer observes, "thus con-
 stitutes really a new life,  returning at unequal  intervals,  connected
 together by a new  species of  memory."*   We  may observe that
 something of this kind  is perceived in the instance of  dreams.  A
 person strongly impressed by a dream,  on again falling asleep, ex-
 periences not unfrequently a  recurrence of the same impressions, and
 the imagination will even take up  the dream at  the precise point
 where  it was before  interrupted.
   These observations seem to prove that somnambulism is a modifi-
 cation of dreaming ; and this conclusion appears so probable, that it
 will perhaps  be admitted without hesitation ; yet there  are many
 writers of great research and ability who maintain a different opinion.
 Bertrand, who has investigated the circumstances connected with the
 history  of sleep-walking  with  great pains and  accuracy, considers
 the state in question to be something entirely different from dream-
 ing. The same opinion is expressed in the most positive manner by
 Professor Heinroth,  who says that somnambulists are to  be reckoned
 as awake, since their perceptive powers is in some respects even more
 acute than during the ordinary waking state ; and that this condition
 bears no relation to dreaming, inasmuch as dreamers exist in an ideal
 world, whereas night-wanderers are conversant with actually existing
 and material  objects.t  Both of these writers maintain an  opinion

  *Traite du Somnambulisme, par A. Bertrand.  Paris, 1823.
  f Lehrbuch der Stoerungen des Seelenlebens und ihrer Behandlung, von Pro-
fessor J.  C. A.  Heinroth.  Leipsig, 1818, b. ii. p. 270. 
290
ECSTATIC AFFECTIONS.
which is very prevalent in France and Germany, that somnambulists,
as well as persons who have been brought  into  a  state resembling
that of sleep-walking by the process of animal magnetism, have the
ordinary channels of sensation entirely closed ; that they neither see
with their  eyes nor hear with  their ears,  but are endowed with a
peculiar mode of sensation, which, in its highest degree, constitutes
what is termed clairvoyance.   This is supposed to be diffused over
the whole  surface of the  body, but to be especially seated in the
epigastrium and fingers' ends.   It is not exactly sight or hearing, but
fulfils all the functions of both these modes of perception.
  An opinion so improbable will be thought by some scarcely worthy
of consideration.   Its extensive reception, however, among a large
number of continental writers, together with some other reasons
which will become apparent, must prevent  my passing it over as an
idle speculation.  The facts, also, of somnambulism are, as I  have
above remarked, deserving of further attention on account  of  their
relation to a variety of obscure pathological phenomena, with which I
shall have-to compare them. For these reasons I deem it advisable to
enter into further details of the history of somnambulism ; but in order
that my readers may be fully aware of the points connected with this
subject which are controverted, and may be prepared to collect from
the facts adduced the evidence which they are calculated to afford, I
shall in the first place lay before them a brief history of animal  mag-
netism, as I have collected  it from the French and German writers
who have delivered it.
            }
Section H.^—Ofi'Artificial Somnambulism : History of Animal
                          Magnetism.

   It is well known that the practisers  of animal magnetism profess
to have the power of calling forth,  by the  exercise of their art, a
state of the system analogous to that of natural somnambulism, or to
the ecstasy of cataleptic  persons, and  that surprising  accounts are
related  of  individuals  in this  state.  They are said to become pos-
sessed of clairvoyance, a sort of second sight, or the power of seeing
at an indefinite distance,  of foretelling  future events, discovering
diseases in the interior of their own bodies and in those of others,
knowing  the  unexpressed thoughts of persons  by whom they are
magnetised, or with whom they are brought  into  magnetic connec-
tion.   Such testimonies are treated in this country with the ridicule
which they seem at the first view of the subject to deserve ; they are
rejected in the mass ;  few persons give themselves the trouble  to
inquire whether there is any basis of truth on which a superstructure
of such extraordinary pretensions has  been  raised.  The Germans
and French have treated the matter differently. Among the physio-
logists and other scientific men  on the continent, many are persuaded
that animal magnetism, though  its powers  have been  greatly exag-
gerated, is not without a foundation  in  truth, and  even contains in
itself the discovery of some hitherto unknown and very  important
fact  or  series of facts in the animal economy.  M. Cuvier expressed 
ANIMAL MAGNETISM.                  291
this  opinion  many years since, and  long before the persuasion be-
came so general as it is at present.  He says, " We must confess that
it is  very difficult, in the experiments which have for therr object the
action that the nervous system Of two different individuals can exer-
cise one upon the  other, to distinguish the effect of the  imagination
of the individual upon whom the experiment is tried, from the phy-
sical results produced by the person who acts upon him.  The effects,
however, obtained on persons ignorant of the agency, and upon in-
dividuals whom the operation  itself has deprived  of consciousness,
and those which animals present, do  not permit us to doubt that the
proximity of two animated bodies in  certain positions, combined
with certain  movements, have  a  real effect, independently of all
participation of the fancy.   It appears also clearly  that these  effects
arise from some communication which is  established between their
nervous s)rstems."  Here we find Baron Cuvier apparently giving a
full assent to the fundamental doctrine of the animal magnetists.
  M. De la Place, in his work entitled "Theorie Analytique du Cal-
cul des Probabilites," says,  " The  singular phenomena which result
from the extreme sensibility of the nerves of  some individuals, have
given rise to  many opinions upon the existence of a new agent, that
has been called  animal magnetism.  It is natural to suppose  that the
action of these  causes is  of a very delicate nature, and  very easily
disturbed by a number  of accidental circumstances ; thus, when  in
many cases it is not manifested, we must not conclude'that it does not
exist  We are so far from knowing all the agents of nature and their
different modes of action, that it would  be very unphilosophical  to
deny the existence of phenomena solely because they are inexplica-
ble in the present state of our knowledge."
   In Germany  and other northern countries animal magnetism has
long had partisans among men  celebrated for  their attainments  in
science, and for their rank in the medical profession.
   The supporters of animal magnetism carry back its history, as do
the historians of freemasonry, to a period  of high  antiquity.   Some
of these writers persuade us that it was the great arcanum of the mys-
teries, the initiations, and secret ceremonies of the pagan world ; that
the vertigo of the  Delphian priestess, the prophetic visions  of the
sybils, the wonderful  powers of  magic, the raptures of eastern seers,
and, in fact, all  that is related of miraculous or portentous in former
periods  of the world,  is to  be explained by reference to this power,
now for the first time developed and understood.   Many passages have
been discovered in the writings of the ancients which have appeared
to afford some plausible ground for the supposition that  animal mag-
netism was not unknown to the priests who ministered in the temples
of iEsculapius, or in those  of Apollo.   Some of these passages bear
allusions more or  less obvious or probable to ceremonies not unlike
those of the magnetisers.  In none is the allusion in this sense more
closely  applicable than in a passage attributed to Solon, and preserved
by Stobseus, which was first pointed out in a work very recently pub-
lished :— 
292
ECSTATIC AFFECTIONS.
           " The smallest hurts sometimes increase and rage
            More than all art of physic can assuage.
            Sometimes the fury of the worst disease
            The hand by gentle stroking will appease."*

   A passage in Plautus has been cited to the same purpose.   The poet
 means to express, in a humorous manner, "What  if I knock him
 down?"   Quid si  ilium  tractim  tangam  ut dormiat!  There
 seems, as  it was remarked by Schelling, to be an allusion to some
 method of setting persons asleep by a particular process of manipula-
 tion similar to that of the magnetisers.t
   It has been only in periods comparatively recent, and especially
 in the visionary times of Paracelsus and  Van Helmont, that we find
 theories becoming general  which approach very nearly  to  those  of
 Mesmer, and in fact identify themselves with  the very speculations
 which that singular person  actually adopted and made the basis  of
 his art.  The doctrine of a  subtle fluid  universally diffused, which
 was supposed  to  be the  agent in all  the  great  movements  of the
 heavenly bodies, was very  long general, and  served to account for
 the phenomena of electricity and of magnetism  at the several periods
 of their discovery.   By the chemical physiologists this fluid  was
 imagined to have its chief seat in organized living bodies.   Here a
 preparation was obviously made for pretensions such as those with
 which Mesmer began his career.J
   Antony  Mesmer  was a Switzer by birth, who came to Vienna in
 low circumstances to  study medicine.  After  being for some years
 an auditor  of Van Swieten and  Von  Haen's prelections, he took his
 degree  in  1776, and wrote his inaugural dissertation, " On  the In-
fluence of the  Planefs on the Human Body."  According to his
 theory all the phenomena of life depend upon a particular current of
 the universal magnetic fluid enclosed in each organized body.   It can
 be increased or diminished in intensity by external  agencies, and es-
 pecially  by the  medium of magnetic instruments.  According to
 Bertrand, Mesmer was a man of very moderate  talents, but possessed
 with an  ardent desire to distinguish himself by novelties, and by
 escaping frbm  the beaten track of his contemporaries.  Maximilian
 Hell, a Jesuit, an astronomer at Vienna, had invented artificial mag-
 nets of different  forms.   Mesmer, in  conjunction  With Hell, made

  * See Mr.  Colquhoun's Introduction to the Report on Animal Magnetism by a
 Committee of the Royal Academy of  Medicine of Paris.
  + Versuch einer darstellung des Animalischen Magnetismus als Heilsmittel
 von C. A. F. Kluge. Berlin, 1818.
  X Kluge has a long catalogue, filling several pages with  the titles  of works
 published in various countries on animal magnetism before the time of Mesmer.
 Van Helmont, Goclenius, Fludd, and Athanasius Kircher, are some of the most
 celebrated names which occur among the authors of these; and, judging from the
 titles, one might suppose that many of the modern doctrines as well as practices
 had been long ago anticipated.   In England, Valentine  Greatrakes was particu-
 larly celebrated.  See Mr. Colquhoun's Introduction; Kluge's Derstellung, p. 19;
 and Dr. Stieglitz, iiber den thierischen magnetismus,—" Die Geschichte des Mer-
 merismus vor Mesmer.," 
HISTORY OF ANIMAL MAGNETISM.            293
 experiments on the influence of these on the living body, with results
 as marvellous as those which Perkins obtained in later times by his
 tractors.   The effects of the magnetic  remedy  were published, but
 the statements of Mesmer were contradicted by Hell, and only drew
 on their author ridicule and contempt; and Mesmer quitted Vienna
 for Paris, as affording a more  ample field.   At the latter  place he
 took up his residence in 1778 ; and here he soon became the object
 of general curiosity.   Crowds  of persons, of all ages and both sexes,
 resorted to him, in the hope of obtaining cures  for their complaints ;
 and his fame spread far and wide.   He  made some attempts to obtain
 the sanction of the Academy of Sciences and of the Royal Society of
 Medicine ; but being treated with coldness, he expressed his contempt
 for such bodies, and declared that he sought patronage from the king,
 the father of his people, and not that "d'un tas depetits importans."
 After some  interval  Mesmer  addressed  himself to the faculty  of
 medicine, and became intimately associated with M. Deslon, a doc-
 teur r&gent of that body, and physician to the  Count d'Artois, who
 strongly espoused his part, notwithstanding the resolution  of the
 faculty to expel any  of its associates who  refused to enter into a
 positive renunciation of Mesmer and his pretentions.   Mesmer talked
 of leaving France and carrying his precious discovery  into foreign
 countries : but the multitude of persons who placed a high value on
 his curative power prevailed upon  the  government to offer  him a
 stipend of 30,000 livres in order to fix him among  them.   This he
 disdainfully refused, and went  to Spa, where he was residing when
 the alarming intelligence was brought him that Deslon had set up for
 himself, and  was  magnetising  multitudes in Paris, and eclipsing his
 master.  Mesmer returned to Paris, and engaged to  communicate his
 secret to a  number of persons, on condition of his receiving payment
 at the rate  of 100 luis-d'or from each.   By this arrangement he  is
 said to have obtained the enormous sum of 340,000 livres.  His pupils
 designated  themselves as the Society "de l'harmonic."   When they
 had acquired the instructions for which they had paid so considerable
 a sum, and were preparing to  publish the same for the benefit of
 humanity, Mesmer complained indignantly of their conduct, declared
 that they were bound to secrecy by an  indenture, which appears to
 have been the fact; and being  yet unable to prevent their  proceed-
 ing, which  interfered with  his unbounded  hopes of gain, left France,
 carrying with him the riches which he  had acquired, and complain-
 ing that he had been cruelly treated and betrayed.*
   Animal  magnetism  was practised very  extensively in  France.
 Ladies of the first quality were among its most  sanguine votaries, as
 well  as  crowds  of  all descriptions.  At length the government
 interposed, it being evident that either  good or  mischievous results
 were likely to ensue from so popular an  object of  attention.  The
appointment of the celebrated royal commission to try the  merits of
Mesmerism is a great event in the history  of this art.  The commis-

