MENTAL 
DISEASES 
BUCKLEY A 
MANUAL 
OF 
MENTAL DISEASES 
FOR THE USE OF 
DOCTORS, LAWYERS, AND NURSES 
* By C. F. Buckley,1' b. a., m. d. 
NEW YORK 
THE MEDICO-LEGAL JOURNAL 
1923 Copyright 1923, 
By Dr. A. W. HERZOG PREFACE 
This brief manual is not intended as a 
treatise on Insanity. Its aim is merely to 
point out to the uninitiated Doctors, Law- 
yers, and Nurses that the subject of men- 
tal diseases is not as abstruse and chaotic 
as many of the works written on the sub- 
ject might lead them to apprehend. The 
simple classification that I select, I have 
no hesitation in asserting, includes all and 
every form of mental disturbance and the 
confused multiplication of terms with 
which our books are loaded has no merit 
whatever toward attaining practical re- 
sults. To segregate and classify is most 
laudable and useful in all branches of 
science, but to indulge in the mere verbi- 
age of new terms to express the same 
thought is a useless waste of time and 
only leads to confusion. I give in a last 
page a few of those terms that it would 
do no harm to eliminate. INTRODUCTION 
The subject of mental diseases is one to 
which the average physician and the 
average nurse do not pay as much atten- 
tion as they should. In several articles 
published in medical journals from time 
to time* I have sought to impress this idea 
on the profession. I am strongly of the 
opinion that if our profession would de- 
vote more effort to the observation and 
study of this class of diseases there would 
be very much less of the prevailing and 
bewildering cults, such as Christian 
science, Free Thought, the Emmanuel 
Movement, and hundreds of other kin- 
dred fads, each and every one of which in 
rare cases does some good, but in the ag- 
gregate they all do a great deal of harm 
by exciting the morbid imagination of 
those people whose reason has not been 
carefully and sedulously cultivated, and 
whose technical education has been en- 
tirely neglected. Whatever merit may lie 
1 in this direction of psychological medi- 
cine would be vastly enhanced in the 
hands of the cultivated physician and 
nurse who have in mind the physical con- 
dition also. 
You will observe, as you go along in the 
study of medicine, that there is much 
more achieved by adroit intelligence in 
the handling of many cases than you had 
previously thought was possible. You 
will find that the manner of doing certain 
things for patients is no less important 
than the doing by itself. At the present 
time, as I frequently notice, wherever we 
turn there is no question that our efforts 
as a profession in many points fall short 
because we do not reach out and correct 
the mental attitude of the patient. It 
should be made a separate branch of our 
medical schools. 
We will get some of our most valuable 
information from people of little mental 
culture. This was forcibly drawn to my 
attention in a very plain manner some 
years ago by an uncultivated Slavonian 
patient. He had been at one time very 
severely injured (as much as any person 
could very well be and recover) by the 
falling of an awning upon his head and 
2 crushing the lower extremities of his body 
generally, in a frightful manner. His re- 
covery was extraordinary and quite be- 
yond what ought to be legitimately ex- 
pected, and consequently he was inspired 
with great confidence in the one who re- 
stored him. In succeeding years on va- 
rious occasions after that he became sick 
many times and not once was I called to 
see him as the first doctor, which fact I 
attributed to his inordinate penury. 
He came to my office one day, however- 
from the country whither he had occa- 
sionally gone to lend money, (he had had 
two or three doctors in the country and 
then finally came to visit me) hence after 
he consulted me, I asked him, “How is it, 
Mr. H, that you always seek medical ad- 
vice before calling me in, considering the 
terrible condition you were in when I first 
saw you?” He said, “Well, I tell you, 
Doctor, this one suggests this, and that 
one suggests that, and so I believe them.” 
“But,” he said finally, “you know that a 
man that is sick is a kind of crazy any- 
how.” I was greatly struck by the force 
of this remark and realized very early 
how correct this illiterate man was and 
how clearly it was put. 
3 Now depend upon it that every person 
who is sick is more or less defective in 
mentality whether it is an injury or wheth- 
er it is an acute or chronic illness of any 
kind- because the illness or injury, what- 
ever it may be, necessarily demands the 
first attention of the patient himself. 
Of course, as you know, in a great many 
instances the mentality is manifestly dis- 
turbed and what we call delirium is sim- 
ply a species of insanity for the time be- 
ing. These grades of mental defect that 
ensue upon illness require the most care- 
ful study and no doctor is free from cen- 
sure who ignores that condition of men- 
tality in the patient. 
The law is not often called upon to de- 
cide in these cases whether one’s mind is 
clear or the contrary. But sometimes in- 
dependent of the illness which confines 
one to bed or to a hospital, legal gentle- 
men are very much exercised as to what 
the degree of mental defect is in many of 
these cases, with regard to wills, property 
matters, and especially with regard to the 
conduct of criminals. To any person who 
observes clearly and reflects, it is quite 
manifest that broadly speaking there is 
apart from this such aggregation as a 
4 criminal class, but that “criminal class” is 
not by any means so clearly defined as 
some of our philosophers more or less per- 
sistently assert. Degress of crime are 
rarely ever sequences of degrees of men- 
tal defect, and it would be utterly unsafe 
for us, as some people do, to assert that all 
crime is the direct result of defective men- 
tality. There is one thing about it, how- 
ever, that might be well borne in mind 
and it is that the mind which is more or 
less defective is more easily influenced 
upward or downward than the mind 
which is not defective, and therefore the 
defective mind is more easily led into the 
paths of criminality. 
Man, as Herbert Spencer, as well as 
Thomas Aquinas, have emphasized, is not 
a reasonable animal. Emotions and feel- 
ings which are not governed by reason 
play a larger share in our lives than most 
people are inclined to concede, and it is 
our duty to observe those shades of emo- 
tion, as far as we can, and so by correcting 
the environment we can unquestionably 
very often keep individuals from lives of 
degradation. 
The degrees of mentality between crim- 
inals and average people or people of 
5 splendid genius, are not as great as some 
seem to imagine, and while many of our 
writers, especially in mental diseases, 
claim that everything is the result of here- 
dity, or as they call it, inborn capacity, it 
is to my mind clearly untenable. Not long 
ago one of our local professors made an 
extensive investigation into the condition 
of prisoners in one of the large state peni- 
tentiaries and boldly lectured to his class 
afterwards that he could tell the criminal 
head from the non-criminal. This has 
been gone over many hundred times and 
never found to be correct. This proposi- 
tion is not worth discussing. 
There is a celebrated case always 
quoted in relation to this subject, that of 
the Jukes family in New York. The ad- 
vocates of heredity are ever pressing for- 
ward this remarkably immoral and crim- 
inal family for three or four generations. 
When first reading it, it appeared to me 
that there has been one grave, underlying 
fallacy in the whole matter which has 
been completely ignored- and it is that 
these people for three generations, lived 
precisely in the same surroundings in 
which the original criminal lived and 
flourished; in other words, the environ- 
6 ment of three generations remained sta- 
tionary, and hence the environment over- 
looked, had more to do with their history 
than heredity. I will not go into the case 
further than to say that these criminals 
and prostitutes, people of low morals and 
defective mental parent stock, had no op- 
portunity of getting away from or at any 
rate abandoning the surroundings in 
which the first of them appeared. 
You are probably aware that many of 
our public teachers and employees in the 
state and nation devote much of their 
time just now to the observation and 
classification of these mental defects in 
the growing youth of the country, and 
give them often very absurd names. The 
shades of difference between them, from 
absolute insanity to average soundness of 
mind as we regard it, are so numerous that 
it would be perfectly impossible to bring 
about any classification which would be 
worth any attention. From my observa- 
tion I am convinced that no two of this 
body of teachers would agree upon the 
same nomenclature for half a dozen dif- 
ferent degrees of mental defect if called 
upon separately to supply the names. Of 
course it is very desirable to seek to re- 
7 duce to form or classification all condi- 
tions in nature that admit of it, for then 
the subjects can be more readily grasped 
and more correctly treated, but in the vast 
and limitless fields of ever changing hu- 
man mental conditions and efforts it 
seems a very fruitless task at best. One 
thing is quite certain, however, that what 
may be a mental defect in one social con- 
dition may not be in another, and when 
we see two different people, differently 
trained, coming from entirely opposite 
surroundings, doing precisely the same 
thing, uttering exactly the same thoughts, 
we might truthfully say of the one that it 
is a strong evidence of insanity, whilst in 
the other it may be a perfectly sane and 
normal condition. 
To put an extreme case—a grave, sol- 
emn clergyman is seen pilfering fruit 
from a street corner fruit stand: We im- 
mediately and unhesitatingly pronounce 
the act insane. A street gamin does the 
same thing, but we see no mental defect 
in the act. It is simply mischief or 
knavery. 
A young lady is brought up in the best 
possible surroundings. Her mental and 
moral training has been faultless. She 
8 suddenly or slowly develops a manifest 
tendency to indulge in the language of the 
gutter. Her conduct otherwise may be 
above reproach and she mixes with her 
friends with perfect freedom and on per- 
fect equality and they notice nothing ab- 
normal, but the trained alienist, doctor or 
nurse, very soon discovers in that conduct 
the initial symptom of insanity. The poor 
outcast often the daughter of poverty and 
degrading surroundings, swept into the 
gutter by the perfidious lust of some sem- 
blance of the genus Homo, indulges in 
precisely the same utterances and of 
course her conduct can in nowise be 
ascribed to insanity. 
There is another phase to this side of 
the question that is very important to re- 
member: namely, that whilst most people 
who are insane manifest the insanity in 
speech, in action, and in writing, yet there 
is quite a large minority wherein the in- 
sanity is manifested in speech alone, in 
conduct alone, or in writing. These are 
cases where the average person when 
called upon to investigate, makes very 
serious mistakes. The conduct of itself 
is generally the most pronounced index of 
9 insanity, and next to that comes speech, 
or conversation, last comes writing. 
You will very likely find that persons 
who are afflicted in this way demonstrate 
it very plainly in one or other of the two 
forms of speech or action, but writing 
alone is quite rare. Still it exists- and I 
only refer to it to emphasize how import- 
ant it is to bear this fact in mind. 
Here in these United States where ex- 
perts, so-called, are as numerous as the 
grapes in the vineyards, it is rather sad 
and unpleasant and somewhat degrading 
to the medical profession to see how 
strangely and how frequently their opin- 
ions differ, yet most likely each and all 
are perfectly honest. From my observa- 
tion the learned judges in these matters 
arrogate to themselves altogether too 
much knowledge, or appearance of 
knowledge, in relation to this subject also. 
I just recently, in looking over the “Medi- 
co-Legal Journal” observed some quota- 
tions from one of our California judges 
of the Supreme Court who lays down the 
law for the benefit of the medical and le- 
gal professions. This gentleman ignores 
apparently the opinion of the skilled 
alienists because they had never seen the 
10 patient and answered simply to hypo- 
thetical questions, and yet he called their 
testimony “weakest and most extraor- 
dinary.” Judges, like other people, and 
especially our judges in this country, who 
are not by any means men of highest 
learning and character and not always 
taken from the more learned members of 
the Bar, have just as much prejudice and 
are as one-sided as the medical expert. 
A judge because he is such, is usually not 
less facile in relation to his surroundings 
than a doctor, and we see that from the 
hopeless and self-evident contradictions 
in their many decisions. This is a subject 
which you and I are not concerned about 
except that is my duty to refer to it and 
we must bear it in mind before dwelling 
on the subject in detail, and the public 
should not accept the arrogant lop-sided 
opinion for that is all this judgment means 
—of a man quite uneducated in this de- 
partment of knowledge, in preference to 
the opinion of the trained expert. It 
would be just as reasonable for a judge 
to accept the opinion of an unskilled la- 
borer as of equal value to those of highly 
trained naval constructors when it comes 
11 to pass upon questions touching the build- 
ing of a battleship. 
The whole history of the young lady 
touching whose will the legal contest oc- 
curred which called forth this audacious 
arrogance from the would-be learned 
judge, who rendered this decision, up- 
raiding doctors, I happened to be quite 
familiar with. She belonged to what is 
known as the “four hundred” of the local 
society. She had an insane mother (that 
fact was never disputed) and moved in 
the ordinary frivolous circle of the idle 
rich. She became ill like ordinary hu- 
mans, and by order of her doctor, she was 
sent to travel with no other attendant 
than her ordinary maid. They went as 
fas as New York, no farther, and she 
jumped out of a window eleven stories 
high in one of the fashionable hotels of 
the Metropolis. She had conspicuous 
wealth and left it all to her confidential 
travelling companion, and her relatives 
got nothing because the testimony of med- 
ical experts was ignored as they “had not 
seen her.” 
Bearing in mind that at least ninety-five 
per cent, of all suicides are insane, and 
omitting all the other considerations, 
12 these experts (in this ease men of consu- 
mate knowledge of the subject) pro- 
nounced her insane, but the dozen or two 
((society)) gabblers testified otherwise 
and evidently their opinion weighed more 
with this particular judge than those of 
the men specially trained and educated. 
It may not be uninteresting to relate that 
one evening during the trial I happened 
to be attending one of this coterie and by 
a half a dozen at least of those who were 
visiting and discussing the subject, was 
asked my opinion. I replied that I pre- 
ferred the opinions of the experts who 
testified that day to those of all the so- 
ciety women on the continent. But they 
urged, “we knew her.” “Yes,” I said* 
“but you cannot see insanity where an ex- 
pert can.” I added, “You’ll be surprised 
to learn that one of the leaders of your 
‘four hundred’ is perfectly insane, though 
mingling in all your functions frequently 
and beautifully entertaining in her own 
home daily. I do not, of course, refer to 
any of you young ladies here present.” 
Not more than a month had passed when 
society was again shaken to its centre by 
the tragic suicide of the young lady I had 
in mind. 
13 CHAPTER I. 
HYPERTHELESIA 
Before coming to the study and classi- 
fication of insanity proper there are in- 
termediate attitudes that admit of a great 
deal of most useful study and observation. 
There are two especially which demand 
our attention, surrounding which there is 
everlasting confusion in our daily prac- 
tice. Those are Hysteria and Neuras- 
thenia, as they are called, but both very 
unsatisfactory terms for any purposes of 
diagnosis. The name Hysteria is a very 
inappropriate one. It comes from the 
Greek work, “Hysteron,” the womb, but 
as fully twenty-five per cent, occurs in 
males, you see how inappropriate the 
name is. That we will discuss later on 
however. 
As regards the term Neurasthenia, it 
approaches nearer to naming the disease 
than the former, but still that also is very 
defective and quite wide of the mark. 
15 Neurasthenia means simply a want of 
strength of the nerves, therefore you see 
the name would apply to the nerves of any 
portion of the body, as well as to the chief 
nerve center, the brain, rather than to the 
mental attitude. 
These two terms I have grouped under 
one general heading, namely Pathelesia. 
The word, “Pathelesia,” means a patho- 
logical condition of the will. In other 
words a will that is abnormal. I am con- 
fident you will find that this peculiarity 
will be the first thing that strikes you in 
relation to these two condition. Hysteria, 
when you are brought a good deal in 
contact with it, will unquestionably de- 
monstrate to you that the will of the pa- 
tient is the first offender, and is simply 
astounding in its exaggerated power. 
Neurasthenia will almost equally astonish 
you by the defect of the will, hence I pre- 
fer to use for both of those defective 
terms, Hyperthelesia and Hypothelesia; 
the one meaning an exaggerated condi- 
tion of the will-power coming from the 
prefix, “hyper,” above; and the other pre- 
fix, “hypo,” beneath, signifying a defect 
of the will. It may be that in the future 
some better nomenclature than this may 
16 be developed, but I am satisfied that the 
more cases of these classes we observe 
the more we will be disposed to see that 
these symptoms are very manifest, in 
fact are the leading symptoms. This 
name after I first used it in a magazine 
article, has been challenged on the ground 
that there was not physical cause under- 
lying it. I rely upon the one fact that 
must guide us all through these classes of 
diseases, that is the influence of the mind 
over the body: that the will quite fre- 
quently produces pathological conditions 
of the body. 
Taking Hysteria at first, or Hyperthe- 
lesia, you will be astonished at the exag- 
gerated functions of the body in this dis- 
ease. When a woman makes a lot of noise 
and behaves in a boisterous, demonstra- 
tive manner, it is the common expression 
of doctors and laymen to say, ‘‘Oh, she is 
hysterical.” There is no Hysteria about 
that, it is simply a little emotional want 
of control for the time being. But in true 
Hysteria it is not a want of control, so 
much as an absolute exaggerated capacity 
to do things that were never dreamt of 
before by the individual nor attendant. 
It is no uncommon thing to find a person 
17 suffering from this disease bringing under 
the will power those functions of the body 
that are normally quite free from any 
voluntary control. For instance- you take 
the stomach: in our normal condition 
none of us have control over its functions, 
fortunately, but in the condition of Hys- 
teria it is marvellous what control is ac- 
quired over it. Concrete examples better 
illustrate these conditions. For example, 
I am called to see a young lady who has 
been three months in a very good general 
hospital and investigated thoroughly, 
with the diagnosis “carcinoma of the 
stomach,” because every time she takes 
food even in very small portions she 
vomits. That has been going on for 
three months. She was greatly ema- 
ciated. After careful examination I con- 
clude that the seat of the trouble is not in 
the stomach at all but must be in the 
brain. Among other things that guided 
me to this conclusion was a marked dif- 
ference in the pupils of the eyes. I con- 
cluded that she had a tumor on one side 
of the brain. While observing her for 
about a week or so, I tried to test the 
stomach delinquency again, by inducing 
her, (which she was very reluctant to do) 
18 to sip a little plain water. I handed her 
about two drachms of ice water, and ob- 
served that she swallowed it apparently, 
but rejected it, as I thought, before it had 
time to reach the stomach. I calculated it 
had not reached more than half way 
down the oesophagus. I concluded that 
she had acquired the capacity to tighten 
up her gullet in some form, and so reject 
anything she wanted to reject. After a 
few visits- accordingly, I turned my atten- 
tion to the question of Hyperthelesia. 
She was lying on a very luxurious couch 
and was apparently uninterested in any- 
thing. There were some quite fine works 
of art in her apartment. I noticed a little 
dust on the frame of one of those pictures, 
and I told her that it was a shame to have 
any dust on such a beautiful work of art, 
and suggested that she might get up and 
dust it. Off her guard, she did so, with 
apparently great effort, but handled her 
little brush very dexteriously. I then 
again suggested to her to try a sip of wa- 
ter in the erect position. This she acceded 
to, and retained the water while I dis- 
tracted her attention by other things. 
After this I prescribed a certain amount 
of duty for her every day, and very soon 
19 the young lady was able to take indicated 
drugs which stayed on her stomach and in 
a very short time she was cured of her 
malady. 
Another illustration of this power of 
the will over the body, or “Hyperthele- 
sia,” occurred in a child, about twelve 
years old. This girl was uncommonly 
handsome, and if anything, over-devel- 
oped for her years. To the ordinary eye 
she looked quite a healthy girl, and her 
father and mother, who were around, 
looked very healthy people also. When I 
first saw her she was in bed with the ster- 
eotyped weight and straps used at that 
time for affections of the hip joint. Sev- 
eral members of our profession had seen 
her in the course of of the three previous 
months, and each one had the same opin- 
ion, hip joint disease. One eminent sur- 
geon, who was a very painstaking, able 
man, was the last who had seen her be- 
fore I was called, and he had given a sim- 
ilar opinion and had treated her for about 
three weeks for this disease. 
After two or three days study of her 
case I concluded that she had not any af- 
fection of the hip joint, but possibly might 
have some spinal meningitis. When freed 
20 from the weight the limb dropped into 
the classical position of those affected 
with hip disease. She commenced to re- 
fuse food and spoke less to her family. 
She neither complained nor apparently 
suffered as one with hip disease usually 
does. After a day or two she declined to 
speak in response to any questions, and I 
certainly felt that if there was any spinal 
trouble it was ascending right rapidly. 
Her arms she could move without diffi- 
culty. Her digestion appeared to be quite 
normal, and with all she was without 
fever. After about four days study of her 
case I concluded that she possibly may 
have Hyperthelesia. At any rate, I de- 
termined to make the experiment, to test 
the matter, and so one day I carried in my 
pocket a small, fine-pointed knife. Her 
father and mother were present in the 
room when I decided to make the experi- 
ment. She had never menstruated* and 
this fact was more or less antagonistic to 
the diagnosis of Hyperthelesia. I then 
sat on the bedside and talked with her a 
little while, but she made no response 
whatever. After this, in an undertone, al- 
most in a whisper, I said to her, “I have 
brought this knife along, determined to 
21 open a vein in your leg if you cannot get 
up today.” She made no response what- 
ever to this also, in fact, at this time she 
had not spoken at all for two days. Calm- 
ly, in a whisper, I urged upon her to get 
up or I would put this knife through her. 
She looked at me rather blankly and 
made no demonstration whatever in rela- 
tion to the threat. I poised the knife over 
her leg so that she would see it plainly, 
emphasizing the fact that she must get 
up or I would put it through her. She 
never moved a muscle or made the slight- 
est demonstration, until suddenly I gave 
her a quick prick of the fine point and 
then she jumped out of bed and ran across 
a good-sized room to her mother for pro- 
tection, and did so with apparently first- 
class power of locomotion. The father 
and mother were quite dumbfounded 
about the matter because they did not 
overhear what was going on, and looked 
upon me as a miracle worker. 
