T . A* w "Si lUfr M £?«* " V^S V" .1 t^fl /• 1 ft ARMY MEDICAL LIBRARY WASHINGTON Founded 1836 Section. Number Fokm 113c, W. D.. S. G. O. iro 3—10543 (Revised June 13, 1936) / OBSCURE DISEASES 9 7- '^ BRAIN AND MIND. t'OR-HEs. WIXSLOW, M.D., D.C.L., Oxon., &c. Ac. Ac. Seconb '3initru m from % f^irb anb l&ebiseb dttglisjj @bition. PHILADELPHIA: HENRY C. L E A. I860. WL W77S^ \8U /r,/>"> ?cl4 > <$ tbat bag Utabuess lies; let me s^rnit tljat." King Lear. " |f our leg or arm offenb us, foe cobct bji all means possible to rebress it; anb if foe labor of a bobilg bisease, foe'scnb for a |1bnsician; but, for f^e diseases of flie Ipinb, foe take no notice of tbem." Burton's "Anatomy of Melancholy." " |3rirtripiis obsta: sero mebitnu prate, . QLnm mala per Jongas conbalum noras." Ovid. SHERMAN 4; CO., PRINTERS. ft^is Hork is § ebicafeb BY HIS FRIEND, THE AUTHOR, TO A. BRIERRE DE BOISMONT, M. D.f DE LA PAC€Ll£ DE PARIS, CHEVALIER DES ORDRES DE LA LEGION D'HONNEUR, PRESIDENT DE LA SOCI£t£ M £ D I C 0 - PS Y C H OLOGI Q UE, ETC. ETC. AS A MARK OF RESPECT FOR HIS PRIVATE CHARACTER, DISTINGUISHED TALENTS, AND HIGH PROFESSIONAL ATTAINMENTS ; ALSO, IN ACKNOWLEDGMENT OF THE EMINENT SERVICES HE HAS RENDERED TO THE CAUSE OF SCIENCE, BY THE PROMULGATION OF HUMANE AND ENLIGHTENED VIEWS RESPECTING THE PHILOSOPHY OF INSANITY, AND THE TREATMENT OF THE INSANE, IN THE ABLE WORKS WITH WHICH HE HAS ENRICHED THE MEDICO- PSYCHOLOGICAL LITERATURE OF HIS COUNTRY, PREFACE. The object of this work is to briefly, clearly, and, free from all unnecessary technicalities of language, point out the more important, salient, and characteristic symptoms, that usually precede and accompany serious and often fatal attacks of disease of the brain and disorder of the mind. This work is to be considered merely as an outline of sketch of a vast and hitherto much-negiected branch of practical medi- cine. All diseases of the brain, independently of, or complicated with, disorders of the mental operations, are, as a general rule, very obscure in their origin, insidious in their progress, and most difficult to treat successfully, particularly when, in con- sequence of their being unobserved in their incipient stage, they are permitted to pass, unarrested, from an acute into a chronic condition. Hence the grave significance attached to the advice so pro- perly given to the practitioner of medicine, that he is not only to watch with the greatest vigilance for the approach of all head affections, but, if possible, to anticipate their stealthy advance and prevent by the early-use of remedial measures those organic and incurable alterations in the delicate structure of the brain which so often follow neglected cerebral and unnoticed mental diseases. A careful study of the premonitory signs of these affections vi PREFACE. should not, if philosophically considered, excite on the part of the patient morbid apprehension or nervous alarm. In all the great transactions of life, the wisdom of the maxim that prevention is better than cure, is universally admitted. Its application is general. Admiral Fitzroy sits quietly like a magician of old in his London studio, and, as the result of much philosophical study and many complex calculations, based upon a large accumula- tion of data illustrating meteorological science, is able, with extraordinary and almost unerring precision, to detect sudden alterations of temperature and changes of weather. With wonderful sagacity he has frequently been known to predict the approach of fearful hurricanes. Having satisfied himself as to the accuracy of his conclusions, the Admiral touches the electric wire, and instantaneously com- municates with the officials on the coast, bidding them to hoist the storm signals. By the wise and timely warning thus given, much valuable property about proceeding to sea in vessels is preserved, and many valuable lives are saved. The skilled mariner by his knowledge of the laws governing storms, and a careful observation of the character of the clouds and elevation'or fall of the barometer, is able to anticipate the approach of foul weather, and thus by the adoption of precau- tionary means, to avoid placing his vessel within the reach of danger. The general in command of an army marching in time of war through an enemy's country, sends out in advance his trustworthy scouts, and is thus protected from all sudden sur- prise. So the philosophical physician, recognizing the fatally destructive character of certain diseases, considers that he is hut ill discharging the duty he owes to the public if he does not point out to the uninitiated, as well as those who are medically educated, the symptoms that, in the great majority of cases are premonitory of serious morbid organic conditions. It may be urged, that it is mischievous to excite anxiety PREFACE. Vll where no danger is close at hand; but surely it is wise to be on our guard against the approach of disease, to observe its first warnings, and thus, by the use of appropriate remedies, prevent the enemy from obtaining a permanent lodgment in one of the vital tissues. The daily records of passing events are full of sad data, pain- fully illustrating the folly of neglecting disease of the brain and mind in its incipient stage. Fatal attacks of apoplexy, serious cases of alarming paralysis, incurable conditions of softening of the brain, lamentable in- stances of insanity, suicide, homicide, and murder, are matters of daily occurrence, springing out of unobserved and neglected affections of the brain and mind. It is with the view of exciting a deeper interest in, and of awakening a profounder and more philosophical attention to this important subject, that these pages have been penned. That this work (of which two large editions have been sold within three years) has been productive of much practical good admits of easy and satisfactory demonstration. Cerebral symp- toms that were too commonly overlooked, or, if noticed, viewed as insignificant, are now properly considered as symptomatic of threatening brain and mental disease. Thus mischievous mala- dies have been detected in the incipient stage and placed under arrest, whilst appropriate medical measures have been adopted for their mitigation and cure. For these known results I have every reason to be grateful. F. W. October, 1863. TABLE OF CONTENTS. CHAPTER I. INTRODUCTION. Important aphorism of Hippocrates in reference to the early treatment of disease—Mar- shall Hall on the neglect of premonitory symptoms of disease of the brain—General neglect of incipient cerebral symptoms—Attention paid to the early symptoms of dis- ease in other organs—Cases illustrating the neglect of incipient symptoms—Insidious character of disease of the brain—Obscure cerebral symptoms—All affections of the brain have an incipient stage—Latent disease of the brain—Diseases of the brain subject to general pathological laws—Neglected affections of the brain—Cases of al- terations of structure of the brain—Physiology of the brain—Necessity of watching for incipient cerebral disease—Early treatment of insanity—Unwillingness to recog- nize the existence of insanity—Importance of early treatment, . . . 17—31 CHAPTER II. MORBID PHENOMENA OF INTELLIGENCE. All physical alterations of the brain modify its psychical functions—Effect of cerebral dis- ease on the mind—Emotional exaltation and excitement—Irresistible impulse to suicide—Ennui not always a condition of mental inactivity—Early symptoms of mental disorder—Disorders of the mind shown by alterations of thought and con- duct, ..............32—35 CHAPTER III. PREMONITORY SYMPTOMS OF INSANITY. Ignorance of the nature of insanity—What is insanity?—Ignorance of the mental and nerve force—The extent of our knowledge of the nature of mind and matter—Impos- sibility of defining insanity—Study of metaphysics and logic—Suggestions for an im- proved analysis of morbid mind—Laws governing the operation of thought—State of the mind between sleeping and waking—Insanity and dreaming—Are intellectual pro- blems solved during dreams ?—Insanity a waking dream—Pascal on dreams—Poetry, &c, composed during sleep—Rapidity of mental action in dreams—Curious case— Resemblance of the phenomena of dreams to insanity—In dreams the mind is often conscious of its creations—Lucid intermissions during attacks of insanity—Singular temporary restoration to reason, . ........ 36—56 CHAPTER IV. CONFESSIONS OF PATIENTS AFTER RECOVERING FROM INSANITY ; OR THE CON- DITION OF THE MIND WHEN IN A STATE OF ABERRATION. The autobiography of the insane interesting and instructive—Indivisibility of mind— Can the insane accurately describe, after recovery, their previous condition of dis- ordered mind?—Shakspeare the only correct delineator of insanity—Former bar- barous treatment of the insane—Pinel's efforts to ameliorate the condition of the in- sane—Progress in the pathology and therapeutics of insanity—Symptoms of insanity described by a lady after recovery—Morbid suggestions in the incipient stage—Cases of incipient insanity—Case of double consciousness—Singular case of incipient insa- nity—Illusions of hearing—Hallucinations of sight—Letters from patients after reco- very—Confessions of the insane after recovery,......57—89 x CONTENTS. CHAPTER V. STATE OF THE MIND WHEN RECOVERING FROM AN ATTACK OF INSANITY. State of the mind when passing out of an insane into a sane condition—Cases illustrating the phenomena—Doubts as to the reality of delusions among the insane—Descriptions given by patients after recovery of their previous state of mind—Singular case of re- covery from attacks of insanity—The Rev. Mr. Walford's account of his recovery from'an attack of mental derangement, ....... 90—95 CHAPTER VI. ANOMALOUS AND MASKED AFFECTIONS OF THE MIND. Impossibility of defining insanity—Singular case of insanity—Insanity among children— Symptoms of insanity—Undetected mental disease—Remarks by Dr. Brierre de Bois- mont and others on the insanity of early life—Insanity in the United States of Ame- rica—Statistics of insanity among children—Hereditary predisposition to insanity— Incipient symptoms of insanity—Transformations of character in the early stage of insanity—Exaggerations of natural states of mind often indicative of insanity— Delusions—Diagnosis of insanity—Obscure disease of the brain—Latent and unrecog- nized insanity—Serious results following a non-recognition of insanity—Pseudo forms of mental disorder—Insidious approach of insanity—Symptoms of latent insanity— Alterations of character and disposition preceding attacks of insanity—Cases of morbid paroxysms of passion—Temper disease—Curious case of disordered mind— Insanity shown in acts of brutality—Concealed monomania—Moral character changed by physical injury—Paralysis of the moral sense—Illustrations of moral idiocy— Shakspeare's description of this affection—Latent case of monomania—Transforma- tion of character caused by physical disease—Effects of diseased brain on the cha- racter—Historical illlustrations of diseased brain on the character—Caligula, Tibe- rius, Catherine de Medici, Frederick William of Prussia, Robespierre, Judge Jeffreys —Meteorological influence on the mind—Effect of chloroform on the mind—Resem- blance of mental phenomena caused by the use of chloroform to insanity—Curious mental phenomena caused by the absorption of poison in the blood—Singular case of hydrophobia affecting the mind—Influence of physical irritation on the mind—Morbid views of religion—Extraordinary organic change discovered after death in the mem- branes of the brain—Brutality and immorality—Cases of erotic monomania—Speedy cure of a case of insanity—Singular case of concealed insanity—Recklessness in monetary transactions exhibited in the incipient phase of mental disorder—Case of undetected insanity—Motiveless acts of brutality connected with latent insanity- Homicidal insanity—The medico-legal witness—Duties of the psychological expert— Importance of the testimony of experts in subtle cases of insanity—Popular ignorance of insanity—Evidence in cases of alleged lunacy—Case of Atkinson, the homicidal idiot—Danger of lunatics being at large—Decisions of juries in cases of insanity— Serious consequences of a wrong verdict in commissions de lunatico—Anomalous de- fective state of the law of lunacy—Justice to be tempered with mercy, . 96—145 CHAPTER VII. THE STAGE OF CONSCIOUSNESS. Neglect of habits of self-inspection—Innate wickedness of the human heart—Mysteries of the inner mental life—Consciousness of the approach of insanity—Foreshadowings of insanity—Struggle between reason and insanity—Morbid apprehensions of insa- nity—Confessions of patients—Insidious advances of morbid thought—Obscene and immoral ideas—Singular perversion of thought—Illusions premonitory of insanity__ Phantasms and spectral illusions—Illusions of hearing (voices)—Singular case of hal- lucination—Incubation of insanity—Efforts made to conceal insanity—Insane impu- rity of thought—The insnnity of Ophelia—Indecent remarks of young women whilst insane—Explanation of the causes of perverted thought—Sources of early moral de- terioration—Purity of thought sometimes exhibited by the insane—Power of con- trolling insane ideas—Symptoms of incipient insanity—Morbid presentiment of in- sanity—Prediction of attacks of apoplexy—Sir W. Scott's anticipation of brain disease—Dean Swift's presentiment of his approaching imbecility—Morbid anticipa- tion of insanity,............146—165 CONTENTS. xi CHAPTER VIII. STAGE OF EXALTATION. Psychical exaltation—State of mind premonitory of insanity—Morbid exaggeration of ideas—Emotional exaltation—Suicidal delirium connected with great exaltation of spirits—Wit, ingenuity, and cunning of the insane—Mental acuteness of the insane— "^Poetical enthusiasm in mania—Mental abilities of the insane—Symptoms of insanity in young women—Peculiar type of mental disease—Self-control and shrewdness of the insane—Art of analyzing subtle cases of insanity—Feigned insanity unmasked by chloroform—Concealment of delusions by the insane—Subtle case of homicidal in- sanity—Cunning, cleverness, and subtlety of the insane—Acute instinctive manifes- tations of the insane—Subtlety of the insane metaphysically explained—Symptoms of insanity—The physical agitation of incipient insanity—Tortures of a wicked con- science—Happy type of insanity—Horace's description of the happy madman—Pre- monitory signs of apoplexy—Disease of the brain caused by a blow upon the head- Insidious symptoms of general paralysis—Obscure case of general paralysis, 166—187 CHAPTER IX. STAGE OF MENTAL DEPRESSION. Acute morbid melancholy—Symptoms of brain disease—Concealed delusions—Subtle types of suicidal insanity—Melancholia a symptom of softening of the brain—Apo- plexy preceded by depression of spirits, ....... 188—189 CHAPTER X. STAGE OF ABERRATION. Obscure progress of aberration of mind—Exaggeration and perversion of ideas—Disorder of the perceptive faculties—Delusions, how they originate—Illusions premonitory of apoplexy—Illusions of hearing—Illusions premonitory of disease of the brain—Sin- gular case of spectral illusions—Perversions of the moral sense—Insane pilfering and concealing—Insanity manifested by avarice and licentiousness—Insanity exhibited by acts of immorality—Softening of the brain, ...... 