               * Bertrand, Traite du Magnetisme Animal.
   May, 1837.                 26 
294                 ECSTATIC AFFECTIONS.
sioners  were  men of the highest authority in science ; Franklin,
Lavoisier, Bailly, and Jessieu were among the number.  The report
of their observations on  the  practices of animal magnetism, carried
on at that time by M. Deslon, is an authentic and important document.
It, was drawn up by M. Bailly ; and it is well observed by Bertrand,
that no unprejudiced person who reads it can fail of partaking in the
opinions of the celebrated men who were parties to its adoption.
   The following is their description of the method in which Mesmer
and  his colleagues carried on their proceedings.  According to this
report, a little wooden tub, of different forms, round, oval, or square,
raised one foot or one foot and a half, was placed in the middle of a
large room.   This tub was called  " the  baquet ;" its covering was
pierced with a certain number of holes, from out of which came
branches of iron, jointed and flexible.   The  patients were placed in
several rows round this "baquet" and each  person held the branch
of iron, which, by means of the joints, could be applied directly to
the part affected ; a cord  was placed round the bodies of the patients,
which united them one to another.  Sometimes a second chain was
formed by communication with the hands, that is to say, by applying
the  thumb of one between  the thumb and  first finger of the next
person ; the thumb thus held was then pressed, and the impression
received on the left  was returned by the right, and  circulated  all
around.   A piano-forte was placed in a corner of a room ; different
airs were played upon it ; sometimes the sound of the voice  in sing-
ing was added.  All the  magnetisers had in  their hands a little rod
of iron, ten or twelve inches long. This rod was looked upon as the
conductor of magnetism ; it possessed the advantage of concentrating
it in  its  point, and of rendering the emanations more powerful.
Sound, according to the principles  of Mesmer, was also a conductor
of magnetism ; and, in order to communicate the fluid to the piano,
it was sufficient to let the rod approach it.  The cord with which the
patients were surrounded was destined, as well as the chain of thumbs,
to augment the effects by communication.   The inside of the '••baquet"
was  said to be so formed that it might concentrate the  magnetic fluid;
there was nothing, however, in reality, in its formation which could
excite or retain magnetism or electricity.
   The patients, ranged in great numbers and in several rows round
the  baquet, received magnetism by all the different  ways ; by the
iron branches  which came out of the tub, by the  cord which was
entangled round their bodies, by the  union  of the thumbs,  by the
sound of the piano,  and  agreeable voices which  mingled  with  it.
They were more directly magnetised  by means of the finger and the
iron rod, moved before the face, above or  behind the head, and uoon
the  diseased  parts,  always observing  the distinction  of the  poles.
They were acted upon  by a fixed look, but,  above  all, they were
magnetised by the application of hands and by the pressure of fingers
upon the hypochondria, and upon  the abdominal region ; an  applica-
tion  often continued for a long time, sometimes during several hours.
Such was  the method of  Mesmer, to  which  was  added a multitude 
HISTORY OF  ANIMAL MAGNETISM.            295
of practices, much too long to describe.  They magnetised in this
manner several natural objects, and among others trees, which  hence
acquired  magnetic virtue ; so that persons who put themselves " en
rapport" with them, fell  into a crisis.  They could likewise magnetise
lifeless bodies, such as a bottle, a glass, or a cup.
  The effects produced on the subjects of this strange ceremony are
thus described :—
  "Some remained calm and tranquil, others coughed, spat, felt some
slight pain, a local or universal heat, and had sweats ; others were
agitated,  tormented with convulsions most  extraordinary by their
force, their number, and their duration ; as soon as one began, another
succeeded ;  the paroxysms lasted sometimes three hours ; the patients
spat a thick, viscous, and sometimes bloody fluid ;  the attacks were
characterised by precipitate, violent, and  involuntary movements of
the members or the whole body, by constrictions of the throat, by
spasms at the epigastrium and hypochondria, piercing  cries, tears,
hiccough, and immoderate laughter.  Nothing could be more aston-
ishing than the sight  of these agitations and various seizures ; the
sympathies which established themselves between all these individ-
uals struck us with amazement.   We beheld the patients precipitating
themselves one towards the other, smiling and talking to each other
with affection, and mutually alleviating their agitations.  Every thing
depended upon the will of the magnetiser ;  were they in  an appa-
rently deep sleep, his voice, a look, a sign  drew them out  of it"
" We cannot," say the commissioners of the king, " prevent ourselves
from recognising in these  constant effects  a powerful agent, which
acts upon patients, subdues them, and of  which the person who mag-
netises them seems to be the depository."
   The commissioners soon discovered  that  it was very difficult to
ascertain to what point the results produced were the  effects  of
imagination, to the excitement of which so many circumstances were
adapted, and how far to any peculiar agency.  They resorted  to pri-
vate trials of the same manipulations.   Some of  the most interesting
of  these experiments were performed at Passy, at the residence of
Dr. Franklin, who could not be present at  Paris at the public exhi-
bition.   Here M. Deslon tried  his art in vain  upon the  obdurate
American, as well as upon the members of his family, who, notwith-
standing that some of them were ladies in delicate health, were found
quite insensible to the whole ceremonial of magnetism.   Neither of
the other commissioners could perceive any effect in his own person.
One of the  experiments made  at  Passy is  worthy of a particular
recital.  It consisted in the magnetising  of a tree in Dr. Franklin's
garden.   M. Deslon  affirmed that  if this was done by himself and a
youth introduced who should be purposely selected as an individual
susceptible of the magnetic  influence, the result would  be manifest
on his approaching the  particular  tree.   A boy, aged twelve years,
was chosen by M. Deslon, who  insisted  on the necessity of his pre-
sence and co-operation.  Care,however, was taken to prevent collusion.
The boy was made to approach four trees successively, without know- 
296
ECSTATIC AFFECTIONS.
  ing which was the magnetised one, having his  eyes  covered with a
  bandage, and to embrace each tree for two minutes, according to the
  previous arrangement with M.  Deslon.   That gentleman  stood in
  the garden, and kept his cane pointed at the magnetised tree, in order
  to maintain its magnetism.   Under the first tree not magnetised, at
  the  end of a  minute the  boy perspired in great drops, coughed,
  expectorated, felt a slight pain in  his  head ; he was then  twenty-
  seven feet distant from the magnetised tree.  Under the second tree
  he felt stupor and the same pain in  his head.  Under the third tree
  these symptoms were greatly increased :  he believed himself to be
  approaching the magnetised tree ; he was, however, then at the dis-
  tance of not less  than thirty-eight  feet from it.   Under the fourth
  tree  not magnetised,  at the distance of twenty-four feet from  the
  magnetised tree, the young  man  fell into a crisis.   He lost  all con-
  sciousness, was carried to a neighbouring grass-plot, where M. Deslon
  soon reanimated  him.  The  operator accounted for  this untoward
  phenomenon by saying that  the trees had probably become sponta-
  neously magnetic.  " But," rejoined the commissioners, " if trees
  are in the dangerous habit of assuming this state of their own accord,
  a susceptible person walking  in  a  garden must incur the continual
  nsk of falling  into a crisis."
   The commissioners having repeated and varied the experiments in
  every way that seemed  to afford an opportunity of  arriving at the
  truth, at length came to  the conclusion that the whole proceeding  of
  the magnetisers was calculated in several  ways to do injury  ; that it
  was devoid of any salutary or useful influence,  and that the results
  were wholly to be attributed to the imagination  and to  the  feelings
  which  were excited  by the performances.  M. Jussieu, however,
 refused to coincide in  the report
   Notwithstanding the  unfavourable nature of  this report,  and the
 retirement of the principal from the scene, Mesmerism continued to
 be practised extensively  in France.   The members of the Society of
 Harmony, who where spread through the country, continued their
 operations in the provinces.  Among them the Marquis de Puysegur
 was one of the  most distinguished, and it was during his proceedings
 that the most  remarkable phenomenon accompanying these exhibi-
 tions was first noticed.  We allude  to the production  of that state
 which has been termed the magic or artificial somnambulism.  The
 commissioners  in the report to which we have already alluded, had
 remarked that nothing was more astonishing than the spectacle which
 they witnessed in the operations of M. Deslon, and that they were
 equally surprised at the profound repose  of a part of  the assembled
 groupe, and at the  agitation of others.  These opposite effects were
 produced  by the same  agency, according to the different predisposi-
 tions of individuals.  But as the method  of  display was gradually
 changed by later operators, the agitations in a great measure  ceased
to be observed,  while the appearance of a state of somnolency  became
much  more striking and general ; and in numerous instances,  though
 by no means in a great proportion of persons, a species of somnam- 
HISTORY OF ANIMAL MAGNETISM.           297
  bulism displayed itself, of which we shall proceed hereafter to examine
  the peculiar characters.
    The political revolutions in France withdrew the public attention
  from animal magnetism.  Many of the parties interested in this pur-
  suit  perished, and  others were exiled.   It was not till the return of
  better  times that the practice of this art was resumed in France, and
  its historians declare that on its revival animal magnetism was found
  to have retained very few features of its ancient character. The mode
  of treating patients was quite  changed ; the theory of the  magne-
  tisers was new ; the only circumstances connecting the old magnetism
  of the  age of Mesmer and his immediate disciples with the  present
  method, was  the appearance in both of somnolency and  somnam-
  bulism.  These  changes in  the character of the  art are attributed
  principally to the attention  bestowed upon it by the deeply studious
  and reflective but not incredulous persons who took up the study in
  Germany.*  In  that country it has had from an early  period advo-
  cates among the most distinguished physicians.
    I shall  trace  very rapidly the few remaining events in the his-
  tory  of animal magnetism, and then  say a  few words  on  its actual
  character.
    In the year 1813 M. Deleuze, a writer highly respectable for his
  moral integrity, talents, and good sense, published his critical history
 of animal magnetism.   The  appearance  of this work occasioned  a
 favourable change in the opinion of many scientific men  in respect to
 the new art, and some who had  before concealed their opinions were
 now emboldened to  speak more openly  in defence of  it.  In 1820
 M. Husson instituted a  series of  experiments at the  Hotel Dieu,
 which were attended by scientific men, and the result was a general
 conviction that some very powerful influence was brought into opera-
 tion,  though some difference of opinion existed as to the nature of
 this influence.
   A series of experiments at the Salpetriere was followed by similar
 effects, and it was  now that animal  magnetism obtained  two  highly
 distinguished proselytes, viz., M. Rostan, the celebrated pathologist,
 who is the author of the essay on  this art in the Dictionnaire de
 Medecine, and M. Georget, well known as a man of most acute pene-
 tration,  who adopted with entire sincerity the whole doctrine.
   In 1825 a letter was addressed by M. "Foissac, an advocate for
 animal magnetism, to the Royal Academy of Medicine,  urging  that
 body to appoint a  new commission  to inquire into  its merits.  The
 proposal met with strong opposition, but was at length carried,  and
 a number of individuals were requested  to  investigate  the subject
 anew.   The report of this body was  drawn up by M. Husson, already
 well known as an advocate for animal magnetism.  It is said by M.
Bertrand to have produced a strong  impression in favour of the art,
but as this document has lately been  translated and published in

               * Kluge's Darstellung.   Erster abschnitt.
                              26* 
298
ECSTATIC AFFECTIONS.
Scotland, I shall  say nothing more on the subject on the present
occasion.*

   Section III.—Of the Phenomena of Animal Magnetism.

  The method of operating, by which the magnetic state is induced,
is thus described  by M. Rostan :—The person, who  is to be subject
to this proceeding, is seated  in a chair, and the operator places him-
self opposite in such a manner that their knees and the extremities
of their feet may touch ; then the magnetiser takes the thumbs  of
the subject and  holds  them till their temperature is  brought  into
equilibrium with that of his own hands.  He afterwards places his
hands on the shoulders of the patient, and after some minutes draws
them down the arms, taking care to direct  the extremity of the fingers
along the tract of the nerves which are there spread.   This manipu-
lation must be repeated several times, after which the hands must be
applied to the epigastrium and held there for some  instants  of time,
and then drawn down towards the knees and even to the feet.  After-
wards the hands of the operator must be  brought back to  the head
of the patient, care being taken to keep  them in returning at a  dis-
tance from his person ; again they must be drawn down the arms,
and as far  as the feet.   After this practice has been repeated several
times, magnetic phenomena begin to display themselves. The patient
experiences involuntary drawings of the limbs (tiraillemens), a sense
of uneasiness (embarras) in the head, heaviness of the eyelids.  After
some repetitions of this performance, and sometimes even at the first
sitting, he  falls into a profound sleep.
   M. Rostan adds that  the magnetiser  must not let his  thoughts
wander while he is performing the operation ; his  attention must be
entirely concentrated upon it ; any distraction of mind is incompati-
ble with success.  He informs us that the looks and the expression
of countenance of the magnetiser powerfully contribute to the effect
We must observe that M. Rostan is one of those who suppose that the
volition  of the  operator, his intense desire to bring about the result,
the  agency of his  mind rather than any  influence  exerted  on the
mind of his patient, is the first and principal cause of the effects which
ensue.
   The most systematic account of the various phenomena said to be-
long to the  magnetic  state is given  by some of  the German writers
 on this subject.   Kluge, one of the most accurate  of these writers,
enumerates six stages  or degrees, each of which  is characterised by
its peculiar traits.  The apparent distinctness and  systematic arrange-
ment with which the phenomena  belonging  to these degrees are
described,  carries with it a most  imposing air  of correctness and
precision, and renders  it extremely difficult to suppose that the whole
affair can be  merely a  matter of fancy or misconception.   The first
  * Report of the Experiments on Animal Magnetism made by a Committee of
 the Royal Academy of Medicine of Paris, read  at the Meetings of the 21st and
28th June, 1831. Translated by J. C. Colquhoun, Esq.  Edin. 1833. 
PHENOMENA OF ANIMAL MAGNETISM.         299
degree is termed the waking state  of somnambulism ; the second is
that  of imperfect or half-sleep ; the third is termed by Kluge the
stage of " Innere Dunkelheit," inward darkness or magnetic stupor.
This is succeeded by "Innere Klarheit," or inward illumination,
which  subsists during the fourth, fifth, and sixth stages.   The fourth
stage is that of somnambulism ;  the fifth is that of Selbstbeschauung
or Clairvoyance ; the sixth is " Allgemeine Klarheit," or universal
clearsightedness : of each of these  degrees I  shall give from Kluge a
brief description.
   First degree.  In  the first, or Waking Stage of magnetisation,
the ordinary  phenomena are, a  sense in the person magnetized of
strong perflation from the head to  the extremities, followed  by a
general increase fof temperature, which  is easily perceptible by the
thermometer, increased  redness of the skin, which is  covered by
transpiration, and a  feeling  of  lightness and comfort in the whole
body, sensation being during this time quite unimpaired.
   II. In the  second degree,  or in that of Half sleep, to the phe-
nomena of the first  stage already  enumerated, which, however, be-
come more intense, others are  superadded.  The sense of warmth
increases and extends itself by a sort of radiation from the stomach,
as from a centre, over  the whole person, the pulse becomes fuller,
the breathing slower and deeper.   The patient  feels drowsiness and
a drawing down of the eyelids, which  being closed he finds himself
unable  to open them again during  the  process ; by the other senses
he still remains in relation with external things, though often unable
to express himself.   The senses undergo partial excitations :  lumi-
nous appearances are seen before  the  eyes, pricking  is felt in  the
ends of the fingers, profuse sweats break out, rigors are experienced
and  sometimes spasms, or cramps of the limbs and other nervous
sensations.
   III. The third degree is that of Innere Dunkelheit, or the mag-
netic sleep, which is very distinct in  its phenomena from the preced-
ing.   The patient is now wholly insensible to words and even to the
loudest cries, is buried in a profound sleep, and  on  waking  from it
has no recollection  of any thing that may have occurred during the
period.  Faintings, cataleptic or  apoplectic  attacks, and  convulsive
shudderings sometimes occur during this stage.   It  terminates grad-
ually,  and the patient indicates  by a  sigh, the transition into  the
second stage  as a prelude to complete awakening.
   IV. In the fourth degree, which is that of Somnambulism, com-
mences that series of remarkable  phenomena so often controverted,
but  established, as  Kluge declares, by the most complete and per-
fectly  authenticated  evidence.   The patient  now recovers his  inter-
nal consciousness, his  outward  senses  being still closed in sleep, or
at least existing only under a particular modification: he recognizes
himself, but under new relations to surrounding objects.  This stage
is considered to bear a near analogy, in the  state of the sensorium,
to that of ordinary sleepwalkers, whence it has  derived its denomi-
nation.  The state of  waking inwardly, joined  with outward  sleep, 
300                 ECSTATIC AFFECTIONS.
does not take place suddenly  but  by degrees.  Nasse has described
the gradual progress from magnetic sleep to somnambulism.  During
the first eight evenings a patient, subjected to the magnetic process,
fell into a state resembling ordinary sleep ; it was not till  the ninth
day that the first signs of the  inward  awakening began to display
themselves in the altered aspect of the features.  It was now mani-
fest that the individual was not really asleep.   On  the succeeding
days the phenomena began gradually to  be perceived which charac-
terise what the German writers term Innere Klarheit, and  of which
magnetic somnambulism is only the commencement  The som-
nambulist can  merely distinguish, by means of the eyes, strong light
from darkness ;  and according to Treviranus, when  the eyelids  are
open, which seldom happens, the pupils are  either turned  up as if
spasmodically, or are  dilated and  insensible, all power of moving
them being suspended.  At the same time the sense of feeling  be-
comes  metamorphosed into something equivalent to perfect sight, so
that the individual perceives by means of it the finest of those modi-
fications which are generally only  perceptible to  the visual sense ;
she recognizes,—for the subjects of these observations are  generally
females,—not  only the  circumferences  and  surfaces,  but  also  the
colours of objects.  She can distinguish the position of the hands of
a  watch held before her, and by  merely touching, or sometimes
without coming into, contact with it: she can read writing and write
without any aid from her eyes !   The  epigastrium is the chief seat
or medium of this new species of vision, and somnambulists distin-
guish the hour on a watch held close to the region of the stomach,
and as Gmelin  positively declares,  know  the  cards  of  a pack  from
each other when they are so placed, without, any possibility of their
having been seen  by the eyes.   A  somnambulist, mentioned  by
Tardy, read a  piece of writing  in  characters  strange and unknown
to her, by pressing it on her stomach, her eyes having been securely
closed. At first, according to these writers, a strong effort is  required
on the part of  the percipient to exercise this new species  of vision
with accuracy, but by degrees and long  practice it acquires greater
perfection. At length, according to the grave and serious declaration
of a host of magnetisers,  the patient is enabled to perceive  through
opaque media, and not only without actual contact but at considerable
distances and in a  most  unaccountable way.  A young lady, men-
tioned  in Wienholt's Miszellen,  was able to read a letter which was
at the  time folded up and lodged in the pocket of Count von Liitzel-
burg.   Mouilleseaux brought a somnambulist  into magnetic relation
with a stranger who had  his hand  in his  pocket, and asked her of
what colour was an object which he held ; she replied, after some
effort,  that it  was red.   That is true—but  what  is it ?   After a
stronger exertion she said, it is a small  pocket-book of red morocco.
The answer was correct, and none of the reporters seem to have sus-
pected that the reply was the result of  any thing else than some ex
traordinary perception.  A damsel, whose case is given in the Stras-
burg Zeitung, was able to read, not only letters folded up. and placed 
FOURTH DEGREE OF MAGNETIZATION.         301
 within a cover over her stomach, but a book in another chamber, on
 a leaf of which  a man  had placed his open hand, while with the
 other he held the hand of a third  person, the latter holding in like
 manner a fourth, and a chain  being thus formed, as in  electrical
 experiments, the last holding his open hand upon the stomach of the
 somnambulist  Some of these facts are reported as having occurred
 to individuals who fell spontaneously into the magnetic state without
 the manipulatory process ;  but it has been well observed that  they
 were all collected in places where the practice of the art was rife and
 a matter of public interest.  How far the cases of  sleep-walking
 which have occurred under opposite circumstances are similar to these
 or different from them I shall endeavour in the sequel to determine.
 It is assumed by the historians of animal magnetism that  there  is  a
 strict analogy in  all the phenomena of natural  and artificial som-
 nambulism, and this is one of the grounds on which they  attempt to
 render the facts which they report less incredible by connecting them
 with a series of phenomena frequently  observed.
   In a  still higher degree  of intensity the new species  of vision
 without eyes becomes capable of  displaying objects too fine for  the
 ordinary ken of  mankind.   Fischer  and Tardy report  that their
 patients saw during the process of  magnetising, a  halo of light  sur-
 rounding both themselves and the  operators, and rays issuing from
 the points of their fingers.   Nasse has reported  a series  of  experi-
 ments on this magnetic light  His somnambulist saw the breath of
 her magnetiser issuing from his mouth like flames of fire !
   The sense of hearing undergoes strange  modifications.  Petetin
 discovered accidentally that a young woman, whose ears were insen-
 sible to noises, heard plainly and replied  to questions uttered close
 to the epigastrium.  A suspicion occurs that the sound reached the
 ears of the patient  This was  obviated  by Petzold, who spoke to
 his somnambulist with so slight a  whisper, close  to the pit of he:
 stomach, that it was impossible for her ears to be affected.  In general
 magnetised persons are insensible of loud sounds, and hear nothing
 when addressed  by persons who are not in magnetic connection with
 them, though they reply readily when the operator speaks to them,
 or when accosted by a third person  with whom the magnetiser brings
 them into relation.  This I have myself observed, when  I had an
 opportunity of witnessing the performance of a celebrated magneti-
 ser in Paris ; and I must confess that, however obvious the  suspicion,
 there was everjr  appearance of good faith and sincerity in the parties,
 and not the slightest indication of collusion.
   F. Hufeland and many others  have  instituted numerous experi-
 ments on the effects of electrical and magnetic substances on persons
 under the state induced  by animal magnetism.   The application of
 magnets, particularly of the mineral magnet, produces pain.  Hufe-
 land supposes that this differs according as different poles are applied.
 The application of the north-pole  of a magnet to the hand occasioned
 pain felt as far as the fore-arm ; the south-pole gave pain only to the
part touched.  As animal magnetism  has  been referred to electrical
 