The child was immediately ordered 
back to bed, laid on her side, fed. She 
cried for a little while, then ate fairly 
well, but never resumed the leg position 
that she previously had assumed. In a 
very short time she became quite a well- 
22 developed young lady and married rather 
young. But no alteration of her social 
position or circumstances ever brought 
back this particular form of disease. 
I wish you to remember the fact that 
this child, who apparently had never seen 
anything of hip disease, had assumed that 
attitude and carried it on successfully for 
three months at least, without men of ex- 
cellent attainment being able to detect 
the simulation. A normal will in one of 
this age could not successfully play this 
role. 
A young lady of sixteen had been treat- 
ed during a period of four months for 
“fits,” by an eminent local specialist, who 
acquired quite suddenly a very extensive 
reputation of curing “fits” because he 
claimed to have a secret nostrum for this 
purpose. After three months trial he did 
not succeed in this young lady’s case and 
the mother, who was a rather intelligent 
woman, asked me to come and see her 
daughter. Of course the presumption was 
that the young lady had suddenly devel- 
oped epilepsy, hence the industry of the 
gentleman alluded to. I accidentally dis- 
covered that she never had one of those 
fits unless a man was present in the room 
23 which immediately led to a convulsion. 
Even the presence of the father sometimes 
led to it. However, the main fact was, as 
related by the mother, that she never got 
any convulsion unless there was a man in 
the room. Without any erotic or immoral 
proclivities this was to me a very strange 
development, but by degrees it was un- 
mistakable that she got a convulsion 
whenever a gentleman was brought into 
her room. 
Acting on this I told the mother that no 
person in male attire should visit her> not 
even her father. The mother was quite 
intelligent and accepted the situation 
without question. After this she went for 
quite a period of some days without any 
epileptiform seizure of any kind. I then 
realized that it was my old friend Hyper- 
thelesia in operation and while I could 
not in any way, shape or form, attribute 
her conduct to any abnormal sex procliv- 
ity, I very soon informed her with great 
confidence that I was going to subject her 
to very rough treatment if she indulged 
further in simulating these convulsions, 
because I felt assured she could control 
them if she made up her mind to do so. 
Meanwhile I gave her some nerve tonics 
24 which had the effect of quieting her,— 
ordered her out of bed and recommended 
a rather spare diet for a while. This 
succeeded admirably and in a very short 
time she was a bright, merry young 
woman of ordinary intelligence and ca- 
pacity. 
The striking peculiarity of it was due 
to the fact that the presence of a gentle- 
man of any age in her room, even with 
her mother present, seemed to lead to the 
attack. Of course, as I have intimated 
before, the will in her case was the of- 
fender, but the normal will of a young 
lady of her age, simple and unsophisti- 
cated, could not simulate epilepsy, hence 
I dwell upon the fact of the diseased will. 
A young man about twenty-two is the 
spoiled child of three maiden aunts who 
have accumulated a competent fortune 
and do not deny him anything he de- 
mands. They are advanced in years* liv- 
ing in nice, comfortable surroundings, 
and he is the apple of their eye. Sub- 
consciously, or otherwise, he realizes this 
and acts accordingly. His hours and 
habits are bad and he becomes quite im- 
perious in his requirements. A family 
council is held and he is refused certain 
25 further demands which he thinks he 
ought to obtain. He stays in bed and eats 
little, and claims that he sleeps not at 
all. Suddenly he is unable to move his 
right arm or leg, speaks with hesitancy, 
and very little at all. The aunts have at 
least half a dozen gentlemen of our pro- 
fession come to see him. One night I was 
called suddenly out of bed (they lived not 
far from my house) with the alarm that 
the darling was dying, and I found him 
with those symptoms just alluded to, but 
very pronounced. The old ladies, all three, 
were around his bed and expected his 
death. He tried a little crude effort at 
convulsion shortly after I had seen him 
and refused to make any replies to ques- 
tions which I asked. He had not taken 
any drink or other stimulant for at least 
forty-eight hours. Before that they half 
fed him on wines generously. I requested 
the old ladies to leave the room and let 
me alone with the patient for a while. I 
then talked to him in great earnestness 
and told him that I understood his posi- 
tion thoroughly and that if he did not get 
out of bed I should see that the police 
compelled him to do so; among other 
things I told him that if he did not do 
26 exactly what I wanted him to do, I should 
have him committed to an insane asylum 
and hold him there until he got very sick 
of it. He seemed a little stirred up at this 
announcement and manifested a slight 
inclination to answer questions. I real- 
ized then that it was all simulation, or 
Hyperthelesia. There was one peculiar 
symptom which he maintained during all 
the time of our conversation, that was a 
rigid extension of his right hand outside 
the side of the bed as far as he could ex- 
tend it. I peremptorily told him to look 
at a certain figure of one of his ancestors 
towards which his face was turned. 
I asked him who the individual was that 
I pointed at, and then told him he must 
point his own finger at this figure so that 
there would be no mistake about the loca- 
tion. He did not do so immediately but 
I pricked him a little bit with a hypoder- 
mic needle in the refractory arm- and he 
then pointed to it quite steadily. After a 
few minutes I said, “as well as you have 
done that, so well can you walk. Your 
aunts are broken-hearted about your con- 
dition and it would be a great pleasure to 
them, and to me, if you would just sit up 
on the side of the bed. He did so almost 
27 immediately and then, following it up 
without giving him much time to reflect, I 
ordered him to stand up and when stand- 
ing I told him to take two or three steps 
across the room, which he did almost in 
absolute fear of refusing any request. I 
walked him around the room several 
times and then while he was in the act of 
walking brought in these three old ladies. 
They were terrified to death to see how 
active he was on his feet. When they ap- 
peared, he immediately laid down as 
though he were very much exhausted and 
gave them the idea that I had treated him 
very roughly. The result was that some 
credence being given to his assertions, the 
old ladies were very indignant toward me. 
I left the house accordingly and told them 
to obtain the advice and opinion of some- 
body else. Next day they realized that 
they had made a mistake, requested- me 
very humble to come and take charge of 
the young man. I felt it a duty to do so, 
because I hold that personalities should 
not enter into the discharge of such duty. 
I denied this young man all spirituous 
drinks and liquors. Otherwise ordered 
him to be very well maintained and sus- 
tained and with the aid of some nerve 
28 tonics had the great pleasure of seeing 
him a very creditable member of the 
community a short time after. The Hy- 
perthelesia here was manifested generally 
in his power of self-denial, but most par- 
ticularly by the manner in which he had 
held the muscles on the right side of the 
body for such a long time. A normal will 
would scarcely be capable of such a sus- 
tained effort, especially in one so feebJe 
physically. 
A lady of middle age, well born and 
well bred, suddenly looms up in San Fran- 
cisco* in a very dilapidated financial con- 
dition. She had an unusually attractive 
personality and a splendid capacity to 
write really brilliant letters both in pen- 
manship and diction. She is living in a 
very poor neighborhood and in a very 
poor way. She writes letters of the most 
appealing and powerful character from 
her room. A fine healthy girl of about 
twelve and a handsome boy of about ten, 
are her children. She evidently discovers 
the most benevolent ladies of the city, and 
she selects them in groups, and in her ap- 
pealing letters she succeeds admirably in 
luring their benevolence to her chamber. I 
happened to know many of the ladies and 
29 at their request I visited her. Her sur- 
roundings were quite appalling, consider- 
ing that she moved in the very highest 
circles in her early days. She easily play- 
ed upon my sympathies. I tried to do 
something for her children, but they did 
not seem inclined to leave her, and the 
result was that through a woman who liv- 
ed in her immediate proximity I discov- 
ered that she was an imposter. She con- 
tinued her industry for some months, but 
after having failed in one direction and 
another to acquire any more of the lux- 
uries that she needed, in the way of wines 
and liquors, she suddenly turned around 
and educated this boy, who was then 
about ten years old, to simulate epilepsy 
in the streets. The lad selected as the 
place for his efforts, always a position 
where a group of well-dressed men were 
standing on some of the principal streets. 
I saw him myself once or twice and the 
imitation of an epileptic spasm was so 
perfect that I thought it was genuine un- 
til by slow degrees I discovered the con- 
trary. He always obtained quite a little 
sum of money, as on recovery from the 
simulated seizure he excited the greatest 
commiseration and has learned how to ap- 
30 peal to the bystanders as regards his pov- 
erty and the condition of his family. By 
degrees he grew so accustomed to this 
habit of simulation that he actually did 
get epileptic seizures which he could not 
control and wound up his latter days in a 
public institution. 
I give this as an illustration of what I 
insist upon in all these cases, that the mor- 
bid will does produce a morbid or path- 
ological condition of the body. It would 
be difficult to find a more pronounced il- 
lustration of Hyperthelesia than this one 
particular case. 
A young lady, a doctor’s wife, is in- 
formed by her husband that she has tu- 
berculosis of the kidneys and must die of 
it in a very short time. This gentleman, 
it appears, was enamoured of another 
woman and was very desirous of getting 
rid of the woman to whom he was mar- 
ried, There was no doubt of this fact, as 
it was developed fully afterwards. But 
the question of tuberculosis of the kid- 
neys was closely investigated and though 
she had no tubercles, she had nephritis 
of an acute character, and was danger- 
ously ill with it. By my advice she was 
taken to her father’s house away from the 
31 influence of her husband, who had almost 
daily consultations on her case with some 
old friends, men of good repute but too 
facile in agreeing to the husband’s opin- 
ions and surmises. After the removal to 
her father’s house she was placed in 
charge of an excellent nurse, with injunc- 
tions to the nurse to allow nobody into her 
room but her mother, the nurse, and the 
doctor. The doctor was a gentleman of 
strong personality and consummate abil- 
ity. After a while there was no apparent 
improvement in the condition of the kid- 
neys. She suffered very much from in- 
somnia and constantly rejected her food. 
At this time I was called in consultation 
by the mother and suggested that she 
should sit up in a bright, sunny room for 
a portion of each day and also that she 
must not regard herself any longer an 
invalid. She was informed that all the 
secretion of albumen had passed away 
from her kidneys, (though it had not all 
disappeared), and she must regard her- 
self as on the high road to health very 
rapidly. At first she rebelled against this 
regime, claiming that she was in a very 
bad way and suffered greatly from back- 
ache. She was induced by the nurse, who 
32 was clever, to take everything that the 
family had taken at the regular meal 
hours. This she did and by degrees, in a 
very short time the albumen did actually 
pass away and she became quite a robust, 
healthy woman. 
I knew this young woman prior to her 
marriage and she was a bright, cheerful, 
happy girl. She seemed to be unusually 
healthy, had a fine, florid complexion. 
When I saw her in consultation all this 
was entirely changed. She looked very 
palid, though not emaciated, and very de- 
pressed in spirits. I concluded and my 
associate in the case also concluded that 
the mental agony to which she had been 
subjected by the unwarrantable conduct 
of her husband, led to her anemic condi- 
tion, and this anemia grew to such an ex- 
tent that albumen found its way through 
the kidneys. After the success of the 
change, she lived no more with this gen- 
tleman, became quite a prominent social 
figure, and enjoyed perfect health whilst 
here in California. I think there is no 
question that the evil suggestion led to the 
degeneracy, and that the removal of the 
suggestion led to the happy recovery. 
A young boy> age about fifteen, a scion 
33 of a member of a wealthy wholesale firm 
of merchandise, becomes sick. A physi- 
cian is called to see him, who discovers 
that he has pronounced heart disease. The 
boy and the family get very much alarmed 
at this discovery and after a little while 
he is very indifferent in his attention to 
his ordinary avocation. 
His grandfather, quite a clever, shrewd, 
intelligent man is one of the firm and dur- 
ing the hours that he is at the store he 
observes the boy pretty closely. Not very 
long after the doctor made his pronounce- 
ment of heart disease, the boy went 
through what was regarded as an epilep- 
tic seizure at least once a day at pretty 
much the same hour, in one of the lofts of 
the store. He never was seized with any- 
thing of the kind at his home, evening or 
morning. His home was not very far 
from mine and though I had attended 
members of his family from time to time, 
he evinced strong antipathy to any con- 
sultations with me. At length he was 
obliged, and consented, to subject himself 
to my examination. I discovered that he 
had no form of heart disease and I had a 
very strong suspicion that this epilepti- 
form seizure which he underwent every 
34 day was assumed. I told the grandfather 
(the father was very weak and unrea- 
sonable—fathers don’t like to think their 
children deceitful) my surmises and I re- 
quested him to make a note of the boy’s 
mental condition in the spasm, that is, to 
ascertain whether he recognized what 
was passing around him or not at the 
time. The grandfather did so and in- 
formed me that in his opinion the boy 
knew quite well what was transpiring 
around him at the time of spasm. After 
this I told the father he must let me take 
him from home and place him in a special 
hospital and allow me alone to handle his 
case, for two or three months. The father 
at this time was preparing to go to New 
York and possibly thence to Europe and I 
told him accordingly that it probably 
would be well for him to take the boy 
along, and I also gave him the name of 
one gentleman in New York* the late Dr. 
Spitzka, and to place him under his care. 
He did not do so. He had heard of some 
wonderful “fit” doctor in New York, 
whom I had never heard of, and after 
about two months sojourn there, no im- 
provement was perceptible in the boy. He 
then took him to London and there no 
35 benefit resulted. If anything the spasms 
became more frequent. From thence he 
proceeded to Berlin as he himself was a 
German, and placed the boy under one of 
the Berlin professors whose name I do not 
recall. I received a letter one day from a 
sister who accompanied them, saying that 
her brother was no better, and Professor 
So-and-So wanted particularly to know 
from me the name of the disease for 
which I treated her brother. I wrote on a 
card “Hysteria” or Hyperthelesia, a better 
name. Shortly after the boy commenced 
to make rapid strides towards recovery 
and returned home in about two months 
perfectly free from his convulsions. Here 
was a lazy, indolent youth, of not much 
power of mental or physical effort, who 
went through this abnormal strain every 
two or three days for the better part of a 
year without any apparent exhaustion. 
A lady of middle age, a polished, re- 
fined woman- three engaging children 
from fifteen to twenty years, has been sick 
off and on for the past few years and ut- 
terly unable to speak. One night after 
dinner she is seized with a violent convul- 
sion, according to her husband, who is an 
intelligent man. In consequence of this 
36 I am called in to see her. She rested 
quietly that night under the influence of a 
narcotic, and the following morning when 
I called, in my presence she acquires a 
violent spasm of the body. At this time I 
learned that she had not spoken for elev- 
en years, and that, eleven years ago, 
while talking to her husband, in her bed- 
room, she suddenly had her first spasm. It 
evidently was in no wise connected with 
her brain, though she had been told elev- 
en years previously that it was a hem- 
orrhage in the brain that caused the 
spasm, and that she would never recover 
completely, and especially would not be 
able to speak after it. This the doctor 
told the husband in her presence and she 
kept the pact. As I saw the form the 
spasm took, I was able to assure her hus- 
band that the brain had nothing what- 
ever to do with it and that it was, in 
my judgment, a form of convulsion 
which would be easily cured. I also 
told him that if permitted to have the 
services of a competent nurse with her I 
believed she would very soon be able to 
speak. I felt confident I had to deal with 
my familiar friend, Hyperthelesia. I 
never before or since saw—not even in 
37 Epilepsy,—such a peculiar contortion of 
the whole muscular system as she in- 
dulged in. It is no exaggeration to say 
that she could twist her head to such a 
degree that her face looked straight back 
of her. The nurse was obtained; I in- 
structed her what to do. This patient was 
quite musical; the nurse, a very culti- 
vated Irish woman, was also well trained 
in music. The patient took music and 
singing lessons from the nurse at my sug- 
gestion, and commenced at the foot of the 
ladder. In a very short time, not more 
than a month, this course was pursued 
and the nurse told me one day in the pa- 
tient’s presence that she (the patient) 
could speak just as well as she (the 
nurse) could if she wanted to. I then 
pointed out to her what a crime it was that 
she should not converse with her loving 
husband and children when she was capa- 
ble of doing it, and they so longed for it, 
and after a little effort in this direction 
and some interrogatories leading up to it, 
she blurted out as plainly as a refined 
woman could, “I assure you my mother 
was a perfect lady.” That broke the spell 
and afterward she talked quite freely. 
I lost sight of this patient some time 
38 afterward, but I learned that she finished 
her career, unfortunately, in an insane 
asylum, and that her husband also had be- 
come afflicted. This might be expected 
from the history of the whole matter. 
A young woman whose husband is 
quite wealthy has completed a beautiful 
new house in one of our most select ave- 
nues. She is fond of entertaining and has 
a multitude of friends. Suddenly she be- 
comes quite ill according to reports; her 
husband and friends abandon all hope of 
her recovery. She is confined to bed for 
about two years and in that time has had 
at least twenty different medical attend- 
ants at various periods. Her husband one 
day called on me> and went at length over 
all her varied symptoms. After some con- 
ference with his friends the lady was 
placed under my care. When I first saw 
her she had four nurses in attendance, 
two night and two day nurses. She had a 
whole coterie of half friends and half de- 
pendants constantly visiting her. After a 
few visits I learned and saw that at noon 
every day she acted as though she was in 
the pangs of parturition. I observed many 
things about her general constitution very 
unsatisfactory, such as occasional vomit- 
39 ing of her food, very frequent micturition 
and a great deal of insomnia. After a few 
days further observation I informed the 
husband that three of the nurses must be 
dispensed with, and that one young lady 
who impressed me as being the proper at- 
tendant for her, alone should have charge 
of her. I also told him that this stream of 
friends and sympathizers and sycophants 
must be stopped, in other words, I told 
him that she must have no person visiting 
her but the nurse in attendance and my- 
self and himself occasionally. This was 
all done under more or less protest from 
her, and a little from him. This perform- 
ance of going through the pangs of labor 
was continued but had not grown any 
worse and the absence of “loving friends,, 
seemed to have a good effect upon her. 
Shortly after this I told the husband he 
must send up a carriage to the house the 
following day at noon, the time when we 
had the would-be tearful tragedy every 
day. The carriage arrived while I was in 
her bedroom and without giving her any 
time for reflection I told her she must get 
up and get ready for a carriage drive that 
day. It happened to be a very beautiful 
day and everything favorable. She in- 
40 sisted that she could not walk and there- 
fore could not go down stairs. I told her 
that was a facile matter to overcome; we 
could take her down stairs if necessary, 
but I felt assured that she could walk. We 
reached the street after very little effort. 
She would go for a drive if I went with 
her. I readily consented. We passed by 
a Catholic Church shortly afterward, (she 
was non-Catholic) the Angelus bells 
rang; she seemed to know intuitively the 
hour for the “performance” and on the 
carriage seat she made a grimance and 
apparently strained as she had been ac- 
customed to do. By a preconcerted ad- 
monition and arrangement the nurse 
laughed at the performance, I tried to 
conceal my emotions, but she herself very 
soon gave way to a genuine paroxysm of 
laughter. This spell was broken, and she 
became perfectly well. She shortly after 
went for a trip to Europe with her hus- 
band, and has been for years a prominent 
social figure. 
A young lady joins a religious order 
wherein there is no seclusion. The mem- 
bers go out to do very useful work, such 
as visiting the sick, poor, and in her avo- 
cation is quite free from any of the brood- 
41 ing propensities and imagining to which 
seclusion might lead. She suddenly con- 
ceives the idea that she must be singularly 
blessed and so develops some marking of 
the crown of thorns and the nails that 
were prominent in the crucifixion. One 
worthy clergyman who took great interest 
in the matter, tried in every possible way 
to ascertain from the doctor of her com- 
munity whether these markings were in 
any way fraudulent or unnatural. The 
doctor, a poor ignorant sycophant, pro- 
claimed the affair as miraculous and con- 
tinued to so assert from time to time* until 
the whole condition and circumstances 
got into the local Press. Investigations 
were then made, and outside physicians 
were brought in consultation, among 
whom I was not, and nearly all those pro- 
claimed the affair as very mysterious to 
say the least of it, and could not explain it. 
Fresh bleedings occurred always on Fri- 
day night. Some Catholic ladies who were 
clients of mine, asked my opinion from 
time to time about it, and I told them that 
it may be possibly some form of Hyper- 
thelesia. Cases of a similar nature were 
known and reported, I assured them, 
where people of their own volition, suf- 
42 fering in this direction could bleed from 
any given part of the body where it was 
demanded. A number of such had been 
reported in Medical Journals. I had mani- 
festly offended them because I did not 
accept the miraculous theory about the 
matter and hence I had nothing further 
to do with it than being an ordinary ob- 
server of what was transpiring in the pa- 
pers from day to day. An associate 
clergyman of the one most concerned, 
called to see me relative to the case and I 
gave him some review which had then 
been published citing some extraordinary 
cases where abnormal will-power pro- 
duced unlooked for results. The cele- 
brated case of Louise Lateau of Belgium 
was cited and reviewed extensively, and 
other collateral cases, the result of all 
which was, that this gentleman after hav- 
ing read them over carefully, reported 
back to me that he personally was quite 
satisfied and wished his bishop were here 
to govern the whole subject. The Bishop 
was absent in Europe. To be brief* at this 
time she was placed under the observation 
of another religious order, whose chief 
was a clever, cultivated woman. It did 
not take her very long to discover that the 
43 young lady, in the crudest possible way, 
produced the bleeding by the use of com- 
mon pins, and so the bubble was burst. 