190—205 CHAPTER XI. IMPAIRMENT OF MIND. Insidious advances of mental imbecility—Symptoms of softening of the brain and apo- plexy—Subtle case of softening of the brain—Singular case of cerebral paralysis— Lesions of intelligence preceding disease of the brain—Impaired nutrition of the brain,..............206—210 CHAPTER XII. MORBID PHENOMENA OF ATTENTION. Importance of the faculty of attention—Genius a continued attention—Impairment of at- tention—Morbid distraction and reverie—Injurious effects of protracted reverie—Re- semblance of reverie to dreaming—Morbid imaginative contemplation—Hypochon- driasis—Morbid concentration of attention—On the importance of controlling the imagination—Weakness of attention a symptom of cerebral disorder—Morbid effect of concentrated attention—Defect of speech—Impairment of attention—Morbid dis- traction a symptom of brain disease—Case of morbid distraction ; post-mortem exa- mination of the brain—The cerebral disease of Oscar, King of Sweden, exhibiting itself in the early stage by distraction of mind,......211—226 xii CONTENTS. CHAPTER XIII. MORBID PHENOMENA OF MEMORY. What is memory?—The natural classification of ideas—Cause of decay of memory in old age-Mode of acquiring knowledge—Theory of memory—Loss of memory in apoplexy —Laws regulating the admission of ideas into the mind.....-"' CHAPTER XIV. ACUTE DISORDERS OF THE MEMORY. Decay of memory in old age-Retention of early impressions in old age-Premature im- pairment of memory-Loss of memory in advanced life—The poet Rogers loss of memory—Importance of preserving the memory—Impairment of memory a symptom of brain disease—Loss of memory a symptom of paralysis and softening of the brain- Sudden and transient loss of memory—Symptoms of mental disorder—Case ot soften- ing of the brain—Causes of impaired and paralyzed memory—Sir H. Holland s case of temporary loss of memory—Effect of stimulants in restoring the memory—ireat- ment of cases of loss of memory1—Disease of brain indicated by loss of memory—Case of sudden loss of memory—Enfeebled memory caused by mental anxiety—Successful treatment of a case of loss of memory—Loss of memory caused by blows upon the head—Singular case of forgetfulness of dates and names—Insidious case of brain disease—Injurious effect of the hot bath in cases of cerebral disease—Confused state of the memory—Symptoms of brain disease—Confused state of the memory a symptom of ramollissement of the brain—Effect of mental emotion on the ideas, . 233—248 CHAPTER XV. CHRONIC AFFECTIONS OF THE MKMORY. Forgetfulness of names previously to an attack of brain disease—Loss of language caused by a blow on the head—Singular case of revival of a language long forgotten—Loss of language after attacks of apoplexy, &c—Effect of injury to the head on the memory —Singular case of defect of memory—Loss of memory after acute bodily disease— Effects of paralysis on the memory—Loss of certain words, &c.—Remarkable cases of disordered memory—Effect of a bullet-wound on the memory—Impairment of memory after epidemics—Paralysis of the memory caused by intense cold—Effect of the Rus- sian campaign on Bonaparte's memory—Loss of memory caused by fever—Loss of language—Singular manifestations of memory prior to death—Effect of apoplexy on the memory—Singular loss of memory, the result of a blow upon the head—Effect of a mental shock on the memory—Remarkable case of disordered memory—Proximate cause of morbid memory—Singular cases of defect of memory—Cases of impairment of memory, ............ 249—266 CHAPTER XVI. PERVERSION AND EXALTATION OF MEMORY—MEMORY OF THE INSANE. Curious cases of perversion of memory—Remarkable case of double personality—Case of double or divided consciousness—Exaltation of memory a fatal diagnostic sign—Ex- altation of memory in brain diseases of early life—Improvement of memory in ad- vanced life often precursory of apoplexy—Cases of exaltation of memory—Memory of the insane—Shakspeare on the memory of the insane, .... 267—273 CHAPTER XVII. PSYCHOLOGY AN'D PATHOLOGY OF MEMORY. Destruction, a physical and moral impossibility—Indestructibility of mental impressions— Effects of organic physical changes on the mind—Inexplicable psychical and physical phenomena,—Assimilative power of the blood—Nutrition of the brain—Is the mind situated in the brain?—The subject of chemico-cerebral pathology ought to be more CONTENTS. Xlll investigated—Phenomena of latent mental impressions—Curious facts relative to latent light—Indestructible character of ideas—Singular phenomena caused by hang- ing—Mental phenomena caused by drowning—Curious phenomena manifested at death—Morbid phenomena of language—Knowledge of languages revived by fever— Curious phenomena observed in somnambulism and catalepsy—Laws governing the association of ideas—Morbid and sensitive state of activity of the memory—Physical theory of latent mental impressions—Physical impediments interfering with thought —The brain compared to a galvanic battery—Sudden resuscitation of latent ideas— Rapidity of mental action—Cases of loss of memory, and its sudden restoration- Idiocy cured by blows upon the head—Connection between wit and madness—Dor- mant nature of mental impressions—Latent ideas suddenly recalled to consciousness —Loss of speech and consciousness—Sudden arrest of intelligence—Garrick's accurate knowledge of insanity, how acquired—Morbid fixedness of idea, . . 274—303 CHAPTER XVIII. MORBID PHENOMENA OF MOTION. Diagnosis between cerebral and spinal paralysis—General muscular debility—Early signs of softening of the brain—Partial loss of motor power—Incipient symptoms of apo- plexy and paralysis—Insidious progress of brain disease—Case of brain disease without impairment of intellect—Muscular tremors symptomatic of brain disease—Irregular muscular action--Morbid want of muscular co-ordination—Difficulty of explaining these phenomena—Convulsive action—Obscure types of nocturnal epilepsy—Loss of memory in epilepsy—Diagnosis of epilepsy—Premonitory symptoms of epilepsy.—Affec- tions of the tongue and muscles of the mouth—Insidious symptojH8-"0'f paralysis— Effects of softening of the brain on the motility—Morbid^Bandwriting—Paralysis agitans—Premonitory symptoms of paralysis agitans—Loss of sleep—Morbid affections of the spinal cord—Acute ramollissement of the spinal cord—Peripheral paralysis, 304-321 CHAPTER XIX. MORBID PHENOMENA OF SPEECH. Cerebral localization of speech—Is loss of speech the result of affections of the anterior lobes of the brain?—Loss of speech caused by cerebral paralysis—Cases of loss of speech in general paralysis and softening of the cerebellum—Disease of the corpora olivaria a cause of loss of speech—Morbid impairment of speech—Irregular impair- ment of the articulation—Paralysis of ideas in incipient cerebral disease—Morbid irregularity of speech—Forgetfulness of certain words a symptom of apoplexy—Singu- lar misplacement of words—Cases of curious defect of articulation—Morbid articula- tion—Loss of speech a symptom of apoplexy, congestion, and softening—Morbid mis- use of words—Singular alterations of speech—Irregularity and impairment of speech —Diagnostic value of affections of speech—Symptoms of acute softening—Loss of speech caused by mental distress—Loss of speech a symptom of epilepsy and apoplexy —Premonitory signs of paralysis—Sudden loss of speech—Successful treatment of a case of loss of speech—Morbid speech following apoplexy—Singular case of mutism caused by a bullet-wound—Perversion of speech the result of a wound on the head— Case of extraordinary perversion of speech—Morbid imitative movements of articula- tion—The "echo" symptom of softening of the brain—Involuntary articulation a symptom of brain disease—Effect of insanity upon the Voice—Singular recovery of speech shortly before death—Alterations of voice symptomatic of insanity, 322—346 CHAPTER XX. MORBID PHENOMENA OF SENSATION. Exaltation of sensation—Softening of the spinal cord—Vertigo a symptom of cerebral disease—Cause of vertigo—Symptoms of epileptic vertigo—Obscure cases of epilepsy— Diagnosis of epilepsy—Hyperaesthesia of the brain—Cephalalgia generally accompany- ing cerebral affections—Cerebral headache—Anassthesia a symptom of brain disease— Incipient symptoms of apoplexy—Insensibility of the mucous membrane of the con- junctiva in incipient disease of the brain—Sensation of cold a symptom of apoplexy- Impairment of the sense of taste a symptom of softening—Sensation of weight and xiv CONTENTS. heaviness in the side a symptom of cerebral softening—Deficient sensibility of the in- sane—Explanation of the causes of anaesthesia—Impairment of sensibility in incipient general paralysis—Remarks by Pinel on the insensibility of the insane—Cases of in- sensibility to pain among the insane—Insensibility from preoccupation of mind- Vitiated sensation symptomatic of cerebral disease,.....347 360 CHAPTER XXI. MORBID PHENOMENA OF THE SPECIAL SENSES. Normal acuteness of the senses—Mental distress caused by certain odors—Mozart's acute- ness of hearing—Acuteness of the sense of touch among the blind—Singular defects of vision—Inability to distinguish colors symptomatic of brain disease—Curious cases of error of color, ........... 361—363 CHAPTER XXII. MORBID PHENOMENA OF VISION, HEARING, TASTE, TOUCH, AND SMELL. Impaired and paralyzed sight—Defect of vision symptomatic of disease of the brain—Early signs of cerebral amaurosis—Cephalalgia a symptom of centric cerebral amaurosis— Value of the ophthalmoscope in detecting obscure diseases of the eye—Double vision a symptom of disease of the brain—Case of sudden restoration of sight—Loss of sight caused by tumors in the brain—Causes of amaurosis—Loss of sight premonitory of apoplexy—Singular case of sudden recovery of the sense of vision—Importance of the early detection of cerebral disease—Symptoms of amaurosis dependent upon vascular congestion—Singular case of morbid derangement of sight—Exaltation of vision pre- monitory of brain disease—Cases of morbid exaltation of vision—Spectral illusions— Goethe's power of producing phantasms—Cases of hyperaesthesia of vision connected with disease of the optic thalamus—Perversion and aberration of sight—Peculiar ex- pression of the eyes in some forms of brain disease—Incipient symptoms of apoplexy —Derangement of sight premonitory of meningitis, congestion, and cerebral hyperae- mia—Vitiated perception a symptom of apoplexy—Symptoms of cerebral hemorrhage —Morbid luminous phenomena—Photopsia a symptom of disease of the brain—Singu- lar phantasmal phenomena—Illusions of sight—Morbid phenomena of sight—Strabis- mus symptomatic of disease of the brain—Double vision an important symptom of cerebral disease—Double vision symptomatic of apoplexy, paralysis, cerebritis, and meningitis—Morbid phenomena of hearing—Acuteness of hearing in incipient cere- bral affections—Hyperaesthesia of hearing a symptom of insanity—Illusions of the sense of hearing—Murder and suicide caused by illusions of hearing—Morbid pheno- mena of taste, touch, and smell—Disordered state of the taste and smell in incipient insanity—Disordered condition of the tactile sensibility in incipient paralysis— Exalted tactile sensibility,..........364—386 CHAPTER XXIII. MORBID PHENOMENA OF SLEEP AND DREAMING.' ^Sleeplessness of incipient insanity—Heavy and drowsy sensation a symptom of cerebral disorder—Insomnia caused by a severe mental shock—Death from want of sleep__ Pathology of sleeplessness—Case of long-continued sleeplessness—Sleeplessness in in- sanity often caused by spectral illusions—Singular illusions causing sleeplessness__The poet Southey's insanity caused by loss of sleep—Morbid disposition to excess of sleep —Drowsiness a symptom of apoplexy—Lethargy a symptom of cerebral disorder in- duced by renal disorder causing a retention of urea in the blood—Method of detecting urea in the blood and brain after death—Morbid drowsiness and excess of sleep__ Morbid phenomena of dreaming—Dreams often symptomatic of disease of the brain__ Hallucinations between sleeping and waking—Morbid dreaming preceding insanity__ Insanity commencing in a dream—Murder committed during sleep, . . 387__398 CONTENTS. XV CHAPTER XXIV. MORBID PHENOMENA OF ORGANIC AND NUTRITIVE LIFE. Sympathy between the brain and digestive organs—Case of delirium caused by indiges- tion—Derangement of the stomach in incipient insanity—Nausea resembiing sea-sick- ness symptomatic of cerebral tumors and softening of the brain—Influence of chronic disorders of the digestive organs on the mental impressions during insanity—Refusal of food by the insane, causes of—Vitiated and depraved appetite of the insane—Em- bonpoint in chronic insanity.—Influence of disorders of the nervous system upon the functions of nutrition—Morbid phenomena of circulation, respiration, and genera- tion—Connection between apoplexy and cardiac disease—Influence of cardiac disease on the psychical functions of the cerebrum—Hallucinations caused by disease of the heart—State of the pulse in incipient insanity—Sympathy between the lungs and brain—Post-mortem examination of the lungs of the insane—Exaltation and impair- ment of the reproductive organs, ........ 399—404 CHAPTER XXV. GENERAL PRINCIPLES OF PATHOLOGY, DIAGNOSIS, TREATMENT, AND PROPHYLAXIS. Obscurity of the pathology of the brain—Cases illustrating the difficulties attending the investigation of cerebral pathology—Opinions of celebrated authorities as to the proximate cause of insanity.—Capillary congestion a cause of insanity—Apparently normal condition of the brain often observed after death from acute insanity—Disor- dered condition of the psychical co-ordinating principle a cause of insanity—Patho- logical phenomena of general paralysis—Softening of the brain and hemiplegia—Idio- pathic ramollissement of the brain—Influence of deposits in the arteries upon the circulation—Diseased arteries a cause of apoplexy—Diagnosis of insanity—Affections with which insanity is liable to be confounded—Distinction between insanity and de- lirium—Diagnosis of cerebral congestion—Distinction between insanity and cerebritis —Diagnosis between meningitis and inflammation of the substance of the brain— Anaesthesia preceding cerebro-spinal disease—Incipient symptoms of general paralysis —Diagnosis between general paralysis and wasting palsy—Diagnosis of softening of the brain—Premonitory symptoms of acute and chronic softening—Cerebral abscesses and tumors—Importance of knowing the antecedents of patients—Diagnosis of cere- bral cephalalgia—Importance of cephalalgia in a diagnostic point of view—Neuralgic and rheumatic cephalalgia—Nervous headache, and the cephalalgia symptomatic of tumors of the brain—Diagnosis between cerebral and idiopathic sickness of the stomach—Treatment of incipient insanity—Duties of the physician—Depletion in in- sanity, its use and abuse—Caution to be exercised in the exhibition of purgatives— Use of hellebore by the ancients for the cure of insanity—The use of prolonged hot baths in the treatment of acute mania—Value of opium in the treatment of incipient insanity—The beneficial result of sedatives in cases of melancholia—Use of chloro- form in cases of insanity—Isolation of the patient from his friends—Mr. Spurgeon's method of subduing evil thoughts—Necessity of self-control—Baxter on the sinless character of involuntary evil thoughts—Archbishop Seeker on " Sin against the Holy Ghost"—Emerson on religious sentiment induced by bodily disease—Importance of early treatment of organic disease of the brain—Value of tonic treatment in inci- pient apoplexy and paralysis—Treatment of softening of the brain—Disease of the brain caused by mechanical injuries to the head—Injurious effects of blows upon the head—Importance of watching the state of the brain after injuries to the head- Various diseases of the brain preventable if treated in the early stage—Abscesses from blows upon the head—Course of treatment to be adopted after severe blows upon the head—Importance of the early detection of head symptoms—Treatment of cases of impaired intelligence—Importance of the cultivation of the faculty of attention— Treatment of impairment and loss of memory—The decay of memory illustrated in the case of Themistocles—Sophocles's refutation of imbecility in his old age—Treat- ment of the mind after an attack of insanity—Susceptibility of the memory to im- provement—Mental remedies for the improvement of memory—On the cultivation of the memory—Montaigne's loss of memory—On the advantages and disadvantages of a commonplace book—Impairment of memory the result of undue straining in early life—Importance of the careful cultivation of the memory—Excessive straining of the memory in schools—When does the intellect begin to decline ?