302
ECSTATIC AFFECTIONS.
agency, Gmelin,  Heinecken, and Nasse, instituted experiments 'on
this subject, but could  detect no trace of electricity excited  in any
period of the process.
  When a patient awakes from the magnetic sleep, all traces of what
had  occurred to  her during the period  of  somnambulism  are in
general obliterated ;  but it was  observed by Nasse, that  ideas which
have excited lively interest and emotion have sometimes recurred to
the individual in  dreams.  It is a more ordinary observation that all
the impressions of the magnetic state, though obliterated during the
waking period, are renewed when somnambulism is restored.
  V. The fifth and  sixth  stages of the magnetic  state retain  all
the characteristics of the fourth, or of somnambulism, and only differ
from it in the addition of new phenomena.  The fifth stage does not
follow the fourth quickly and  without effort, but  requires frequent
and strong exertions on the part of the magnetiser and the mag-
netised, to direct the  attention of the  latter  and  concentrate it
powerfully in  inward consciousness- and the contemplation of his
internal bodily state, before he can  become possessed of that faculty
which  is termed Selbstbeschauung, self-inspection  or  self-contem-
plation, and  by the French Clairvoyance.   In this state patients
view the whole interior of their own bodies, and are able to describe
minutely  all the internal  organs  with  as  much  accuracy  as  an
anatomist who  sees  them  laid open by the knife.   Heinecken's
patient said, "I see  the interior of my body  ; all parts  of it seem to
me equally transparent, and penetrated by light  and warmth.   I see
the blood flow in my veins,  remark accurately the  irregularities
 which exist in this or in another part, and direct my attention to the
 means by which they may be  removed.  It  then seems to me as if
 some body counsels me,—this or  that measure must  you adopt"
 In this state of things the clairvoyant has the instinct  of  remedies,
 and is capable of prescribing for himself.  Often when he is unac-
 quainted with the names of particular drugs, he describes them in
 6uch  a way as  they  can be recognised by  physicians.   This last
 assertion, absurd as it  is, has a host of  magnetical  witnesses in its
 favour.
    It is a still more curious  fact that the Insichhineingehen, or power
 of self-penetration, Js  not  limited  to the body of  the clairvoyant
 himself;  it extends also to the bodies of  other persons who  are
 brought  into  magnetic  rapport with  the  illuminated  individual.
 Some amusing anecdotes in illustration of this fact are  related by
 Fischer.  When the magnetiser puts pepper or salt into the mouth,
 the magnetised person tastes it immediately  by sympathy.   Gmelin
 once magnetised when he had a diarrhoea,  and the patient on the
 following  day suffered great  uneasiness.  The  sympathy between
 persons  in  magnetic relation is so great  that  they partake of all the
 corporeal feelings of each other, and each has the power of inspecting
 internally the body of his  fellow as exaotly as  his own ;  if one has.
 a disease the other participates in its symptoms: and among Nadler'a
 patients, if one was deaf the other became hard of hearing. 
THEORY OF ANIMAL MAGNETISM.
303
  VI.  Sixth degree—Allgemeine Klarheit.—In  passing from the
fifth to  the sixth stage, the luminous perspective of the clairvoyant
which had been  confined to  the  interior of his body, penetrates the
outward veil and obtains an  insight into all nature:  things hidden  in
futurity or in distance of space are subjected  to his survey.   Wein-
holt's patient  ascertained the illness of her brother separated from
her  at  the  distance of  some hundred  miles.   In  the  Strasburg
hospital a patient, being in relation with a stranger, told him that his
indisposition arose from a  fall  on  horseback, which  had really
occurred  fifteen years before.   A clairvoyante  in this degree can
foretell  the  complaints  which not  only herself  but others  brought
into relation with  her are destined to undergo at almost any future
period of time.   She requires now only the  will of the magnetiser
to bring her into  rapport with  any absent person to such a degree
that she can absolutely see through him, and tell  not  only  what  he
is doing at the present time, but  what will become of him hereafter.
In  fact, the examples of this state recorded by  Kluge and other
German writers approach very nearly to the stories of second sight,
which were formerly so  commonly related in Scotland.

          Section IV.— Theory of Animal Magnetism.

   How does the proceeding of the magnetisers operate in giving rise
to these effects ?   The theory generally adopted by the  partisans of
this art is as  follows.   The instrument which is set in action  is a
peculiar vital  fluid, to  which the nerves perform  the office of con-
ductors.  This  fluid, which  presides over all  the  movements of  the
body, is in  an especial  manner under the direction of the will, and
may, through its  influence,  be  propelled, or directed towards, and
accumulated upon, any external  body living or inert.  If this theory
is not clearly developed in the  writings of all the magnetisers, it is
at least implicitly adopted by them.  The characteristic peculiarity
of their doctrine is the admission  of an  influence, residing in  the
will o£the magnetiser, on the emanation of the fluid alleged to exist,
 and on the consequent production of magnetic phenomena—an influ-
 ence so great, according to  the  prevailing theory, that all  magnetic
 action is regajrded as subordinate to  the exertion of will which  sets
 the fluid in activity.
   The doctrine  thus stated, which has been with some trifling
 modifications adopted  by MM. Georget, Rostan, Husson, and  the
 generality of  those who maintain the efficacy of  animal magnetism
 in  France, must, in  the  actual state of our knowledge, be considered
 as  a very  wild speculation.  It soars  so far above the region of
 observation and experiment, that it  cannot be subjected to proof,  and
 it is at the same time impossible to determine whether, if  conceded
 or established, it  would be sufficient to account for  the phenomena
 of which an explanation is  sought.  A different opinion  has been
 maintained by  M. Bertrand, who, after surveying with  discrimina-
 tion the whole  history  of magnetism, and  witnessing the proceedings 
304
ECSTATIC AFFECTIONS.
 of the operators in this art, and practising them himself with consi-
 derable effect, has come to the conclusion that all the results of these
 operations are brought about through the influence of the mind ;  not
 by the  will of the magnetiser, radiating forth his own vital spirit,
 and operating through this material or  immaterial instrument on the
 vital spirits of other men,  who  are the passive  recipients, but by
 the energy with which the feelings and imagination of the latter act
 upon themselves.
   A strong  confirmation of this opinion  is  derived by Bertrand,'
 from the manner in which the Abbe Faria performed magnetisation,
 in which  he  brought about all the results of this agency in the per-
 sons  subjected to his attempts  without the  instrumental methods
 used  by Mesmer's earlier or later followers, and in a  way  which
 seems to preclude any other influence than that merely of the mind.
 Abbe Faria made  no  attempt to avoid the imputation of quackery,
 and actually  received sums of money for  his exhibitions.   Yet,
 according to M. Bertrand, he entertained much more correct notions
 of the  real  principles of magnetic phenomena than most  of its
 partisans.  Having been  taught  by a long  course of experiments
 that the cause of somnambulism, or, as he termed it, the lucid sleep,
 as well  as of all the other magnetic phenomena, is connected with
 the state of the individual who is the subject of treatment, he varied
 his proceedings in such a manner  as  to render them expeditious.
 He sometimes placed the patient  in an arm-chair, and after telling
 him to shut his eyes and collect himself, suddenly pronounced, in a
 strong voice  and imperative tone, the word " dormez," which
 generally  produced an impression sufficiently strong to give a slight
 shock, and occasion warmth, transpiration, and sometimes somnam-
 bulism.  If the first attempt failed, he tried  the experiment a second,
 third, and even a fourth time, after which he declared the individual
 incapable  of entering into the state of lucid sleep.   Abbe Faria used
 to boast that he had put more than five thousand persons into som-
 nambulism ; and though in  this there may  be some exaggeration,
 yet it is incontestible, as M. Bertrand observes, that  he very often
 succeeded.  A very considerable  number of persons, removed from
 all suspicion  of connivance, have experienced the influence.   The
 complete  identity  of the phenomena produced by a method which
 operated confessedly  through the  imagination,  with those which
 display themselves under the ordinary treatment of the magnetisers,
 affords a  strong  reason  for concluding that  the  results in  other
 instances depend upon a  similar principle.  The state of crisis or
 insensibility produced  in Dr. Franklin's garden, in the experiment
 before described, is sufficient of itself  to  prove that the influence
 ascribed to the imagination is not greater than the reality.   We have
 here a cause proved to be sufficient  for the  phenomena, with which
 it  is  more philosophical  to rest satisfied than  to  resort to  the
 visionary hypothesis of the magnetic fluid radiated forth by the will
of the operator upon surrounding persons and objects, or to confess
the strange doctrine, that the volition of a human body is capable of 
THEORY OF ANIMAL MAGNETISM.
305
 exerting an immediate  influence on other minds and bodies than  his
 own.   The  generality  of magnetisers insist, indeed, in the assertion
 that  the manipulations of the performer have  no  effect  upon  the
 subject, unless accompanied by a powerful agency of the will, by
 continued, strong,  intense volition  to produce the  result.   This is
 denied by M. Bertrand, who declares that in trials made by himself,
 precisely the same results followed, whether he willed to produce
 them or not, provided that  the patient was inwardly persuaded that
 the whole ritual was duly observed.
   The theory of animal magnetism has been investigated  in a most
 elaborate manner by Dr. Johann Stieglitz of Hanover.  According
 to this  writer* there are three different hypotheses, each  of  which
 deserves the attentive consideration of those who wish to compre-
 hend the mysteries of the magnetic art.  These are, 1, the theory of
 sympathy and  antipathy ;  2, the assumed existence  of  a  sort of
 polarity in every individual, forming a medium  of  communication
 between the  operator and the  subject; and. 3, the more lately pre-
 valent doctrine of a "Gemeingefuhl," coenaesthesis, or common feel-
 ing, maintained by Autenrieth and  Reil, and connected  with  the
 imagined elevation of the nervous system of the abdominal ganglions
 to the function of sensorial  nerves.
   According to this hypothesis the operations of the brain and  the
 system of cerebral  and spinal  nerves being suspended during  the
 magnetic somnambulism, the nervous structure connected with  the
 ganglions, and appropriated generally to the functions of physical
 life, assumes  vicariously the office of the brain, and  becomes a new
 sensorium.   Specific sensation through the organs of sense ceases to
 exist, but the " Gemeingefuhl," or common feeling, taking its centre
 in the epigastrium near the  gastric system of nerves, becomes capa-
 ble through its exaltation of all that belongs naturally to the cerebral
 structures, and in many instances in a higher and more intense  de-
 gree.  Attempts have been made to  support this speculation  by a
 variety of cases of somnambulism  which took  place without the
 magnetising process, and in  which analogous phenomena are said to
 have  been observed.   The most remarkable of these, as I  have
 already observed,werepublished by M.Petetin,aphysicianof Lyons.
 In a work on what he  entitled " Animal Electricity,"  this  writer
 detailed experiments  made  by him on eight cataleptic females,—a
 surprising number as  occurring in  the practice  of one  physician
 within a short space of time,—in which, according to the statement,
 the seat of sensation was transferred to the epigastrium.  Young
 females, quite deaf to  sounds in  the  ordinary way, heard plainly
 when M. Petetin whispered to them close to the epigastrium.  M.
 Bertrand also refers to the Annates de Chimie et de  Physique, and
to the  Gazette  de Sante, for  December, 1807, for  the account  of
another female who saw with  her fingers' ends ; and to a publica-
tion in Germany, by Baron  Strombeck, describing the case of a