This young lady came from Liverpool and 
was here some years before she joined 
this religious order. As a consequence of 
her conduct she was, of course, expelled 
from the order which she had joined. 
These few cases are culled from many 
hundred because they sufficienty illus- 
trate in a marked manner how varied are 
the manifestations of this peculiar mal- 
ady. You will observe that it is not lim- 
ited to any age or sex, as I stated at the 
outset. Surmises, nothing more, are fre- 
quently put forward to denote the type of 
constitution of the individual susceptible 
to this class of disease, that is to say, the 
constitution that begets Hyperthelesia 
and allied troubles. From a protracted 
study of these maladies I am unable to 
point to any form of constitution specially 
indicative of them, further than to say 
that the male who is the subject of Hy- 
perthelesia is generally of a somewhat ef- 
feminate appearance and character. 
A recent Irish poet has put this marvel- 
ous power of the will, in beautiful blank 
verse rather tersely* when he says: 
44 What a mild wonder is a woman’s will, 
Impulse commands it, hope and faith and 
love, 
But justice never, truth and justice never: 
Who would control it would make fast the 
sun and whirling earth, 
And pluck the arrow from the lighten- 
ing’s shaft. 
All writers agree that subjects of this 
malady are capable of simulating all the 
bodily ills from which we suffer, and from 
my own observation I do not think there 
is much question of this fact. I have seen 
frail, feeble women when thus afflicted, 
stand on one toe much longer than the 
most renowned danseuse of the stage 
could ever do. 
45 CHAPTER 2 
Hypothelesia, or Neurasthenia, which 
was formerly named Hypochondria, is a 
very much more general complaint than 
Hyperthelesia. 
In point of fact, it is a very common 
complaint and very easily produced by 
evil suggestion or by nervous shock of 
any kind, protracted or sudden. 
Some writers claim that it is confined 
in both sexes to the period around 
adolescence or puberty. My own observa- 
tion does not agree with this view by any 
means. 
Ladies of mature years, when told by 
some medical man that some of their 
organs are out of order may start brood- 
ing over it, thus their nerves becoming 
affected and very often they imagine that 
they have some form of heart disease. 
Palpitation around the heart, or some 
throbbing of the Solar Plexus in the 
heart region is one of the commonest 
signs of Neurasthenia, and marked cold 
46 and clammy extremities always denote it 
strongly. 
Neurasthenics almost incessantly con- 
sult medical men and the slightest word 
touching any disease, conveyed to them, 
immediately gives them the impression 
that they have that particular disease. 
I think it may be fairly said that half 
the operations demanded for abdominal 
incision are due to Hypothelesia and I 
also believe that from these suggestions 
and constant dwelling upon them, certain 
organs of the abdomen absolutely do 
acquire pathological conditions. There 
is a vicious habit that prevails among the 
female portion of the community of tell- 
ing each other of the wonderful opera- 
tions they have undergone, and if not 
undergone by themselves, of talking 
freely touching some operations done 
upon some friend of theirs “ in the hos- 
pital.” It seems to be a source of pleas- 
ure to them to relate minute details of 
these subjects of which they know noth- 
ing. It is not a very difficult problem to 
understand then that, say one-tenth of 
those who hear these wonderful tales 
immediately seek relief because they 
think they have something of that nature. 
47 Recent writers seem to think that Hy- 
pothelesia is entirely hereditary, and like 
Hyperthelesia, a disease of adolescence, 
and juvenile periods of life. My obser- 
vation has not been in accord with this 
view. Those cases of hypothelesia that 
I have met, were for the most part among 
people of mature years and of rather 
strong and energetic mentality. 
In a case which came into court, I tes- 
tified that the party was not in a condi- 
tion of mind to sign any documents re- 
lating to business because he would not 
take the trouble to investigate anything 
of the kind. This is a marked charac- 
teristic of Hypothelesia. The documents 
of co-partnership and all other matters 
incidental thereto were very long and 
tedious reading accompanied with the 
usual circumlocution of legal lore, and 
while I could not claim that he was in- 
sane, when I saw him, I testified that he 
was not fit to sign any documents which 
required any protracted effort. Where 
Hypothelesia terminates and Melancholia 
begins is very difficult of distinction, and 
while Melancholia is unquestionably in- 
sanity, Hypothelesia is emphatically not 
insanity. We do not make the laws, but 
48 I am of the opinion that the law makers 
should take cognizance of those condi- 
tions and appoint a commission to inves- 
tigate any important cases. 
One of the worst Hypothelesics I have 
ever known was a gentleman of consum- 
mate learning, great mental grasp, fine 
physical constitution, and great execu- 
tive ability. His life was exemplary as a 
high order of clergyman. He had at- 
tended to a great many things, and he 
had always pursued the details of any- 
thing he was engaged in, with great min- 
uteness. His advice was very much 
sought about ordinary transactions, and 
every now and then for a period of 
twenty years he would become Hypothe- 
lesic. I have been more than once 
called in a hurry to his residence where 
he was declared by his people to be dy- 
ing. He would lay prostrate on a lounge, 
claiming that he could not move arm or 
leg, that he had some trouble which, as 
he apprehended, 'caused a paralytic 
stroke. He was always oppressed by the 
idea that his heart or brain would sud- 
denly give way. After a little assurance 
on my part, and a little adroit moving, 
he would get up and walk around the 
49 room, and shortly after take a substantial 
meal. Like all people afflicted in this 
way, though he (had unbounded confi- 
dence in me, he would often seek the 
advice of some “phenomenal” doctor, 
whom he had heard of, and whatever 
the last doctor had said of an evil nature, 
invariably dwelt uppermost in his mind. 
During those twenty years he had two 
apprehensions that scarcely ever left 
him—that he had heart disease or was 
threatened with apoplexy. Both of those 
came to him undoubtedly from prior sug- 
gestions. He was about seventy years old 
when I last attended him. A short while 
prior to this attention, through some in- 
fluential friend he brought in a strange 
doctor who had performed wonderful 
feats, and this gentleman brought a 
friend of his in consultation. Both of 
them, especially the consultant, gave him 
to understand that he had some form of 
heart disease. This coincided decidedly 
with his prior apprehension and he be- 
came very much disturbed. After this I 
was recalled to see him. I discovered no 
heart disease or threatening of it, and 
advised him to take a trip to Europe 
which on several previous occasions had 
50 restored him to perfect equilibrium. He 
had heard of Nauheim and stayed there 
for a little while. He there met an 
English physician who advised him not 
to remain at Nauheim, but consult a heart 
specialist at Heidelberg. This latter 
gentleman examined him very carefully 
for a period of two weeks, day after 
day, and told him he could not detect 
any heart disease. He then sent him to a 
high Altitude in the Alps, telling him to 
stay there two weeks and then come 
back to see him on his return. He did 
so, was again repeatedly examined and 
assured that he had not yet been able to 
detect any form of heart affection. After 
this he sent him to a higher altitude in 
the Alps and told him to stay there a 
month. This he did, and on his return 
to Heidelberg was again very thoroughly 
and carefully examined, with the result 
that nothing was discovered, and he was 
also assured that he could now return to 
his home without any fear of danger. On 
his arrival home he sent for me and 
told me very minutely all that had 
transpired. Of course this restored his 
confidence, and it pointed out to me 
that the professor at Heidelberg was a 
51 man of consummate ability in dealing 
with people of this character. The de- 
lays and careful examinations, 'the in- 
tervals and the high altitudes all went to 
impress the patient with the fact that 
everything was thoroughly done and it 
was entirely satisfactory to him. There 
was no time during my acquaintance with 
him and attendance upon him that his 
intellect was not as unclouded as any 
able, scholarly man ever had been. He 
had realy a magnificent mind, stored 
with knowledge of a very varied and 
useful kind, and carried on his shoulders 
great responsibilities from the time he 
was a young man. He was a remarkably 
capable executor of all those responsibil- 
ities and the attention to their details 
seemed to exercise his intellect !to his 
complete satisfaction, but small side is- 
sues, attention to which his position de- 
manded, very soon depressed him, and 
the only thing that relieved him was 
travel. 
Cases of Hyperthelesia and Hypothe- 
lesia, run in some cases very close to 
insanity, in others they are widely apart, 
but the main difference is that Hypothe- 
lesia is more frequently associated with 
52 high endeavor, and more intellectual 
powers. It is well to remember that in 
some cases both come very close to the 
insanity line and in consequence very 
often lead to insanity. One develops 
into the excited or hysterical form of in- 
sanity, as it is called, and the other into 
Melancholia. In consequence of these 
tendencies the patients have to be care- 
fully guarded and if a firm hand is not 
laid on them they terminate in disaster. 
It is a remarkable fact that when you see 
a patient in a hospital jump out of a 
window, or fall down an elevator shaft, 
or who has tied a rope around a bed- 
stead and so perished, you will commonly 
find that while it is in itself, at this 
stage a strong evidence lof insanity, a 
prior history of the cases will show that 
there had been previously a very marked 
evidence of one or other of those condi- 
tions that I allude to. 
I now pass to the insanities proper, so 
to speak, and I will seek as far as I can 
to classify them in some intelligible form 
so that their study will be more easily 
followed. As I have said at the outset, 
the question of insanity to most educated 
and professional men, not excepting 
53 doctors, is a very imperfect and cha- 
otic idea, and I think that writers on 
the subject are largely responsible for 
this situation, because no two of them 
agree upon any classification; nearly all 
seek to draw too fine distinctions, which 
fact in itself leads to great confusion of 
thought. 
I have lately been reading some publi- 
cations on this subject and I am free to 
confess that I am amazed at the appar- 
ent effort to string out a lot of meaning- 
less words and classifications that really 
produce no picture in the mind. For in- 
stance, one writer states, “These disor- 
ders may manifest themselves in the 
form of abnormal fears, chronic indeci- 
sion, deficient control of impulses, or 
deficient will. To this group the term 
“neurasthenic insanities” was long ago 
applied by French writers. The term 
“neurasthenic-neuropathic” is more ex- 
pressive, though perhaps a little awk- 
ward.” Then again there is discrimina- 
tion sought to be made between this term 
and the “psychastenias,” and so the 
jumble runs along, and of course the 
user of all this meaningless rubbish is 
regarded as very learned, whereas to one 
54 who understands both the meaning of the 
words and the general trend of those dis- 
eases these terms are simply used as a 
cloak for ignorance. Just think of this. 
The insanities according to this writer 
should be divided into the following: 
1. Delirium, Confusion, Stupor. 
2. Melancholia, Mania, Circular In- 
sanity (Melancholia-mania, Manic-de- 
pressive insanity). 
3. The Heboid-paranoid Group (De- 
mentia Praecox, Paranoia). 
4. The Neurasthenic-neuropathic In- 
sanities (Psychasthenias). 
5. The Dementias. 
This is certainly an illuminating picture 
of this branch of medicine. In point of 
fact so illuminating that it dazzles the 
understanding, and like what happens to 
those who gaze too long at the sun, noth- 
ing is left but an undefined void. 
To classify insanity in a judicious form 
so as to make a perfect picture in minds 
of different shades is difficult, but not 
more so than in other diseases. It is very 
rare that any disease is quite unaccom- 
panied by some other, and frequently, 
in accordance with the temperament of 
the individual the one which is most im- 
55 portant may be the one to which most 
attention is devoted. To my mind the 
same thing applies to insanity distinc- 
tions. As I have said, with regard to 
Hypothelesia, and Hyperthelesia, one 
form runs so closely into another that it 
is sometimes impossible to discriminate 
between them, but fortunately it is not so 
very important. 
My own classification of insanities, will 
be sufficient, in my opinion, to formulate 
useful distinctions. The word “insanity” 
in itself obviously covers the whole 
ground, because as you know, it is prac- 
tically a Latin word, which in English 
might be translated into “unsoundness;” 
but usage has made it, as we know, the 
term applied to unsoundness of mind. 
There are many other terms used but I 
think none of them are as plain and 
clear and simple as the term “insanity.” 
The classification that I make is this: 
Idiocy. 
Imbecility. 
Epileptiform Insanity. 
Acute 
Mania: 
Chronic 
56 Dementia. 
Melancholia. 
General Paralysis. 
Delusional Insanity. 
Though this classification is by no 
means complete it is quite enough to 
guide us in the study of the matter. All 
pretentious terms that are heralded by 
writers serve no purpose that cannot be 
reached in this simple classification. It 
is a very common thing for physicians to 
get on the stand when testifying on this 
subject and state under oath that every- 
body, including themselves, is more or 
less insane. This form of opinion is of 
no value whatever, and such people ex- 
clude themselves as witnesses. 
The lines between sanity and insanity 
are difficult, if not sometimes impossible 
to draw, but in general, and to the expert 
the lines are quite clear. It is no uncom- 
mon thing to see in books pictures of the 
various faces and craniums that indicate 
the different forms of insanity. There is 
no merit in that. Sometimes an idiot has 
a fine head. Sometimes an imbecile has 
a good strong face. But the expression is 
lacking. It is a customaiy thing to paint 
57 an imbecile as one with distorted features 
and small head, etc., but the number of 
exceptions to this rule point to the con- 
trary and make the rule of no practical 
value. Other portions of the body almost 
as much as the head indicate defects of 
the imbecile. For instance, the limbs 
are scarcely ever well-formed. Locomo- 
tion is very defective as a rule, owing to 
the undeveloped muscles of that portion 
of the body, and the prehensile power of 
the hands is commonly defective also. 
There is admost invariably a marked dif- 
ference as to the power of the two sides 
of the body. Speech is commonly some- 
what defective. Hearing and sight not 
so much but they also suffer betimes. The 
animal propensities are largely in the as- 
cendant, or entirely obliterated. The 
habits of the individual very soon indi- 
cate this. All are very irregular appar- 
ently, the subject not having the proper 
control. This would appear to apply to 
almost every function of the body. Blank 
features show almost invariably an ab- 
sence of mental effort. It may be said 
however, as a rule that the heads of im- 
beciles and idiots are rather small and 
irregular in shape compared with the 
58 normal cranium of an individual of the 
same weight. These two classes of in- 
sanity, idiocy and imbecility, run so 
closely one into another that it is scarcely 
worth the effort to seek to discriminate 
between them. Idiocy is defined by some 
writers as an absence of mind, while im- 
becility as an undeveloped mind. You 
will see how crude this discrimination is 
because if one is born without a mind 
and another has an undeveloped one, 
where is the difference? The fact is that 
in both cases there is quite a marked de- 
fect of mind at the outset, or may be ac- 
quired later in life through injury. It is 
simply a question of degree, and a ques- 
tion of the temperament of the medical 
observer whether he shall call one idiocy 
and the other imbecility or not. I think 
if half a dozen of our medical experts 
were to visit the ordinary home for feeble 
minded children, no two of them would 
select the s&me classification, would 
make the same groupings, as between im- 
becile and idiots. Therefore it is a very 
unreasonable effort to spend time over 
these minute differences. 
There is one thing that the law ought 
to take cognizance of, and undoubtedly it 
59 will come to it sometime; that whatever 
category we place them in, whether it be 
imbecility or idiocy, once the line is thor- 
oughly drawn in this direction it would 
be certainly not immoral or in any way 
cruel to unsex the individuals so afflicted, 
because the unfortunate fact remains 
that the sex passions are very often pre- 
dominant in those cases. While the use- 
ful arts of various kinds may be taught 
them and they may undoubtedly in many 
cases be able to be made proficient in the 
economic sense, the sex appetites being 
abnormal is a strong deterrent to their 
utilization in this direction. This is, 
however, a question for legislative bod- 
ies, and I simply refer to it as one of the 
things within our scope of observation. 
I hardly think it worth while to devote 
much attention to these two forms of in- 
sanity because sufferers from them are 
generally sent to homes for their protec- 
tion at an early age, and physicians, 
nurses, and lawyers have very little inter- 
communication with them afterwards, 
except those in immediate charge of 
them. Of course cases arise now and 
then where some crime is committed by 
one or the other of these people for 
60 which they are totally irresponsible, or 
some estate may be involved in their 
condition. 
The second class of insanity to which 
I call your attention is Epileptiform In- 
sanity, and it is a very important one 
because the individual apparently is 
quite capable of attending to all the or- 
dinary business of life, whether it be 
mercantile, mechanical or professional, 
and suddenly at some interval, greater or 
less, the Epileptiform seizure comes on 
and unfortunately very frequently takes 
the shape of homicidal or suicidal mania. 
There are very many instances recorded 
of this nature wherein during an attack 
a murder was committed in which the 
individual was perfectly unconscious of 
what had happened. A striking illus- 
tration of this occured in the case of 
two mechanics in England. They were 
both friends and had worked together 
a great deal. Work grew slack in their 
particular location and they went to seek 
work elsewhere. They slept in the open 
air one night during the journey and one 
was found dead in the morning by the 
roadside with skull crushed and evidence 
of his being very brutally murdered. His 
61 partner, as we will call him, was imme- 
diately accused. He denied strongly that 
he had anything to do with it and felt 
very bitterly the death of his friend. His 
protests were unheeded and he was tried 
and found guilty of murder in the first 
degree. Execution was stayed for some 
time whilst a thorough investigation was 
made by the commissioners of insanity, 
the only people who are allowed in Eng- 
land, to investigate such cases judicially. 
After about three months investigation 
they saw nothing to interfere with the 
course of justice, but suddenly at that 
time, the man was observed to go 
through a somewhat similar proceed- 
ing as that which happened on the high- 
way. Execution then was postponed in- 
definitely and the unfortunate was placed 
in a criminal asylum for the insane 
where he was to remain until the close 
of his life. 
This is a very pointed illustration of 
this particular form of insanity and of 
course in its way uncommon, but the 
malady itself, in various forms, is much 
more prevalent than the profession of 
medicine in general has any idea of. The 
French took great pains to elucidate this 
62 disease of epilepsy. The ordinary physi- 
cal manifestations of epilepsy are quite 
plain and most people, even outside the 
medical profession, are familiar with 
them. It is no uncommon thing to hear 
people speak of others as having “fits,” 
and they mean by that generally, that the 
individual is subject to epileptic seizures. 
Hughlings Jackson has probably devoted 
more attention to this disease than any of 
our recent writers, and he sought very 
elaborately to connect it with some local 
brain lesions. I do not think that his 
success was as great as he anticipated, 
yet every little step in the elucidation of 
disease is important. The French long 
since divided the physical manifestations 
of epilepsy and the mental manifestations 
into “grand mal” and “petit mal.” That 
accompanied by physical manifestations 
they called “grand mal,” and that ac- 
companied by mental manifestations they 
called “petit mal.” In all relations of 
life it is quite manifest that the terms 
should be reversed, and that mental epi- 
lepsy is by far the more important of 
the two, and hence should be called 
“grand mal.” With this slight explana- 
tion it is unnecessary to pursue the defi- 
63 nition any further as we have to deal 
with mental epilepsy alone. There are 
some very curious tales authentically re- 
lated concerning this condition. It has 
been long observed, but it has been more 
or less confused by nomenclature. For 
instance, Abercrombie of Edinburgh who 
was a great observer in his time, relates a 
case of hysteria, as he calls it, as follows: 
A wealthy family in Edinburgh had a 
private tutor for their household. The 
tutor’s functions were exclusively for the 
purpose of teaching the boys Hebrew and 
Greek. Through the school room in 
which they were always instructed, 
frequently passed a tolerably uneducated 
domestic. According to Abercrombie she 
occasionally got “fits” as he thought it, 
of hysteria, and during that paroxysm 
she spoke nothing but Greek and He- 
brew. When she was out of this pa- 
roxysm she could not speak a word of 
Greek or Hebrew, and if a word of either 
language was spoken to her, her mind 
was an utter blank with regard to its 
meaning. In the case of the boy who as- 
sumed spasms in his father’s store, and 
by due process of elimination was discov- 
ered to have Hyperthelesia or Hysteria. 
64 He never once was unconscious of what 
transpired during the paroxysm, and 
therein lies the essential difference be- 
twen Hyperthelesia and Epilepsy. There- 
fore it is a necessary conclusion that the 
young woman whom Abercrombie speaks 
of in the vein of Hysteria, or Hyperthe- 
lesia, was really a subject of Epilepsy. 
The form of it was quite manifest, even 
from its physical appearances as des- 
cribed by Abercrombie. The fundamen- 
tal difference between the two maladies is 
the consciousness or unconsciousness of 
the patient. 
It is a matter ,of common historical 
statement that Julius Caesar, Mahommet, 
and the great Napoleon were all victims 
of this disease. 
From personal observation I have 
known the disease to be developed by the 
excessive use of alcohol, by sexual excess 
and by flagrant abuse of drugs in the 
various forms. The alcoholics I have 
seen most of, and as a general thing 
their malady assumes the physical type. 
I have been frequently surprised at the 
wonderfully beneficial effect produced in 
these people by the simple withdrawal of 
alcohol. The physical form of epilepsy 
65 generally is most prevalent among those 
from ten to thirty years. Whilst the 
mental malady is more an accompani- 
ment of advanced years and more 
frequent among men than women. It 
very often is unnoticed by the family and 
those around the subject, and I am sorry 
to say, quite frequently unobserved by 
the family physician. I have distinctly 
in mind many cases of this nature 
whereof this remark is particularly true. 