—The vital, not the XVI CONTENTS. intellectual, principle affected in old age—Celebrated men who have retained their intellectual powers to a great age, as exhibited in the lives of Cherubini, Corneille, M. des Quensounnieres, M. Leroy, Fontenelle, Voltaire, Richelieu, Mr. Waller, Jonn Mapletoft, Titian, Benjamin West, R. Cumberland, Handel, Ben Jonson fair Isaac Newton, Locke, Dr. Johnson, Bacon, Chaucer, Sir E. Coke, Lord Eldon, Lora Kenyon, Lord Hardwicke, Lord Stowell, Bolingbroke, and Lord Mansfield—Is great vigor of memory allied to defect of judgment?—The memory of idiots—Great strength of memory combined with intellectual vigor, illustrated in the lives of-Dr. Johnson, Edmund Burke, Clarendon, Gibbon, Locke, Archbishop Tillotson, Grotius Pascal, Leibnitz, Euler. Muratori, Ben Jonson, Themistocles, Cyrus, Hortensius, Niebuhr, Sir James Mackintosh, Dugald Stewart, Dr. Gregory, and Seneca—The effect of lite- rary pursuits upon longevity—Dr. Caldwell's remarks on this subject—.Kind treat- ment of the insane—Duties of the psychological physician, . . . 405—465 Index,..............M~*8S 9 ON OBSCUEE DISEASES OF THE BRAIN AND MIND. CHAPTER I. INTRODUCTORY OBSERVATIONS. How important it is fully to appreciate, when considering the treatment of all diseases of vital structures, the practical sig- nificance of the celebrated apophthegm of Hippocrates, " 0 de xatpbs o£u?." " The occasion fleeting!" Let this profoundly wise axiom be ever present to the mind and engraven in imperishable charac- ters upon the memory, for if these "fleeting" moments of incal- culable value are trifled with and serious morbid states of brain are overlooked, or if recognized not immediately subjected to proper treatment, chronic irreparable and incurable organic alterations in the material instrument of thought may be the result, succeeded, when it is too late to remedy the mischief, by the bitterness of self-accusation, and the unceasing lamentations of those who ought to have been the first to observe and attack the fatal lesion. How often does the physician witness the melancholy conse- quences, to health of body and mind, life and reason, of a neglect of well-marked premonitory symptoms of cerebral disease. It is frequently his painful duty to hear relatives and friends re- proach themselves when the time for action has, alas! passed away, for their criminal negligence in closing their eyes to the long-existing evidence of serious disease of the brain. The late Dr. Marshall Hall, who was admirably qualified by habits of thought, education, practical sagacity, and enlarged experience to form a right estimate of the importance of an ac- curate acquaintance with the incipient symptoms of the diseases of the nervous system, remarks, "A useful work might be writ- ten on the subject of insidious and impending diseases, with the 2 18 INTRODUCTORY OBSERVATIONS. view of making their first or antecedent symptoms known to the public, and of thus suggesting the care and means necessary for their prevention." It was the painful province of this distin- guished physician, in the course of a long and brilliant career, to witness the sad consequences of the neglect of the precursory or premonitory symptoms of those organic affections of the brain, for the relief of which his great skill and extensive knowledge were so often called into requisition. He fully appreciated the importance of accurate diagnosis, and the necessity of prompt action and treatment in these cases. Upon investigating the history of the diseases of the brain, how frequently does the medical man discover that unequivocal cerebral symptoms have existed, and perhaps during the early stage been observed for months, and in some cases for years, without exciting any apprehension on the part of the patient, his family, or friends! In many of such instances, clearly manifested head symptoms were entirely overlooked. If noticed, no right estimation was made of their value. My attention has been called to cases, in which serious mischief to the delicate structure of the brain and its investing membranes, has been thus permitted to proceed uninterruptedly for years, no treatment having been adopted to arrest the progress of the fatal disorganization! The brain, the most important, and exquisitely organized, of all the structures of the human body, the physical instrument of intelligence, centre of sensation, and source of volition, is per- mitted, in many cases, to be in a state of undoubted disorder, without exciting any attention until some frightfully urgent, alarming, and dangerous symptoms have been manifested, and then, and not till then, has the actual extent of the mischief been appreciated, the condition of the patient recognized, and advice obtained for his relief! Other deviations from health do not, as a general rule, meet with similar neglect. In affections of the stomach, liver, bowels, lungs, and skin, &c, the first symptoms of approaching disease are in most cases immediately observed, and the patient, without loss of time, seeks the aid of his physician. But when the brain is affected, and the patient troubled with persistent headache, associated with some slight derangement of the intelligence, dis- order of the sensibility, illusions of the senses, depression of spirits, loss of mental power, or modification of motility, his condition is, in many cases, entirely overlooked, or studiously ignored, as if such symptoms were signs of robust health, instead of being, as they frequently are, indications of cerebral disorder reqiring the most grave and serious attention, prompt, energetic and skilful treatment! One reason of the neglect to which the brain is subjected when under the influence of disease, is a notion, too generally ILLUSTRATIVE CASES. 19 entertained, that many of the more fatal forms of cerebral dis- eases are suddenly developed affections, presenting no evidence of any antecedent encephalic organic change, and unaccompa- nied by any premonitory stage, or incipient symptom. It is indeed natural that such an idea should be entertained, even by an educated professional man, whose attention has not been specially directed to a study of this class of disease, or whose opportunities of watching the progress of such affections have been limited, and circumscribed. A man, apparently in vigorous health, mixing daily with his family, going to his counting-house, engaging in the active pur- suits of commerce, or occupying his attention in professional or literary duties, whilst entering his carriage, or when entertain- ing his friends at dinner, falls down either at his door in a state of unconsciousness, the effect of cerebral hemorrhage, or quietly bows his head on his plate at the table and dies. A midwife, sitting by the bed of a patient whom she was at- tending, suddenly exclaimed, " I am gone !" and immediately lapsed into a state of apoplectic coma ! A gentleman during dinner suddenly complained of giddiness and sickness. He retired to another room, where he was found a minute afterwards supporting himself by a bed-post, confused and pale. He soon became comatose, and died. A person in good health, after using rather violent exercise in the forenoon, returned home to dinner, and whilst sitting near the fire, without any warning started up, pushed his chair back- wards with violence, and exclaimed," Oh, my head!" Immedi- ately afterwards he fell on the floor in a state of apoplectic in- sensibility. A literary man, whilst speaking at a public meeting, was sud- denly seized with an uneasy sensation in his head. He said it feels "as if it would burst," and that the "brain is too big for my skull." He returned home, became apoplectic, and died on the evening of that day. A clergyman, whilst preaching, was suddenly observed to stop, and put his hand to his head. He then attempted to proceed with his sermon, but articulated indistinctly, and had evidently lost his recollection. He preserved himself from falling by grasping the side of the pulpit. He was immediately removed from the church, was found cold, pale, speechless, and paralytic, and died in a few days after the attack.1 A young lad who had not previously complained of ill health, or of any uneasy head symptoms, suddenly awoke from an ap- parent state of profound slumber, and began screaming, " Oh,. my head ! my head ! my head!" Before his parents could be 1 After death there was found in this case extensive extravasation of blood in the left ventricle, which had passed partly into the right, by laceration of the septum. All the arteries of the brain were extensively ossified.—Abercrombie. 20 INTRODUCTORY OBSERVATIONS. summoned into the room, he became insensible, and died with- out being restored to a state of consciousness I1 A lady, apparently in excellent health, whilst riding with her brother in Rotten Row, and engaged in animated and cheerful conversation, suddenly complained of giddiness and sickness, and became deadly pale. A few minutes afterwards it was found that she could not articulate. She was carried home and soon became unconscious, and died on the following day! A gentleman who had formerly been in Parliament, and many years engaged in electioneering contests, was in the act of step- ping into a railway carriage. He complained of vertigo, mental confusion and defective power of articulation. He, however, took his seat, apparently restored to health. Once, during a three hours' journey, he had a slight recurrence of these symp- toms, but they again pass away. On his arrival home, he com- plained of nausea, and an indisposition to take food. He had no headache, and could speak clearly and distinctly. As he re- sided some distance from a medical man, and as the symptoms were not considered such as to create any grave apprehensions, nothing was done medically for the case. After partaking of a light dinner, he retired in a cheerful state of mind to bed. About two o'clock in the morning his wife was suddenly roused from sleep by her husband's loud stertorous breathing. She found him in a state of profound coma. He died before the surgeon, who was immediately summoned, could arrive. The brain exhibited symptoms, of what was assumed to be, organic disease of long existence. A medical gentleman of known reputation and great personal worth having been to one of her Majesty's levees, visited on the evening of that day the home of a friend in the environs of town. He appeared during dinner and afterwards in excellent health and spirits. After playing a rubber of whist he retired with his wife to bed, complaining of general lassitude but ex- hibiting no other sign of bodily indisposition. In the middle of the night he was found by her in a state of apoplectic coma. In the attempt made to place him on his back, he heaved a deep sigh, and instantly expired ! The history of these sad cases is perhaps carefully investi- gated, without affording satisfactory evidence of any precursory symptoms, that would have justified the suspicion of the presence of latent and concealed mischief within the head. It is possible there may have been headache, defective articulation, dimness and loss of vision, vertigo, cerebral lassitude, and evanescent attacks of mental depression and confusion, but of so trivial 1 All the ventricles were completely filled with coagulated blood. In the sub- stance of the left hemisphere, there was a cavity formed by laceration of the cerebral substance, filled also by the coagulum, and communicating with the ventricle. There was no other morbid appearance.—Abercrombie. INSIDIOUS ATTACKS. 