    * Dr. J. Stieglitz, uber den thierischen Magnetismus.   Hannover, 1814.
  Mat, 1837.                 27 
306
ECSTATIC AFFECTIONS.
young woman, who had the still more admirable faculty of seeing
through floors and walls, and even of discovering objects in an upper
story of the house where she dwelt, and far removed from her own
apartment.  With respect to these cases, I  have  already  observed
that they have been brought forward  by  professed supporters of
animal magnetism,  and that they occurred in places  where that
practice was at the time an object of interest.  I have therefore con-
sidered these cases as belonging properly to the  history of animal
magnetism, and as forming a part of the  same aggregate of facts.
My readers will be  disposed to allow  the fairness of such a proceed-
ing when they shall have observed how different are all these rela-
tions from  those of  real somnambulism as  collected from different
sources.
  It would be altogether beside my  present purpose to make any
attempt at estimating the evidence brought  forward by  the suppor-
ters of animal magnetism.   I  have  given  a  brief outline  of the
alleged facts, principally with a view  of illustrating somnambulism,
and suggesting some inquiries  important as to our conception  of
that state.
  I shall now return to the history of  somnambulism properly  so
termed, and independent of any magnetic proceedings, in analysing
the most remarkable of the facts upon record in connexion with this
subject, shall endeavour to discover whether they afford any proof
of that change in the state of the  nervous system which  the writers
abovecited imagineto take place.  The stateof the sensorium in som-
nambulism is very curious, and the facts related are sufficiently sur-
prising.  I shall select someof themost characteristic cases,and learn
from them  whether  the organs of sense are entirely without action,
and whether in reality the nerves of physical lifeassumethefunction
which belongs to the brain and its derivatives or connexions.

Section V.—Phenomena of real  Somnambulism :  Ordinary
  and Cataleptic Somnambulism, or Ecstasis : Comparison  of
  the  Phenomena  of Somnambulism ivith  those of the State
  induced by  Animal Magnetism.

  I shall now  call the attention of my readers to some of the most
remarkable of  the cases of somnambulism which have been recorded
in  different countries,  and  which  are  occasionally appealed to  as
affording evidence on controverted  points.
  Somnambulism was  known to Hippocrates and Aristotle, and  to
Galen by  his  own experience, but is  briefly mentioned by them.
Diogenes Laertius has recorded  two  cases  of this  affection.   One
was that of a stoic philosopher, who  in this state used to compose
works,read, and correctthem.  Such actions, as M. Bertrand observes,
under the  ordinary circumstances would  imply  the possession  of
sight; still this writer is inclined to  maintain  that somnambulists
have  rather a  new faculty  which supplies the  place  of vision,
though he  admits that the supposition  should not be adopted without 
PHENOMENA OF SOMNAMBULISM.
307
 incontestible proof.*   Gassendi has related in a more detailed man-
 ner several cases of somnambulism.   These are extracted  by Mu-
 ratori in his work on " The Imagination," in which are also to be
 found some of the most interesting facts on record connected with
 this and other mental phenomena.!  One of Gassendi's somnambu-
 lists used to  rise and dress himself in  his  sleep, go down to the
 cellar and draw  wine from a cask : he  appeared to see in the dark
 as well as in a clear day : but when he awoke, either in the street
 or cellar, he was obliged to grope and feel his way back to  his bed.
 He always answered his wife as if awake, but in the morning recol-
 lected nothing of  what had passed.  It often seemed to him as  if
 there was not light enough, and he thought he had risen before day.
 He then  struck fire, and lighted a candle.  Another sleepwalker, a
 countryman of Gassendi, passed on stilts over a swollen torrent in
 the night, but  on waking was afraid to return before daylight, or
 until the water had subsided.  Two of the most curious and best
 related cases on  record  are those of Signor  Augustin  Forari and
 John Baptist Negretti ; both of these are given by Muratori, from
 whom I shall take a brief extract of them.
  " Signor Augustin was an Italian nobleman, dark, thin, melancho-
 lic, and  cold-blooded,  addicted to the study of the abstract sciences.
 His attacks occurred at the waning of the moon, and were stronger
 in autumn and winter than in the summer. An eye-witness,  Vigneul
 Marville, gave the following description of them.
  " One evening towards the end of October, we played at various
 games after dinner; Signor Augustin took a part in them along with
 the rest of the company, and afterwards retired to repose. At eleven
 o'clock his servant told us that his master would walk  that night,
 and that we  might come  and watch him.   I examined him  after
 some time with a candle in my hand.  He was lying upon his back,
 and sleeping with open, staring, unmoved eyes.  We were told that
 this  was  a sure sign that he would walk in his sleep.   I  felt his
 hands and found them extremely cold, and  his pulse beat so slowly
 that his blood appeared not to circulate.  We played at trictrac until
 the spectacle began.  It was about midnight, when Signor Augustin
 drew aside the  bed-curtains with violence,  arose, and  put on his
 clothes.   I went  up to him and held the light under his eyes.   He
 took no notice of it, although his eyes were open and staring.  Be-
 fore he put. on his hat, he fastened  on his sword-belt, which hung
 on the bed-post: the  sword  had been removed.   Signor Augustin
 then went in and out of several rooms, approached the fire,  warmed
 himself in an arm-chair,  and went thence into a closet where was
 his wardrobe.   He sought something in it, put all  the  things into
disorder, and  having set them right again locked the door and put

  * Bertrand, Traite du Somnambulisme.
  ■j- L. A. Muratori, della forza della Fantasia Umana, Venez. 1766.  It is sin-
gular that this treatise has not been translated into either French  or  English.
The German translation is a very  valuable work, containing various notes and
additions by the editor, Richertz of Gottingen. 
308
ECSTATIC AFFECTIONS.
 the key into  his pocket.  He went  to  the  door of the chamber,
 opened it, and stepped out on the staircase.   When he came below,
 one of us made a noise by accident: he appeared frightened, and
 hastened his steps.  His servant desired us to move softly and not
 speak, or he would become out of his mind ;  and sometimes he ran
 a's if he were pursued, if the least noise was made by those standing
 round him.  He then went into a  large court and to the stable,
 stroked his horse, bridled it, and looked for the saddle  to put on it.
 As he did not find it in the accustomed place, he appeared confused.
 He then mounted  his horse, and  galloped to the house door.  He
 found this  shut ;  dismounted, and knocked  with a stone which he
 picked up,  several times at the door.   After many unsuccessful
 efforts he remounted, and led his horse to the watering-place, which
 was at the  other end of the court, let him drink, tied him to a post,
 and went quietly to  the  house.   Upon  hearing  a noise which the
 servants made in the kitchen,  he listened attentively,  went to the
 door, and held his ear to the keyhole.  After some time he went to
 the other side, and into a parlour in which was  a billiard-table.  He
 walked round it several times, and acted the  motions  of a player.
 He then went to a harpsicord on which he was accustomed to  prac-
 tice, and played a  few irregular  airs.   After having  moved about
 for two hours, he went to his room and threw himself upon his bed
 clothed as  he was, and the next morning we  found him  in the same
 state  ; for as often as  his attack came on, he slept afterwards from
 eight to ten hours.   The servants declared that they could only put
 an end to  his paroxysms either by tickling him under  the soles of
 his feet, or by  blowing a trumpet in  his ears."
   The history  of Negretti was published separately by two physi-
 cians, Righellini and Pigatti, who were both eye-witnesses of the
 curious facts which they relate.  The former corresponded with
 Muratori, and gave replies to his questions as to particular circum-
 stances.  Negretti was about  twenty-four years old, was a sleep-
 walker from his eleventh year, but his attacks  only occurred in the
 Month of March, lasting at farthest till the  month of  April.   He
 was a servant of Marquis Luigi  Sale.  On the evening  of the  16th
 of March 1740, after  going to sleep  on a bench in the kitchen, he
 began first  to talk, then walked about, went to  the dining-room and
 spread a table for dinner, placed  himself behind a chair with a plate
 in his hand, as if waiting on his master.   After waiting until he
 thought his master had dined, he uncovered the table, put away all
 the materials in a basket, which he locked in a  cupboard.  He after-
 wards warmed  a  bed, locked  up the house,  and prepared for his
 nightly rest.  Being then awakened and asked if he remembered
 what  he had been doing, he answered no.  This, however, was not
 always :  he often recollected what he had been doing.  Pigatti says
 that he would awake when water was thrown into his face, or when
 his eyes were forcibly opened.  According to  Maffei  he then re-
 mained some time faint and  stupid.   Righellini assured Muratori
that his eyes were firmly closed during the  paroxysm, and that, 
PHENOMENA OF SOMNAMBULISM.
309
 when a candle was put near to him, he took no notice of it.  Some-
 times  he struck himself against the wall, and even hurt himself
 severely.  Hence it would seem that he was directed in his move-
 ments by habit, and had no actual perception of external  objects.
 This is confirmed by the assurance that  if any body pushed him he
 got out of the way, and moved his arms rapidly about on every side,
 and  that when he was  in a place of which he had no distinct know-
 ledge, he felt with his  hands all the objects about him, and displayed
 much inaccuracy in his proceedings; but in places to which he had
 been accustomed, he was under no confusion, but went through his
 business  very cleverly.  Pigatti shut a  door through which he had
 just  passed :  he struck himself against it on returning.  The writer
 last  mentioned was confident that Negretti could not see.  He some-
 times carried  about him a candle, as  if to give him light in his
 employment;  but on a bottle being substituted, took it and carried
 it, fancying that it was a candle.   He once said during his sleep that
 he must  go and hold a light to his master in his coach.   Righellini
 followed him  closely,  and  marked that  he stood still at the corners
 of the streets  with his torch in his hand not lighted, and  waited a
 while in  order that the coach which  he supposed to be following
 might  pass  through the place where lights was required.   On the
 18th of March he went through nearly  the same process as before,
 in laying a table, &c. and then went to the kitchen and sat  down to
 supper.  Signor Righellini observed him in  company with many
 other cavalieri very curious to see him  eat.   At once he  said, as
 recollecting himself, " How can  I  so forget?   To-day is Friday,
 and  I must not dine."  He then locked up every thing and went to
 bed.  On another occasion he ate several cakes of bread and some
 salad, which he had just before demanded of  the cook.   He then
 went with a lighted candle into the cellar and drew wine, which he
 drank. All these acts he performed as usual, and carried a tray upon
 which were wine-glasses and  knives, turning it obliquely  on pass-
 ing through a narrow doorway, but avoiding any accident
  My limits prevent me from  extracting the further  details which
 relate to  the history of this night-wanderer.  The  preceding rela-
 tions, to  which I shall incidentally add a few olher particulars from
 the same sources, furnish a body of  facts sufficient for displaying,
 as far as these individual  cases are concerned, the state of the facul-
 ties in somnambulism.  In the  analysis of these I shall now attempt
 to discover some general principle which may serve as a clue to the
 variety of analogous phenomena on record.   To begin with the in-
 ferior senses :  Pigatti  says that Negretti sat down to eat a bowl of
 salad which he had prepared.   It  was taken from him,  and some
 strongly  seasoned cabbage  put in its place ; this he ate  without
 perceiving the difference,  as he  did  also some pudding which was
presently substituted.  At another time, having asked for wine, he
drank water which was given him. He sniffed ground coffee instead
of snuff,  which he had demanded.   Other sleepwalkers are  well
known to have detected similar deceptions, as it will appear from a
                             27* 
310
ECSTATIC AFFECTIONS.
case hereafter to be  related.   The  difference appears to be in the
degree of attention : a more lively perception as to the qualities of
the object desired existed in one case than in the other, the mind
being more  directed to particular sensations  in the one  case,  and
more distracted or diverted from them in the others.
  The sense of hearing presents similar  variations.  In  general
somnambulists do not hear  persons who talk aloud in their presence.
It has often  been observed that  very  loud noises are unperceived by
them,—that a trumpet must be sounded in their  ears  before their
attention can be forcibly withdrawn from reverie to the perception
of the real world, and to the waking state.  At  other times they
converse and hear the lowest sounds.  Signor Augustin repeatedly
listened and heard slight noises at a distance.   The difference seems
here to depend upon the same principle as in the preceding instances
which refer to smell and  taste.   When attention  is by a voluntary
act directed to  the particular operations of  sense, the perceptive
faculty of the sleeper is perfect, even remarkably acute.  But when
his mind is distracted, his reverie presenting different objects, even
loud sounds are imperceptible to him.  Perhaps from the same con-
sideration we shall obtain a clue to unravel the perplexing varieties
of phenomena  connected with  the  state of vision in  some  cases
which will be presently mentioned.  Negretti, as  it seems, had his
eyes shut and saw not.  Habit guided him  in places with which he
was familiar, and in other places he frequently showed  the  want of
accurate  perception, and assisted himself by  feeling and  groping
about.  Etmuller observed that sleepwalkers go about  " oculis
clausis," but he adds that some  have  acted  "oculis conniventibus."
Haller says  decidedly, that they get out of their beds fast asleep,
their eyes being either firmly closed  or otherwise sightless, since a
strong light is unperceived, though held near.*  The fact is doubt-
less, yet  why may we not avail ourselves of the analogy presented
by  the sense of hearing, and  allow the insensibility to light under
the ordinary circumstances of sleep-walking to be  compatible with
the use of the same faculty in other instances where we can find no
other explanation of the  phenomena ?  Such  cases will  presently
come under  our notice.   Negretti and Augustin did not  see,  and
Richertz well observes that the want of vision  seems to have been
supplied by various means.  Habit, as we have  observed, is  the
principal guide.   The sense of  feeling, when under the guidance of
attention, and even that of  hearing in similar circumstances, appear
to be remarkably acute.  Then  as to  the hypothesis to which in the
sequel we shall have further to  advert, viz. that somnambulists have
a new kind  of sight independentof the eyes ;—although vve are not
called upon to  disprove such  a position, yet  many facts  may  be
found  in the history above  related which  would enable us to do so.
The defect was not  supplied in such a degree and manner as  the
hypothesis implies.  Negretti stood  behind his master's chair sup-
* Elem. Physiol, torn. t. p. 626. 
PHENOMENA OF SOMNAMBULISM.
311
posing him to be at dinner ; he fancied that the torch which he held
to guide his coach  was lighted when it was not.  In a variety of
cases  he displayed the total want of any sensation analogous  to
sight; he stumbled when he walked in places  to which he had not
been accustomed, felt his way on various sides, struck himself against
a wall.  In attempting to  pass through a closed door, he hurt him-
self.  Other  histories  of  somnambulists supply parallel remarks.
Galen mentions of himself that he once walked about a whole night
in his sleep till he was awakened by striking himself against a stone
which happened to  be in his way.*
   These are facts which prove that even the sense of feeling, which
is the principal guiding faculty in somnambulism, is limited in its
sphere of action, and  exists under a  modification similar to that
which affects the other perceptive powers, and which, according to
the opinion above stated, explains the  anomalies  of their operation.
Negretti seems not to have distinguished accurately even objects of
feeling ivhen they were not particularly the  objects of attention.
When struck a blow by a stick on the leg, he fancied  that a dog
had touched him, and scolded  it.   Being again struck, he  threw a
bit of bread, calling the hound by name.   A  muff was thrown at
him, which he again took for the dog.t
   In other instances somnambulists have been  known to write, and
even to correct their compositions, and to do other acts which could
not possibly be performed without sight.
   Castelli, a sleepwalker whose case is one of  the most remarkable,
was a pupil of Porati, an Italian apothecary.   His history  has been
published by Francesco Soave, a physician, who personally observed
him.  He was found one night in the act of translating from Italian
into French, and looked for words in  a dictionary as  usual, being
asleep.  His candle being extinguished, he found himself to be  in
the dark, groped for the candle, and went to  light  it again at the
kitchen fire.   Bertrand thinks that Castelli did  not really experience
the want of  light, because the room was, as we are informed, actually
illumined at the time by other candles.  This  is  a most improbable
supposition, and seems irreconcilable with the  fact just  related, that
he perceived his candle to become extinguished.  There, are,indeed,
man3r circumstances related of this somnambulist which prove  to
our entire conviction that he not only saw, but had his other organs
of sense in a state capable of perception whenever his attention was
excited, and  he wished to  avail  himself of their operation.   He
used to  leave his bed, go down to the shop and weigh out medicines
to supposed customers, to whom  he talked.   When any one con-
versed with him on a subject on which his mind was bent, he gave
rational answers.  He had been reading Macquer's Chemistry, and
somebody altered his  marks to try if he would notice it.  This
puzzled him, and he said,  " Bel piacere di 3empre togliermi i segni."