Hospitals for the insane are filled with 
people suffering from this form of 
disease and the medical attendants take 
special precautions accordingly, in order 
to guard against consequences at the par- 
ticular period when the attack is expec- 
ted. Some writers name this inter- 
mittent insanity. It is called also by the 
French, “follie circulaire,” but another 
class of the insane more correctly are 
thus described. In my opinion the word 
“epileptiform” is by far better, because 
its manifestations and the patient’s con- 
duct is entirely different during the 
paroxysms from what it is under ordinary 
circumstances. 
I remember a fine athletic young man 
about thirty, of splendid type, apparently 
66 remarkably healthy, and very clever in 
all his actions. He was fond of reading, 
very gentlemanly in his behavior and 
very fond of entertaining any person who 
came around him. He was a highly 
civilized, cultivated young man. He had 
great advantages. He was fond of all 
athletic games and easily excelled in 
most of them. But once every six months 
as regularly as clock-work he would get 
for two or three days violent paroxysms. 
Always seeking to take some 
life, it took two or three men to control 
him at this time. Though he was con- 
fined in an asylum, he would express his 
regrets for his conduct, of which he 
learned afterwards from the attendants, 
like any ordinary gentleman living out in 
the world. 
In epilepsy from liquor it usually as- 
sumes the physical form. Many cases of 
this kind come under the care of most 
practitioners and it is not very difficult of 
detection, but it is commonly regarded as 
more serious than it really is. Accord- 
ing to my observation, when the liquor is 
withheld and strict temperance enforced 
the disease usually disappears without 
much further, if any, effort. I have in 
67 mind a number of such cases, mostly 
occurring in young men who had dissi- 
pated habits. 
It may be laid down in general that 
murders and other crimes committed in 
this stage are accompanied with unusual 
brutality and there is a wonderful same- 
ness about them. 
A young man of rather feeble physique, 
of general good conduct, is duly arraig- 
ned for murder. His age somewhere 
about twenty; his weight not more than 
120 pounds, light hair, small head and ir- 
regular features. Works in a racing sta- 
ble where horses of many owners are sta- 
bled. On one afternoon he and an older 
man were seen together and not far from 
the stable, where bars abounded, and 
were seen to have taken several drinks. 
They were not the employees of the same 
man, but their horses were stabled toge- 
ther. The younger man had been a horse 
jockey, but was obliged to give that up 
from his getting too heavy. One morning 
the elder man was found murdered in one 
of his own stalls not far from the other’s 
horses, and the murder was committed 
in a very brutal manner. He had his skull 
crushed by severe blows from some blunt 
68 instrument, and his body was pierced 
with a hay-fork in different parts. The 
circumstances all pointed to the younger 
man being the murderer. The boy denied 
all knowledge of the crime. He went on 
to assert that the murdered one was his 
very best friend, and that they always 
worked harmoniously together. That 
statement was confirmed by a number of 
people who knew them. One feature in 
the history of the boy had been com- 
pletely overlooked by the prosecuting at- 
torney and the lawyers who defended 
him. According to the sworn testimony 
of his parents and other friends he had 
had “fits,” (that of course meant epilep- 
tic convulsions) for a number of years 
before he had become a horse jockey. He 
got them at irregular intervals according 
to the statement, and did not get them at 
all after he had commenced his career as 
a horse jockey. They affirmed that these 
convulsions occurred at no particular 
time and had no particular period of re- 
currence, but they did, without intend- 
ing to attach much importance to it, as- 
sert that whenever the boy took any form 
of alcoholic beverage he either got some 
convulsion or “he was not himself,” as 
69 they put it. I testified that in my judg- 
ment, all things considered, the boy was 
the subject of epileptiform insanity when 
the crime was committed, and that what 
he swore to himself, about not knowing 
anything concerning the crime was very 
likely to be true. He was acquitted after 
very severe prosecution by the prosecut- 
ing attorney, and soon after some of his 
friends informed me that he had devel- 
oped this homicidal tendency so strongly 
thereafter that his family decided to put 
him in a hospital for the insane. The 
case needs no comment whatever, but it 
is important to bear in mind in matters 
of criminal prosecution when the plea of 
insanity is urged in defence. We are en- 
tirely too prone to pass by unheedingly 
the fact that this terrible disease every 
now and then is the cause of murder, 
and there is one thing that is almost an 
unvarying index of it, as I previously 
stated, and that is that the murder is ac- 
companied by unwonted and revolting 
brutality. 
An authentic case is reported by one of 
our French writers relating to a member 
of the French Academy. A very prom- 
inent man in debates on scientific sub- 
70 jects especially would suddenly leave the 
hall wherein the debates were held. In 
the midst of the debate and while he was 
speaking, he would suddenly leave his 
place and take a stroll around some dis- 
trict in the neighborhood, return and 
again take up the thread of the discourse 
which he had previously engaged in, and 
continue speaking until he had finished 
what he had to say. That is to say, he 
would in the midst of the discourse lay 
aside the thread of it, completely change 
his attitude and conduct, was seen out- 
side, would come back to where he 
dropped off and proceed as if nothing 
had happened, while in fact, he had been 
absent quite a noticeable period of time 
and knew nothing of that absent period 
of his life. 
There are many cases where the pa- 
tient indulges in a very different form of 
conduct from usual, but cannot control it. 
He does most extraordinary things, quite 
different from his general demeanor, real- 
izes afterwards that he was wrong, but 
at the time had no power whatever to 
control the affair. In these cases if any 
crime is committed the plea is usually 
emotional insanity. There is no question 
71 of the existence of emotional insanity, 
but according to my observation it is most 
commonly preceded by some other form 
of insanity. 
I remember very well an uncommonly 
strong, robust young man, who was one 
of several that dined with us every day 
and who demonstrated this emotional in- 
sanity in a very striking form. One eve- 
ning whilst he sat some few seats from 
my left hand, his customary place, I sud- 
denly observed him clutch at his knife 
and fork very formidably and quickly. I 
felt he was probably inclined to some 
mischief, so I just called him by name— 
Alfred!—in a quiet but determined way. 
The calling of his name seemed to rouse 
him from that particular frame of mind 
which he then developed. I told him 
quietly that he had better be careful of 
his conduct, and that was enough to 
compel him to do so. (His face grew 
florid and an expression of deep anger 
and determination showed on it, yet on 
the mention of his name, the knife and 
fork seemed to drop out of his hand). 
After dinner I asked him to come to my 
quarters. He did so, and then I request- 
ed him to tell me what was passing 
72 through his mind at the time he got the 
sudden emotion at the table. I said, 
“what was passing through your mind at 
that time, do you remember?” He said, 
“Yes, very well.” He broke down cry- 
ing, and replied, “I wanted to kill you.” 
He wept like a child and informed me 
that he had no cause whatever to bear 
me any ill will, but on the contrary that 
he loved me very much for the kind- 
nesses I had shown him. “Then,” I said, 
“there was no real motive for your being 
angry with me?” He said, “No, none 
whatever, but the feeling at that time I 
could not control.” 
73 CHAPTER 3 
Epileptiform Insanity approaches more 
nearly Hyperthelesia and Hypothelesia 
than any other form of insanity, and 
therefore it has to be discriminated from 
them when it comes to medico-legal in- 
vestigation. 
The next form of insanity that some- 
what naturally follows and should be 
discussed, is that of Mania, Acute and 
Chronic. This is probably the most pro- 
nounced form of all the insanities to in- 
dividuals who are not acquainted with 
the subject. In the case of Mania, gen- 
erally speaking, “he who runs may 
read.” The wild eye, the disturbed ex- 
pression, the usual exposition of ungov- 
erned and unreasonable conduct. Vio- 
lence, shouting, threatening and all these 
manifestations of erratic behaviour the 
public at once recognizes as the charac- 
teristics of a maniac. It does not always 
follow, however, that the maniac’s con- 
74 duct is so expressive as to be visible to 
everybody. Sometimes they are quite 
sly in the presence of certain people with 
regard to any display of their feelings, 
but commonly the most ordinary ob- 
server can discern that they have to deal 
with a lunatic. It is in consequence of 
what they see, so manifest in this class 
of cases, that most people regard that as 
the only form of insanity, and hence it 
is the form almost invariably assumed 
by criminals. It might be laid down as a 
general proposition that of all the forms 
of insanity with which we have to deal 
it is the most hopeful as regards ultimate 
cure and permanent recovery. The bois- 
terous, noisy, ungovernable maniac is 
commonly a tractable individual when 
closely watched and affords great hope 
of speedy relief. It is often the result of 
certain conditions, injuries, or poisons of 
various kinds from different diseases and 
consequently the successful treatment of 
those diseases leads rapidly to the ame- 
lioration of the patient’s mental condi- 
tion. 
The term “lunacy” has arisen from the 
fact that individuals, especially in this 
class, have alternate periods of iquies- 
75 cence and periods of boisterousness. 
Hence these attacks occurring, but not 
governed in any way by the phases of 
the moon, led to the idea that the moon 
had much to do with this form of disease 
in general. 
Almost all forms of insanity have 
periods of this nature, but the most pro- 
nounced is the maniacal. It also should 
be observed that this intermits. They go 
on for a while perfectly calm and even 
appear to get perfectly well, and sud- 
denly, without being epileptiform in 
character, a period of aggravation oc- 
curs. This may possibly be due to some 
physical, but it is more frequently due to 
mental causes. Some indiscretion, a 
noise, excites the patient and brings 
about the recrudescence of the aggra- 
vated period. It is very easy to under- 
stand this by observing one phase of it 
and that is what is called Puerperal 
Mania. Puerperal Mania is that form 
connected with the after consequences of 
pregnancy. Around about the time of 
parturition the mother gets anxious and 
nervous, possibly due to some defective 
secretion of the kidneys and this nervous 
agitation, in a certain number of all 
76 mothers, leads to insanity for the time, 
which usually is quite curable by attend- 
ing to the physical condition that gener- 
ated it. Sometimes, however, like all 
other diseases that obtain too much 
headway, the insanity becomes more or 
less obstinate and may remain so for 
quite a while, often for such a period 
that the woman has to be sent to a pub- 
lic institution. If there is any manifes- 
tation of this disease around the time of 
parturition, the nurse and physician 
should both be very vigilant and see that 
the patient acquires no harm either by 
suggestion from outside or by some self- 
inflicted trouble. 
In acute mania of this nature there is 
not much probability of the patient 
doing much harm to herself. In other 
words, there is not much danger of sui- 
cide : but, nevertheless, it should be care- 
fully guarded against by every precau- 
tion, such as the removal of sharp in- 
struments, of strings and the securing of 
unbarred windows or doors. I remem- 
ber one case where a very fine woman, 
the mother of two children, was afflicted 
in this way, which came on quite sud- 
denly over night; next morning I asked 
77 her nurse particularly whether she had 
any lack of coherence, or any tendency 
to do anything to herself. I particularly 
notified her to gaurd against any win- 
dows being unbarred, and not to allow 
knives or strings anywhere within reach 
or around the room. I gave her all the 
instructions with regard to precautions 
that should be given. The nurse ob- 
served to me very emphatically that she 
was very quite, very gentle and perfectly 
harmless, and I suppose, therefore, treat- 
ing my instructions rather lightly, the 
nurse left a door leading into a long hall 
open; the patient went into this hall 
while the nurse was off her guard and 
jumped through a window on a third 
floor at the end of it, which led to her 
death very shortly after. 
The disease known as Mania-a-potu is 
different from epileptiform insanity that 
comes from excessive use of alcohol. It 
is simply a mental disturbance which is 
entirely free from the tremor of delirium 
tremens. Some patients instead of de- 
veloping the ordinary delirium tremens 
simply get insane from liquor. I remem- 
ber this peculiarity in a medical gentle- 
man of my acquaintance who was a very 
78 busy man of affairs outside of his profes- 
sion, and was a very bright, well-inform- 
ed man generally. When I saw him the 
first time three of his medical friends 
were around his room trying to persuade 
him that he was not in Washington at all, 
where he insisted he was. I requested 
those gentlemen to let me be alone with 
the patient for a while. When called to 
see him the messengers informed me that 
he was insane, and of course he was. 
When at his bedside I did not endeavor 
to persuade him that he was not in Wash- 
ington—it is always useless to reason 
with an insane patient no matter what 
form of insanity it may be. He recog- 
nized my voice (he had two nurses with 
him) and asked me where I was staying. 
I had not been before that time in Wash- 
ington, so I told him I just arrived and 
that I would like very much to learn from 
him where I should stay. Accordingly he 
told me, and straight away I acquired his 
confidence; before this he was very bois- 
terous and resistant. He then dwelt on 
his physical condition very minutely, and 
recognized that he was quite ill, and suf- 
fering great pain. I then proceeded to 
tell him that I would immediately relieve 
79 him of his pain by the use of a hypoder- 
mic needle. He wanted some leeches 
placed over the pain in his neck, but I 
persuaded him I could relieve the pain 
more quickly by the hypodermic needle. 
He grasped the idea, had a hypodermic 
dose of morphia, and in less than ten 
minutes was asleep; and when he awoke 
in the morning he was in full possession 
of his senses. 
I have noticed many cases where acute 
mania supervened upon typhoid when all 
the typhoid conditions appeared to have 
been completely subdued. A young lady, 
quite healthy and robust has had typhoid, 
and has gone to the country to rusticate 
for some time. She came from a very 
healthy family and there was no trace of 
insanity in her heredity. In this resort, 
she being very attractive, the people be- 
came quite interested in her and got very 
inquisite about her preceding conditions. 
She told them frankly all about a recov- 
ery from a severe illness. They proceed- 
ed to condemn the doctor who had al- 
lowed her to get to the country and away 
from supervision so soon, which was 
about a month after her recovery from 
the disease. She brooded over this and 
80 got upset by it. From hour to hour and 
from day to day she kept asking the la- 
dies whether she did not look better to- 
day. Some said yes, some said no, but 
the “no” in these cases generally sinks 
deepest into the mind of the afflicted. A *- 
cordingly she became quite insane on the 
subject of herself and her appearance, 
and had to be brought back and placed 
in an institution for a short time. 
I also recall the case of a young doctor, 
an associate of mine, who went precisely 
through the same ordeal in connection 
with typhoid. He had, however, some 
hereditary taint, and it took quite six 
months and various diversions to cure 
him of his trouble. It started with sug- 
gestion, precisely as in the case of the 
young lady. Though he was a highly edu- 
cated man, having spent several years in 
Europe after he had graduated in New 
York, he was not aware that he had ty- 
phoid fever until he was entirely out of 
danger. About a month after sitting up 
he was informed by his mother, who de- 
voted much attention to him, that he got 
well of a very serious, dangerous attack of 
typhoid. He was quite startled by this 
announcement and immediately mani- 
81 fested some mental defect. He was at 
once ordered to the country for recrea- 
tion and rest, and he took long walks 
away from the portion of the country 
where he was, and constantly interro- 
gated people on the highway, as to his 
aspect. This became so unpleasant to his 
mother than he was immediately brought 
back to the city at my suggestion. I dis- 
covered from the old lady that as a boy 
he was very fond of the cultivation of 
flowers. Accordingly she rented a house 
surrounded by an ample garden, and he 
devoted all his time and attention to his 
favorite pastime. I never saw more beau- 
tiful roses and flowers than he produced 
in a very short time, and in a few months 
he was back into harness, intelligently 
practicing his profession. 
These instances of acute mania are 
given this prominence at the start in or- 
der to point out that they are curable and 
that this is mainly brought about by sug- 
gestion. When the mania becomes more 
or less chronic, there is not so much pro- 
bability of speedy restoration to health, 
yet even when they last quite a while they 
are not to be despaired of. 
As in the case of mania arising from 
82 the excessive use of alcohol there is a 
form closely allied to it which comes 
from uraemic poisoning. It matters not 
what has induced the uraemia, whether 
alcohol, drugs, or other diseases, but 
there is in connection with uraemic poi- 
soning a distinct sequence of acute mania 
every now and then which lasts for a 
greater or lesser period. From time to 
time I have seen several such cases, near- 
ly always as the result of dissipation and 
excesses. They are very important every 
now and then in their medico-legal as- 
pects because the vices inducing the ma- 
nia are largely confined to the wealthy. 
I recall one conspicuous case here 
where a gentleman about forty-five had 
gone the pace and left a very large for- 
tune at the time of his death. A few 
years before he died he got into a perfect 
condition of mania after a more than 
usual indulgence. Several consultations 
occurred in this case and the greatest dif- 
ficulty was experienced in restraining him 
within the precincts of a large, fine house 
which he occupied. He had to be sur- 
rounded with three male attendants and 
greatly to the horror of his friends, who 
were numerous, and members of the lead- 
83 ing clubs, he was pronounced hopelessly 
insane. On close investigation it was 
found that he had urinary suppression 
lasting for a period of forty-eight hours 
at one time before this maniacal attack 
had seized him. Immediately all atten- 
tion was turned to the relief of this symp- 
tom. All the diuretics then known were 
used in this case. The usual hot baths 
and treatment towards stimulating the 
functions of the skin were also put into 
practice and found to work very well, but 
it took fully six weeks before his mind 
cleared up. Meanwhile his wife, who was 
on a cruise around the world with some 
friends, arrived. At this time he made a 
will which was not very favorable to her. 
He died some years after, and this will be- 
came a subject of litigation. I saw him 
shortly after he became maniacal, and 
with a gentleman who recently died, at- 
tended him to the successful gaining of his 
mentality. In the courts here he was justly 
declared to be incompetent at the time he 
made his will but in another state, where 
the bulk of his estate was held, he was 
declared to be competent and so the un- 
fortunate wife who had devoted her life to 
him was deprived of even a small portion 
84 of his great property. In my testimony I 
held the view, and I hold it now, that he 
had not quite recovered from the insan- 
ity which had been developed in its 
highest form some time before. Reflect- 
ing on it from a purely scientific point of 
view I think his condition was that of an 
insane person whose intellect was weak- 
ened by a prior acute attack, and this 
very frequently happens. 
This disease is also very frequently in- 
duced by severe mental shock and in this 
connection it is not at all infrequently 
accompanied by the sudden danger of 
death. During the war with Spain, 
which was in many ways quite unex- 
pected, a great many youths who were 
utterly unfit for the hardships of war- 
fare, became quite infatuated with the 
idea of volunteering in large numbers 
from this city. Many of them were sent 
to camps at a distance, some were or- 
dered to Cuba, and some to the Philip- 
pine Islands. 
Every now and then, in rapid succes- 
sion the death of one of those youths 
would be heralded through the press. 
One devoted mother would get violent 
disturbance of the stomach and di- 
85 gestion; another would get prostra- 
ted and jaundiced, and a third would 
get a seizure of maniacal disturbance. 
There were many differences of opinion 
as to what led to the mania. The ques- 
tion of pathology it is not my province to 
discuss just now, but the simple fact re- 
mains and it is very well worth remem- 
bering, that a severe shock of any kind 
may produce a maniacal seizure and this 
is frequently followed by death. Let me 
again recall what I have many times 
claimed, that a mental disturbance will 
produce physical alterations in our sys- 
tems. 
A police officer of middle age called on 
me one day. He was very well known 
for his excellence in athletic sports of 
every kind, and a man of unblemished 
character. He had a wife and three 
children. About a year before his visit 
to me he undertook to arrest some three 
or four criminals who were disturbing 
the neighborhood. They assailed him, 
beat him severely over the head with 
clubs with his own pistol. After 
about a month in the hospital from the 
punishment to which he was subjected, 
he returned to duty and was as efficient 
86 as any other officer in the city. In fact 
he had distinguished himself for effi- 
ciency. He lived in quite a good part of 
the city and informed me that he was 
greatly annoyed by his neighbors knock- 
ing on his walls at night, peering through 
his keyholes, jumping over his roof, and 
in every way trying to torment and de- 
grade him. He told those things that go 
to make up a common chain of symp- 
toms usually accompanying acute mania, 
and probably one of the most common 
chain of all symptoms connected with it. 
I wrote a note to the then chief of police, 
telling him that the man was insane and 
should be sent to a sanitarium or state 
hospital; that he was utterly unfit to be 
at large, especially as a police officer 
with the privilege of carrying fire arms. 
The chief of police though a very well- 
meaning and clever man in his way, not 
only did not follow my advice, but told 
the man the contents of my letter. A 
short time after, the man came to my 
office very indignantly censuring me for 
the opinion that I had written to the 
chief of police, but at the same time 
said he was not feeling very well; that he 
had changed his location and asked me 
87 to prescribe for him. I did so, and after 
this second visit with the officer and an 
interview with the chief of police, I 
could not make him understand the 
necessity of placing this man in such a 
position that he could not be of any dan- 
ger to the public. One of the police 
commission at the time was quite an in- 
timate personal friend and patient of 
mine and I reported the whole matter to 
him. He at once took steps to have this 
man under proper care as far as he 
could, but the chief was persistent in his 
ideas, and so he was placed in charge of 
an outlying prison, where the holder has 
no necessity of carrying weapons. The 
patient acted quite efficiently for a little 
while, but suddenly before his hour of 
duty one morning he rushed down to the 
district prison and demanded of one of 
the assembled officers a gun in order to 
get rid of some tramps who lived next 
door to him and were annoying him to 
death. The men around at the time saw 
immediately that he was insane. After 
this exhibition at the prison the chief 
was convinced, the commissioners for 
insanity were notified and he was duly 
88 placed in safe keeping, where the unfor- 
tunate now remains. 