21 and unimportant a character, as not to awaken apprehension or excite attention. In many similar instances it is affirmed that no appreciable precursory stage could be discovered. The attack, whether it be one of apoplexy, acute softening, paralysis, epilepsy, menin- gitis, cerebritis or mania, had all the characteristics of a sudden seizure, which no prudence could have anticipated or foresight prevented, even although the patient's state of brain and gene- ral health had been made the subject of careful and anxious medical analysis.1 It occasionally happens that in some cases, from false feelings of delicacy, ignorance or neglect of close investigation, what a priori Avould be considered as most important symptoms of seri- ous brain disorder, are represented to be altogether absent. For example : attacks of apoplexy and. paralysis are alleged to occur without being preceded by any observable cerebral symptoms! There have been no headache, alienation of mind, lesion of the sensorial or motor power, to warn the unhappy patient or his friends of the enemy's approach. The fatal, obscure and insidi- ous disease has crept quietly and stealthily on its victim, giving no sign of its advent, indication of its advance, no notice of its presence, until it has surprised the sentinels, boldly seized upon the outposts, scaled the ramparts, and by an act of pathological coup de main, taken possession of the citadel! Even where the able and conscientious physician makes an effort to become acquainted with the past condition of his pa- tient, how often is his kind attention baffled by the information he receives. To the often repeated interrogatory, " Have there been observed any previously manifested symptoms of disorder of the brain and nervous system ?" how commonly is the re- sponse, " No, none whatever; the patient has not known a day's illness, his brain has never shown the slightest indication of any kind of disorder!" It is singular, in some cases, how pertina- ciously and obstinately all idea of past, and even existing cere- bral indisposition, is emphatically ignored and zealously repudi- 1 "Almost all affections of the head," says the late Dr. Armstrong, "though they appear to be sudden, will be found, on examination, to be very slow, espe- cially madness. If the case, whether it occur in a congestive or in an excitive form, be traced backward, you will find evidence of the patient having, in the one case, been in a most depressed state of mind, and in the other of his having been in a most active state of mind; and in both cases it will appear that the stomach, liver, bowels, head and skin were affected. This is important to re- member in a preventive point of view. Examples of this kind have occurred in public characters. "We have lost a Komilly, a Whitbread, and a Castlereagh ; and the history of these distinguished men shows that their corporeal functions were disordered before their madness came on. Some persons have requested to be bled on account of the great depression which they have felt previous to an attack of insanity. I knew an individual who repeatedly requested his medical man to bleed him under these circumstances. His request was refused ; and the consequence was that he made an atttempt—and that an effectual one—upon his life." 22 INTRODUCTORY OBSERVATIONS. ated by the relations of the patient! But how often does the physician detect, before he concludes his investigation of the history of the case, that his patient has exhibited, previously to his attack, evidences of the threatening and approaching storm, which, if seen, had not been made matter of observation, reflec- tion, anxiety or treatment! The headache has been attributed to derangement of the stomach or biliary disorder; the vacilla- tion of temper, feebleness of purpose, flightiness of manner, paroxysms of irritability or passion, inaptitude for business, de- pression or exaltation of spirits, the loss of sensibility, even manifest lesion of motion, have all (if made the subject of com- ment) been thought to arise from some trifling and transient bodily ailment, connected with the digestive, hepatic or renal organs. Epileptic vertigo, cerebral headache, and disordered condi- tions of vision, caused by the pressure of a tumor in the cen- tral portions of the brain, have been known to exist for some time without exciting a suspicion as to the presence of serious disease. The attacks of epileptic giddiness have occurred, un- observed, at night, with little or no convulsive movement or loss of consciousness; the headache has been considered to be of a bilious, rheumatic or nervous character; the impairment of vision has been treated as an affection of the eye, unconnected with disease in the neighborhood of the origin of the optic nerves, for the relief of which the optician, instead of the physi- cian, has been consulted, and thus have all the salient, important and significant symptoms of organic brain-mischief been per- mitted to undermine the bodily health, damage and impair the intellect, threaten the extinction of reason and destruction of life, without any remedial or palliative treatment being adopted to arrest the steady and onward advancing progress of the fear- fully destructive cerebral disorganization! Fully recognizing the obscurity in which this subject is in- volved, I would ask whether the affections of the brain in the majority of the cases are not preceded by a well-marked, clearly- defined, but often undetected and unobserved precursory stage? Is it possible for a person to be suddenly laid prostrate in the arms of death by an attack of apoplexy, cerebritis, meningitis, paralysis, acute softening or mania, evidencing after death long- existing chronic alterations in the cerebral structure, without having exhibited, for some time previously, faint and transitory they may be, but nevertheless decidedly characteristic symp- toms, pointing unmistakably to the brain, as the fons et origo malt f1 1 I freely realize the fact that in many cases of sudden death the heart is pri- marily, and the brain secondarily, affected. This will account for the absence of all morbid conditions of the brain in many cases of death from what is termed apoplexy, associated with appreciable organic diseases of the heart. It is often difficult to decide, in cases of sudden death, conjoined with head OBSCURE CEREBRAL SYMPTOMS. 23 Is not the alleged absence of all premonitory symptoms more apparent than real f "Would not the antecedent history of the pathological state of these cases, if carefully unravelled and cautiously analyzed, afford conclusive, if not demonstrative evi- dence of a prior state, of undetected and unrecognized brain disorder ? A man dies of what is termed a sudden attack of cerebral he- morrhage, or acute softening of the brain. The post mortem examination reveals a state of serious organic change in the structure of the brain, which, from its anatomical character, must have been of long duration, and of slow and progressive growth ll The bloodvessels in the head are found in a state of fatty degeneration, or the seat of atheromatous .deposits. A scirrhous tumor of some magnitude is discovered embedded in the substance of the cerebral mass, the consequence of an injury inflicted upon the cranium some years previously. An encysted abscess is detected in the head, evidently not of recent origin. There may exist an aneurismal tumor connected with one of the cerebral arteries, and considerable thickening and opacity of the membranes enveloping the encephalon, or dipping down between its sulci, or, an extensive pulpy disorganization of the brain, involving a large portion of one of its hemispheres. Upon a priori reasoning the physician has no right to conclude that such a degree of fatal organic lesion and serious positive structural disease of the brain, could have been developing itself for months, and in some cases for years, without impairing, de- ranging, disturbing or modifying the recognized and admitted psychical, 'motorial and sensorial functions of the cerebro-spinal system. Has the intelligence in such cases been intact, the vo- lition unenfeebled, the emotional powers in a sound state, the brain free from all symptoms of physical as well as psychical dis- turbance, the cerebral circulation (as respects the quantity, quality and momentum of the blood sent to the brain) been proceeding in healthy integrity ; the sensibility natural, the organs of special sense, viz., sight, smell, hearing, taste and touch, in a normal state of activity; the life of relation, as well as the phenomena of nutritive and organic life, free from all signs of derangement ? No structural changes can originate in the heart, lungs, liver, symptoms, what proportion of the fatal issue is attributable to the heart and what to the brain. If the former organ be examined after death, and the slightest alteration is detected in its structure, the conclusion drawn is, that this is the cause of death, even although the vessels of the brain may be discovered in a condition of great turgescence. Under such circumstances, we have no right to infer that the brain has had nothing to do with the death, merely because the heart is found either in a partial state of disease, or weak,'small and flabby in its condition. It would be safer, under such circumstances, to conclude that death has been caused by the combined effect of disorder in both organs. 1 In my forthcoming work on Softening of the Brain will be detailed several remarkable illustrations of fatal disease of the brain, the origin of which could be traced back for long periods, in one case for forty years! 24 INTRODUCTORY OBSERVATIONS. stomach, uterus, kidneys or bladder, without presenting, prior to death, obvious symptoms of their existence. Tubercular dis- ease of the lungs, hydatids of the liver, cancer of the uterus, calculus of the bladder, fatty degeneration of the kidneys, hyper- trophy and valvular disease of the heart, cannot (in the majority of cases) exist without manifestly, and often seriously, disturbing the special functions of these organs. Upon what principle, then, should the brain be an exception to the general pathological and physiological laws regulating other organic structures ? Affections of the brain, like those of other organs, have a premonitory and precursory stage. In the majority of cases the mischief established within the cranium, disorganizing the deli- cate tissue of the brain, may, upon careful examination, be de- tected. There are precursory signs which serve to guide the inquiring, observant and intelligent eye of the practical physi- cian, and enable him, with some degree of certainty, to discover the early evidences of brain disease, even when the patient and those about him repudiate all idea of cerebral ill health, and refuse to acknowledge the necessity for medical advice or treat- ment. I do not affirm that in all cases of incipient disease of the brain, the physician, even if his attention were closely riveted to the existing pathological condition, could satisfactorily ascer- tain its exact nature, or point out its precise locality; but he will have little or no difficulty, after carefully analyzing the case, in deciding the general question, whether the brain is the seat of disease, and the disorder, apparently referable to that organ, is of a sympathetic or an idiopathic character ? Structural alterations may, undoubtedly, to a considerable extent, be developed in the material instrument of the mind, without, for a period, in a marked manner, interfering with the mental, sensorial or motorial functions. This admits of a satisfac- tory explanation. This disorder of the functions of the brain, in the early period of its manifestation, is often of so slight and transient a charac- ter that it is easily overlooked by the patient, as well as by his physician. An apparently unimportant knitting of the brows, a trifling sensation of numbness, in some part of the body, a condition of general or local muscular weakness, a state of ennui, mental peevishness, irritability and physical restlessness, an al- most unappreciable depression or exaltation of the animal spirits, an impairment and disorder of the sense of sight, loss aberra- tion or confusion of memory, defect in or acute manifestation of the sense of hearing, an inaptitude for mental work, an inability to concentrate the attention continuously on any subject a state of sleeplessness or condition of lethargy, a trivial deviation from the usual mode of talking, such as suddenly pausing in the con- versation, as if to regain a lost train of ideas, a slight defect in LATENT DISEASE OF THE BRAIN. 25 the articulation, associated wTith a transposition of words, and inability to pronounce certain letters, are all characteristic symp- toms, frequently significant of disease having commenced in the brain.1 How often do we discover, when the history of a serious case of brain disease is made a matter of investigation, that years prior to its apparent existence, the patient has exhibited symp- toms of cerebral disorder, somewhat similar to those just detailed, which have entirely escaped observation! * Slight epileptiform seizures, marked deviations from healthy thought, obvious impairment of the intelligence, occasional loss or exaltation of sensation in some part of the body, trifling de- fect of motor power, and headache of an acute type, have ex- isted for some time previously to the supposed commencement of the disease, and yet have entirely escaped observation, and if recognized been soon forgotten by the patient and his friends. The alterations of structure so frequently observed after death on the internal table of the skull, dura mater, pia mater, tunica arachnoidea, and in the fibrous, as well as in the vesicular structure of the brain, are commonly the results of long-con- tinued irritation, capillary congestion, inflammation (causing depositions of adventitious matter), toxic agents circulating in the blood producing modifications of cerebral nutrition, morbid changes in the coats of the bloodvessels of the brain, which have, in many cases, commenced years anteriorly to the atten- tion being awakened to the state of this organ, and before death has revealed to the eye of the pathologist the sad extent of fatal structural disorganization that has been progressing, almost un- recognized and untreated, within the cranium. In considering this subject we are bound not to ignore the fact that the brain has great accommodating power, and is facile to the existence of a considerable degree of organic pressure, if equally diffused, and of structural lesion, provided it be restricted to the medullary matter, and has been of slow and progressive growth, while the smallest amount of sudden extravasation of blood, the effect of the rupture of one of the minute cerebral vessels on the surface of one of the hemispheres, or on the cor- pus striatum, thalami optici, pons varolii, or medulla oblongata, is immediately followed by paralysis or convulsions, and often by death itself. A considerable extent of pulpy disorganization, or softening of the cerebral structure, large amount of fluid ef- fused into the ventricles, or great extent of thickening and opa- city of the membranes investing the encephalon, as well as large collections of encysted pus in the shape of abscesses, may exist imbedded in the substance of the brain, without apparently, for a period,, disordering, to any serious extent, its functions. 1 Vide the interesting case of the late King of Sweden, detailed in the chapter on "The Morbid Phenomena of Attention." 