      •  De Motu Musculorum, lib. ii. cap. 5.  Bertrand, ouv. cit.
      | Muratori, ubi supra, p. 3^3. 
312
ECSTATIC AFFECTIONS.
He found his place and read aloud, but his voice growing fainter,
his master told him  to raise it, which he did.   Yet he  perceived
none of the persons standing round him, and "though he heard,"
says Soave,  " any  conversation which  was in conformity with the
train of his ideas, he heard nothing of the discourse which those
persons held on other subjects."   His eyes seemed to be  very sen-
sible to objects relating to his thoughts, but appeared  to have no life
in them, and so fixed were they that when he read he was observed
not to  move his eyes but his whole head, from one side of the page
to the  other.*
   Facts which appear even still more strongly to evince  the pos-
session of accurate sight are related in  a very curious case of som-
nambulism,  which  was  published  in  the French  Encyclopaedia.
The account has been copied by Bertrand, who endeavours to turn
aside the evidences afforded by it, or to reconcile it  with  his  own
hypothesis.   I  shall conclude  this part  of my inquiry  with an
abstract of the most remarkable facts contained in the narrative, and
request my readers to bear in mind the explanation  of the pheno-
mena which I have proposed.
   This somnambulist was a young priest in a Catholic seminary ;
the witness and reporter  of the facts, the  archbishop of Bordeaux,
who used to go into  his chamber after the priest was  gone to sleep,
and observe his proceedings.  He sometimes arose from  bed, took
paper, and wrote sermons.  After finishing a page, he  read  (if the
act was properly reading) the whole aloud ; and, if necessary, erased
words and wrote his corrections over the line with great  accuracy.
" I have seen the beginning of one of  his  sermons, which he had
written when asleep ;  it  was well composed, but one correction
surprised  me : having written at  first the words ' ce divin enfant,'
he had afterwards effaced  the word divin, and written over it ador-
able.  Then perceiving that ce could not stand before the last word,
he had dexterously inserted a t, so as to make the word cet."   The
witness, in order to ascertain whether he  made use of his eyes, put
a card  under his chin, so  as to intercept the sight of the paper which
was on the table ;  but he  continued to write without perceiving it.
Wishing  to  know by  what means he judged of the presence of
objects which were under his eyes, the witness  took from him the
paper on which he was writing, and substituted  others repeatedly.
He always perceived this  by the difference of size, for when a paper
of exactly the same shape was given to him, he took  it for his own,
and wrote his corrections  on places corresponding to those  on the
paper  which had been taken away from him.  The most astonishing
thing is that he would write music with great exactness, tracing on
it at equal distances the  five lines, and  putting upon them the clef,
flats, and  sharps.  Afterwards he marked  the notes,  at first white,
and then blackened those which were to be black ; the words were
  * Riflessioni sopra il  Somnambolismo; di Francesco  Soave.  Many of the
particulars  relating to this case of Castelli have been inserted by  Mr. P. B.
Duncan, fellow of New  College, in a very ingenious essay on somnambulism. 
PHENOMENA OF SOMNAMBULISM.
313
written under, and once happening to make  them  too  long, he
quickly perceived that they were not exactly under the correspond-
ing notes ;  he corrected this inaccuracy by rubbing out what he had
written, and putting the line below with the greatest precision.
   On one occasion, in the midst of winter, he fancied  himself to be
walking on the bank of a river, and to see  a  child fall into it, in
danger of drowning.   He leaped into the river, as he thought, in
order to rescue the child, and  actually threw himself upon his bed
with the action of a man swimming.  He imitated the movements
of a swimmer for some time, and at length feeling in a  corner of
the bed a bundle of the clothes, fancied that he had seized the child,
held it in one hand, and with  the  other swam, as he supposed, to
the bank of the river ;  he there put down the bundle, and came out
shivering and chattering with his teeth,  as if he really had just
emerged from a cold stream.  He said to the persons near him that it
was freezing, and that he was almost dead with cold, and asked for a
glass of brandy to warm him ;  as there was none at hand they  gave
him water, but he knew the deception, and again demanded brandy,
mentioning the risk which he incurred.  He  drank a glass of strong
liquor, and seemed refreshed,  but without awaking, lay down, and
continued to  sleep soundly.
   The reporters of this curious story suggest, by way of comment,
the following queries :—" 1. How is it possible for a man  buried in
profound sleep, to hear, speak, write, see,  and in  short enjoy the
use of his senses, and perform  correctly different movements ?  To
facilitate the solution  of this problem, we  shall  add,"  says the
writers, " that  the somnambulist sees only those objects  which he
seeks,  or which  are present to his imagination.   This  individual
composed sermons, saw his paper, his ink, pens, could distinguish
whether they marked or not the paper.   For  the rest he did not sus-
pect that any person was in his room, neither seeing nor hearing any
body, unless when he had asked for any thing.
   "2.  How any person can experience sensation without the assis-
tance of the organs of sense ?   The somnambulist above-mentioned
appeared evidently to see those objects which  had relation  to his
own ideas.  When he traced the notes of music, he knew exactly
those which ought to be black  and those that were to  be left white,
and without mistake blackened the  former and omitted the  others,
and if  the lines were not dry, he took the precaution to avoid blot-
ting them.  There is no reason to suspect  that the other channels
of sensation were less interrupted than the ordinary one  of  vision.
This might have been ascertained by stopping his ears, &c.
  " 3.  How did  it happen that during the paroxysm of  somnam-
bulism he remembered what had occurred during former paroxysms,
although, when awake, he lost  all traces of such matters ?
  " How is it possible that,  without any real cause, he was strongly
affected by agents of which he had only imagined the existence, as
by the coldness of the water, in which he supposed himself to be
immersed ?" 
314                ECSTATIC AFFECTIONS.
  I shall leave these inquiries to the consideration of my readers,
and now proceed to another division of the subject.

                          article II.

                  Cataleptic somnambulism.
  A morbid affection analogous in many of its phenomena to sleep-
walking, but occurring under different circumstances, has been well
known to medical  writers since  the time of Sauvages and Lorry,
who first described it.   Sauvages gave it the  designation  of cata-
leptic somnambulism.  According to this writer the attack is ushered
in and followed by a complete fit of catalepsy.   This happened  in
the case described by him, but in other instances the preceding
symptoms  are not so strongly marked : coma, or insensibility in
various degrees, may, however, be considered as universally present.
The most correct  idea of the phenomena of this affection will  be
conveyed by some examples.   The  following is the first case pub-
lished by Sauvages :—"In the month of April 1737, a female who
had been for some time affected with fits of  hysterical catalepsy,
experienced in conjunction with these attacks other symptoms, of
which she had more than fifty returns.   The fits were divided into
three periods : the beginning and  termination  had perfectly the
character of catalepsy ;  the intermediate period, which sometimes
lasted from the morning till the evening, was occupied by what the
girls in the house called the live fit, while they termed the catalepsy
the dead fit.  I shall now describe the phenomena," says Sauvages,
" which I should certainly have believed to be feigned if I had not
become convinced of the contrary  by numerous proofs.   What I
shall say respecting one attack may be  understood to apply, with
the variation of some circumstances, to all the rest.  On the  5th of
April 1737, visiting the hospital at ten o'clock  in  the morning, I
found the patient in bed, which she  kept on account of her debility
and the pain in her head  : the fit of catalepsy had just seized her, and
it quitted her after five or six minutes ; this was perceived by her
yawning and raising herself into a  sitting posture, the prelude  to
the following scene.   She began  to talk with a degree of animation
and esprit never  observed  in  her  except when in this state.  She
sometimes changed her  subject, and appeared to converse with some
friends whom she saw around her bed.   Her discourse had relation
to what she had said during her attack on the preceding day.  She
repeated word for  word an  instruction in the form  of  a catechism,
which she had heard on the evening before, and she made pointed
applications of it to persons in the  house, whom she took care to
designate by invented names, accompanying the whole with gestures
and movements of her eyes, which she kept open, and alluding to
the circumstances  and actions of the preceding evening.   Yet she
was ail this time in deep sleep ; a fact which was strongly averred,
but which I should never  have  ventured to  declare  if I had  not
obtained satisfactory proof by a series of experiments on the organs 
CATALEPTIC SOMNAMBULISM.
315
of sense : when she began to talk,  a blow of the hand  inflicted
smartly on her face, a finger moved rapidly towards  her eyes, a
lighted candle brought so near to the organ of vision as even to burn
the hair of her eyebrows, a person unseen uttering suddenly a loud
cry into her ear, and making a stunning noise with a stone struck
forcibly against her bedstead, brandy and a solution of ammoniacal
salt placed  under her eyes  and introduced into her mouth, the
feather of a pen, and afterwards the extremity of a finger applied
on the cornea, Spanish snuff blown  into the nostrils,  pricking by
pins, twisting her fingers ;  all these means were  tried without pro-
ducing the least sign of feeling or perception.  Soon afterwards she
rose, and I expected to see her strike herself against the neighbour-
ing beds; but she passed between them and  turned corners with the
greatest exactness, avoiding chairs and other furniture that happened
to be in her way, and having walked about  the  ward, returned be-
tween the beds without feeling her way, lay down, covered herself,
and in a few  minutes became  again  cataleptic.   She afterwards
awoke as if from a deep sleep, and perceiving by the looks of those
about her that  she had been  in  her fits, she became very confused
and wept all the rest of  the day, not having the least idea of  what
had passed during the paroxysm."   Sauvages adds that this patient
recovered ; her fits became less frequent;  she had some relapses,
but the disorder at length entirely left her.*
   Lorry has described the phenomena  of two  remarkable cases of
 ecstasis, of which  he  was an eye-witness.   A  woman  in a state
 resembling somnambulism used to converse aloud with absent per-
 sons, supposing them to be present.   She was so insensible to ex-
 ternal impressions that  she  could  not be excited by pricking or
 pinching her body, yet she perceived  objects to which the current
 of her thoughts directed her, or to which they  had relation.   Her
 arms and fingers retained the positions in which they were placed
 till they were  changed by a voluntary movement of the limb.  After
 the paroxysm  she had lost all recollection of what had passed.  The
 other case given by Lorry was  that of a female who had deficient
 catamenia.   During her paroxysms she used to address  herself to
 some individual actually  present, whom she evidently saw, while
 all that she said  to him turned upon the subject  of her reverie.  In
 the mean lime she appeared unconscious of the  presence of others,
 and could not be  made  to  hear  them or  perceive them.  "This
 fact," says Lorry, " I witnessed with the utmost astonishment, but
 many other persons are living  who can  attest  it.   The  mother of
 this female died unexpectedly ; after  which the  daughter used  to
 hold conversations with her as  if she were present"
    A remarkable  circumstance  in  these cases is the fact that while

   * Histoire de l'Academie des Sciences,  an 1742.  Traite du Somnambulisme,
 par A. Bertrand.  Paris, 1823.  A very curious and remarkable case of ecstatic
 somnambulism is  to be found in the German translation of Muratori.  It was
 extracted  by Richertz from the Breslau Sammlungen.  See Muratori iiber die
 Einbildungskraft, band. i. p. 361. 
316
ECSTATIC AFFECTIONS.
 the individual is insensible to  all other impressions in a wonderful
 degree, he retains perception of all  objects which  fall  in  with the
 course of his ideas, or connect themselves  with the thoughts  and
 feelings which occupy his attention for the time being.  This feature
 is common to the cases of  ecstasy and somnambulism.  It was ob-
 served in an example of the former kind, of which an account was
 published several years  ago  in my work, " On  Disorders of the
 Nervous System."   A boy, about thirteen or fourteen years of age,
 suddenly exclaimed that somebody was beating  him on his  head,
 and fell into a state of insensibility ; he became subject afterwards
 to similar attacks.  He first perceived a mist or darkness before his
 eyes, and would say that he was then going off.  He became uncon-
 scious of external impressions ; had his eyes open, but  did not per-
 ceive objects ; used to hold conversations with absent persons, repeat
 his lessons, supposing himself  to be at  school, and  play on a flute,
 during which action he sometimes perceived that other boys accom-
 panied him,  and evidently directed his attention to  them.  He
 recovered from this  state by starting  as  if from sleep, and never
 retained the slightest trace of any occurrence during the paroxysm.
 The circumstance above indicated, in reference to the  state of the
 perceptive faculty, is  important as illustrating the character of these
 affections, and as accounting for the phenomena.
   The  fact mentioned by Lorry, which he witnessed  with so much
 astonishment, is  likewise interesting by its  bearing on the phe-
 nomena of animal magnetism.  In  Lorry's account, written  long
 before the time  of magnetism, it appears that a female in somnam-
 bulism  held  conversation with one individual with whom her feel-
 ings and ideas brought her into relation, while she was unaware  of
 the presence of any other individual and unconscious of her state.
  Another striking  characteristic of this affection  is  the instanta-
 neous change  which it occasions in the thoughts  and  state  of con-
 sciousness, and in the whole catastasis of the  mind, the total  sus-
 pension of present ideas which  takes  place during  an indefinite
 period, and the equally sudden and remarkable  restoration  of the
 former  state of mind  after the termination of the paroxysm.
  I shall close this series of cases by adducing the facts of  one not
 long since recorded by Dr. Dyce of Aberdeen, and published in the
 Edinburgh Philosophical Transactions.*  This case is one of singu-
 lar interest :  in  some  respects it resembles that of Negretti, but it
 will be  thought, unless I am mistaken, to be quite conclusive  on the
 question whether somnambulism  involves  or not  a suspension of
 specific sense, or of  sense  through  the ordinary channels, and a
transference of external feeling to  the nervous system of physical
life.
  The subject of this  relation  was a girl sixteen years of age, and
the phenomena ceased when the uterine  functions were established.