In the asylum with which I was con- 
nected we had several persons of title and 
rank. One lady of this class had been in 
the institution fully five years when I as- 
sumed the duties of superintendent. She 
was a strong, robust woman, past fifty. 
Her habits were very boisterous at times, 
and always untidy and unclean. The 
nurses in charge seemed to be unable to 
to keep her tidy and cleanly. I happened 
to get one head nurse who was very clever 
and well educated, and she took quite an 
interest in this particular patient. I did 
not know it for quite a long time, but she 
conversed a great deal with her and con- 
veyed to her the idea that I was in love 
with her, and hence she must be always 
tidy and clean when my visits were ex- 
pected. As I visited all parts of the house 
about twice a day she appeared to be very 
much elated over this fact, and so com- 
menced to wear better clothes, look bet- 
ter and conduct herself more like one of 
her position would be expected to do. I 
noticed the change and made many in- 
quiries of the head nurse regarding her, 
after which she informed me why the pa- 
89 tient had looked so well and so changed. 
I advised her to follow it up carefully and 
in about four months she was able to 
leave the asylum and return to the beau- 
tiful place which she owned some fifty 
miles from Liverpool and not far from 
the ocean. 
It is very rare that after five years any 
person afflicted with insanity recovers 
completely, and I think that except in rare 
instances the only form of it that does re- 
cover is the maniacal form where there 
are no epileptic seizures or delusions. 
There are quite a large number of peo- 
ple who find their way to the asylums or 
sanitariums of the world without having 
any specially marked form of disease. The 
classification as nearly as can be made in 
such cases might be called Chronic Ma- 
nia. The lady just referred to had no 
more defined insanity than the fact of a 
general confusion and unreasonableness 
of thought which was effectively treated. 
This Chronic Mania sometimes becomes a 
very curious, if not a very happy form of 
existence. In the disease which I have 
called General Paralysis as I point out, 
the predominant feature of it is supreme 
happiness. But like any ordinary mental 
90 attitudes there are degrees of this run- 
ing the whole scale from depression to 
the happiness spoken of. 
I remember one clever, mischievous fel- 
low, about fifty years old, who never 
ceased to be amusing either himself or 
those around him. He had none of the 
other symptoms of General Paralysis, nor 
had he anything to warrant being kept 
in an asylum, but the fact that he was 
eternally in some mischief, or another, 
like a schoolboy on a lark, doing nothing 
particularly wrong, but perfectly erratic 
and utterly unable to attend to business of 
any kind. Like all such people, he be- 
came a sort of torment to the attendants 
in his department, because he kept them 
on the qui vive all the time. There were 
two things he relished. He came from a 
certain town in England, and liked to be 
addressed as the Lord of that particular 
place. He did not get angry if this at- 
tention did not occur, like one suffering 
from delusion would, but he was more 
pleased if addressed as “My Lord .” 
The spirit of mischief seemed to be in 
him at all hours of the day and ran into 
the night. One day I was passing through 
one of the corridors, and I found him 
91 with a big bunch of keys and he was 
marching, military fashion, up and down 
the corridor. I said, “Well, Lord B., 
(giving this title that he desired), what 
are you up to now, and what are those 
keys for?” “Well, Sir,” he said, “I am 
just looking after poor old John Oates. 
He is in here, (pointing to one of the 
rooms in which he had confined the at- 
tendant), and I am afraid he will get out. 
Hence, I am keeping guard over the 
door.” He did so effectively. On de- 
manding the keys, he immediately re- 
turned them to me. In point of fact this 
attendant was a little careless and passed 
into the room while he left his keys in the 
door on the outside, and all the locks be- 
ing spring locks, he locked himself in, 
and poor B., seeing the opportunity, held 
him there. 
Showing the uncontrollable disposition 
to mischief on the part of this particular 
patient, not very long after this, sleeping 
with four others in one apartment, mostly 
subjects of dementia, by some means or 
another he Unscrewed some 'bolts that 
were holding the bars of windows and led 
them all forth from the asylum by scaling 
quite a high wall. He had them thor- 
92 oughly drilled and marched them during 
the night some fifteen miles to one of the 
suburbs of Liverpool, and then applied to 
the police station for some change of 
clothing for “these poor soldiers of his 
that were waiting at a certain point for 
him.” We had scoured the neighborhood 
everywhere and telegraphed in every di- 
rection. We knew nothing of Lord B.’s 
whereabouts until we received a dispatch 
from the Liverpool police who detected 
that the patients were escaped luna- 
tics only by the marking in their under- 
wear. Lord B. returned with quite a vi- 
vacious account of his generalship and 
was immediately ready for another es- 
capade, but he never had another oppor- 
tunity. 
There is another interesting phase of 
this disease, and that is the intermittent 
form. A celebrated case occurred here 
in which two judges were involved. One 
judge became insane and was placed in 
one of the neighboring institutions. He 
completely recovered in a very short time, 
and then through some legitimate pro- 
ceeding in the local laws, and mutual 
agreement, he sold his place to another 
judge. Later, he had a second attack of 
93 mania and recovered from it, and after 
the second attack he sought to get his 
place back from the judge to whom he 
had sold it on the ground that he was in- 
sane at the time of the transaction of the 
business. He was in court during the trial 
of this matter, apparently perfectly well. 
I was a witness, and I held that the gentle- 
man may be insane at one time and per- 
fectly sane at another, and if he trans- 
acted the business with judge No. 2 at 
the period of his being sane, there was no 
justification for seeking to abolish the 
obligation. The judge took this view and 
the post was retained by judge No. 2, 
and not very long after judge No. 1 had 
to be placed again under restraint. 
This particular case led to a great deal 
of confusion, because one gentleman who 
was at the time superintendent of a local 
asylum, testified that there was no form 
of insanity that intermitted, which is to 
say the least, was a very startling state- 
ment in view of the ordinary observa- 
tions of superintendents of asylums as 
well as ordinary mortals. People in or- 
dinary life who have had the misfortune 
to have insane kin have always observed 
those periods. 
94 CHAPTER 4 
The next in order in my classification 
is Dementia. This term is very much 
abused and is frequently misleading. 
The meaning of the word is simply an 
absence of mind, and therefore “amen- 
tia” as well as “dementia” might be used. 
But it assumes perfectly ridiculous, mean- 
ingless proportions from the manner in 
which the term is travestied in public 
literature and in courts of law. 
In a celebrated case which lately oc- 
cured in this country, the term “Dementia 
Praecox” was bandied around very free- 
ly, because a young gentleman, supposed- 
ly of great wealth perpetrated murder in 
a public place. I think it was in this trial 
that medical terms were strained to the 
utmost to hide perfidy or ignorance, or 
both. The term Dementia Praecox, tak- 
ing it literally, has no meaning whatever. 
It might be twisted, perhaps, to refer pos- 
sibly to any form of insanity that should 
95 happen to come at a period of immaturity 
in either man or woman. If insanity 
should at all occur at this time, it would be 
very unlike Dementia, it would be most 
likely of another kind for the reason that 
Dementia is very like Melancholia and 
Melancholia is not by any means the char- 
acteristic form of insanity that occurs at 
this period of life. To describe Dementia 
as we see it and are able to segregate it 
from the other forms of insanity, is very 
difficult, and one of my medical associ- 
ates one time, I think best described it 
by comparing the sufferer to a good-na- 
tured cabbage. 
The individual thus afflicted may be 
placed on a form in the yard of an asylum, 
for instance, and will sit all day long 
without scarcely a move from the position 
in which he was placed. I have ordered 
patients at ten o’clock in the morning 
to be seated along in long forms sitting 
quite close to each other, and at twelve 
would investigate the patients again, and 
there was not the slightest disturbance 
of either seats or individuals. You would 
naturally think that it would be almost 
impossible for any person to be placed 
on a straight back chair with sunny ex- 
96 posure for two hours and remain in the 
same position, but in true Dementia they 
will. They would not hold any conversa- 
tion with each other, never complain of 
any strained position, and even though 
food may never be asked for, yet they 
would absolutely feed like voracious ani- 
mals if food was tendered to them at 
that time. They are generally very ema- 
ciated, and it is very astonishing to me 
how they remain so even with the best 
food liberally supplied, and more or less 
complete quiescence. They look brooding 
and despondent. I once wrote to the 
London Lancet inquiring as to the reason 
of that condition. How it was that the 
persons so suffering from this form of 
insanity, perfectly undisturbed by every 
form of physical labor ,and no mental 
effort of any kind, and no physical disease 
of any exhausting character could con- 
sume so much food and not accumulate 
any flesh. The question was approached 
and answered from different points of 
view but neither one of them was in any 
way satisfactory. 
In this form of disease if the patient 
has any of those troubles of the nerves, 
such as arises from an insect perching 
97 upon him, or any other condition engen- 
dering a requirement of scratching, they 
never appear to manifest it. So you can 
understand readily my friend’s illustra- 
tion of a good-natured cabbage is not 
very far afield. 
As far as the medico-legal aspect of 
this form of insanity is concerned, any 
person can see it without any technical 
training whatever. It is rarely, if ever, 
simulated, and I doubt if any normal 
person could simulate it with success. 
The difference between this condition 
and melancholia is very slight, except in 
one respect. There is never in this any 
complaint, there is no wrong or grievance 
to be redressed. There is no demand 
upon the superintendent of attendants of 
those around to do certain things. There 
is no tendency to suicide. The patient 
is a perfect automaton as far as all ap- 
pearances go. Dementia Praecox is an 
utterly unwarrantable term, and should 
be obliterated from medical literature. 
Later on I shall have to deal with another 
term, which should be obliterated, and 
that is Paranoia, which has become a very 
pronounced term in this same class of 
cases I have already alluded to. 
98 There is one thing, however, that must 
never be forgotten in relation to this di- 
sease, as in every other form of insanity, 
viz: that the individual is at no time safe 
to himself or others. While the aspect 
and the demeanor of the patient is very 
liable to remove all apprehension as re- 
gards any tendency to violence, it must 
be considered a negligible consideration. 
It will occur and quite suddenly. It is 
in cases of this nature that the trouble 
of which we hear so much in courts of 
law, called emotional insanity, is most apt 
to occur. When all is calm and serene 
for a period of weeks or even months, 
suddenly something strikes the imagina- 
tion of the patient and unexpected vio- 
lence ensues, but very rarely suicide. 
One who is apparently very feeble and 
emaciated suddenly acquires an amount 
of muscular vigor and force that surpas- 
ses all calculation. I have seen one pa- 
tient, a young man, look so sad and quiet, 
and meek for a long time sitting in the 
yard among other patients, that you could 
not possibly suspect any violence from 
such a source, but suddenly one day he 
got boisterous and excited without any 
cause, had to be immediately shut up in 
99 a solitary cell. Our cells are apparently 
very well formed, perfectly smooth sur- 
face of wood on the inside, so constructed 
that patients could not injure themselves. 
Without any implement whatever he 
managed to separate those pieces of wood 
from one another, after which he made 
wedges and drove these wedges into the 
wall and so made a ladder to escape 
through the skylight fourteen feet from 
the ground. Thus he ascended to the 
roof; he had no clothing and was obser- 
ved in one of the yards in a perfectly 
nude condition. He immediately scaled 
over other walls that appeared to be im- 
possible to climb and got out of the asy- 
lum. Through the grounds three atten- 
dants pursued him and though men of 
fine physique, they had great difficulty 
in overhauling him and capturing him. 
He assailed all three. They were, of 
course, obliged by law not to inflict any 
punishment on him, but after great diffi- 
culty they bound him and about a mile 
from the asylum grounds they put some 
clothes on him and brought him back. 
There was no doubt at all that if he had 
had anything wherewith to inflict punish- 
ment he would have done all the bodily 
100 harm he could to any person whom he 
confronted. 
A lady suffering from the same malady 
became very docile and tractable as far 
as her mentality would reach, and when 
placed in any work not accompanied with 
any danger or effort she would do it just 
like a piece of machinery. She seemed 
to be more contented with washing at the 
laundry wash tubs than in anything else, 
and she would stay at this for hours with- 
out any apparent fatigue. One day the 
attendant told her that she had 'other 
work for her to do, but did not mention 
of what nature. She suddenly sprang 
upon her and the nurse had the utmost 
difficulty in protecting herself against 
her. 
It is among these that this pestilence 
of the law courts called “emotional in- 
sanity” most commonly is developed but 
scarcely ever exists without some form of 
insanity prior to it except at the start of 
acute mania. 
101 CHAPTER 5 
I introduce the subject of Melancholia 
next because it is closely allied to Demen- 
tia except in one way, that it is a never 
ceasing complaint, a never ending wail, 
of some thing or another. The patient 
finds all sorts of trouble in his or her 
personality or in the surroundings. There 
is great difficulty to retain attendants 
whose duties lie in wards devoted to 
patients suffering from Melancholia. 
Their woes and toubles irritate the atten- 
dants and their very aspect disturbs them. 
Very naturally sad scenes, sad com- 
plaints, and sad faces prolonged for a 
given period of time and in close connec- 
tion with us would disturb anybody and 
asylum attendants are not superhuman. 
If you ask the average individual suf- 
fering from this disease why their de- 
meanor and expression are so gloomy, 
probably nine times out of ten they will 
not be able (to give you !any tangible 
cause, but occassionally it is otherwise, 
102 and some of it is very appalling. The 
idea of having committed an unpardon- 
able sin is very predominant. They al- 
ways have done something which can- 
not be redressed. 
I knew one, a woman, who actually 
believed that she was already a damned 
spirit, which she carried out by a terrible 
wail occasionally which compelled the at- 
tendants to place her at some distance 
from other patients, in a quiet cell by her- 
self. This woman from all accounts of 
her previous history had really led a noble 
sort of life. She had in her district been 
a sort of “lady bountiful” who did all the 
benevolent acts that generally come with- 
in the scope of the average lady of wealth. 
Pointing these facts out to her and dwel- 
ling on them as promising a hopeful and 
better future were utterly vain. She had 
when I knew her, been already three 
years in the asylum and remained after 
my connection with it ceased. Pitiful 
cases of this nature are of course very 
numerous in asylums, but outside they are 
not at all uncommon and very often are 
set down as Neurasthenia or Hypothel- 
esia, which stage they have passed. From 
what I have seen I believe that Hypothel- 
103 esia is the first step towards Melancholia, 
and if we get the patient in the stage of 
Neurasthenia it generally becomes quite 
hopeful, whereas in Melancholia it is 
necessarily quite a sad prospect. One 
thing about the Melancholic has to be 
very carefully guarded against and that is 
suicide. In this disease there is more 
proneness in this direction than in any 
other form of insanity. Not only does the 
suicide feeling frequently express itself 
but it assumes a cunning and activity 
that seems quite incredible. Very many 
times a patient suffering from this condi- 
tion assumes an air of cheerfulness and 
happiness to deceive those around. They 
do things just like other people would do 
it with care and ability and thereby ac- 
quire the confidence of their guardians, 
but meanwhile watching carefully the op- 
portunity to commit suicide. 
The attendants as a rule do not recog- 
nize these facts and so get lax. Instruc- 
tions are neglected, attendants are thrown 
off their guard by the deceitful conduct of 
the patient and in consequence the un- 
expected trouble occurs before the atten- 
dants know it. I have in mind some of 
those cases which are very instructive. 
104 A gentleman of mature years, member 
of a wealthy family had been an active 
man of business before entering the asy- 
lum and coming under our care. He first 
spoke freely of his desire to “shuffle off 
this mortal coil” as he expressed it. After 
a while, seeing that this was forbidden, 
and prevented pretty well in our insti- 
tution, he resorted to all sorts of subter- 
fuges to get into dangerous positions. 
For instance, he would request to be put 
up at some altitude for the purpose of 
decorating some place, perhaps. He 
would request to be sent out to do some 
errand, and would keep writing very 
cheerful letters to his family as to how he 
was getting along, and how well pleased 
he was with his surroundings. In the 
midst of this I found him one day in his 
bed very nearly strangled by a large neck- 
tie which he wore, and which he had 
tied so tightly around his neck with his 
own strength that he almost accomplished 
his end. At times he would stop me in 
the corridor and beg of me to substitute 
him for some notorious criminal who was 
about to be executed. He had access 
to the papers, as all those who cared to 
read had them, (in the reading room and 
105 the library), and he would notice in some 
paragraph that there was some individual 
who was going to be executed some time 
after, and he would plead to get the 
government and the authorities to substi- 
tute him for this criminal. It appears he 
had tried these same tactics with his own 
family before he came into the institu- 
tion, but he had concealed from us very 
well all his inclinations after he was with 
us. The curious thing about it is that he 
was not only desirous of committing sui- 
cide, but absolutely bent upon it, and 
would fabricate ingenious lies in order to 
get an opportunity of doing so. 
In the case of ladies the tendency is 
yet stronger in-as-much as their emotions 
are higher and greater than the emotions 
of the male sex. One of our patients who 
had been for quite a long time very civil- 
ized and genteel in her demeanor, though 
known to have a suicidal tendency, was 
brought without my knowledge to one 
of our monthly balls. Many of the 
patients went to these balls and were as 
well behaved and proper in demeanor as 
ladies of the highest class usually are. 
The matron thought that this patient 
had some very fine raiment for the sur- 
106 roundings, and other qualifications and 
therefore that she should be there on this 
occasion. Among about one hundred 
and fifty people I did not observe her, 
but from all I understood she had 
not demonstrated any unpleasant symp- 
toms of any (kind during the evening. 
After the ball she was found to be absent, 
and the next morning her body was found 
with all her finery in a little pond of three 
or four feet in depth at most, about half 
a mile from the house. When at the ball 
she requested one of the female atten- 
dants, it appears, to allow her to go to the 
kitchen-department to get a little water. 
She cajoled this attendant into unlocking 
one of the rear doors and letting her get 
out and in a very short time she accom- 
plished her purpose ingeniously. 
107 CHAPTER 6 
Whilst acting as superintendent of the 
asylum I had under my care a very inter- 
esting young lad who was very musical 
and picked up music very quickly, and 
could play on at least three different musi- 
cal instruments very well. He was obliged 
to be removed from his home because his 
habits were bad, and therefore, could not 
be tolerated. He was duly committed be- 
cause he was also excessively mischievous, 
would tear things and act in a very des- 
tructive way. When under judicious res- 
traint he appeared to be improving and 
able to control his habits, and he did ul- 
timately recover. One day, when he was 
at the institution for about six months, a 
very handsome, comely lady and gentle- 
man, of the same type called to see him. 
They were his father and mother, and 
spent a portion of the day around my 
quarters, in the garden and the grounds. 
The gentleman seemed to be very desi- 
rous of investigating very minutely all 
108 our surroundings. He appeared very- 
shrewd in his efforts. I noticed him tot- 
ter in gait and also halt in his movements. 
He was a prominent cotton broker and 
one of three brothers who did a very large 
business. I had no right to interrogate 
his wife about him, and therefore 
desisted, though I had a very strong sus- 
picion that he was commencing with gen- 
eral paralysis. Not more than three 
months after, when the boy was about 
to be sent home, the wife came to the 
asylum by herself and sought my advice 
relative to her husband. She told me 
many things that indicated very clearly 
that he was gradually getting into the 
condition of which I had suspicion. Not 
more than two months after this, at the 
cotton exchange, he displayed complete 
absence of self-respect and some violence, 
which brought him under the customary 
medical examination, and he became a 
patient of ours. It would be rather diffi- 
cult to see a man of finer proportions, 
about fifty-five years old, and consum- 
mately educated. His manners were very 
polished, but occassionally he would take 
a sudden fit of violence that was very diffi- 
cult to subdue. Tremor of the muscles, 
109 those of speech and gait, were the first 
indications here. Defect of the arms does 
not seem to be so pronounced and the 
conduct is generally of the happiest kind. 
It is said, and I believe truly, of those 
suffering from this form of insanity, that 
they are the happiest mortals on earth. 
It is the very antithesis of melancholia in 
that respect. They generally have al- 
ready accomplished great things in their 
own imaginations, and expect to accom- 
plish still greater. Their appetites for 
food are usually very ungovernable. 
They have not apparently perfect co-or- 
dination over their deglutition and a very 
common symptom of their disease is a 
perpetual dribble from the mouth. Death 
usually comes by way of an apopletic 
seizure. It so happened in this gentle- 
man’s case, but some time after he was 
committed. 
A medical student, a friend of mine 
who pursued his studies in Paris, but 
visited me every summer by the seaside, 
some years after graduating became in- 
sane. I did not know anything of the 
nature of his insanity, but on the occas- 
sion of one of my visits to Europe I made 
it a point to call to see him. Up to that 
110 time I had not seen him for about ten 
years. He was already two years an in- 
mate of this institution, and when he was 
introduced into the reception room where 
I was sitting he at once recognized me, 
calling me by name, was glad to see me 
in his beautiful place. The institution 
was situated on a river bank, beautifully 
wooded and surrounded by woodlands 
that were remarkably picturesque and 
well kept. In the course of conversation 
he recalled many incidents that happened 
to us as boys in two or three parts of Eu- 
rope, and remembered quite as distinctly 
as I did everything connected with them, 
even to the most minute details. I was 
greatly interested in his well being, and 
of course asked as to his feeling about 
things in general. I recognized in his 
case the disease of which I am speaking 
very plainly, and was not unprepared 
when he told me that his condition was 
superb (he was a large, fine, well-formed 
man), and that he was the happiest crea- 
ture on the face of the earth. “All the 
surrounding country which you see,” he 
said, “is mine. I dominate it all; I dom- 
inate several large banks of the country, 
and what you will be most astonished at, 
111 I dominate the Pope of Rome. He dares 
not do anything without my permission. 