26 INTRODUCTORY OBSERVATIONS. It is necessary, for a right appreciation of this subject, that we should fully recognize, as one of the laws regulating, and governing the physiological action of the brain, that although it is admitted to be the material instrument of the mind, the seat of sensation, the organ which takes cognizance of impressions, made either upon the peripheral extremities of the nerves, re- mote from the encephalon, or of those conveyed through the special-senses directly to the sensorial ganglia, is, when in a state of health, insensible to any kind of irritation, or even laceration of its substance. The brain, whilst destined to perceive acutely the painful im- pressions of other organs, is itself not conscious, in the incipi- ent stage of disease, of the lesions of its own structure. Its sen- sibility, however, becomes most acute under certain conditions of disease. Large portions of the hemispherical ganglia have been removed by the knife, and have even sloughed away, with- out giving rise to any appreciable disturbance of cerebral phe- nomena, pain, or obvious inconvenience; but any injury, how- ever slight, inflicted upon the sensorial ganglia, whether the result of a morbid process, or artificial irritation, is invariably followed by great cerebral disorder, and unequivocal disturbance of their special functions.1 The physiological physician has no difficulty in predicating the immediate effect of an alteration in the structure of, or mechan- ical pressure upon the thalami .optici, pons varolii, corpora quadri- gemina, or medulla oblongata. The functions, as well as pathology of these, and other ganglia, are well ascertained, and fully estab- lished. When referring to this subject, a distinguished physiologist says: " Considered theoretically, we should expect, that the sentient fibres, which proceed from the medulla oblongata, and expand themselves in all parts of the greater and lesser brain, 1 As to the sensibility in those parts of the brain supposed to be the seat of the intellectual faculties, Sir Charles Bell observes, that we ought not to expect the same phenomena to result from the cutting or tearing of the brain as from injurv done to the nerves. The function of the latter is to transmit sensation ; that of the former is higher, and this is inferred from its being insensible. "If on ex- amining the structure of the brain," says this eminent physiologist, "we find a part consisting of white medullary stria?, and fasciculated like a nerve, we should conclude that, as the use of the nerve is to transmit sensation, such tracts of mat- ter are media of communication connecting parts of the brain. If masses are found in the brain unlike the matter of the nerves, and which yet occupy a place guarded as an organ of importance, and holding evidently important relations we may presume that such parts have uses different from that of merely convey- ing sensation; we may rather look upon such as the seat of the higher powers. I have found," continues the same authority, "atdifferent times alfthe internal parts of the brain diseased, without loss of sense, but I have never seen disease general on the surface of the hemispheres without derangement of the mind. If I be correct in this view of the subject, then the experiments made upon the brain tend to confirm the conclusions which I should be inclined to draw from anato- my, viz., that the cineritious and superficial parts of the brain are the seat of the intellectual functions." NEGLECT OF BRAIN DISEASE. 27 would bestow on these formations, as well as upon the medulla oblongata, a high degree of sensibility. But experience gives results for which a satisfactory explanation is still entirely defi- cient ; thus, if the cerebral hemispheres be laid bare in a mam- mal or bird, an operation which in itself in no degree destroys the capability of perceiving pain, we find that they can be touched and even transfixed without in the least disturbing the animal; it only struggles and cries out when the trifacial nerve, the crura cerebri, the optic thalami, or the medulla oblongata are accident- ally touched. Again, if the hemispheres be removed by slices down to the centrum ovale or the cavity of the lateral ventricle, the animal remains as indifferent as if we were cutting a hair or a nail. The same phenomena have also been repeatedly ob- served in man; thus, a portion of the hemisphere projecting through a wound of the skull has been removed without produ- cing any action; and, again, parts of the substance of the hemi- sphere have been taken away by the surgeon in removing pus or foreign bodies without the patient's consciousness."1 The sad neglect of incipient brain disease, be the cause wThat it may, is a fact that should engage the serious attention of the medical profession. To the non-professional friends of persons so afflicted, the abnormal mental phenomena they observe may appear either as healthy exaggerations of feeling, eccentricities of manner, or extravagances of thought. It is not reasonable to expect that persons ignorant of the first principles of medicine should understand the important physiological principle that disturbed intelligence has the same relation to the brain that disordered respiration has to the lungs, pleura, and heart; but the physician should see that the importance of detecting the earliest symptoms of approaching, or existing disease of the brain, cannot, in a practical point of view, be over-estimated or exaggerated. Considering the peculiar and special functions of this organ, and the close sympathy established between the sen- sorium, and other organic tissues ; appreciating how slight, and minute a degree of structural change in the nerve vesicle para- lyzes both body and mind, we can have no difficulty in estimating the value which should attach to the detection, at the earliest possible period, of the faintest evidence, of any actual disease existing in the delicate nervous organization. How cautiously, zealously, and closely should the physician watch for the incipient dawnings of cerebral mischief! Who can guarantee the integrity of the intelligence, normal condition of the sensibility, and healthy action of the motor power, if the delicate vesicular structure is the seat of morbid action ? Is it not possible to predicate with certainty the result of neglected 1 " Lehrbuch der Physiologie des Menschen." Band 11. Yon Dr. Q. Valen- tin. P. 743. 28 INTRODUCTORY OBSERVATIONS. inflammation of the periphery of the brain ? We should never lose sight of the fact, that no irritation or inflammatory action can exist for any length of time, in the more important tissues, or ganglia of the brain, without seriously perilling the reason, and endangering life! How forcibly do these observations apply to the detection of the incipient symptoms, of all types and degrees of mental dis- order! It is a well-established fact, that seventy, if not eighty, per cent, of cases of insanity admit of easy and speedy cure, if treated in the early stage, provided there be no strong constitu- tional predisposition to cerebral and mental affections, or exist- ing cranial malformation; and even when an hereditary taint exists, derangement of mind generally yields to the steady and persevering administration of therapeutic agents, combined with judicious moral measures, provided the first symptoms of the malady be fully recognized, and, the cerebral condition, without loss of time, combated by remedial treatment. A vast and frightful amount of chronic and incurable insanity exists at this moment, in our county and private asylums, which can be clearly traced to the criminal neglect of the disease, in the first or incipient stage. Sir AVilliam Ellis, formerly of Hanwell Asylum, thus speaks of the sad consequences of neglecting to recognize and treat in- sanity in its early stage : " It is a melancholy fact, that, on a most careful personal ex- amination of each of the 588 cases now in the house, there do not appear more than 50 which, under the most favorable point of view, can be considered curable. This is to be attributed almost entirely to the neglect of proper remedies in the early stages of the disease. To become acquainted with the symptoms first indicat- ing insanity not only requires much care and attention, but much experience; for a diseased action of the brain or some part of the nervous system may be gradually undermining the health, and still be scarcely expected by common observers to exist, from the insidious manner in which it steals upon the constitution at first: it manifests itself by some trifling aberra- tion of intellect, and that generally upon one point only; such aberration, if unaccompanied by bodily pain, is not only neg- lected by the sufferers, but disregarded by those around them. This, however, is precisely the time when medical aid is the most capable of being beneficial; and could the patients but be placed under proper care then, certainly three-fourths of them would be cured. But, unfortunately, the golden opportunity is too often neglected. Diseased action is allowed to proceed un- checked until diseased organization has taken place, and the patient has become incurable ; and it is only in consequence of the com- mission of some violent outrage that he is at last sent to an IMPORTANCE OF EARLY TREATMENT. 29 asylum. Until something serious has occurred, the friends hope in a few days the mind will recover its tone. " Unfortunately, this unwillingness to consider the patient sufficiently insane to be sent to an asylum is not confined to the friends of the patient. There have been instances of the magistrates themselves, from the kindest motives, refusing to grant warrants for the admission of a patient, even after he has been examined by a medical gentleman, who has given a cer- tificate of his insanity, because when brought before them he has been able to answer certain questions correctly. The conse- quence is that from this delay, instead of returning to his friends in a few weeks, which, in all probability, would have been the case if proper medical and moral remedies had at once been ap- plied, he becomes incurable, and remains in the asylum for life, a burden to the parish. In some instances similar delay has been attended with fatal consequences. " It is sincerely hoped that the knowledge of these circum- stances will induce an early application to be made for the ad- mission of patients; as, even if the neglect does not prove fatal, it is contrary to every principle of justice and humanity that a fellow-creature, deranged, perhaps only on one point, should, from the want of the early attention of those whose duty it is to watch over him, linger out his existence separated from all who are dear to him, and condemned, without any crime, to be a prisoner for life." Dr. F. Hawkins, when speaking on the same subject, says : " The importance or rather necessity of recognizing disorders of the head in their early stage, is obvious from the consideration that they can then alone be attacked with any chance of suc- cess. In acute cases the period is brief indeed in which the power of art is available. But whether the case be acute or chronic, it is only in the early stage that its precise nature ad- mits of being distinguished with accuracy. In its further pro- gress, from the extensive sympathies of the brain with all parts of the body, so many functions become implicated, and so vari- ous are the symptoms which arise, as to preclude arrangement or classification, and defy the art of diagnosis. The aid which in most other cases the sensations of the patient are capable of af- fording us is lost to us too soon in disorders of the head, until, in their advanced state, they all resemble one another, and pre- sent alike a dreary abolition of the powers of animal life. The period, therefore, is highly precious in which these affections admit of being distinguished with precision or treated with any hope of advantage."1 Let the physician estimate, in all its vital importance, the grave necessity for prompt treatment and decisive remedial mea- 1 Croomian Lectures, delivered before the College of Physicians, May, 1829. 30 INTRODUCTORY OBSERVATIONS. sures, when satisfied that the enemy is at the gates, and has attacked, or is on the eve of assaulting the citadel! Under these circumstances, hesitation, delay or procrastination in bringing the patient within the range of curative measures, is fraught with the direst results, and with the saddest consequences. Let us not wilfully close our eyes to the premonitory signs, however apparently insignificant, slight, transient and fugitive they may appear, of actual mental disorder and brain disease, for it is in this early stage when so much may be effected by judicious medical treatment to check the advance of the fatal cerebral mischief. Having dwelt at some length on the existence of a precursory stage in all affections of the brain and on the importance of watch- ing for the first threatenings of incipient cerebral disorder, I propose to investigate in detail the general character of the pre- monitory symptoms of encephalic and mental disease. It will be well, however, to premise that I cannot in this work do more than generalize on this wide and expansive subject. When I address myself, in the succeeding volume, to the con- sideration of specific types of brain disease it will be my object to enter more elaborately into detail and to point out, as far as practicable, the diagnostic premonitory signs of the various organic affections of the encephalon. Many of the symptoms to which I shall refer as valid evidences of incipient brain dis- order will be found common to several lesions of this organ, each presenting an essentially different aggregate group of symp- toms, as well as distinctive anatomical and pathological charac- teristics. Nevertheless, I am of opinion that a general description or re- sume of the incipient signs of morbid conditions of the brain before considering individual forms of cerebral disease, will not be without its practical value and importance. Agreeably to this arrangement, I propose to analyze the subject in the following order: 1. Morbid Phenomena of Intelligence. 2. Morbid States of Motion. 3. Morbid Conditions of Sensation. This classification of the subject fully recognizes the three physiological functions of the cerebro-spinal system, viz.: a. Thought. p. Motion. r. Sensation. 4. Morbid Phenomena of the Special Senses, Viz. : d. Sight. ,. Touch. e. Hearing. o. Smell. Z. Taste. division of the subject. 31 5. Morbid Phenomena of Sleep and Dreaming. 6. Morbid Phenomena of Organic or Nutritive Life, Viz.: a. Digestion and Assimilation. y. Respiration. /3. Circulation. d. Generation. In conclusion, General Principles of Pathology, Treatment, and Prophylaxis. 32 morbid phenomena of intelligence. CHAPTER II. morbid phenomena of intelligence. The brain, being the material instrument of the intelligence, the physical medium through which the mind manifests its varied powers, it is rational to infer that no changes in its structure or investing membranes can take place, no alteration in the quality of the vital fluid, or anatomical character or calibre of the nu- merous bloodvessels that circulate and ramify through its sub- stance can exist, without, to some extent, interfering with or modifying its psychical functions. Cases, however, are on record, in which serious injury has been done to the brain during life without apparently damaging the intelligence; and considerable encephalic disorganization (as the result of disease) has taken place, without any aberration, exaltation, depression or impair- ment of the mind having been observed previously to death. If such cases have occurred they must be considered either of a rare and exceptional character, or as pathological curiosities, un- less in every instance the alteration of structure be strictly con- fined to one hemisphere or restricted to the fibrous or conducting part of the nervous structure, the vesicular matter and its minute vessels remaining intact and entirely free from all morbid change or abnormal modification. Is it possible to conceive any great extent of disorganization even in the medullary portion of the cerebral mass, to exist, without implicating, to some degree, the gray matter of the brain, and as a consequence deranging the phenomena of thought ? It is not my intention to discuss in this volume the complex questions (physiological and metaphysical) involved in an analy- sis of the psycho-somatic relation or union between mind and matter, life and organization. It is sufficient for my purpose to affirm, as a postulate, that all structural lesions of the encephalon, its investing membranes and bloodvessels, are associated with some derangement, modification or altered action of the psychi- cal, molorial, or sensorial functions of the great cerebral o-anglion the izp&Tov Ato-drjTTipiov, or sensorium commune. Softening of the brain, abscesses, tumors, atrophy, induration and other forms of cerebral disorganization, have, it is alleged been discovered in the brain after death, without disordering or even impairing the intelligence. But are not these to be viewTed EMOTIONAL EXALTATION AND .EXCITEMENT. 