  ♦Report of a communication from Dr. Dyce of Aberdeen to  the Royal Society
of Edinburgh.  Edinb. Phil. Trans. 1822, vol. ix. 
CATALEPTIC SOMNAMBULISM.
317
The first symptom was a propensity to fall asleep in the  evening :
this was followed by the  habit of talking on  these  occasions, but
not incoherently, as  sleep-talkers  are  wont to do.  She repeated
the occurrences of the day, and sang musical airs, sacred and pro-
fane.   Falling one evening asleep she imagined herself to be going
to Epsom races, placed herself on a kitchen stool, and rode into a
room with a  clattering noise.   Afterwards she became able to an-
swer questions put to her in this state without being awakened. The
fits occurred  more frequently, and came on at different times.  She
dressed the children  of the family, still " dead asleep," as her mis-
tress termed  her state, and once set in order a  breakfast-table  with
her eyes  shut
   Some of the  phenomena of  this case are astonishing, and would
be almost incredible, if the testimony were not fully supported  by
the analogy of other circumstances.  When  taken to  church, she
heard and was affected by a  sermon, particularly by an account of
an execution  of three young men, and of their progress in depravity,
which was related by the  preacher.  On  returning home, when
questioned, after the fit had passed, she denied that she had  been at
the church, but in a  subsequent paroxysm, repeated the text  and
substance of the sermon.   The following fact is still more remarka-
ble.   " Another )'oung woman, a depraved fellow servant of the
patient, understanding that she wholly forgot every transaction that
occurred during the  fit, clandestinely introduced a young man into
the house, who treated  her with  the  utmost rudeness, while her
fellow servant stopped her breath with the bed-clothes, and other-
wise overpowered a vigorous  resistance, which was made by her
even while under the influence of her  complaint   Next day she
had not the slightest recollection of even that transaction,  nor did
any person interested in her welfare know it  for several  days,  till
she was in one of her paroxysms, when she related the whole facts
to her mother.   Some particulars  are given by Dr. D}rce in Latin,
and others were told him  which he does not  think it necessary at
all to detail."
   This relation renders the account recently given of  a  lady in
Paris who underwent an operation during a fit  of magnetic  som-
nambulism without being  roused from it, less incredible than, taken
by itself, it would appear to be.*   The phenomena of divided con-
sciousness, as Dr. Devvar has termed them, were ver}r remarkable.
During the  paroxysms,  the girl,  whose case is reported  by Dr.
Dyce, remembered things which had excited her attention in former
paroxysms, but had  been entirely forgotten  during the intervals,
and on recovering from an attack recurred to the impressions which
had last been made upon her mind previously to a fit. Facts nearly
parallel to these are recorded in the history of a  case given  by Dr.
Silliman  in the American Journal of Science.   The subject of the

  * Sir M. Colquhon's Translation of the Report of a Committee of the Royal
Academy of Medicine.
   May,  1837.                28 
318
ECSTATIC AFFECTIONS.
relation was a lady in New England, who was subject to sudden
fits of ecstasis.  After awakening from a paroxysm she used to con-
tinue the conversation in which she had been  engaged previously
to the  fit, and even to take up an  unfinished story,  or sentence, or
word ; and  during  the next paroxysm she pursued  in like manner
the discourse of the  preceding one, so that, as the writer observes,
she might be fancied  to have two souls, each active, and each dor-
mant in alternation.
   In a strongly marked  case of ecstatic somnambulism, the pheno-
mena of which are so accurately and satisfactorily recorded, as are
those related by Dr. Dyce, it is  interesting  to  observe the facts
which  relate to the state  of the senses, with a reference  to  the
pathology of somnambulism in general,  and  particularly  to  the
question whether magnetised persons as well as spontaneous sleep-
walkers, have the ordinary channels of sensation closed, and per-
ceive by a new medium.
   It appears evident that  hearing took place in the natural and
ordinary way.  The patient heard a sermon at church, and replied
to questions put  to  her  by other persons apparently in the usual
way.  We find no hint of M. Petetin's new process of hearing
through the  epigastrium.
   The state of  vision is a  matter of more difficult determination ;
but it  seems on the  whole evident  that she saw by means of her
eyes.   " It  was  remarked, that  while under the  paroxysm she
knew a person better by looking at the shadow than at the  body ;
that  is, she  perceived those  objects best which were  presented
merely in outline, or even very dimly  illuminated."  Dr. Dyce
examined her eyes  during a paroxysm :  " Her eyelids  appeared
shut ;  but when  he  stooped and  looked to  them from  below, he
found them not entirely closed.   When he raised the upper eyelid
a little, it seemed to give  her pain.  When desired to -point out
different objects, she could not do  it  when the light of a  candle
shone fully on them, but did it accurately when  they were  in the
shade.   He then found the  pupils greatly contracted, though in his
previous examinations they had  been dilated, and did not even
contract when turned towards the direct rays of the sun.  On one
occasion her stare  during a fit was  accompanied  by something
resembling a squint of the eye.   One day, during a  fit, she walked
over a  single plank between two vessels on a quay, and danced on
it.  After the paroxysm she denied  this circumstance, but remem-
bered it again under the fit. She evidently saw when she directed
her attention, and one day read  the text in a book which she had
not  before  seen, though  it was  on  that occasion that her iris
appeared dilated and  insensible.  There seems to be no doubt that
her vision look place through the usual organs, though  their state
was  in some respects singular.   The condition of the organ of sight
appears to have  been very similar in the cases of Signor Augustin,
Negretti, and Castelli, as before described.
   If we now advert to the bearing  which the history of real som- 
MANIACAL ECSTACY.
319
nambulists has  upon the  state of persons  who  fall under  the
operations of animal magnetism into torpor and the temporary loss
of external sense, we shall  conclude that this acquired state is in
many respects very similar to natural somnambulism, that some of
its phenomena are illustrated  and  rendered more credible by the
comparison ;  but that other changes supposed to take place in the
artificial  process become still  more improbable.  The dipsychical
phenomena, if I may invent such a term, are placed within  the
sphere of analogy and probability;  but the notion that the ordinary
specific sensation is lost,  and a new sense acquired, is rendered
extremely improbable, by  the consideration  that no  such  change
appears to have taken place in the most strongly marked and best
authenticated cases of real somnambulism.

  Section VI.—Of Maniacal Ecstacy or Ecstatic Madness.

  There are two modifications of cataleptic or ecstatic somnambu-
lism which give rise to some remarkable  phenomena.  In one of
these the mind of the individual  is, during the paroxysm, in  a
condition different from that which the preceding relations display;
it is more nearly in  the state of  mania or of  incoherence : such
cases may be termed  examples of  ecstatic madness, or of maniacal
ecstacy.   In the other modification  the. peculiarity consists in  the
subsequent recollection retained by the patient of the reverie which
had occupied his mind during the paroxysm, and which afterwards
appears to him  as a  vivid and  impressive dream, or as an ideal
scene, which  he can  scarcely distinguish from  reality.  This  last
affection  is termed a trance, or ecstatic vision.  I shall consider the
former of these affections in the first instance.
  I  observed, when entering  on this subject, that somnambulism
bears a near relation to ordinary dreaming.  I  must  now remark
that  there is a difference between these  affections in regard to  the
state of the mind.  In general the reverie which occupies the mind
of the somnambulist is connected  or coherent, his  purposes  are
defined, his conceptions apparently clear, and his ideas consequent
or relevant to the pursuit  in  which he is  engaged ;  they  do  not
come into his mind in irregular groupes or make those sudden  and
casual  changes  and  reverses  which  render ordinary dreams so
absurd and confused.  In the  internal operations of his mind, the
somnambulist  is in this respect  more like a person  awake than a
dreamer.   Volition  is more  alive, the will more  active, in  the
somnambulist than in the dreamer, not only with respect to bodily
action, but also in the influence exerted  over the train of  thoughts.
But  there are some instances in which the case is  different, the
thoughts are confused and incoherent or imperfectly connected, and
the active exertions  to which volition gives rise are  consequently
like  those of a maniac or  a  demented  person.   Such instances of
ecstasis or somnambulism  appear to have  been  taken for cases of
madness.  They differ from madness in the circumstance that the 
320
ECSTATIC AFFECTIONS.
 individual falls suddenly into a new state of consciousness, if such
 an expression may be allowed, or if ideal existence, and after being
 aroused  from it, or passing out of it, is found  to have lost the
 recollection of ideas which  had passed through his mind  in the
 interval.  In  these particulars the affection resembles somnambu-
 lism ;  and it only differs from somnambulism as to the state of the
 mind and of the sensorium displayed during the paroxysm.
   Dr.  Haslam has recorded  a case which fully exemplifies these
 remarks.  The phenomena of the disease were during its continu-
 ance those of a maniacal attack ; by the complete  obliteration of all
 the ideas which had occupied the mind of  the patient, and which
 in  real  mania are  more  or less remembered, this affection  was
 assimilated to ecstasis.
   Two of the cases  already referred to  in  the American Journal
 of  Science, published  by Dr. Silliman of Yale College, appear to
 have been similar to the preceding.   I have remarked in a former
 section that one of them  was an  example of ecstasis properly so
 termed,  the state pf  the  mind during  the paroxysm having been,
 not that of madness,  but of consistent reverie.   Both of the  indivi-
 duals now adverted  to remained  a long time under the affection :
 one of them, a lady in New York, about seven  years, the  other,
 who was a farmer,  several  years.  Both  recurred, immediately
 after the paroxysm  ceased, to the  ideas which had  occupied the
 mind in the moments preceding the attack.   I have copied both of
 these cases from Dr. Silliman's Journal, in the article Somnambu-
 lism in  the "Cyclopaedia of Practical  Medicine," and  omit them
 here for the sake of brevity.

         Section VII.—Of Ecstatic Visions or Trances.

   I now proceed to the consideration of cases in which the impres-
 sions of  the paroxysms are retained  in the memory of  the  person
 affected; and give rise to a variety of singular phenomena.
   The expression "  day-dream" is a familiar  one, and  answers to
 the French word reverie, which our language has almost adopted :
 it means a voluntary abandonment of the mind to  the  leading of
 fancy,  which differs from the state of ecstacy, or trance.  The ideas
 of reverie have not in retrospect  the appearance  of reality.  A
 person who falls into ecstacy believes his impressions to be real,
 and could not at the  time convince himself of their unreal nature.
 Sleep-walkers, properly  so  termed,  occasionally  retain, as I have
 shown, a recollection of  the visionary scenes  presented  to them
 during their paroxysms.  When this reminiscence occurs after a
 paroxysm of ecstacies, into which a person has fallen when awake,
 it produces the result above described.
   There are instances  in  which  the impressions retained after a
 paroxysm of ecstacy are so  connected  with  external events  or ob-
jects, and so blended with realities, as to make up a most singular
 and puzzling combination, and this is perhaps  the true rationale of
 many a strange and mysterious tale. 
ECSTATIC VISIONS OR TRANCES.
321
   I know the relatives of a clergyman who had been for some time
 in indifferent health, when standing one day at the corner of a street
 he saw a funeral procession  approaching him.  He waited  till  it
 came near to him, saw all the train pass him  with  black  nodding
 plumes and read his own name on the coffin, which  was carried by
 and entered  with the whole procession into the house where  he re-
 sided.  This was the commencement of an illness which put an end
 to his life in a few days.
   The following is a very striking case, with which my readers will
 not fail to be interested.
   A gentleman, about thirty-five years of age, of active habits and
 good constitution, living in the neighbourhood of London, had com-
 plained for about five weeks  of slight  headach.  He was feverish,
 inattentive to his occupations, and  negligent of his family.  He had
 been cupped and had  taken some purgative medicine, when he was
 visited by Dr. Arnould, of Camberwell, who has favoured me with
 the  following history.  By that, gentleman's  advice  he  was sent to
 a private asylum, where he remained about two years ; his delusions
 very gradually  subsided, and  he was  afterwards restored to his
 family.
   The account which  he  gave of himself was almost verbatim  as
 follows.   I insert the statement as I received it from his physician.
 '•One  afternoon in the month of May, feeling himself a little un-
 settled and  not inclined to business, he thought he  would take  a
 walk into the city to  amuse his mind ; and having strolled into St.
 Paul's Church-yard, he stopped at the shop-window of Carrington
 and Bowles, and looked at the pictures, among  which was one  of
 the cathedral.  He  had not been long there before a short grave-
 looking elderly gentleman, dressed in dark brown clothes, came up
 and began to examine the prints, and  occasionally casting a glance
 at him, very soon entered into conversation with him, and praising
 the view of St. Paul's which was exhibited at the window, told him
 many anecdotes of Sir Christopher Wren, the architect, and  asked
 him at the same time if he had ever  ascended  to  the top of the
 dome.   He replied  in the negative.  The stranger then inquired  if
 he  had dined, and proposed that they should go to an eating-house
 in the neighbourhood, and said that after dinner he would accom-
 pany him up St. Paul's; 'it was a glorious afternoon for  a  view,
 and he was so familiar with the place that he could point out every
 object  worthy of attention.'   The kindness of  the old gentleman's
 manner induced him to comply with the invitation,  and they went
 to a tavern in some dark alley, the name of which he did not know.
 They dined,  and very soon left the table, and  ascended to the ball
just below the cross, which they entered alone.   They had not been
 there many minutes, when, while he was gazing  on the extensive
 prospect, and delighted with  the  splendid scene below him, the
 grave gentleman pulled out from an inside coat-pocket  something
 like a compass, having round  the edges some curious figures ;  then
 having muttered some unintelligible words, he placed it in the centre 
322                ECSTATIC AFFECTIONS.
of the ball.  He felt a great trembling and a sort of horror come
over him, which was increased by his companion asking him if he
should like to  see any friend  at a distance, and to know what he
was at that moment doing, for if so, the latter could show him any
such person.  It happened that his father had been for a long time
in bad health, and for some weeks past he had not visited him.   A
sudden thought came into his mind, so powerful that it overcame
his terror, that he should like to see  his father.  He had no sooner
expressed the wish  than the exact person of his father was imme-
diately presented to his sight on the mirror,reclining in his arm-chair,
and taking his afternoon sleep.   Not having fully believed in the
power of thestranger to make good hisoffer,he became overwhelmed
with  terror at  the  clearness and truth of the vision presented  to
him ; and he entreated his mysterious companion that they might
immediately descend, as he felt himself very ill.  The request was
complied  with ; and on parting under the portico of the  northern
entrance, the stranger said to him, ' Remember, you are the slave
of the man of the mirror !'   He returned in the evening to his house,
he does not know exactly  at what hour ; felt himself unquiet, de-
pressed, gloomy, apprehensive, and  haunted with thoughts of the
stranger.   For  the  last three months he has been conscious of the
power of the latter over him."  Dr. Arnould adds, " I inquired  in
what way his power was exercised ?   He cast on me a look of sus-
picion mingled with confidence, took my arm, and after leading me
through two  or three rooms, and then into  the garden, exclaimed,
' It is of no use—there is  no concealment from him, for all places
are alike open to him—he sees us and he hears  us now.'   I asked
him  where this being was who saw and heard us?  He replied,  in
a voice of deep  agitation, 'Have I  not told you that he lives in the
ball below the cross on the top of St. Paul's, and that he only comes
down to take a  walk in the church-yard, and get  his dinner at the
house in the dark alley.  Since that fatal interview with the necroman-
cer,' he continued, 'for such I believe  him  to be, he is continually
dragging me before him on his mirror, and he not only sees me every
moment of the  day, but he  reads all  my thoughts, and I have a
dreadful consciousness that no action of my  life is free from his in-
spection, and no place can afford me security from his power.'  On
my replying that the darkness of the night would afford him pro-
tection from these machinations, he said,  'I know what you mean,
hut you are quite mistaken.  I have only told you of the mirror,
but in  some part of the building which we passed in  coming away,
he showed me what he called a great bell, and I heard sounds which
came  from it, and winch  went to it; sounds of laughter,  and  of
anger, and of pain ;  there was a dreadful confusion of sounds, and as
I listened with  wonder and affright, he said, 'This is my organ  of
hearing ; this great  bell is in  communication with all other bells
within the circle of  hieroglyphics, by which every word spoken by
those  under my control is made audible to me.'   Seeing me look
surprised at him, he said,' I have not yet told you all; for he prac- 
PATHOLOGY OF THESE DISORDERS.
323
tises his spells by hieroglyphics on walls and houses, and wields his
power, like a detestable tyrant as he  is,  over the minds of those
whom he has enchanted, and who are the objects of his constant
spite, within the  circle of the hieroglyphics.'   I  asked  him what
these hieroglyphics were, and how he perceived them ?   He replied,
' Signs and symbols which you in your ignorance of their true mean-
ing have taken for letters and words, and  read as you have thought,
'•Day and Martin and Warren's blacking.'  Oh ! that is all non-
sense ! they are only the mysterious characters which he traces to
mark the boundary of his dominion, and  by which he prevents all
escape from his  tremendous  power.  How  have I toiled and la-
boured  to get beyond the limits of  his influence!  Once I walked
for three days and three nights, till  I fell down  under a wall ex-
hausted by fatigue, and dropped  asleep; hut on  awaking I saw the
dreadful  signs before my eyes, and I felt myself as completely under
his infernal spells at the end as at the beginning of my journey."'
   It  is  probable that this gentleman had actually ascended to the
top of St.  Paul's, and that impressions there received being after-
wards renewed in his mind when in a state of vivid excitement, in
a dream  or  ecstatic reverie, became so blended with the creations
of  fancy  as to form one  mysterious vision, in which  the true  and
imaginary  were afterwards inseparable.