As to the government of this country (al- 
luding to the government of the British 
Islands), all their factors are simply my 
pawns, and when you see a change of 
ministry (I don’t publish it to the world), 
you may rest assured that I am the one 
manipulating it. There are some times 
when I feel like declaring war on some 
of the European potentates, and especial- 
ly on this French republic which I cordi- 
lally detest. If you, now, say so, and 
you think I am justified in it, I will ham- 
mer at them tomorrow. As to your coun- 
try (alluding to the United States), I have 
no grievance. I am perfectly satisfied 
with their conduct of affairs, but they 
must be careful and not follow into the 
misgovernment of these old institutions 
of Europe.” 
In very good humor I begged of him 
not to declare war on any country until I 
got safely out of this. He promised ac- 
cordingly, and added, “If you have any 
trouble or any misgiving about those 
things, just come in here and we’ll look 
after you carefully.” I never met any 
person who was apparently more happy 
112 or more self-satisfied, and it is a very 
common concommitant of this form of 
disease. Though he had been in the in- 
stitution two years, he showed no signs 
of physical defect, except in those partic- 
ulars already referred to in the case of 
the gentleman just mentioned previously 
who was under my personal care. Just to 
test him in one particular which is a fav- 
orite method of mine to arrive at conclu- 
sions about such cases, I asked him what 
the day of the week was then, and though 
he had read the papers that morning, he 
did not know; he mentioned the wrong 
day; and this thoroughly simple interro- 
gation is usually a very valuable one in 
this class of cases. The memory of past 
things seems to be as clear to them as to 
the average person, but the memory of re- 
cent events is usually to them a perfect 
blank. In view of the physiological ac- 
tion of the brain this is a very remarkable 
and incomprehensible fact and one lead- 
ing almost invariably to great confusion 
among the uninitiated. 
A gentleman of past middle life whom 
you know for a long time tottering a lit- 
tle in gait and speaking with more or less 
impediment, stops you on the street and 
113 asks you very kindly how you are, and in- 
quires how some member of your family 
is whom he has known and who is dead 
possibly some years; and then rambles off 
to tell you something of his own affairs, 
part or whole of which may be correct 
but utterly unconnected with his previous 
conversation, and in this you have a good 
type of general paralysis of the insane, or 
what is now called Paresis. I prefer the 
former term because in its latter stages 
the insanity is the more pronounced. 
Not very long ago a gentleman of this 
kind, well educated and connected with 
a very good family, a very polished man 
of affairs and the head of a large mercan- 
tile firm, in somewhat this fashion ap- 
proached me. I recognized the trouble 
and was very sorry to see it. One of his 
family with whom I was quite familiar I 
met a few days after and asked her if she 
were interested in the firm of which her 
brother was president. She replied that 
she was. I told her then, and apologized 
for introducing the subject, but knowing 
them all so well I concluded it was my 
duty to point out to her that her brother 
was not mentally correct and that it was 
worth her while to ascertain how his busi- 
114 ness was conducted. Without a moment’s 
hesitation she replied that he had been 
doing rather odd things of late in con- 
nection with the business and that he had 
signed receipts which they found were not 
correct. Shortly after he was discovered 
to have been duped in various ways, was 
fleeced by some adventurous woman with 
whom he had no sex relations, and it was 
not very long until a guardianship was 
appointed. 
This is a good example of the manner 
in which this disease passes along before 
the eyes of friends and relatives without 
observation. 
Some time ago a gentleman, past sixty, 
who occupied a very prominent political 
position in the nation, got an unusual and 
unexpected fit of ill-temper one day after 
which I was called to see him. After a 
careful examination I concluded that he 
was suffering from the disease to which I 
now refer. His public duties called him 
to Washington. I advised against his re- 
turn to Washington, but my instructions 
were not heeded and he very soon demon- 
strated in Washington a flagrant lack of 
memory in debates, and consequently 
those interested had him resign from his 
115 political position and brought him home. 
Among his other local industries he had 
been president of a bank which had fail- 
ed during his absence in Washington. He 
was a perfectly honorable man, but as the 
only one of the bank directors and trus- 
tees who possessed a goodly share of the 
world’s goods, he was immediately the 
butt for very aggressive litigation, and 
many and potent assaults on his private 
purse. He attended apparently to his 
business daily; went to resorts in the 
country where people assemble and did 
all the other things that a man’ of his 
class and kind usually does. He had quite 
a number of prominent friends, some 
judges and other men of affairs. His 
disease went on progressively, but ap- 
parently unnoticed by those people 
around him. On one occasion he was sub- 
poenaed, and I appeared in court and tes- 
tified that he was utterly unfit to appear in 
court to testify about any transaction of 
any kind. At this time he lived on one of 
the principal streets and when he got out 
of the carriage or other conveyance not 
far from his home, he would frequently 
walk in the very opposite direction from 
his house. At this particular period and 
116 before the time of the trial, he was at a 
fashionable resort, Del Monte, in Monte- 
rey. A number of lawyers and judges 
who were very much interested in this 
money transaction visited him quite fre- 
quently at this place where he was stay- 
ing with his family. When I testified in 
court that he was unfit to appear and give 
any testimony, the statement was imme- 
diately refuted by a number of the higher 
lights of the legal profession, all of whom 
testified that they had seen him a day or 
two before and that they had never 
known him as bright mentally as he was 
on the occasion of their visit. 
I assured the judge that these gentle- 
men were mistaken and that if he hap- 
pened to be anywhere within reach I 
could demonstrate to them in a few min- 
nutes that his mentality was entirely 
gone. My opinion was ignored, and the 
gentleman was brought into court a day 
or two after. As I entered the door of the 
court room he was testifying to some 
transaction. A former district attorney, 
a very able, honest, fearless ttian, up- 
braided me with allowing him to come to 
court, as he knew that I had attended 
him. I said, “I am not responsible for it, 
117 I tried to prevent it.” He then said quite 
excitedly in court, “It is a perfect outrage 
that a man like this, who has been such a 
valuable public servant, should be 
brought here into this court to be made an 
exhibit of, that the public should see the 
decadence of his mind. Here he is,” he 
said, “testifying to important facts, and 
he does not know the back of a certifi- 
cate from the front.” Which was the 
fact. 
According to my observation, this 
form of insanity is much more common 
among men than among women and some 
of the older writers ascribe it largely to 
sexual excesses. This contention, in my 
opinion, has very little merit, and as a 
matter of fact, all those who came under 
my notice were people of rather strict and 
proper habits and it is not a flagrantly 
common form of disease among that class 
that might be called professional liber- 
tines, whilst they have undoubtedly more 
than the average of other forms of insan- 
ity. Syphilis unmistakably figures con- 
spicuously in its history, and though it is 
claimed by some prominent authors as 
the exclusive cause, I cannot agree with 
this view either. Women are not quite as 
118 numerously afflicted with syphilis as men 
apparently, (but of course they are not 
immune against its ravages), yet it will 
be quite evident to investigators that gen- 
eral paralysis is rare among them. 
A married lady with three interesting 
children, a very fine, healthy type of 
young matron, consults me one day in re- 
lation to a little gastric disturbance. 
Usually such people are very repressed 
and disposed to look at the gloomy side 
of all questions, but this lady was quite 
the contrary. She was quite exalted and 
jubilant, and minimized her troubles, 
stating that she consulted me principally 
because her husband wanted her to do so. 
I knew her as a young girl; she came from 
very humble people, bore an excellent 
reputation, and to my mind amply de- 
served it. She had much toilsome effort in 
life with a young family and restricted 
income, and she demeaned herself with 
consummate credit. 
A few years before this consultation 
she was the victim of a carriage accident 
in the country. The high trap in which 
she and some of her friends were riding 
rolled over the side of a precipice and all 
were injured. She had at that time a 
119 broken arm, bruises and other injuries 
around the chest, (but none apparently 
around the head), from which she recov- 
ered seemingly, quite quickly and well. 
When talking to me on this occasion 
about her condition, I noticed that she 
had a slight stammering of the speech 
which was not her wonted conduct. On 
noticing this I examined her as to loco- 
motion, and not a little to my surprise her 
locomotion was quite impaired. I then 
led her into a conversation about her 
present social position and delicately re- 
ferred to her past, and was not surprised 
to find that while she remembered every- 
thing of her remote past quite clearly, her 
memory was rather obscure about very re- 
cent happenings. She immediately 
launched out into a most exaggerated 
high-flown statement of her surround- 
ings, which I had some occasion to know 
were false, especially with regard to her 
husband’s and her own enormous expec- 
tation. I noted very carefully that in re- 
lation to most things just then happening 
she adhered absolutely to the truth, but 
her grandiloquence with regard to her 
own importance and her past power 
coupled with her staggering expression 
120 made me at once recognize that I had to 
deal with the commencement of the sad- 
dening condition of “general paralysis.” 
I accordingly informed her husband of 
my suspicion and told him that he must 
be prepared for some trouble at any time. 
He was a very prudent, sensible man; he 
watched things very closely as he was ad- 
vised to do, but not long after this his 
wife’s mentality suddenly gave away in 
the shape of an ebulition of violence to 
her children. Matters then rapidly de- 
veloped and very shortly afterwards she 
had to be sent to a sanitarium where she 
now has been for several years. 
This no doubt resulted from a concus- 
sion of the brain at the time of the acci- 
dent, but was not observed until some 
years afterward. I allude to it because 
general paralysis of the insane is rarely 
acquired in this way, though unquestion- 
ably sometimes its origin is attributable 
to this cause alone. 
121 CHAPTER VII. 
Of all the forms of insanity that is least 
suspected or least recognized by the sur- 
rounding public or by friends, and is most 
quickly recognized by the expert, is the 
disease which I classify by itself as Delu- 
sional Insanity. It is a most remarkable 
fact in connection with our human econ- 
omy that one can be perfectly sane and 
capable of transacting any business, so- 
cial, financial, and even international, 
follow any calling efficiently, and yet be 
the victim of Delusional Insanity. The 
interminable category, the multifarious 
forms in this incomprehensible malady 
which are observed from time to time, 
seem perfectly incredible to the average 
person, and hence the eternal contests in 
relation to it. The delusions are not only 
commensurate with the heights and di- 
vergencies of the sane human imagina- 
tion, but far transcend it, and there is no 
form of insanity, in any classification that 
is made, at all equal to this form in its so- 
122 cial importance and in its medico-legal 
aspects. It would be difficult, if not im- 
possible, for the most brilliant fiction 
writer to soar to the ideas that occur to 
those in delusions. The works on insan- 
ity, though referring amply to this sub- 
ject, get somewhat confusing in not point- 
ing out more distinctly the simple, abso- 
lute facts. Hallucination, illusion and de- 
lusion are blended too indiscriminately, 
and leave a very imperfect idea of this 
trouble. Hallucination is a condition that 
frequently occurs to people in perfect 
mental health, and though it might now 
and then be turned into ghosts of one 
kind or another, it is usually corrected by 
the same mind that begets it in a very 
short time. Illusion is a little more 
tardy in being dispelled, yet the individ- 
ual suffering therefrom soon shakes it off 
if properly surrounded and directed. De- 
lusion is an entirely different condition 
and no kind of effort on the part of the 
most excellent talent around the patient 
will have any weight whatever in relation 
to it as a general thing. 
I just spoke of the imagination of fic- 
tion writers being put completely into the 
shade by the delusions of a poor lunatic 
123 who has not probably much intellectual 
development otherwise. Certain condi- 
tions arise and become prevalent like epi- 
demics from time to time that make many 
different persons all work on that parti- 
cular hobby of the day. For example, the 
squaring of the circle, and perpetual mo- 
tion in years past claimed an intermin- 
able number of this class. I had at one 
time under care half a dozen gentlemen 
who claimed they discovered perpetual 
motion and about an equal number of 
those who squared the circle. Neither of 
them were profound mathematicians or 
even above the average of common school 
education, but their days and nights were 
passionately spent in the pursuit of those 
two impossible theorems. They usually 
had long since discovered it, and it was a 
settled problem in their minds. 
It would be very difficult for a sane 
imagination to think or grasp the idea that 
any individual himself had “become a 
gutta percha machine,” nothing less, 
“through which the government of Bri- 
tain was doing all its thinking.” A gen- 
tleman under my care, a graduate of Cam- 
bridge, educated for the ministry in the 
Episcopal Church, and the nephew of one 
124 of its most distinguished professors in 
Cambridge, insisted for years that he was 
that gutta percha machine, and resented 
bitterly the use being made of him. He 
was, of course, as all the men of his call- 
ing are, highly educated in logic and met- 
aphysics. Go with him into a corner, 
which he was very fond of frequenting, 
and admit his first premises, and he had 
you in a corner as regards the correct- 
ness of his position. 
Once in a while a visitor who, from ap- 
pearances he thought, might be of some 
use to him in relieving him of the onus of 
being thus treated as a portion of ma- 
chinery, he would slyly take into the 
grounds, sit under a tree, argue with him 
on this problem, and then laugh at the 
credulity of the visitor. This gentleman 
could not be kept at home because of his 
violence when opposed in regard to this 
delusion of his. Whilst under proper 
guardianship he never made the slightest 
attempt to do any violence to anybody 
and regarded his stay in an asylum as a 
part of the petty persecutions of the gov- 
ernment. 
Early in my asylum life, so to speak, 
a tall, comely looking gentleman of the 
125 highest Spanish type, (though entirely 
English), with long flowing beard, cour- 
teous and refined manners and bearing, 
came up to me one morning and asked 
me how long I was in. I told him the 
exact time and he expressed great sympa- 
thy for me, because he had been here 
now two years, but it did not concern him 
because he had a special mission to sub- 
serve, and part of the program was his in- 
carceration in an asylum for five years. I 
looked over his record and I found that 
he believed himself, and was posing as a 
great reformer who wanted to bring about 
the most important world results. Though 
not bred a Catholic, he was about to blend 
all religions into one great whole with 
the Catholic Church at its head; he was 
about to transform all the languages into 
the English tongue, and bring all the na- 
tions of the world into one consolidation 
of government with himself at the head. 
This patient became to me an interest- 
ing study. In all those affairs of life that 
were before the public, he had as much 
discrimination and more information 
than the average gentleman at large. In 
consequence of his demeanor, he was al- 
lowed to travel around the countryside 
126 without an attendant. He strictly kept 
his word about time or location, and 
nothing apparently happened whilst he 
was outside as far as could be ascer- 
tained. Not far from the asylum, about a 
mile and a half, was a Catholic Church 
in the grounds of one of the Catholic 
nobles of the country. The priest of this 
church was an unusually clever, sensible 
man. He had been long associated with 
this particular asylum and its works and 
pointed out to me several of the locations 
where the incidents in Charles Reade’s 
“Very Hard Cash” occurred. In conse- 
quence, he in a large measure, and 
through an intimate acquaintance with 
Lord Derby was instrumental in changing 
for the better all the previous lunacy laws 
of Britain. He wTas very popular in the 
adjoining town and was quite popular 
with all the wealthy residents for miles 
around. He was a man of unusually 
calm, unperturbed demeanor, and from 
long association knew the habits and pe- 
culiarities of lunatics very well. He call- 
ed to see me one afternoon and told me 
that I must curtail the privileges of the pa- 
tient just referred to. As he was known 
to be a very benevolent man I was rather 
127 surprised at this sudden request of his. 
He laughingly told me that he had a visit 
from this particular patient the evening 
before last, at his church. That he found 
him sitting in his confessional and asked 
him why he was there. The patient im- 
mediately and preemptorily ordered him 
to kneel down and confess to him as he 
must know that he was a great bishop, not 
only of that district, but the leading bish- 
op of Great Britain. The priest, with 
consummate presence of mind, begged to 
be excused for a little while, retreated 
from his location, told the patient to re- 
main where he was for a little while, as he 
had some slight preparations to make be- 
fore entering the confessional. Mean- 
while he sent a messenger to our institu- 
tion and two of the attendants were sent 
over to bring the patient back to the 
house. This action on the part of the pa- 
tient was not wholly free from danger. 
He was a big, powerful man, but the 
priest was an ascetic student and the con- 
sequences might have been disastrous if 
he had resisted in a commonplace way. 
The patient never referred to this episode, 
and after that went on in the usual way 
128 minus the privilege of going out by him- 
self. 
One day at dinner, a gentleman who 
had been a commissioned officer in the 
army sat opposite this particular patient. 
The officer was suddenly seized with some 
grievance, imaginary of course, and re- 
ferred to me about the matter just as I 
was seated at dinner. I addressed him 
as Captain, and he immediately proceed- 
ed to inform me that he had never been 
a captain in Her Majesty’s Service, never 
had risen higher than the grade of first 
lieutenant. The patient to whom I refer, 
seated across the table from him, turned 
to me and said, “Doctor, he is not a cap- 
tain, nor yet a major in Her Majesty’s 
Service, but he might well be considered 
a brigadier-general of the light-fingered 
brigade.” It appears that in their card 
parties this particular “general” was in 
the habit of cribbing the pennies off the 
table when the others were not watching. 
This will give some slight idea of the 
wonderful scope of the intellect and the 
little disturbance of individuals except in 
one perverted direction. 
This “brigadier-general” alluded to, 
had also the privilege of taking walks 
129 whither he desired, and he scarcely ever 
missed being very punctual as regarded 
his movements and the time that he was 
at certain points. He was very likely much 
more punctual than he had ever been in 
his life except when in the army. He 
looked exceedingly like the pictures of 
Don Quixote in Gustave Dore’s illustra- 
tions of that work, so much so that I 
thought Gustave Dore must have seen 
him, and the curious fact of it is that his 
delusions were exceedingly like those of 
Don Quixote. If he walked out, and saw 
a most commonplace little pig, it was al- 
ways the largest and most wonderful pig 
that had ever been seen. Any poor little 
hardworking factory girl that passed 
along the highway was the most beautiful 
woman on earth, especially if she spoke 
to him or recognized him,—and all other 
things of a similar nature were in this 
proportion. He had never done anything 
approaching violence in his life from the 
record before us, and he very likely would 
not in the balance of it, but his family, 
of course, thought that it was better he 
should be under care where anything of 
that kind was impossible for-him. 
On one occasion a medical friend of 
130 mine from London paid me a visit. He 
had acquired great prominence already 
for one of his age, and was very much in- 
terested in everything pertaining to his 
profession. On dining with me one eve- 
ning he noticed the demeanor of this gen- 
tleman of Spanish appearance,—he was 
a very striking personality anywhere,— 
and he asked me if I could not bring him 
to my quarters; he would like very much 
to have a talk with him, etc., etc. That 
evening, after dinner, he came to my 
quarters by my request and spent the 
evening with us pleasantly for about two 
hours. The conversation ran along in 
relation to the current topics of the day 
and on things that interested everybody, 
in which, as I intimated, the patient was 
very well informed. After he left for his 
own department, my visiting friend turn- 
ed to me and said, “Do you mean to tell 
me that man is mad?” I said, “Yes, un- 
fortunately he is quite insane, and would 
be a dangerous lunatic if not under su- 
pervision.” “Well,” he said, “I don’t 
want to hurt your feelings, Buckley, but if 
that fellow is mad you are immeasurably 
beyond him.” I said, “I am sorry, but 
we never see ourselves as others us.” 
131 However, I did not give him very much 
information further; we turned the con- 
versation on other subjects; but next day 
I asked my guest if he would not like to 
take a stroll around the grounds and gar- 
dens while I was occupied with some- 
thing touching our institution, and sug- 
gested that he would probably like this 
gentleman patient as a companion. So 
they went off together; the patient knew 
all the territory very well; and they spent 
all the forenoon together. When my 
guest came back at the lunch hour, I said, 
“Well, Dr. , how did you spend the 
day?” “Oh,” he said, “my heavens! You 
frightened the life out of me today by 
sending me around with a lunatic like 
that.” He added, ‘he is the maddest man 
I ever dreamt of.” Evidently the patient 
had been expounding some of his ideas to 
my learned friend from London, and 
frightened him very likely more than the 
circumstances would warrant. However, 
he was convinced that delusional insanity 
was a pronounced disease and then ex- 
pressed his regret that he had not paid 
some attention to this branch of medicine. 
Through the temporary illness of one of 
our patients I discovered that we had 
132 among us a gentleman who was holding a 
learned discussion with no less a person 
than Prof. Airy, the Astronomer Royal 
at the time. This gentleman, passed 
sixty, had the post assigned to him of go- 
ing to the neighboring town twice a day 
to attend to the post office department for 
the purpose of receiving and delivering 
letters for the institution. He did this as 
punctually and faithfully as anybody 
could do, and in this way he was able to 
carry on the correspondence referred to. 
All our letters coming in to patients, and 
going out from them had to pass 
through official hands, but this scrutiny 
was of course easily evaded by our post- 
master. Our paper heading did not bear 
any trace of asylum association, it was 
simply headed “Haddock Lodge” and 
hence Prof. Airy thought he had to deal 
with a country gentleman living there 
who was well versed in mathematics and 
astronomy. This patient was one of those 
that “had squared the circle,” and one 
day I dropped into his room when he was 
sick and made no reference to the squar- 
ing of the circle, but he suddenly jumped 
out of bed, went to a bureau, and pulled 
out a little box and confided to me how he 
133 had managed to accomplish the result 
that he claimed. This box contained a 
very remarkable toy, as I should call it. He 
had tied up pieces of paste board so that 
by pulling one set of strings he displayed 
a perfect square. By another he would 
make an octagon and by a third he would 
make to all intends and purposes a per- 
fect ball. On the outside of this ball he 
had figures of the Sun, Moon, and Stars, 
and always wound up his remarks by 
saying, “Well, you can see now the glory 
of the Heavens.” He was perfectly con- 
tented with his achievements and I did 
not disturb him in it. 