33 as unusual and anomalous pathological conditions, in fact ex- ceptions that prove the rule ? If the mental and cerebral condition of those who have been represented to have died of organic disease of the brain, appar- ently in full possession of their intellectual, sensorial, and mo- torial powers, had been subjected to a close and rigid analysis, some degree of disorder, or impairment of these functions would, I believe, in many cases have been detected. We are too much disposed to form hasty opinions, and to infer, because the patient talks rationally for a time, on ordinary subjects, is under the influence of no appreciable illusion, hallucination, or aberration, that, therefore, the intellect is unclouded, and the brain in a perfectly sound and normal state; yet such apparently healthy psychical, and cerebral manifestations, are quite consistent with the existence of encephalic disease, impairment, and even of actual latent, and concealed mental aberration : and these con- ditions of the brain, and mind, would, I believe, be more fre- quently.detected, if sufficient time were devoted to their analy- tical investigation, and accurate pathological and psychical diagnostic tests were scientifically employed by experts, practi- cally acquainted with the art of examining the subtle phenomena of insanity. It has been observed, " that could we see the interior workings of such intellects, they would be found altered, limited, perverted, or changed in some way from their normal condition, although it may not be discovered in their external manifestations. It should be recollected that there are many oddities which are dependent upon cerebral conditions, but which pass for mental peculiarities, and in this way the disordered actions escape notice. Yet the rule will be found logically true, that wherever there has been discovered the trace of organic cerebral change, there must have been disturbed mental manifestations." In every case of disease of the encephalon, particularly if the organic change or pressure be established in the vesicular matter, or in the membranes immediately investing the brain, a disor- dered, or abnormal state of cerebro-psychical phenomena may, in the incipient stage, on careful examination, be detected. I now proceed to the investigation of the first, or psychical section of the subject. The mind may be in a state of morbid— 1. Exaltation. 2. Depression. 3. Aberration. 4. Impairment. These conditions of unhealthy intelligence exhibit in their origin, progress, and termination, a variety of shades and degrees 3 34 morbid phenomena of intelligence. - of disturbance, and disease, commensurate with the nature, ex- tent, and position of the cerebral lesion. The state of mind, included under the head of exaltation, often resembles, in its earlier manifestations, a trifling exuberance, excessive buoyancy, and unnatural elasticity, extravagance or exhilaration of the spirits. The patient is unusually cheerful, is voluble and violent in his speech, is boisterously loquacious, and manifests phases of hysterical, emotional, and pleasurable mental, as well as physical exaltation, rarely considered, except by the experienced observer, in the early stages of diseases of the brain, and alienation of mind, to be symptomatic of morbid cerebral, or disordered, mental conditions. " E ai volti troppo alti e repentini Sogliono i precipitii esser vicini."1—Tasso. This unnatural, and, often suddenly developed flow of animal spirits, frequently merges into a state of unhealthy exaltation of mind and morbid cerebral excitement clearly indicative of disease of the brain, irritation, congestion, or inflammation of its investing membranes, unhealthy blood poisoning the source of thought, disordered states of nerve nutrition, retained excretions, or disturbed conditions of the circulation within the cranium. When considering the second division of the subject, viz., that of depression, it will be apparent that this phase of mental dis- order often ranges, from mere listlessness, slight degrees of de- pression of spirits, tsediumvitse (the uatra cura" of Horace), and ennui, to profound conditions of despondency, despair, and acute melancholia, frequently ending in suicide.2 1 Our own illustrious poet thus gives expression to the same idea: " These violent delights have violent ends, And in their triumph die." 2 It is a fallacy to suppose, a state of ennui to be one of brain rest, and psychical inactivity. It is, in many cases, an active condition of the mind, unaccompa- nied by the pleasurable, and, consequently, healthy gratification, usually asso- ciated with ordinary phases of intellectual labor, and emotional excitement. " In life," says Pascal, " we always believe that we are seeking repose, while, in reality, all that we seek is agitation." "Is," says Sir W. Hamilton, "the 'far niente'—is that doing nothing in which so many find so sincere a gratification, in reality a negation of activity, and not in truth itself an activity intense and va- ried ? To do nothing in this sense is simply to do nothing irksome, nothing difficult, nothing fatiguing, especially to do no outward work. But is the mind internally the while unoccupied and inert? This, on the contrary, may be vividly alive ; may be intently engaged in the spontaneous play of imagination ; and so far, therefore, in this case, from pleasure being the concomitant of inac- tivity, the activity is, on the contrary, at once vigorous and unimpeded..... Ennui is a state in which we find nothing on which to exercise our powers -but ennui is a state of pain. All energy, all occupation, is either play or labor In the former, the energy appears as free and spontaneous; in the latter as either compulsorily put forth, or its exertion is so impeded by difficulties that it is only continued by a forced and painful effort, in order to accomplish certain ulterior ends. Under certain circumstances, play may become a labor and labor .may become play." A mind ennuyed, may unconsciously be occupied in the contemplation of men- emotional exaltation and excitement. 35 It is in this state of insane thought, that a terrible struggle occasionally ensues between an acutely morbid and often irre- sistible impulse to suicide, and the natural instinct of the love of life, worldly prudence, religion, and morality, that occasion- ally retain a mastery and exercise a controlling influence over the mind goaded on by disease to self-destruction. In the morbid mental affections included under the heads of, aberration and impairment are observed various gradations (blending almost imperceptibly with each other) of moral and intellectual disorder and weakness, extending from the more shadowy forms of false perception, erroneous judgment, para- lyzed volition, perversions of the moral sense, derangement and confusion of thought, to hallucinations and clearly manifested insane delusions; and from brain-fag, cerebral lassitude, loss of mental stamina, tone, weakened, memory (dyskinesia), actual loss of memory {amnesia), and flagging powers of attention to obvious states of imbecility, and idiocy. In analyzing the _ precursory symptoms of cerebro-psychical disease, it will be important to remember, that the early signs of appreciable modifications of mental health, often resemble, in a remarkable degree, temporary and transient exaggerations of natural and healthy conditions, or states of mind, the first symp- toms of the psychical affection being recognized by certain marked deviations from ordinary healthy phases of thought, and normal modes of action, or conduct, to states of an opposite cha- racter. tally distressing, and physically laborious and depressing thoughts. Let us, therefore, not flatter ourselves with the illusion, that a life of idleness and inac- tivity is necessarily one of repose, rest, and freedom from painfully-perturbed thoughts. How true it is— "A want of occupation gives no rest; A mind quite vacant is a mind distressed." 36 premonitory symptoms of insanity. CHAPTER III. premonitory symptoms of insanity. This section will be considered in the following order: 1. Anomalous and Masked Affections of the Mind. 2. Stage of Consciousness. 3. Exaltation of Mind. 4. Depression of Mind. 5. Aberration of Mind. 6. Impairment and Loss of Mind. This classification of the phenomena of disordered thought will embrace the more prominent and salient points connected with the subject of incipient insanity. Previously, however, to my considering any one of the pre- ceding sections, I propose to discuss cursorily,— 1. The present limited knowledge of the physiology of the nervous system, and ignorance of the phenomena of mind, and life. 2. Analogy between insanity and dreaming. 3. State of the mind, when passing into a condition of alienation, as deduced from the written confessions of patients after recovery from attacks of insanity. 4. Morbid phenomena of thought, as manifested during the states of transition, and convalescence. In order to obtain a right appreciation of the mind in its in- cipient as well as matured conditions of disorder it will be requisite to analyze with metaphysical exactness, scientific, and medical precision the intellect when in such states of un- healthy manifestation. These are four points d'appui in this important inquiry, and if elaborately and faithfully investi- gated an insight may be obtained of morbid psychical phe- nomena still deemed obscure, if not, altogether inexplicable. Before analyzing the premonitory symptoms of the various types and phases of mental and cerebral disorder it will be well to refer to the following important preliminary interroga- tories, as prefatory or starting-points. What is insanity? Is its nature known, its essence discovered, and are the laws gov- erning its phenomena understood? What is the constitution of its materia morbi, the exact condition of the moral and intel- lectual faculties, emotions, instincts, or passions, during to ignorance of the nature of insanity. 37 use the significantly suggestive language of Coleridge, "the mind's own revolt upon itself?" In what does mental derange- ment consist ? Is it an affection of the moral, intellectual, emo- tional or perceptive faculties, and are the reason, judgment, memory or imagination most implicated in the malady? Is there a type of insanity manifesting itself more in conduct, than in the ideas? What is the nature and where the seat of the alienation of mind? In which of the mental faculties does the disease commence its ravages, and where is the precise position in the brain of the latent insane nidus, or germ ? Has insanity a centrifugal or a centripetal, a subjective or an objective origin? In less technical phraseology, do the disor- dered ideas of the insane depend upon centric causes of irrita- tion and disease operating from within to without, or are they the consequences of eccentric or objective influences, acting from without to within; in other words, are we to consider the_ symptoms^ of mental alienation, as emanations from the brain, similar in character (to borrow an appropriate image) to the "rays of light proceeding from a body which is itself ignited," or, are they analogous to the rays reflected from a polished surface, in intimate organic sympathy with disordered action established in a remote part of the body ? Is insanity an affection of the minder se? Has the disease a psychical or a somatic origin ? Is it possible for thought in the abstract to be diseased ? Does alienation of mind depend not exclusively upon a psychical or somatic cause, but upon a disturbance in the normal relations existing (in states of cere- bral, and ^mental health) between the white and gray matter of the brain ? Before endeavoring to solve these subtle and abstruse psycho- logical problems it will be necessary to ask what is mind? Have we any knowledge of its nature, clue to its seat, accurate idea as to its mode of action, or right conception, of its essence? What are the modifications, the metamorphoses, organic or functional, which the vital principle, and nerve-force undergo during their passage through the exquisitely organized, and highly vascular cineritious, and vesicular brain structure ? How does the occult mental principle believed by physiolo- gists to be evolved in the gray matter of the brain become so mysteriously and marvellously changed from nerve to mental force, and vice versa, in the hemispherical ganglia? Is the de- velopment of psychical phenomena the result of what is termed, a correlation of the two preceding modes of dynamical action, or, is mind a new creation, essence, principle, or power, or- ganized or elaborated in the vesicular portions of the cerebral mass ? What is the nature of the vis nervosa of Haller ? Is the brain a galvanic battery, and are the nerves constituted for the trans- 38 premonitory symptoms of insanity. mission of impressions, like electric wTires ? Is the mysterious and undefinable fluid or force, circulating in the nerve-tubes a voltaic current, a principle identical with that of electricity, or one, in its essence, origin, and operations, entirely sui generis ? What is the vis vitas, and how is it associated with, and depen- dent upon, organized structures? What are the relations be- tween the intellectual, and vital manifestations? _ Are not all these great problems of organic, and psychical life, still, with physiologists, subjudice t * Have we arrived at any exact know- ledge of the substratum of nervous matter? Are we not obliged to confess our ignorance of the principle of vitality aa well as of intelligence? Do we know anything of its nature or essence? Is not our knowledge of mental, as well as of vital phenomena, entirely confined to an acquaintance with these powers as manifested during life ?f If our ignorance of healthy psychical conditions is so profound, is it practicable * Speaking of the mysterious union of mind and matter, St. Austin says— " Materiam spiritumque cognoscendo ignorari et ignorando cognosci." "Man is to himself the mightiest prodigy in nature, for he is unable to con- ceive what is body, still less what is mind; but least of all is he able to con- ceive how a body can be united to a mind; yet this is his proper being."