 Section  VIII.—Further  Observations on  the Pathology of
                     Ecstatic  Affections.

   Richertz has observed that the tendency to somnambulism is to
be  reckoned among morbid conditions of the system, and he founds
his opinion on the following reasons :—First, the relation of this
affection to  various diseases.   He says that when somnambulism
has continued long, with frequent and severe returns, it is  apt to
pass into epilepsy, apoplexy, hypochondriasis, melancholy, and mad-
ness,to which last he thinks it has a near relation.*   I shall presently
consider the reasons for this opinion.
   Secondly, he regards somnambulism as a disease, inasmuch  as it
is a phenomenon contrary to nature, which ordains sleep as a state
of  repose and refreshment  from labour,  whereas with  night-wan-
derers it becomes an occasion of additional weariness and more  than
ordinary fatigue.  Paroxysms of somnambulism  are generally fol-
lowed bv long and heavy sleep, and by a feeling  of debility and
lassitude on the  ensuing day.
   Among the predisponent  causes  of  somnambulism, the most
important, as may be  observed with respect to other diseases of the
nervous  system, is a peculiarity of constitution.   This appears from
the fact  that the disease is hereditary.  Negretti's son was subject
to it from early boyhood.  Dr. Willis knew a family  in which the

   ♦ Zusatze des herausgebers von Muratori iiber die  Einbildingskraft,  th.  i.
p. 326, &c. 
324
ECSTATIC AFFECTIONS.
 father and all the  sons were afflicted with this troublesome com-
 plaint : the sons in their nightly discursions ran against and awakened
 each other.
   Intemperance is said to be among the causes of somnambulism,
 and the  analogy  of facts  prevents our doubting the assertion.
 Scipio Maffei, a correspondent of Mead, and one of the eye-witnesses
 of  Negretti's adventures, attributed the disorder of that person to
 his immoderate fondness for wine.
   Age and sex are to be  taken into  the account by those  who
 investigate the  etiology of any constitutional disease.   According
 to Richertz, somnambulism is chiefly incident to the male sex and
 to the early period of manhood.   It seldom  appears in a strongly
 marked form in early  youth, and generally lessens or  ceases with
 the commencement of old age.
   A plethoric  slate  of the  constitution, and  whatever causes tend
 to induce fulness in the vessels of the head, increase the disposition
 to this disorder.   Signor Pozzi, body-physician to his holiness Pope
 Benedict XIV. assured  Muratori, that he was obliged  to  have his
 hair cut at least every second month, in  order to prevent his becom-
 ing a somnambulist.
   Richertz was certainly correct in his opinion as to the patholo-
 gical relations of somnambulism both to comatose and to maniacal
 diseases, and this is a consideration  of some  interest.   In the first
 place, the symptoms which usher in and terminate the paroxysms
 of  somnambulism, and the transitions from one disease to another,
 mark the connection between sleep-walking and comatose affections.
These facts may be noticed in many of the cases above mentioned.
 There are  frequent conversions of one  of these  diseases into the
other.  Ecstatic somnambulism, as being the most  severe affection,
has been  most frequently connected with  other disorders of the
brain.  In females it is often conjoined with catalepsy and hysteria,
and in  males with epilepsy.  Dr.  Darwin has related a  case of
ecstasis occurring  in a boy, which was  supposed to  proceed from
worms.  It began  with an epileptic  aura, and  terminated in stupor.
Another instance recorded by the same writer was that  of a female,
and it was combined with uterine epilepsy, or perhaps with hysteria.
In its phenomena it appears to have resembled the example related
by  Sauvages.   Two cases are described by  Martinet, in  both of
which epileptic fits formed a  part of the disease.  In one of these
somnambulism  was  vicarious of epilepsy :  in the other,  fits  of
ecstasis were  ushered in by the usual symptoms of epilepsy.
  The relation  of ecstasis to insanity is in several of its phenomena
still more apparent than that which it bears to comatose diseases. 
PECULIAR FORMS OF THE HEAD.
325
SUPPLEMENTARY   NOTE
                                    ON

Peculiar  Configurations 'of the  Skull connected with M&ntal Derangement, with
  Observations on the Evidence of Phrenology, and on Opinions respecting the
  Functions of the Brain.

  In that part of my woTk which relates to the congenital predisposition  to
insanity, I have referred  to  a supplementary note some  further remarks  on
peculiarities of external form, which are connected with, and give indications
of,  defects or disorders of the  mind.   A consideration of this  subject seemed
requisite, in order to render complete the history of mental derangement; and
in any other place than that which I have assigned to it, it would have occa-
sioned too long a digression from the matter in hand.   I shall now subjoin'some
observations on the  subject referred to, which  appear to be necessary for  its
illustration.
  The attention of medical writers has long been directed to peculiarities in the
form of the skull as connected with  mental  derangement,   Plattner, in 1767,
reported  instances in which the forehead, and others in which the  occiput, was
flattened.  Dr. Greding observed that the size of the head is generally natural
in deranged persons.  He says that, in one hundred  lunatics,  there were four
whose heads  were  larger, and only  two with heads much smaller than the
general size.   In twenty-six epileptic madmen there were four, and in sixteen
epileptic idiots two, with small  heads.  In thirty idiots six had large heads,
and only two very small ones.  These remarks refer to size or dimension : with
respect to the  shape of the head, Greding says that it is in most lunatics natural:
sixteen only had small and contracted foreheads,  compressed temples, and large
and expanded  occiputs.   A few had the head too  long and compressed at the
sides.  Some  had their heads almost  round, or of  a square shape; these were
epileptic idiots. Two epileptic madmen had small heads of a circular form.*
  M. Pinel instituted an inquiry into the forms of the head occurring in lunatics
and idiots.  The result, as he declares, proved  to him that there are certain
peculiarities in the shape of the skull which  are frequently connected with men-
tal  diseases, particularly with dementia and  idiotism.   He reduced these forms
to two prevalent varieties, which are a laterally compressed shape of the head,
giving a very long diameter  from the  forehead to the occiput, and a short and
almost spheroidal form, the line above described  being shorter than usual.   He
adds  that he  could  never  detect any mental conditions or peculiarities in  the
state of the intellectual faculties that corresponded  with these opposite forms of
the head.f
  M. Georget, in his work on insanity, has  given  the result of observations on
the form of the head in lunatics, which were made chiefly in the collection of
M.  Esquirol, containing at that time  more than five hundred heads carefully
prepared.  The following are the most important of M. Georget's remarks.
  " The observations which I have made, have led me to this one result; one-
half of the skulls had nothing remarkable; they appeared as regular and as
well-formed as in other circumstanees  of life.  The other half present peculia-
rities in the form, the regularity of the bony case, in the thickness, the density,
the organization of the bones which compose it.   We remark some skulls  un-

  * Observations on Insanity, by Dr. Greding, of Waldheim.—Crichton on Insanity.
  + Pinel,  Traite Philo»ophico-M6dicaIe sur 1'Alienation. 
326
PECULIAR FORMS OF  THE  HEAD
equally developed,  one of the sides  being larger  and more arched than the
other; it is the right side that 1 have generally found with this  disposition.
Some skulls are as if they were  twisted in such a manner that one side of the
head is too forward, and  the  other too much behind.  There are some which
have not the  antero-posterior diameter more extended than the  lateral; the
cavity of these is elevated very much, especially in the  posterior part.  The
cavities of the base of the skull present likewise inequalities; those of one side
are sometimes larger than those of the other."*
  It has often been  observed that lunatics who have very contracted heads, fall
more easily than others  into dementia: such  cases of insanity are less  curable
than others,  owing to a predisposition, as it would appear, to  a decay of the
faculties.  Hence it happens that a contracted size and deformity in the shape
of the head are so frequent in demented persons.

                      Of the Form of the Head in Idiots.