Apart from this he was an exemplary 
patient, stayed a great deal in his room 
and read light literature and discussed 
it as intelligently as anybody. If, how- 
ever, any of his family, when he was 
home, or any of the attendants in the in- 
stitution, disputed the fact that he had 
not accomplished all that he claimed in 
relation to squaring the circle, he would 
not become very amiable with them. 
These delusions at that time were quite 
prevalent, and did not escape the atten- 
tion of a class intellectually much below 
this man, and it was a very amusing fact 
134 that he, and the gentleman to whom I 
shall now allude, recognized very dis- 
tinctly the mental defects of one of the 
other. 
Mr. J., as we will call him, very sym- 
pathetically referred to the unfortunate 
insanity of Dr. H. This gentleman was a 
well-known writer on deep philosophical 
subjects. He was a remarkably gifted 
man, I understood that he was at one 
time President of the Anthropological 
Society, and though a clergyman of the 
Church of England, devoted a great deal 
of thought to these and kindred subjects. 
It appeared that he and his favorite 
daughter were walking along by the river- 
side in the North of Lancashire where 
his parish was. The river was swollen to 
the bank,—it was winter time,—and be- 
fore his eyes, almost by his side, his 
daughter slipped and was carried into the 
eddy of the river and drowned. It was a 
great shock to him; he took the matter 
very much to heart, and became so un- 
governable that he would neither eat nor 
drink. He was brought under our care a 
very few days after, and had to be fed 
three times a day by a tube. He did not 
appear to have any viciousness in his 
135 makeup, and so was allowed freedom of 
certain enclosed parts. One noontide,— 
he was in the house not more than two 
weeks—I met him in the grounds and we 
entered into a social chat. That morning 
like all others preceding he had to be fed 
in the way alluded to. In our conversa- 
tion he remarked to me “Doctor, don’t 
you think that in order to regain mental 
health one must have mental exercise?” 
I said, “decidedly, and you see we culti- 
vate that as much as possible. We have 
all kinds of games, we have a fairly good 
library, we have billiards and music and 
all those things that apply to mental ex- 
ercise which is not too severe.” “Yes,” 
he said, “but different people require dif- 
ferent mental exercise.” I assented, and 
then he told me that the only thing that 
exercised his mentality was preaching. 
This was quite a surprise to me, and I told 
him that I feared we could not indulge 
that proclivity of his in our institution. 
Thinking it over, however, in the after- 
noon, I approached the chaplain who had 
just come in (it happened to be Satur- 
day) and asked him whether he could al- 
low Dr. H. to preach at his afternoon 
services the day after. The parson knew 
136 the patient very well but looked very sus- 
piciously at me and I could see from his 
manner that he had a very serious ap- 
prehension that one of the germs floating 
around had made assault on me. There 
and then I propounded to him my plan 
and he, with becoming prudence, imme- 
diately urged, “What about order?” I 
said, “As far as the order is concerned 
you can trust that to me.” And he re- 
plied, “Very well.” The services were at 
two o’clock the day following, so I has- 
tened to see the patient and told him that 
he would have the privilege of preaching 
at two o’clock as he requested. “But,” I 
said, “remember that we have many sects, 
and that you are not to hurt the feelings 
of any of those who differ from your doc- 
trines and ideas.” He said“ Very well,” 
nothing more. He had no extensive li- 
brary dealing with those subjects he had 
selected, and he had very little time, but 
on the following day at two o’clock when 
it became his time to preach he preached 
on the remarkable “Universality of the 
Doctrine that there was a Deity.” A be- 
lief coeval with humanity as to the exist- 
ence of God. It was the most remarkable 
and beautiful discourse I ever listened to 
137 on this subject. He was a master of San- 
scrit, Hebrew, Greek, and Latin, and I 
was amazed at the facility with which he 
quoted from all the ancient classics, the 
Pagan and Jewish writers, proving his 
theory. The Chaplain was no less aston- 
ished than I was; he also proclaimed the 
discourse wonderful; and we were both 
deeply impressed by the fine, well-stored, 
well balanced intellect of this gentleman. 
Yet that very morning he had to be fed 
by a tube as usual. The stimulus of the 
preaching effort seemed to have the ef- 
fect he anticipated. The people who were 
seeking to poison him vanished. He com- 
menced taking nourishment in very small 
portions and in about one month he be- 
came his normal self and I never heard of 
any recurrence of the attack. 
A Manchester merchant of some sixty 
years old endeavored to kill al his famiiy 
one night and was sent to our institution. 
He had at this time returned from Ameri- 
ca where he previously had served in the 
commissary department of the Civil War 
during the whole period of the Civil War. 
Before going to America he had escaped 
from a Manchester institution and bor- 
rowed money from an old employee of his 
138 at Liverpool and went across as a steer- 
age passenger. This man seemed to me 
in every way to be an unfit subject for 
our institution. In consequence I (met 
him frequently and talked quite freely 
with him. He never alluded to his being 
in America and avoided carefully any al- 
lusion to a prior asylum experience. Hav- 
ing in our book the whole previous his- 
tory I interrogated him on those lines but 
he always avoided the subject very cun- 
ningly and insisted that there Was no 
foundation for these stories. In conver- 
sation with him no person would take him 
to be other than a sensible, sane man of 
the world who was quite capable of tak- 
ing care of himself and probably able to 
attend to any ordinary business that he 
understood. He was always well dressed, 
very neat, and well groomed as though he 
were going on change every day. I stu- 
died this man for fully three months be- 
fore I could find out any weak spot in his 
mental makeup. But on some casual men- 
tion one day of Lord Derby’s name, he 
seemed to get quite excited and angry but 
soon dropped the subject. 
Fully six months after this we had an 
unexpected visit, as usual, from the Com- 
139 missioners of Insanity of England, for the 
purpose of examination. These gentle- 
men always dropped in at irregular times 
to all the asylums in the country and made 
their own investigations about all the de- 
tails of the house. The commission was 
composed of two medical men who had 
been selected for their eminence in this 
branch of medicine, and also one lawyer 
who made those diseases a study. In 
passing through one of the apartments 
this gentleman to whom I refer politely 
asked the commissioners if he might not 
have a word with them privately. I re- 
tired and the interview went on. After 
their rounds, and on their retiring to an- 
other part of the house, where the offices 
were located, they told me that they want- 
ed this man up before them. They said, 
“he makes charges that are very serious, 
and we want them investigated thorough- 
ly,” and added, “the charges are mostly 
against you.” This man and I had been 
on walks together, were very agreeable, 
apparently, to each other, and I was not a 
little surprised at this attitude of his. They 
had a record of his history before them 
and before I had time to explain anything 
they had peremptorily ordered his dis- 
140 missal from the institution. I did not 
know this until afterwards. When I con- 
fronted him in the office rooms where 
these gentleman held their meeting, he 
was asked to repeat in my presence the 
charges he had made. He demurred at 
doing so, he did not like to incriminate 
me in any way, therefore peremptorily 
declined. Dr. Buckmill, the well-known 
authority on lunacy was one of the com- 
missioners, and he insisted that he must 
repeat the charges in my presence. They 
appeared to be quite connected, and dates 
and periods were carefully noted. They 
chiefly referred to my coming to his de- 
partment of the building, (he had very 
fine quarters) at night with other people 
and annoying him and disturbing him in 
his sleep. I quietly asked him to tell the 
commissioners the name of one of those 
parties, and whether he belonged to the 
house or not. He stated that they did not 
belong to the house but he knew who they 
were. I then said to him, “I think you 
have placed me in a very false light, Mr. 
H. and it is not only just to me but also to 
the commissioners to tell them the name 
of even one of those parties who have 
been disturbing you.” He would not do 
141 so, and then I urged, “was not Lord Der- 
by one of those parties?” He declined 
to answer this and though frequently ur- 
ged by the commissioners, withheld it un- 
til finally Dr. Buckmill said to him, “Un- 
less you answer this question immediate- 
ly, Mr. H. we shall have to send you back 
to your ward.” He then replied, “Yes, 
Lord Derby was among them and was 
most active among them.” That ended 
the investigation, and the dismissal from 
the institution which the commissioners 
had just ordered was summarily with- 
drawn and wiped off the books. 
Thus, you see, in this particular form 
of insanity it is very difficult sometimes 
to discern its existence. Here the lead- 
ing lights of the nation, perfectly famil- 
iar with this form of illness, and having 
long experience in the various pranks 
and peculiarities of the insane, were 
cajoled into a very ludicrous and serious 
error by one mild, cultivated gentleman 
whose mind was disturbed. If this man 
were permitted to go at large at that 
time, in all probability it would not have 
been very many days before the country 
would have been horrified and shocked 
by another brutal murder. He seemed 
142 to be set, and very set, on the destruction 
of members of his own family, and very 
likely would go straight home and ac- 
complish his purpose. 
Most of our investigations here take 
about an hour or less to decide whether 
people are insane or not, and these in- 
vestigations are held by inexperienced, 
untrained examiners. Very often the re- 
sults of such inefficiency become very 
dishonorable to the medical and legal 
professions, and painful in their effects 
to the whole community. 
At the outset I have intimated that in 
our institution we had at the same time 
three queens. Two of those were the 
very antithesis of each other. 
One was a little hunchback, very un- 
pleasant to look at, and the other was a 
portly, large woman of good physique, 
but of very indifferent and unpreposses- 
sing features. They were both usually at 
a cottage in the grounds where a good 
many spent their days in different forms 
of needlework, and occasionally culti- 
vated some flowers that they showed a 
predilection for. This cottage was rather 
picturesquely situated, and it gave more 
color of pleasure to those poor people 
143 who desired to be away from the haunts 
of those in the main building. The lar- 
ger one of those queens made it a habit 
every day to deck herself with all the 
scraps of colored cloth she could find, 
and she wore a wreath of flowers, poorly 
adjusted around her hair. She was per- 
fectly harmless and did not interfere with 
any person as long as she was undis- 
turbed. She simply revelled in her own 
gorgeousness. Such needlework as came 
within her range, always, of course, 
under the guidance of a lady nurse, she 
executed with consummate skill and abil- 
ity. When asked, “by what right she 
came to be a queen, she simply answered, 
“by the right of succession.” She did not 
have the slightest idea of English his- 
tory, but this trite expression seemed to 
satisfy her, hence she was not disturbed 
about it. The smaller oue of the two 
tried to pose as a queen in a very differ- 
ent way. She would sit the greater part 
of the day on the veranda outside the 
cottage, wear some big, ridiculous col- 
ored cloth over her knees and spoke 
quite grandiloquently to all those around 
her. She was a queen by the right of 
144 “the Lay,” and the meaning of this I 
could never fathom. 
She demanded obeisance from her sub- 
jects, as she put it, and it became very 
unpleasant to any person for the time be- 
ing that disobeyed her majesty’s orders. 
She was not particularly strong, and 
when ordered peremptorily to do things 
by the head nurse, she never hesitated to 
obey, but any other person interfering 
with her got tongue lashed pretty well. 
Neither of these two patients came from 
the highest classes of England; they were 
both from rather obscure surroundings 
in a sense, and hence knew nothing of 
royalty or its simplicity, nor its formali- 
ties other than what they may have read 
perhaps in novels in their younger days. 
One day a party of ladies came to visit 
the institution and went around to see 
those different parts that might be in- 
teresting to them. The matron showed 
them every civility commensurate with 
proper order and safety and took them 
incautiously to this cottage where the 
queens were in the habit of staying. The 
queen who had arrived at the throne “by 
right of succession” received them in a 
very dignified and appropriate manner, 
145 but the little one asked them to “make 
their obeisance to her majesty.” They 
did not quite understand her and so hes- 
itated for a time about doing anything of 
this kind, and straight away she jumped 
around the veranda, exposed most of her 
body and grew very violent, and fright- 
ened them half to death by her violence 
of temper and indecent exposure. This 
curtailed her majesty’s privileges for 
some days after. 
Closely allied to these extraordinary 
flights of the imagination is another class 
where they are not exactly queens or 
kings or potentates, but some great per- 
sonages, it might be historical or other- 
wise. 
A lady living in London is one of a 
family who grew suddenly rich. An un- 
cle was what is called an East India tea 
merchant. At this time these merchants 
suddenly made great fortunes and he was 
one of them. He had no family of his 
own, but three nieces became the inher- 
itors of a great fortune. Up to that time 
they were struggling along in an ordi- 
nary way not overwhelmed with the 
world’s goods but this sudden acquisition 
of wealth drove one of the three insane 
146 and she came to be a patient of this in- 
stitution. At the time that I first en- 
tered upon my duties she had been al- 
ready seven years an inmate of the 
house. She had her own carriage and 
horses, her coachman, footman and maid. 
She lived in a part of the building which 
was suitable for a “grande dame.” She 
drove out every day when the weather 
was suitable. She had her own servants, 
and to all intents and purposes she was 
living in the condition of one who enjoys 
firstclass modern hotel life. She claimed 
that all the surrounding country was 
hers; there were some nobles not very far 
off, and they were simply her vassals, 
and she would not condescend to visit 
them, (which incidentally was not per- 
missible). Her territory extended from 
Lands End to the limits of John ’O 
Ghaunt. She was very obstinate now 
and then and would obey no person, head 
attendants or anybody, but the superin- 
tendent. She was a very tigress when 
roused and spared no person around her 
in her.excitement. One day a very pre- 
tentious lady from Liverpool called to 
see a stepson of hers who was an inmate 
of the institution. She knew of this pa- 
147 tient, (the conspicuous wealth of the 
family was extensively discussed), and 
she requested to be allowed to talk with 
her for a little while. I declined to per- 
mit her to do so. She was rather famil- 
iar with one of the local visitors who 
came from near Liverpool and made to 
him a complaint of my incivility to her. 
This gentleman informing me by letter of 
the fact, I explained to him what had 
happened, and he approved of my course, 
but when she came next time to visit the 
institution (it was two or three months 
after) she was armed with a card of her 
friend, so I surpassed myself in atten- 
tion to her. When she asked to see the 
lady patient, (not expecting the explo- 
sion that followed) I sent the head nurse 
with her to this lady’s quarters, and I 
was suddenly called from my portion of 
the building to Miss B’s rooms. The sight 
that confronted me was a very deplor- 
able one. This visitor was a very comely, 
stylish, handsome woman, very well 
dressed, etc., so while in the room the 
patient, it appears, observed her expen- 
sive costume closely, and asked her by 
what right she was keeping her son as a 
pensioner on her in that institution. The 
148 institution, like everything around, be- 
longed to her. Not getting a satisfactory 
reply from this lady, she tore her finery 
to fragments, and when I went in she 
was very industriously pulling at her 
hair. The nurse and her maid were 
powerless before her onslaught. It was 
an easy matter then to explain what she 
was good enough to call my previous in- 
civility. These matters are dwelt upon 
to show what cannot be too frequently 
urged and emphasized in relation to the 
uncertainty of the conduct or actions of 
the insane. 
This beautiful countryside, with several 
castellated old mansions in the distant 
view, with their extensive and varied 
groves, all belonged in her imagination, 
to the lady under discussion. The insti- 
tution in which she dwelt of course was 
her property, and she kept more or less 
tab upon everything, as far as she could 
reach, that was going on around the in- 
stitution. Her residence portion of it 
was quite insignificant in extent com- 
pared with the whole, but our gardens, 
which were quite extensive and well kept, 
were of constant source of delight to her. 
Anything that occurred in reference to 
149 supplies, what I might call exportations 
and importations concerned her very 
much, and it was in consequence of this, 
thinking that the young man whose 
mother was assailed, was infringing upon 
her purse, that she made this terrible 
assault. This patient I discovered to have 
one very well marked peculiarity, of 
which I never knew another instance but 
one, in a very marked second sight. One 
of her sisters living in a beautiful country 
place some twenty miles off, for some 
time past had entered into a correspond- 
ence with me relative to changing our 
patient to a private home she had pur- 
chased and have her attendants there 
with her, instead of being an inmate of 
an asylum. There were several letters to 
and fro, and hence I was invited one day 
to come and lunch with her and talk the 
matter over. There was quite a gala 
party, everything went along very 
smoothly, and after lunch she asked me 
if it were possible for her insane sister to 
know anything of our correspondence, 
which had to be strictly private from all 
the circumstances connected with it. I 
assured her that I could not see how her 
sister could in any way get the slightest 
150 information touching my correspondence. 
She said, “Well, she seems to know all 
about it,” and showed me one or two let- 
ters from the sister. I was quite amazed 
and explained how and why it was im- 
possible, but added, “I will make further 
investigations.” She said, “Well, it is not 
only now that my sister seems to have 
had this double vision, in a way, but she 
has also been quite prophetic from the 
time she was first afflicted. Before she 
was sent from our home near London, 
she spoke of many things as happening, 
and some of them at that time impos- 
sible to conceive and too horrible to 
think of, have since then actually oc- 
curred in our family.” Of course this 
stimulated further exertion to discover if 
there was any way directly or indirectly 
in which she could obtain any informa- 
tion. Close watch in every direction was 
kept, but we certainly were not able to 
discover any clue as to how or why she 
got this information. 
Before departing from the interesting 
surroundings in which this series of very 
instructive cases occurred, I must refer to 
another which did not come exactly under 
my own observation but which I am con- 
151 vinced is quite authentic. I must again 
refer to the very clever Catholic priest 
who was chaplain to a neighboring noble- 
man. He was quite a good judge of the 
lines between sanity and insanity. Some 
celebrated case occurred round about 
this time in which the plea of klepto- 
mania was entered as a defense for theft. 
I do not recall the incident further than 
it occurred in the neighborhood of Lon- 
don. It was “a lady of high degree” who 
had been observed pilfering jewelry in 
one of the great marts of the city. In 
our friendly discussion, I took the ground 
that kleptomania pure and simple with- 
out some other manifestation of the in- 
sanity did not exist in my opinion. The 
clergyman said, “I differ with you en- 
tirely.” I illustrated my position by the 
conduct of our “general” already referred 
to, who was very much addicted to steal- 
ing the wagers of his fellow gamesters. 
He had another form of insanity plus the 
pilfering propensity. He said, “Yes, but 
you know Lord So-and-so by reputation?” 
I said, “Yes.” This nobleman was at that 
time one of the most important function- 
aries of the British Empire. The clergy- 
man said to me, “Now you know he fre- 
152 quently comes to dine and spend the 
week-end with your neighbor up here; 
and he always has his valet with him. 
The principle duty of his valet when he 
goes visiting, is to examine his trunks 
after he has dined, and before he leaves 
his host’s house, restore the silver which 
he has adeptly put into his pockets while 
at dinner.” He said, “it’s a very extra- 
ordinary fact; he is a very brilliant pub- 
lic man; he is greatly gifted; he is one 
of the ablest public men very likely in 
the world; but I, myself, have seen him 
take from the table from time to time sil- 
ver spoons and forks and put them in his 
pocket, and he did it as though he were 
fully cognizant that nobody had observed 
him. This, I assure you, I have myself 
more than once witnessed.” As I said, I 
have no question of the veracity of this 
statement because this clergyman and the 
nobleman were quite friendly. 
Shortly after my arrival in San Fran- 
cisco, two very remarkable cases filled 
up the time of our courts for quite long 
periods. One was a criminal trial and 
the other a civil action, the contest of a 
will. The civil action appertained to the 
will of a very well known lawyer who 
153 was the author of the “consolidation act” 
which governed this city for over forty 
years. His life and his career has been 
frequently written and not one reference 
has ever been made to his mental condi- 
tion by the writers. Recently one of the 
ablest journalists in the community wrote 
a summary of this man’s biography laud- 
ing his excellent qualities of head and 
heart, but no reference was made to the 
will contest. The history of the will 
contest was this. He left large tracts of 
land for the purpose of founding several 
institutions. He left little or nothing to 
his family who were never antagonistic 
to him. He was always supposed to be 
penurious and it was proven that at the 
time he disposed of those great posses- 
sions for the purposes he intended, he 
was actually starving himself for want 
of the necessaries of life. It was proven 
by many witnesses that he would deny 
himself sufficient food of the commonest 
kind, but if some benevolent person in 
his neighborhood who was not a hun- 
dreth part as affluent, would bring him 
good and substantial nourishment, he 
would take it and eat ravenously. This 
was proven by many witnesses. In rela- 
154 tion to those benefactions of his, he kept 
constantly referring to them and vastly 
enlarging on their importance, according 
to the testimony, and invariably pro- 
claimed that he was a greater man than 
the Lord Jesus Christ. There were many 
witnesses of his brothers in the legal pro- 
fession called to prove his perfect sanity. 