— (Pascal.) "A contented ignorance," says Sir W.Hamilton, when referring to this subject, "is indeed wiser than a presumptuous knowledge; but this is a lesson which seems the last that philosophers are willing to learn. In the words of one of the acutest of modern thinkers, ' Magna immo maxima pars sapientise est qusedam aequo nescire velle.' " f "The notion we annex to the words matter and mind," says Keid, "is merely relative. If I am asked what I mean by matter, I can only explain myself by saying it is that which is extended, figured, colored, movable, hard, rough and smooth, hot or cold—that is, I can define it in no other way than by enumerating its sensible qualities. It is not matter or body which I perceive by my senses, but only extension, color, and certain other qualities which the constitution of my nature leads me to refer to something which is extended, figured, and colored. The case is precisely similar with respect to mind. We are not immediately conscious of its existence, but we are of sen- sation, thought, volition—operations which imply the existence of something which feels, thinks, wills." Sir Isaac Newton was asked, why he stepped forward when he was so in- clined, and from what cause his arm obeyed his will ? He honestly replied that he knew nothing about the matter. If we were to follow the example of this great philosopher, and modestly admit our ignorance of those subjects about which we really have no knowledge, we should have a just conception of the shallow pretensions of man. No undertaking would perhaps prove more beneficial to mankind than that which endeavored to draw a correct line of demarcation between what is really known and that which is merely conjec- Our notion of the nature of mind is as limited as our knowledge of material substances. '« When we wish to have a rude knowledge of a piece of metal " says a great French philosopher, " we put it on. the fire in a crucible ; but have we any crucible wherein to put the soul? Is it spirit? says one • 'but what is spirit? Assuredly no one knows. This a word so void of meaning that to tell what spirit is, you are obliged to say what it is not. The soul is matter' says another; but what is matter? We know nothing of it but a few appear- ances and properties; and not one of these properties, or appearances bears the least affinity to thought." ignorance of the mental and nerve force. 39 for the psychological inquirer to arrive at an accurate know- ledge of mind when disturbed and disordered by disease? Have not all the efforts that have hitherto been made, to solve the mystery connected with alienation of thought, proved ut- terly unproductive of any scientific results? Is there any theory of insanity yet propounded from the bench, taught in the schools, or registered in our text-books, which will bear the test of metaphysical analysis, or stand the ordeal of strict medical or legal criticism? Distinguished philosophers, expe- rienced psychological physicians, accurate and profound logi- cians, have vainly attempted to discover the nature of this dis- ease, with a view of possessing a key to its accurate definition. The pursuit, it must be admitted, has hitherto signally failed. Let us then, with a spirit of humility, fully acknowledge the extent of our ignorance of subtle abnormal mental phenomena, as well as our limited knowledge of the healthy constitution of the human mind. " We sometimes," says an eminent philosophical writer, " re- pine at the narrow limits prescribed to human capacity: ' hitherto shaltthou come and no further,' seems a hard prohibition, when applied to the operations of the mind. But, as in the material world, it is to this prohibition man owes his security and exist- ence, so, in the immaterial system, it is to this we owe our dignity, our virtue, and our happiness. A beacon blazing from a well-knowm promontory is a welcome object to the bewildered mariner, who is so far from repining that he has not the benefi- cial light in his own keeping, that he is sensible its utility depends on its being placed on the firm land, and committed to the care of others."1 Dr. Reid, when referring to the limited nature of our know- ledge, and the difficulties attendant upon the investigation of psychical, as well as somatic phenomena, observes: " The labyrinth may be too intricate, and the thread too fine to be traced through all its windings, but if we stop where we can trace it no farther, and secure the ground we have gained, there is no harm done; a quicker eye may in time trace it farther." I would, previously to entering upon an analysis of the incip- ient symptoms of mental disorders and cerebral diseases, offer a few cursory remarks on a subject of great psychological interest and medical importance, having a close bearing upon many points discussed in this volume. I refer, not only to the intimate union between the science of mind, and that of practical medi- cine, but to the neglect of the study of moral therapeutics. I claim for the cultivators of medical science higher and more exalted functions than those usually assigned to them. The ', "Essay on the Nature and Immutability of Truth," p. 79, by Dr. James Beattie, LL.D. 40 premonitory symptoms of insanity. physician has at his command, and under his control, amedicina mentis as well as a medicina corporis—agents of great power and magnitude which have not been sufficiently recognized or appre- ciated. The close connection between the science of mind, and the science and practice of medicine, and the true philosophic character of the professors of the healing art is thus beautifully described by the Father of Physic : " Aet p.eTayeiv ttjv ooyiav etq ttjv larpty.rlv, xac ttjv larptxrjv £t<; ttjv fetch me. Don't you hear his horses neigh ?" The military were in the habit, many years back, of performing their various evolutions in the immediate neighborhood of the Salpetriere Lunatic Asylum Paris. A female patient in one of the wards heard the repeated discharge of TEMPORARY RESTORATION TO REASON OF INSANE. 55 actively morbid imagination of the descent of a fearful avalanche, or of that aw7ful crisis in the world's history when, to use the sublime language of the Scripture, " the heavens shall pass away with a great noise, and the elements shall melt with fer- vent heat, the earth also, and the works that are therein, shall be burned up." Again, how often all idea of duration appears to be obliterated from the mind of the insane during the continuance of the disease, the patient appearing after many months and sometimes years of sad illness, and distressing isolation, to awaken, as it were, out of a fanciful and troubled dream, the healthy ideas that had occupied the mind a short period previously to the accession of the insanity, suggesting themselves to the consciousness (with all the freshness, vividness, and force of recently received sane impressions), contemporaneously with the restoration of reason to its healthy supremacy. In dreaming, as well as in some forms of mental aberration, the mind has occasionally, a clear apprehension of its morbidly automatic condition. A person, whilst under the influence of a series of fanciful occurrences created by dreaming or insanity, will, occasionally, acutely reason with himself as to the reality of the images occupying the attention, and be fully conscious that he is insane or dreaming.1 In cases of fully developed insanity, the mind has occasional gleams of healthy thought and sane consciousness, during which conditions (in accordance with the confession of patients), the lunatic fully recognizes the disordered state of his ideas, the abnormal conditions of the emotions and instincts, and makes a repeated effort to crush or dissipate the predominant morbid impression. These lucid moments and transitorily sane condi- tions of intellect are, however, evanescent in character, and ap- pear like a flash of lightning across the dark and troubled mind. In chronic as well as acute insanity, the reason has been known suddenly to be restored to its rightful sovereignty, either during the course of the malady, or immediately before death. " There are few cases of mania or melancholy where the light of reason does not now and then shine between the clouds. In fevers of the mind, as well as those of the body, there occur frequent intermissions. But the mere interruption of a disorder is not to be mistaken for its cure or its ultimate conclusion. musketry. She immediately began, with great eagerness, to tear up her linen into bandages. Upon being asked, for what purpose she was destroying her clothes, she replied, "I am preparing bandages for the poor wounded soldiers." The lunatic believed that she was the queen, and that her right to the throne was about to be established by a battle, which was being fought near the hospital. _ 1 Dr. Johnson says, "I was often during sleep engaged in controversial dis- cussions, and whilst recognizing that my antagonist occasionally had the best of the contest, I entirely forgot that my own arguments, as well as those advanced by my opponent, were supplied by myself." 56 PREMONITORY SYMPTOMS OF INSANITY. Little stress ought to be laid upon those occasional and uncer- tain disentanglements of intellect, in which the patient is for a time only extricated from the labyrinth of his morbid hallucina- tions. Madmen may show, at starts, more sense than ordinary men. There is, perhaps, as much genius confined as at large; and he who should court coruscations of talent might be as likely to meet with them in a receptacle for lunatics as in almost any other theatre of intellectual exhibition. But the flashes of wit betray too often the ruins of wisdom, and the mind which is conspicuous for the brilliancy, will frequently be found deficient in the steadiness of its lustre."1 A young female domestic servant became insane, and eventu- ally sank into a state of apparently perfect dementia. In this condition she continued many years. Late in life she had an attack of typhus fever. The physician who was in attendance upon her was surprised to observe that, as the fever advanced, a development of the mental powers took place. During the height of the fever, when delirium generally exists, this patient was entirely rational. She recognized, in the face of her medi- cal attendant, the son of her old master, whom she had known so many years before, and she related many circumstances re- specting his family, and others that had happened to herself in earlier days! But, alas! the reign of reason was but of short duration. It came like a blaze of light across the intellectual desert, leaving in its track a hopeless- state of mental obscurity! As the fever abated, and her bodily health returned, dark clouds again enshrouded her mind, and she sank into her former de- plorable state of idiocy, and continued so for many years, until she died. 1 Dr. Eeid's " Essays on Hypochondriasis." STATE OF MIND DURING INSANITY. 57 CHAPTER IV. CONFESSIONS OF PATIENTS AFTER RECOVERING FROM INSANITY; OR, THE CONDITION OF THE MIND WHEN IN A STATE OF ABERRATION. The autobiography of the insane, embodying a faithful record of the state of the intellect, emotions and instincts, whilst fading into a condition of alienation, as well as an accurate account of the condition of the mind after its complete subjugation by dis- ease, proceeding from the pens of persons who have passed through the terrible ordeal of insanity, opens a new and pro- foundly interesting page in the history of cerebral pathology, as well as mental philosophy. Is it possible for the insane accurately to describe their men- tal state during a paroxysm of mania ? Can they have any re- collection of their incoherent ramblings, wild and fanciful ima- ginings, horrible and frightful hallucinations ? In order to thoroughly understand this subject we should bear in mind that insanity does not invariably overthrow and alienate all the powers of the understanding. It is often a mixed con- dition, a combined state of reason and insanity. This theory does not militate against the view that I have elsewhere pro- pounded, as to what in legal phraseology is termed, "partial" insanity. Adopting the language of metaphysicians, I affirm that the mind is one and indivisible. A part of the intellect cannot be affected, without, to a certain extent, influencing and modifying the whole of the operations of thought; neverthe- less, there is in derangement of the mind occasional lucid mo- ments when the patient is conscious of his disorder, and is able to describe his sensations clearly to those about him. It occa- sionally occurs that after recovery those who have passed through acute attacks of insanity, are able to recollect with singular clear- ness many things that occurred during their long and painful illness. As they, however, have frequently very confused and incoherent notions of such events, extreme caution should be exercised in admitting and acting upon their evidence, particu- larly if it materially involves the motives and compromises the actions of others. With a view of analyzing the phenomena of morbid thought, patients have been asked to detail the actual operations of the mind during the incipient as well as advanced stages of disor- der. In many cases it has been impossible to obtain any trust- 58 STATE OF MIND DURING INSANITY. worthy representation of facts; in other instances they could not, without considerable and painful revulsion of feeling, re- vert, even for a single moment, to the past. In a few instances no difficulty has been encountered in persuading patients not only to talk about their past condition, but to write with great minuteness an account of their sensations, mental and bodily, whilst insane. I should commit a violation of good faith, and a breach of professional confidence, were I to publish some of these remark- able confessions. I may, however, revert to them in general terms. Before doing so I would briefly refer to the fallacy per- vading all the poetic, dramatic and artistic descriptions of in- sanity, save and excepting our own illustrious and immortal Shakspeare, whose wonderfully truthful delineations of the dif- ferent types of disordered mind embodied in passages of rare and matchless beauty, must ever entitle him to the distinction of holding the foremost rank among the most eminent psycho- logists that have conferred lustre on the annals of this or any other country. The descriptions of insanity proceeding from the pens of no- velists, as well as of poets, constitute unquestionably strikingly clever and graphic melo-dramatic sketches, but these poetical and theatrical portraits do not correspond with the true charac- ter of mental disease, as exhibited by insane persons. In con- sidering this subject it should be remembered that the effect of the modern treatment of lunatics has been to alter the character of insanity. The immortal Pinel effected a great revolution in the moral treatment of the insane. Lunatic asylums no longer resemble a Bastile surrounded by high serrated walls, and pro- tected by iron-barred windows. We are not shocked,at the sight of the straw bed upon which " Poor Tom" of former days was in the habit, like a wild animal, of crouching, with little or no covering to protect him, during the most inclement seasons of the year, from the cold. We no longer observe the dens in which lunatics were formerly caged like ferocious beasts, or witness the iron chains with which their attenuated and palsied limbs were frequently manacled. The sense of hearing is not pained by the wild and unearthly wailings of bitter anguish, caused by the whip of the keeper, as it fell unmercifully across the back of the unruly and excited patient. Pinel, and those who have followed humbly in his wake, have given'the death- blow to such brutal proceedings and horrible barbarities. Pari passu with a liberal and enlightened recognition of the great principles of treatment, which the genius of the illustrious Frenchman conceived and boldly carried into effect has the character of insanity been deprived of many of its most painful and repulsive features. The modern principles of moral treat- ment, based upon kindness, gentleness, and soothing tender- CRUEL TREATMENT OF THE INSANE. 