  Idiots have faults in the conformation of the head much more frequently than
insane  persons;  there  are comparatively  few who have  not some  defect or
anomaly in  the shape  of the skull.   M. Belhomme, in a thesis published
in  Paris in  1824,  remarked  that, out of one hundred idiots  and imbecile
persons  in   the  Salpetriere,  only  fourteen  had heads  of a  natural  form,
and these were  imbeciles and not  complete  idiots.  Pinel  has  given de-
scriptions, with drawings of  the heads of two  idiots laterally flattened,  with
the fronto-occipital  diameter very long.  I have seen some idiots with very small
heads, wanting a great  part of the  space  which usually contains the anterior
lobes of the brain,  and  likewise of that belonging to the cerebellum.  M. Es-
quirol observes that the skulls of idiots are  either too large or too small: the
anomalies of form which he particularly mentions, are a flattening of the  head
laterally or behind.   In the  former case the fronto-occipital  diameter is length-
ened, and the parietal bones flattened  down  towards the  plane of the sagittal
suture,  giving a short transverse diameter.  Sometimes,  as M. Esquirol ob-
serves, the two sides  of the oranium are unequal: this happens more frequently
in imbecile and deranged persons than in others,  though it is not  peculiar to the
former.  M.  Georget  has enumerated  the varieties of form observed by him in
the  heads of idiots, and among them are included  almost all the anomalies of
which the figure of the human cranium is susceptible.
  An inquiry will here suggest itself  to many of my readers, whether the pecu-
liarities in the shape of the head  said  to exist in deranged  persons, correspond
with the  observations or opinions of Dr. Gall and the school of  phrenologists.
1 have had my attention directed to this inquiry for many years, and have omit-
ted no opportunity that has presented itself of gaining information on the sub-
feet.  Before I state the results which I have obtained, I  think it necessary to
introduce  some remarks on the  general credibility and evidence of Dr. Gall's
system. This doctrine has been so much discussed in connection with disorders
of the mind, and phrenology,  if founded in truth, has so extensive a bearing on
the nature of the human faculties and on all the morbid affections  to which they
are  liable, that it cannot be well passed over in a treatise on mental disorders.
By many it will be  expected that 1 should  state my reasons for having hitherto
omitted all reference to this subject.
  Phrenology has obtained many zealous  advocates in different  countries, and
some of them have  been men of distinguished talents and extensive knowledge,
though in general they iave not been among the most cautious reasoners.  Few
opinions,  however,  on physical subjects whioh have gained so many proselytes
have been without some foundation in truth.  Even  animal magnetism, as we
have seen, wild and visionary as it appears when  taken  as a whole, has yet
brought with it the  discovery of some curious and interesting facts.  Phrenology
appeals for proof to facts and observations,  and therefore a number of voices in,
its favour may be deemed a presumptive proof that it rests on some foundation
* M, Georget, de la Folie, 8vo,  Paris, 
IN  LUNATICS AND  IDIOTS.
327
of evidence.  This conclusion may, however, be questioned, if it is true, as I
believe it to be, that the real ground on which so many have become converts to
phrenology has not been the evidence  of facts, but the plausible  and specious
nature of the theory,  and the ready explanation which it seems to afford of a
great number of phenomena in natural history and psychology.
  About the period when Dr. Gall  began to advance his new speculations, the
prevailing notions repecting the mental faculties were almost  everywhere  such
as had been founded on Mr. Locke's doctrine of the human understanding.  The
followers of  Hartley, of Condillac, and Helvetius were  not satisfied with the
denial of innate ideas and innate speculative principles ;  some of them went on
so far as to call in question the natural diversity of mental powers, or the en-
dowment by nature of particular individuals with peculiar moral or intellectual
qualities.  Under the persuasion that  the human understanding is, like a white
surface  previously unmarked, capable of receiving  any impressions that might
be stamped  upon it, metaphysicians amused themselves by attempting to account
for the formation of peculiar powers or tendencies of mind by tracing some early
bias given to the thoughts  and inclinations of children in the  cradle.  The per-
ception of the beautiful in the forms  of external nature  was  suggested to the
infant by the winding  surface of his  mother's breast.   Many a puerile  conceit
passed  current under  the  name  of a philosophical speculation.  Few in the
meantime were perfectly satisfied with such inadequate attempts to explain phe-
 nomena, though they  were supported by the  authority of learned names.  Facts
daily observed afforded convincing proofs that the real constitution of the human
mind is  far other than it was thus represented to be,  that not only the powers of
the  understanding are given naturally in different proportions, but that peculiar
moral dispositions and propensities belong in different degrees, by original dis-
 tribution, to different individuals.  The  first writer who should reduce  these
 observations into a connected form was sure to make many proselytes.  This, in
fact, was done by Dr. Gall, who stated in a more distinct and systematic way
 than any preceding writer, the  doctrine of the  innateness of particular talents
 and intellectual and moral  propensities.  The chief peculiarity,however, of Dr.
 Gall's psychological theory was the attempt to draw a parallel between the animal
 qualities displayed by the  lower  tribes, and  the individual varieties discovered
 among  men.  By tracing the  phenomena  of  action,  feeling,  appetency,  so
 strikingly diversified  in the various tribes of animals, he endeavoured to illus-
 trate and render more  probable a diversity of talents and innate propensities in
 the  human mind.
   The point of view in which Dr. Gall and the phrenologists have contemplated
the mental faculties may be termed that of comparative psychology.   It is founded
 on the principle that the innate or original faculties are common to man and  the
 lower tribes of animals, to those at least which bear to man a general analogy
 in their organization, and especially in the structure of their nervous system : it
 discovers  analogies in psychical  phenomena between the brute tribes, and
 traces in them the rudiments of those properties which in the highest degree of
 development and taken collectively  form  the  human character, and  which in
 lower decrees and various  relations constitute the distinctive nature of each of
 the  inferior kinds. This is a new view of the  mind and its powers, founded on
 a principle analogous to that which comparative anatomy applies to the structure
 of the body.
   It was a  novel and amusing  speculation to trace  the  fundamental laws of
 political society, not  in the higher principles where Aristotle or where Hooker
 have sought them, but in  analogies with the economy of the ant or of the bee.
 By some it  may be objected to such  attempts that they are unworthy of so dig-
 nified a theme, and tend to lower rather  than to ennoble the philosophy  of the
 human mind.   But perhaps this is only one of the idola tribus.  There is sound
 reason in the observation  that the  Author of man's  existence formed also the
 inferior orders of the creation, and that extensive-analogies may and do exist in
 the  different departments of his works, the development of which may lead
 in this,  as it has done in other instances, to the discovery of important principles.
   The'second department of  Dr. Gall's doctrine is Organology.  A comparison 
328
SURVEY OF THE EVIDENCE
having been instituted between the psychical endowments of c ifferent tribes, the
inquiry is next suggested, in what part of the constitution  of men and of animals
are these properties inherent 1—of what are  they the attributes or  powers 1   If
the question had referred only to  the  nature of man, the  reply would  probably
have been,—as  Dr.  Gall  with most  of  his countrymen  appears to admit  the
existence of such an entity,—that the phenomena of which we are conscious, the
properties of the mind,  of feeling,  of desire and will, belong to the soul or
immaterial part of our compound nature.  But the inferior animals are  not com-
monly reputed to  be, like men,  of a compounded nature, and it  would have
appeared paradoxical to assume that  they have soul3  or  immaterial essences.
The idea that a  psychical principle,  or a principle in its nature distinct from
organized body, exists in all sentient beings,* has not been generally recognised,
otherwise it would have occurred to many that such an entity, if it exists at all,
must have attributes of its own, and the psychical manifestations  of animals
would have been considered as in some manner their result.
   As it did not enter into the view of the  phrenologists to assume the existence
of a psychical principle coextensive with conscious or sentient  being, the only
resource left was to connect the series of animal properties developed  by their
system,of comparative psychology,  with some part of the corporeal organization
that  should be found common to mankind and the lower animals.  Here  the brain
and the nervous system came in as having the best claim. This, in vertebrated
animals,  from which the comparative observations  of the phrenologists were
principally  deduced, bears such a degree of correspondence in  its  structure
through different tribes, as readily to fall  in with the ideas of those who sought
to connect with it a series  of analogous psychical manifestations, and who were
desirous of tracing a coincidence between varieties in those manifestations and
diversities to be pointed out in the structure with  which  they were to be con-
nected.  Accordingly, where one tribe differed from another in the phenomena of
instinct or feeling, it was often found  that a parallel  variety might  be traced or
imagined between the cerebral structures of the respective species.  There was
no great hiatus, or remarkable and sudden difference in  the powers of sense, in
instinct, or other animal properties, or, on the other hand, in the series of grada-
tions by which  the  organic type of tribes higher in the  scale  of intelligence
gradually deviates into  a lower  stage of development.   On this  groundwork,
accordingly,  the school   of Dr.  Gall have chosen to erect  their system of
organology.
   I shall not insist on the  assertion that the above is precisely the train  of reflec-
tions which led Dr. Gall  in his first speculations, but it is nearly that  in which
they were set forth by his amiable and  ingenious follower and coadjutor,  Dr.
Spurzheim; and 1 doubt not that it is the way in which most of the converts to
phrenology have been led  to adopt their  persuasion of its truth.  In this they
have chiefly been confirmed by  the ready solution which this  doctrine affords of
so many phenomena. In  the first place,  the various appetites, propensities, or
active impulses, of which the  operation holds so large  a  place in the sphere of
human action, were regarded as original and constituent principles of our nature.
The attempts to account  for them in various accidents of education,  in  early
impressions and  associations, which  had  been for the most part unsatisfactory,
were rejected, and these properties were laid down as innate and distinct princi-
ples.  The originally distinct nature of these properties was rendered somewhat
more probable by tracing phenomena apparently or really  analogous to them in
other departments of the creation.  Then c^me in  organology, with its train of
asserted relations or universal  correspondences between psychical endowments
and proportional developments in various parts  of the nervous structure.   The
whole series of these  speculations  was calculated  to  excite great  interest.
They opened new views of both psychical and organic nature, and  so extensive
a field could scarcely be cultivated  without bringing  to light some  valuable
discoveries.

   * On the considerations connected with this subject 1 beg to refer the  reader to my
treatise on the  " Doctrine of a Vital Principle." 
GROUNDWORK OF THE DOCTRINE.
329
   I shall now state briefly some of the objections which have probably occurred
 to the minds of many persons, and have prevented their admitting the truth of
 those assumed principles on which the phrenologists build their system.   I have
 but a few words to offer on the scheme of comparative psychology in addition to
 what has been said already on this subject.
   The attempt to  illustrate the  phenomena of the  human mind, and, viewed
 externally, of human action, by comparison with the powers, habits, and propen-
 sities of the inferior orders of the creation, is extremely ingenious, and seems to
 hold out the prospect of discovering curious and interesting relations.  The only
 question that occurs to us as a preliminary one, or as requiring a solution before
 we are at liberty to embark in the enterprise,—the only impediment we have to
 remove before we  get fairly into the new field of inquiry without leaping over
 the fence forbidden to  cautious reasoners, is, whether  the analogies to be found
 between human  actions and  sentiments and the characteristic habitudes of the
 brute tribes are real and complete, or only apparent and superficial.  Has it not
 been tacitly assumed as a preliminary step to this comparison, that the supposed
 distinction  between instinct and reason is unreal, and  that the active principles
 are of the same kind in the higher and lower beings in the creation ?   Perhaps
 metaphysical writers  have been mistaken in laying down so broad a line of dif-
 ference as they have established.   We must, then, either elevate the brutes or
 lower the superiority  of mankind.  Shall we say, after tracing the operations of
 a constructive instinct so wonderfully displayed by the beaver, or in the  cells in
 which the bee lays  up its honey, that an impulse to action precisely similar gave
 origin to the pyramids of Egypt  or to the building  of Constantinople?  Shall
 we venture  to affirm that  the  tunnel under the Thames owes its existence-to a
 burrowing propensity resembling that of the rabbit or the mole ?   Shall we con-
 clude that Parry and Franklin sought the regions of the north impelled by the
 instinct of the migratory rat,  and  that Magellan  and  De Gama traversed the
 southern oceans  directed by  an influence analogous to that which moves the
 flight of swallows'?  Or  may we, with greater probability,  determine that the
 lower tribes act under the guidance, not of blind  instinct, but  of enlightened
 reason,—that metaphysicians  were mistaken when they laid down the principle,
 " Dens est anima brutorum,"—that the birds of passage have some acquaintance
 with  physical geography, and know the quarter where tropical  warmth exists
 and genial breezes  blow ;—that  the bee has studied  the  exact  sciences, and
 knows by calculation  the form most advisable for its cells ?—in short, that there
 is a real analogy and correspondence between the mental faculties  of man  and the
 psychical endowments of those  creatures whom he conceitedly regards as his
 inferiors?  If either of these positions can be maintained,  there will be a sound
 foundation for the comparative psychology of Dr. Gall and his followers; but if
 they should be rejected as improbable, we must admit that the analogies pointed
 out are remote, the  things compared are different in kind, they agree only in out-
 ward  appearances, and we shall be brought to the conclusion that it has pleased
 the Author  of nature to bring about corresponding results, in the rational and
 irrational departments of the creation, by very dissimilar means.
   I shall  now proceed to make  a few remarks on the remaining part of the
 phrenological  theory, which may be distinguished by the term organology.
   We have seen that the basis of this doctrine  is a supposed universal connec-
 tion between psychical powers and particular modifications of the  cerebral struc-
 ture,  the varities  of one kind being thought to bear  every-where perceptible
 relations to corresponding varieties  in  the other.   The proof held forth is an
 alleo-ed  universal coincidence  in point of fact, or the actual correspondence be-
tween the two things in degrees and modifications.   The nervous fabric  being,
 throughout certain departments of the animal kingdom, analogous to its general
 form and type, this  circumstance is thought to be the groundwork  of that general
resemblance'in psychical  endowments which is traced or imagined through all
of them, and slighter variations in this type are  only maintained to be connected
with such  psychical varieties on the alleged ground that they do, in point of fact,
universally correspond with them.
  If  the evidence brought in support  of the organological system depends so
      May, 1837.                29 
330
SURVEY OF PHRENOLOGY.
entirely on universal coincidence between psychical properties and corresponding
variations in the structure of the nervous fabric, it must be important to deter-
mine whether there are any departments of the animal kingdom in which instincts
and motive habitudes, and an entire psychical nature are displayed analogous to
those of vertebrated animals, while yet in these departments there is no structure
which can be said  to bear resemblance to the complicated cerebral system of the
so-termed higher animals.  In all the vertebrated kinds, as I have observed, the
organisation of the nervous fabric is on one principle, and the same fundamental
type with different degrees  of development is traced  in  man and  in all other
mammifers, in birds, reptiles, and fishes ; but  here the resemblance terminates,
and the nervous system of molluscous animals and insects presents but few and
remote analogies to that which belongs to the  first great branch of the animal
creation.  It is indeed to be presumed that the nervous system, taken as a whole,
fulfils, in the tribes last mentioned, the same  offices as  in  those  animals who
have it enclosed in a bony case.  Still, nothing exists at all resembling the com-
plicated formation of the brain with its lobes and  convolutions.  It is so much
the more surprising to find the higher instincts, which had almost disappeared
in fishes, display  themselves  with  new splendour arid variety in the' brainless
insects, creatures  which, in the wonderful imitations of intelligence that govern
their motive habits, rival, if they do not even exceed, the sagacity of the  animals
which most approximate to man.
   The psychical phenomena displayed'by the insect tribes have been the favourite
theme of many popular writers, but  I know of no author who has placed the
relation which they bear to the active principles of vertebrated animals,  and par-
ticularly to those of mammifers, in so striking a point of view as Jacobi, Whose
observations oh this subject I shall venture to insert, with some abridgment.
   " It is a fact," as he remarks, " that among insects, if we take collectively the
different tribes, manifestations of all the psychical qualities which we  observe
 in mammifers and birds, regarding as a whole the properties divided  between
 different departments, may be recognised in the most strict analogy.   Attention,
 memory, the faculty of combining means to obtain  ends,  cunning, the desire of
 revenge, care of offspring, and alt the other psychical qualities which have been
 traced in the former classes of animals, are likewise to be discovered in the latter
 as typical or characteristic phenomena, sometimes in one, sometimes in another
 combination,  or in different groupes, sometimes more strongly, at others more
 feebly expressed.
   " Nor can it  be maintained on any solid  ground that phenomena so analogous
 depend on different causes, or that the lower tribes of animals, and these exclu-
 sively,  act  under  merely  mechanical impulses,  while their activity  displays
 effects parallel to the manifestations  of animal life  in the higher orders.  For
 what essential  difference can be pointed out in the principle of action, when we
 observe the young bee, in  its first flight from the maternal hive, hasten  straight-
 ways to the nearest meadow, or  sunny bank, and  return home laden with wax
 and honey; and  when the colt of the river-horse, foaled upon the land,  after his
 mother has been  killed, rushes from the spot, and betakes himself to the wateT
 which he has never seen ;  or when the young goat in the first hours of his life
 hides himself in  the clefts  of rocks, which nature already points out to him as
 his dwelling-place?  Does psychical life  display itself under a more limited or
 doubtful character  in the  flights  of grasshoppers  or  dragon  flies, than  in the
  marches of lemmings, so closely bound by the impulse which directs the course
  of  their wanderings, that they even attempt to gnaw through rocks which lie in
  their way rather  than go round them, and  follow  each other troop by troop  to
  their certain destruction, into the deepest rivers or widest lakes ?  Does not the
  earth-worm secure himself against the pursuit of the mole, provided with a well-
  formed brain, by making his way along the surface of the soil, where  the latter
  cannot further trace him, with as much cunning as the fox and the beaver dis-
   play  in acts which are typical  or characteristic of their kinds?  I  will ask
   again, what difference is there between the skill with which the insect ichneu-
   mon and the ant-eater procure for themselves the same food, between that of the
   diving-spider or  the corpse-beetle, and the arts displayed by so  many  birds and 
OBJECTIONS OF  JACOBI.
331
 mammifers impelled to similar pursuits?  Are  not like phenomena repeated in
 tne economy of the beaver or of the Alpine marmot ?   And if we must refer to
 manifestations of a higher and freer sphere of agency, in  what tribe of sucking
 animals does such a power display itself more wonderfully than in the wars of
 conquest carried on by different races of termites, in which the subdued become
 vassals to the victorious tribes, and serve their lords, in laying up for them their
 stores and watching and protecting their young ?
   " ?f we look but cursorily through the works of writers who have investigated
 the instincts, the habits, and the econo