Many outsiders, businessmen with whom 
he was brought in contact, also so testi- 
fied. But others, again, thought that he 
was very odd. Some two or three ex- 
perts of good repute were brought to 
testify that there was nothing in all this 
condition to show insanity. I was one of 
two or three others who held that the 
conduct showed clear symptoms of in- 
sanity. No rational man, I claimed 
would starve himself to death practically, 
with this kind of surrounding, and at 
the same time accept food from people 
whom he knew to be poor. I also 
claimed that his position in contrast with 
the Lord Jesus Christ if he firmly be- 
lieved in it, was an absolute evidence of 
insanity. The details of this matter were 
gone into very fully and it was shown 
that that was his belief. I was asked the 
very important question in cross-ex- 
155 amination, suppose a man were brought 
up an Israelite, or agnostic, would you 
still think that his belief in relation to his 
superiority to the Lord Jesus Christ 
would be an evidence of insanity? I 
said, “I certainly do. If he were an 
Israelite or agnostic of education, and 
knew the great changes brought about 
in the world by Jesus Christ,—the whole 
transformation of the moral atmosphere 
of the world, and the change from all 
points of view, it would not lead to any 
change in my opinion because the mere 
fact of founding a few institutions in a 
little remote community as we are here, 
to any rational mind could not possibly 
make him believe, or convince him, that 
those bear any proportion whatever to 
the mighty sweep of Christian civiliza- 
tion.” 
The theme constantly dwelt upon in 
that investigation and trial was the fact 
of this great performance of the consoli- 
dation act. I informed the court then, 
as I have done since then, hundreds of 
times, that persons suffering from delu- 
sional insanity are capable of transact- 
ing any business outside the delusion, in 
a perfectly rational way. I particularly 
156 dwelt on this discourse by the clergy- 
man that I have already referred to, and 
numbers of others, where men for many 
years were capable of transacting any 
business and still be the victims of delu- 
sional insanity. 
The criminal case was that of a woman 
of low character, violent and dissipated, 
and who had captured a prominent com- 
mercial lawyer of the city. He was the 
lawyer for several banks and other large 
institutions and regarded as a man of 
first class caliber. His family were in 
Europe for some time and on their return 
he met them some distance out of town. 
He was seated in one of the ferry boats 
crossing the Bay, beside his wife, and 
this woman came in front of him and 
shot him, the bullet piercing three cham- 
bers of the heart and the liver. He lived 
about forty-eight hours after, and she 
was accused of willful murder. The plea 
for the defense was insanity, as happens 
so frequently in these disgraceful cases. 
Three experts, so-called, who were not 
family doctors of either party, were 
called in her behalf, testified she was 
quite mad, and the twelve jurymen found 
her guilty of murder in the first degree 
157 notwithstanding. A new trial was 
brought forward. In this second trial, 
among ten other medical gentlemen of 
well-known local repute, I was a witness, 
not for the defense but for the prosecu- 
tion. The trial occupied a great deal of 
public attention and lasted for a good 
many days. We had to listen to the whole 
testimony. All ten of us agreed from tes- 
timony, nothing else, that the woman was 
perfectly sane. The three gentlemen who 
testified in her behalf on the first trial 
did not appear. There was nothing in 
the trial to convey to the jury any differ- 
ent impression from what ten of us doc- 
tors overheard. We had in all particulars 
to go over the same routine and yet the 
evidence of the ten doctors was discarded 
by the jury and the woman was acquitted 
on the ground of insanity. I refer to this 
to illustrate as far as it can reach the 
absurd, ludicrous, and frightful condition 
of medical jurisprudence and juries in 
this community. In the scientific sense 
one incident occurred that should not be 
forgotten. 
A woman named Kelly, who had been 
a matron at one of the insane asylums in 
the state at a previous period of her life, 
158 was at the time this criminal was ar- 
rested matron of the local county prison. 
She gave her testimony of what happened 
with clearness and evident integrity. On 
cross-examination by a very able and 
astute advocate: “Now, Mrs. Kelly, you 
was (he always insisted on the ‘was’) 
matron at the insane asylum at Stockton 
for some years?” “Yes, Sir.” “You saw 
the patients there do so-and-so” he went 
over a lot of details. And she answered, 
“Yes, Sir.” “Now,” he shouted with 
appalling emphasis, “you was matron of 
the county jail at the time this lady was 
taken there?” Yes, Sir.” “Didn’t she 
do so-and-so, etc., just as the patients 
did in Stockton?” She said. “Yes, Sir, 
but they did it in a different manner 
somehow.” This uneducated woman, 
who was brought in contact with the in- 
sane, recognized the difference between 
their conduct and the conduct of this 
tigress. This reply is more far-reaching 
than Mrs. Kelly dreamt of, and very in- 
structive for the reason that insane peo- 
ple do the same things and act precisely 
as other people do, but in a different 
manner somehow, as Mrs. Kelly put it. 
This criminal was acquitted by the 
159 jury, and as a reason for their conclu- 
sion gave public announcement to the 
fact that all the other doctors admitted 
that the lady might have had some hys- 
terical attack, except myself, who claimed 
that all her boisterous conduct was pure 
pretense and deviltry. 
From the medico-legal point of view 
two very interesting trials occurred some 
years ago in San Mateo County within a 
short period of each other. In contrast 
they illustrate the value of special or ex- 
pert education in relation to this whole 
subject. In the first case, a respectable 
grocer in the town of San Mateo was shot 
clean through the heart by a rifle bullet 
as he was watering his garden one sum- 
mer evening. A man who was refused 
groceries the morning before was seen 
crouching behind his fence waiting for 
some time before the grocer proceeded to 
irrigate his plot. After the act he ran 
away and escaped, nobody knew whither. 
The sheriff’s posse hunted up and down, 
but were unable to find him. Next morn- 
ing they proceeded out towards the hills 
in San Mateo County, and on the highway, 
coming in, was a man marching in mili- 
tary order with his rifle at “shoulder 
160 arms.” He seemed not at all disturbed, 
and made no effort to evade the posse. 
When they overhauled and interrogated 
him he readily confessed that he had kil- 
led this man and was proceeding into San 
Mateo again to kill some more bad men 
that he understood were in the town. He 
was arrested there and then, placed in 
jail, and in due time he was placed on trial 
for murder. There were three gentlemen 
of our profession, including myself, 
brought down for the trial at the county 
seat. The trial took place under the juris- 
diction of an uncommonly able, conscien- 
tious judge. The arresting officers found 
on the person of this man a hugh volume 
of a diary which he had kept for at least 
twenty years. This was produced on the 
occasion of the trial, and it was really in- 
troduced by the authorities to prove his 
sanity, it was so carefully and well kept. 
He himself was on the witness stand the 
whole of one day. He had been in the 
Austrian army for a number of years, 
and on coming to this country entered 
the service of the Confederate army. In 
this capacity, though never having any 
command of any consequence, he had the 
dates of every battle which he was en- 
161 gaged in, which were numerous, and he 
had in diagram and in literature the ac- 
tual position of the various regiments 
and battalions immediately within his 
scope, sufficiently accurate and technical, 
apparently to do credit to a careful, com- 
petent commander. His testimony on 
the stand was on similar lines, marvelous 
for the minute details of his life and ac- 
tions and labors, and he certainly looked 
to an untrained mind anything but in- 
sane. There was one feature of this 
whole diary and personal evidence which 
was very often repeated. He was always 
insisting upon calling upon a certain Aus- 
trian count to come over here and reform 
the whole government ;of the country. 
At the present time he would, no doubt, 
be arrested as an alien enemy. This was 
a refrain running right through the 
whole of his correspondence and his dis- 
courses. A prominent medical gentle- 
man from the city who went down with 
me, one of the professors at that time, a 
man of consummate ability and integrity, 
on hearing the diary read and the testi- 
mony in general gone over, declared em- 
phatically the man was sane. No man 
could have such accurate scope of those 
162 things that had happened to him who 
had any mental defect. Dr. Shurtcliff, of 
the Stockton asylum, was called immedi- 
ately after this gentleman’s testimony, 
and he testified that without any ques- 
tion the man’s whole actions and writing 
and speech were those of an insane per- 
son, and that this man had so suffered 
for many years. I emphasized the same 
view as Shurtcliff’s and claimed without 
any hesitation that this man had been 
insane from the time he first kept the 
diary, and possibly while serving in the 
Austrian army. The judge hesitated and 
deferred further trial for some future oc- 
casion, at the same time giving instruc- 
tions to have the matter looked into. 
Shurtcliff was a state official and had 
time and leisure to make the investiga- 
tion. He found out that all he repre- 
sented with regard to the Austrian army 
was correct, but he also discovered that 
he had been an inmate of a state asylum 
before he left Austria and had escaped 
from it. He discovered the more aston- 
ishing fact that he was then, at that very 
time, an escapee from the asylum over 
which he, himself, presided. 
In contrast with this case, the case of 
163 an Irish woman who was married to a 
German. This Irish woman had been 
previously married and had accumulated 
quite a substantial lot of properties in 
San Francisco. She lived in very good 
style down the peninsula and her lord 
and master, and his son by another mar- 
riage, tormented and goaded in every 
possible way this little irritable woman. 
In the house there were outrages con- 
stantly, almost in her presence, that 
would upset the minds of most women. 
She, of course, displayed a good deal of 
temper and in consequence of this the 
two gentlemen concluded that they must 
get hold of her possessions by the facile 
method of having her committed to an 
asylum. She was brought before the 
commissioners of insanity of San Mateo 
county who were three gentlemen of good 
repute, without any knowledge whatever 
of the subject. Through them and the 
judge, who, of course, had to rely upon 
the doctor’s testimony, she was ordered 
to an asylum, after a very hasty examina- 
tion. Some gentlemen in the neighbor- 
hood, knowing of the facts in the case 
had the sentence deferred until further 
investigation was made. I was requested 
164 by those gentlemen to go down on the 
day of the second trial, and I appeared 
accordingly. The woman was placed on 
the stand to give an account of herself, 
to explain what happened, and why she 
lost her temper, and she gave a very 
satisfactory account of the whole pro- 
ceeding. There was no question but she 
had been grossly outraged and the com- 
munity around her felt her condition 
very acutely. I testified that I saw no 
evidence whatever of insanity about the 
woman. The three doctors who had 
committed her three days before signed a 
retraction of their former certificates and 
the whole proceedings terminated quick- 
ly. This woman never thereafter showed 
any evidence whatever of mental disease. 
I allude to these two cases in contrast 
because the gentlemen in both instances 
who had given opinions were bright, 
honorable men, but they had not what 
they should have before giving such 
opinions, a technical, special education. 
While I write these lines I am reminded 
of the fact that a very worthy member 
of our profession right here, was cruelly 
and foully slain by a patient who soon 
afterwards committed suicide. I think 
165 there is scarcely any doubt that if the 
victim knew sufficient about the subject 
of insanity he would have discovered it 
in this man long before and so have 
saved his own life. It is too much the 
habit with professional men generally, 
doctors as well as others, to pooh-pooh 
the idea of insanity unless it is of the 
boisterous, erratic quality that I have des- 
cribed in acute mania. 
Illustrating this, a tall, athletic, well- 
built, well-dressed gentlemanly appear- 
ing man presented himself at my office 
with the cards of three different doctors 
introducing him to me. He had spent a 
good deal of time in those arid districts 
of Arizona and New Mexico. I saw 
him very quickly (I did not want to keep 
him waiting as he had doctors’ cards) 
and he told me about his experiences 
very briefly and asked if I were not in- 
terested in lands. I was quite extensively 
at the time, and exceedingly glad to get 
any information touching those things. 
He said he had something to show me, 
which would interest me. He had a big 
bundle covered with newspaper under 
his arm. At my request then he unfolded 
this newspaper bundle, spoke quite 
166 rationally and connectedly, and exposed 
his wares on a large table in my office. 
He had seeds and grasses carefully 
segregated in one section of the news- 
paper and soils and chemicals in another 
section. He proceeded to discourse about 
them both, in what appeared to be a 
learned and logical way. I followed him 
with close attention but all at once he 
suddenly changed the whole pitch of his 
voice and his manner. There was such 
a change in his demeanor, and so quickly, 
that I bluntly said to him, “Pardon me a 
moment, were you ever an inmate of a 
lunatic asylum?” He looked at me quite 
ferociously and replied, “Yes, about 
twenty years ago in Glasgow, they sent 
me there, but I don’t want anybody to 
know anything about it.” I said, “Very 
well. You fold up your packages care- 
fully (he had segregated one from an- 
other in a very skillful manner) and de- 
part from my premises here as quickly 
as you can, and I shall certainly say 
nothing about it.” One of those gentle- 
men of our profession who had sent this 
man with his card was quite a friend 
of mine whom I frequently met. He 
came hastily to my office and after some 
167 conversation, said to me, “You had quite 
a funny experience yesterday.” I said, 
“In what respect?” He told me of this 
man who had been up to see me with 
the seeds and clays, and the patient, we 
will call him, said to him, “That man 
Buckley is the strangest man I ever 
met.” The other said, “Why?” “Well,” 
he said, “do you know the first question 
that fellow asked me was if I had ever 
been in an asylum.” And the doctor 
immediately gulped out the question, 
“Were you?” The patient replied, “Yes, 
twenty years ago in Glasgow, but I don’t 
want anybody to know anything about 
it.” And so my medical friend got a new 
wrinkle in medical education and 
laughed very heartily over it. Shortly 
after I noticved that this man who was a 
fine specimen to look at, appeared before 
our board of supervisors giving them in- 
structions on various subjects with regard 
to these very hobbies that he was inter- 
ested in. He was listened to with very 
marked attention and respect, and our 
city fathers, whose scientific attainments 
were supposed to be equal to their fel- 
lows in the same position all over the 
country, voted him a vote of thanks. 
168 This was more than he could endure so 
he immediately proceeded to enlighten 
the public through the daily Press. I 
have seen several times two or three 
columns of the local newspapers devoted 
to the mutterings of this poor, deluded 
lunatic, the subject matter of which was 
as plainly as could be discussed from an 
insane standpoint. These dissertations 
of his continued to appear in print for 
three months after which he suddenly 
seemed to disappear and I never heard 
of him again. He was not by any means 
a safe person to have at large because 
suffering in that way, and being a man 
of much more than common physical 
power, he would be very likely, if antag- 
onized by any opposition expressed to his 
views, to dispose of his antagonist very 
quickly. One of the things that should 
be observed in all these cases is that 
very question of antagonism. The old 
priest and the lunatic “bishop” very 
well illustrate that matter, and in con- 
nection with the insane it is of the utmost 
value to avoid antagonism in certain 
directions. 
It is related in one of our books on this 
subject that one day in Paris an elderly 
169 gentleman was ruminating on top of the 
Pantheon. He was suddenly approached 
by a strong young man who said to him, 
“Prepare now for your last end, I have 
come up here to throw you off this 
dome.” The old gentleman, with con- 
summate presence of mind, replied, 
“That is not a very clever trick for a 
large, powerful fellow like you, but it 
would be a clever trick to let us go down 
and see if you can throw me up.” The 
lunatic laughed and they both went down 
together, and, of course, his contract was 
not kept, because he was immediately 
placed in charge of a gendarme. 
A very similar case occurred in our 
own household when I was a boy. We 
had an aged servant who was quite noted 
in his district for his ready wit and rep- 
artee. A fine, big, young farmer in the 
neighborhood became insane and roamed 
over the countryside to the terror of all 
the neighborhood. One beautiful sum- 
mer afternoon the old servant was taking 
a sunbath on a sunny slope looking out 
on the ocean. He was suddenly and ter- 
ribly frightened by the appearance of 
this young lunatic, who jumped over a 
fence just behind him. The peasantry 
170 everywhere seemed to think that the in- 
sane are always bent on nothing but 
slaughter. Both these men knew each 
other quite well, and saluted quite cor- 
dially. After that a long silence ensued. 
The old man was too terror-stricken to 
speak, when suddenly the lunatic look- 
ing down on a very pretty mountain lake 
beneath them said, “I wonder if there are 
many fish in that lake.” The old man 
solemnly remarked, “I don’t know, it’s 
some years now since I’ve been fishing.” 
Another long lull, until the lunatic re- 
marked, “How long the days are getting 
now.” “Sure,” said the old man, “it 
wasn’t today or yesterday that com- 
menced with them; I think that happens 
every year about this time.” And the 
reply so tickled the somewhat educated 
lunatic that he ran off laughing to other 
fields. 
A large comely woman of middle age, 
with her daughter, came to consult me 
one afternoon. We all three talked about 
current events for a few minutes when 
the matron said to me, “Doctor, I have 
come to see you on a very curious errand. 
I understand that you have devoted a 
great deal of attention to the subject of 
171 insanity and I want to know whether I 
am insane or not.” This was very direct 
and required some consideration. I 
asked her very many questions about 
herself, her health, her surroundings, her 
history, and all those things that I should 
know before arriving at any conclusion 
on this subject. The sheet appeared to 
be clean. I could not gather anything 
from this interview which would enable 
me to reach any proper conclusion. I 
told the daughter I would like to see her 
again, appearing to consider her the pa- 
tient. In a private conversation of a few 
minutes with the daughter I told her I 
would like to see her mother at some 
time, by herself. After a few days she 
returned, as I requested, and then she 
developed quite readily her delusion. 
She had a mission which she did not like 
the daughter to know anything of, one of 
those common grandiose ideas to reform 
society, very like my friend in the asy- 
lum, who played bishop for a while, but 
hers was to reform first of all the Cath- 
olic Church itself. She had a special mis- 
sion to get rid of the Archbishop of San 
Francisco, and several of the priests 
whom she knew quite well. I then in- 
172 formed her daughter that her mother 
was quite insane and should be placed 
in some sanitarium or other place of 
safety, or she would do something which 
she would very much regret. I accord- 
ingly cautioned the worthy Archbishop 
that if this lady should visit him on any 
pretext whatsoever, he should not allow 
her into his presence without some other 
person being there. I told one of the 
priests whom she mentioned the same 
thing, and in doing so I thought I had 
done simply my duty. The Archbishop, 
who was a man of common sense, and 
who did not know this woman person- 
ally, accepted my advice and thanked 
me. The clergyman who was not of the 
same calibre, but knew this woman very 
well, informed me that he knew her for 
a long time and knew she was not in- 
sane ; that he was not a particle afraid of 
her, etc., etc., but added, “she is a little 
queer, to be sure, but she is not insane.” I 
went out of my way to admonish him 
and did not go any further. Not more 
than a month after this happened, I read 
in one of the morning papers the usual 
terrorizing announcement, “Attempt of 
brutal murder in the St. Hotel.” 
173 This woman had very extensive interests 
in different parts of the country. She 
had a large interest in some fisheries, 
which her son looked after. The book- 
keeper for the son came down to show 
her his semi-annual report. He dined 
with her and her daughter, and they 
spent the evening together without any 
apparent trouble , in fact, quite pleas- 
antly. When the young man, the book- 
keeper, was about to leave the hotel, she 
asked him where he was stopping. He 
told her, and mentioned another hotel. 
Then she said, “You had better stay here 
for some time, as I will have to see a 
good deal of you, and this will be most 
convenient for me. I will be responsible 
for your account.” Hence he stayed in 
her hotel that night, but on an entirely 
different floor. During the night she 
tapped at his door and without any warn- 
ing whatever assailed him with a big 
dirk knife which she had previously pro- 
cured, but which none of those around 
her had ever seen before. The young 
man was strong and athletic; she was a 
very strong woman, and if it had not 
been for his superior strength she would 
have killed him there and then. On read- 
174 ing it I felt somewhat sadly amused and 
had a sort of mischievous regret that my 
friend, the padre, was not the recipient 
of this delicate attention accorded to the 
clerk. 
A builder and contractor of middle 
age, accompanied by his wife, visited me 
one afternoon, and both were in great 
distress because he was harassed by some 
people who were throwing electricity at 
him. This was the expression. The poor 
wife firmly believed him. I happened to 
have two different electric batteries in 
my office, and after my assistant had 
placed him through different tests in re- 
lation to the effect of electricity, I then 
asked him if it were the same sensation 
which he experienced when these bolts 
of electricity were thrown at him. He 
replied, “No, it is entirely different from 
that, but I know they are doing it.” Ac- 
cordingly, knowing that he did things 
mechanical, I asked him if he ever car- 
ried any nails or penknives or anything 
of that kind about him. I made no ref- 
erence to a pistol. He said, “Yes, very 
frequently”—he always had some nails 
somewhere in his clothing and frequently, 
indeed, almost always carried a penknife. 
175 I said, “You know all these metallic 
things attract electricity, don’t you?” He 
said, “Yes.” “And you see,” I said, “they 
must be laid aside. Everything in the 
shape of metal must be out of your cloth- 
ing.” He agreed to the conditions. He 
did some work for me from time to time, 
supervised everything very honestly and 
very capably, and did in every respect 
professionally everything that I demand- 
ed. One evening late, he came to my 
residence in quite an excited condition. 
He had a large contract out of town but 
was returning home that particular eve- 
ning, and on his way passed by a stand 
where drays and draymen were hud- 
dled together in a goodly number. It 
was rather a chilly, wet evening, and he 
informed me that if it were not for me 
he would have got his enemies that eve- 
ning. I said, “Why?” He said, “Well, 
you know you told me that I must not 
have around me anything in the shape of 
metals. Before that,” he said, “I always 
carried my gun when I was out after 
dark, and if I had my gun with me, as I 
should have had, I would have got these 
fellows, for I saw them working a ma- 
chine under the drays there.” I was 
176 very glad my first admonition had such a 
good effect, for unquestionably from his 
own statement he would have killed some 
of those innocent people. 
177