59 ness, have very materially modified the external characteristics of insanity. In estimating the circumstances that have led to the great improvement that has taken place in the condition of the insane in modern times, I am bound to refer, not only to the abolition, in this country, of the severer forms of mechanical restraint, but to the enlightened progress made in the pathology as well as treatment of insanity. Compare the opinion entertained by medical men of great distinction, and of high professional emi- nence, who flourished and ruled despotic, about sixty years ago, with the enlightened views that are, in the present day, almost universally, adopted and acted upon. I refer to the principles of treatment as enunciated by the celebrated Dr. Brown (author of the "Bruonian theory" of medicine) who, for a short period, entered the arena, and contested, with the illustrious Dr. Cullen, the sovereignty of the medical republic. Dr. Brown, when speaking of his method of curing mania, observes: " The pa- tient should be struck with fear and terror, and driven in his state of insanity, to despair! As a remedy against the great excitement of the organs of voluntary motion, the labor of draft cattle should be imposed upon him, and assiduously continued. The diet should be the poorest possible, and his drink only water. In water, as cold as possible, the patient should be im- mersed, and kept under it, covered all over, for a long time, till he is near killed!" It is evident that Dr. Cullen entertained the most unenlight- ened views with regard to the treatment of insanity, for, he says, when speaking of the management of lunatics, "In most cases it appeared to be necessary to employ a very constant impres- sion of fear to inspire them with the awe and dread of some particular person; this awe and dread is therefore by one means or other to be acquired; sometimes it may be necessary to ac- quire it by stripes and blows."1 It is clear, that these notions were at that time generally prevalent, for I find in Burn2 the following passage: "Any person may justify confining and beating his friend being mad, in such manner as is proper in such circumstances." But Collins3 ventures to expound much more monstrous views, in regard to the insane, than the three authorities previously mentioned, for he asserts, that "furious madmen may be legally despatched by private men!" Whilst contemplating such barbarous and inhumane principles, we are not astonished to hear the solemn protest, which the illustrious Lord Erskine, when Lord Chancellor, deemed it necessary to make, in behalf of the insane. " I consider," says this renowned judge, "the various trusts with wmich I am invested, in a man- 1 Dr. Cullen's "First Lines." 2 Burn's "Justice," vol. iii, p. 311. 3 " Essay on Human Liberty," p. 64. 60 state of mind during insanity. ner, as nothing when compared with the sacred duty of protect- ing those who are visited with mania: it is as much a disease as any other with which it pleases God to afflict mankind, and I am sure it is always exasperated in its symptoms, and frequently rendered incurable by unkind and rigorous treatment." How different are the modern views, with regard to the medi- cal and moral treatment of insanity! To these humanizing and enlightened principles (so successful in the cure of the mal- ady) we may undoubtedly in a measure, trace the great altera- tion that has happily been effected in the features of the disease. Kind, gentle, considerate, and affectionate measures have dis- armed insanity of many of its repulsive and ferocious charac- teristics. A lady who had been eighteen months insane, detailed to me after her recovery the symptoms that characterized the approach of her derangement. She informed me, that for nine months previously to her being considered mentally afflicted, she was fully aware that she was not "quite herself." She manifested extreme irritability at the most trifling circumstances. She had great difficulty in directing her attention to, and steadily occu- pying her mind, with any train of thought. She, to a morbid degree, secluded herself from the society of her old friends, and, to avoid all intimacy with her former associates (with whom she had never quarrelled), left England, and resided for several months in a continental town, having little or no communica- tion with her relatives and friends. She, however, found change of country effect no radical alteration in her feelings. Occasionally, she had sad, depressing, and melancholy forebod- ings, as to approaching insanity. With this conviction, she consulted, when in Paris, an eminent French psychological physician. At this time, she was quite able to conduct herself with great propriety, and to manage with prudence her own affairs. She was not then the subject of any insane delusion, although, at times, she had serious doubts as to her personal identity. This was the first sign of threatening alienation of intellect. On her return to England, she says, "I felt my mind much less disturbed by morbid apprehensions of insanity, and for a period, all the absurd impressions, as to whether I was ac- tually myself, or representing some one else, ceased to trouble me. My general health then became much out of order and I had a severe attack of English cholera, followed by great de- bility, which confined me to my bed for several weeks. It was during this illness that my foolish fancies began to annoy me. At this time I used to talk out loudly to myself, a thing I never did before. This was irresistible. I ejaculated the most foolish remarks, and at times, too, with wonderful volubility of speech. I did my best to control myself, in this particular, but found it difficult to do so. I was quite conscious that my mind must be MORBID phenomena of incipient insanity. 61 affected, and yet no delusion had taken possession of my intel- lect. For several days I succeeded, by strong efforts of thought, in checking this ridiculous inclination to utter absurd expres- sions, but I awoke one night in an excited state, from a trou- blesome dream, and I then began to vociferate a number of most incoherent expressions, to this effect, 'You shall do it.' 'No you sha'n't.' 'He is like Satan.' 'Why don't vou say the devil?' 'Ah! ah! ah!' 'It is beautiful.' 'No he-devils.' 'I can't be saved.' 'You have no hope.' 'Suicide.' 'Poison.' 'Hang yourself.' 'They are after you.' These strange remarks continued for nearly two hours, when I fell asleep, and arose much relieved. My mind, however, was for some time after- wards not in a right state, although I had intermissions from the misery I suffered. Eventually, I became quite insane, and, I am informed, remained so, for nearly eleven months. During the whole of that time, I fancied I was in hell, and tormented by evil spirits. I thought every person near me to be a devil. My mind was gradually restored to a healthy state. I cannot say, when I first began to feel that I was recovering.' " A gentleman, who for nine years had the command of an East Indiaman, encountered during a voyage from Calcutta, great anxiety of mind, in consequence of a quarrel that had taken place among the passengers, and apprehensions he enter- tained of a mutiny occurring among the crew. A few weeks after his arrival in England, he suffered from attacks of agon- izing headache, and one day, whilst getting out of bed, he fell down in a fit of syncope. About a month after the attack of fainting, he became deeply depressed in spirits. This depres- sion continued for nearly a fortnight. It was associated with a great weariness of life, and intense longing for death. He left home late one night, with the full determination of throw- ing himself into the London Docks, and thus putting an end to a miserable existence. When near the East India House, he met an old friend, also a captain of a vessel. They recog- nized each other, and stood for some time in close conversa- tion. The friend then proposed that they should adjourn to a hotel, and take some refreshment. To this suggestion an objection was raised, but upon the question being asked, as to where the gentleman was going, he became confused, and incoherent in his replies, and being pressed upon the point, burst into tears, and made a full confession of his contemplated com- mission of suicide. His friend then insisted upon taking him in tow, and they both proceeded to a neighboring hotel, and he subsequently saw him safely deposited in his own lodgings, with his family. This mental depression continued without any intermission for several weeks. During this time he had no delusion. The case was at this period simply one of acute sui- 62 STATE OF MIND DURING INSANITY. cidal melancholia, accompanied by an overwhelming and appa- rently irresistible desire for eternal destruction. Eventually, this patient fancied that he was the subject of gen- eral remark. He arrived home one day in an unusual state of excitement, affirming that he knew certain parties were watching him in the street, and that a policeman had followed hirn some distance. He then imagined that particular paragraphs in the Times, and skits in Punch, were directed against him. In about a week from this time he was acutely insane. A professional gentleman stated, after his recovery, that for nine months before his wTife noticed anything wrong with his mind, he was under an impression that everything he ate and drank was either drugged or poisoned. He wras occasionally able to master his delusion, and then ate and drank heartily; but he frequently subsisted on the minimum amount of nutriment. When engaged in the City, he was in the habit of taking, almost daily, for luncheon, a basin of mock-turtle soup. For a long pe- riod, he never, for one moment, suspected that the soup con- tained any injurious matter; but one morning he left home feeling physically indisposed, and, mentally, more than ordina- rily depressed. He went into Birch's (Cornhill) at one o'clock, and had his usual basin of soup. He ate one spoonful, and whilst in the act of taking another, the idea of its containing ar- senic forcibly suggested itself to his mind, and he would eat no more. He tried at the same time to reason himself out of this delusion, but without effect. Eventually, the idea of his food being poisoned took complete, possession of his mind, and he nearly starved himself to death! For many months it was found necessary to administer nourishment by means of the stomach- pump. This patient ultimately recovered, and has continued well for many years. A lady informed me (after her recovery), that her insanity commenced by her morbid fancy suggesting to her mind a number of lewd images. Being naturally of chaste feelings, and refined intellect, she was perfectly horror-stricken at the ideas that occurred to her. Everything she saw, and heard, appeared to be associated with physically impure notions. So acute were her mental sufferings, that she endeavored to escape from her horrible thoughts by an act of suicide. For this purpose, she threw herself into the water, but was fortunately observed, and dragged out of the pond before life was extinguished. This state of mind appeared inexplicable to her, because she had never indulged in any improper ideas; and having a literary taste for a high class of books, she was not in the habit of reading any- thing that could have laid the foundation for so fearful a per- version of the animal instincts. A clergyman, remarkable for sweetness of disposition and purity of thought, suffered severely from the same distressing CASES OF INCIPIENT INSANITY. 63 symptoms. - At an early period of an attack of insanity, his un- happy mind was tortured by the most obscene and blasphemous suggestions. Such was his condition, more than twelve months previously to an attack of acute mental derangement. Two years before (so he informs me) he had experienced, but in a somewhat modified form, similar symptoms. For about two months, he never could engage in family prayers, read the les- sons in church, or preach a sermon, without having the most dreadful thoughts enter his mind. It appeared as "if he were under the influence of " double consciousness," or, as if he had, to use his own phrase, " two selfs," one (or the evil self) urging him to utter certain impure expressions, and the words—actual words—were, as he thought, plainly spoken; the second (orgood self), begging and beseeching him to resist the machinations of the devil, and to refuse compliance with his horrible sue-p-es- tions. 86 On my advice he left England and went abroad, residing some short time at Spa. He then visited Baden-Baden, and remained on the Continent for six months, returning home apparently quite free from all nervous symptoms. For four months, pre- viously to the recurrence of the peculiar morbid thought referred to, he had been greatly overworking himself, in attempting to establish a new school in connection with his parish. He was also much annoyed and irritated by an unkind and unexpected opposition that had been raised by some neighbors, upon whom he relied for support. This gentleman's insanity, in course of time, became so obvious that it was necessary to place him un- der control. In less than twelve months he appeared to recover, but was strongly advised not to return to ministerial duty for eighteen months. However, in defiance of such instructions, and in direct opposition to the wishes of his wife and friends, he insisted upon resuming clerical work. In less than three months from this time his mind again became deranged, and whilst under the fearful dominion of a most horrible hallucina- tion, he committed suicide by cutting his throat! " For more than four years," writes a patient, " I was the sub- ject of the most inexpressible and curious mental sensations. They commenced by attacks of, what I thought to be, sick head- ache. These feelings were associated with depression of spirits. I began to lose all interest in matters that had previously pleased and occupied my mind. I carefully avoided the society of my relations and friends, having a morbid graving for solitude, and yet, when so isolated, I was truly unhappy. I could not under- stand what possessed me. I was unable to account for the strange ideas that often suggested themselves to my mind. I felt, at times, very wretched. These symptoms continued in varying degrees of severity for nearly two years. By this time I was quite estranged from all my friends and many of my rela- 64 STATE OF MIND DURING INSANITY. tions. I awoke one night, as I thought, out of a frightful dream. I felt much alarmed, arid yet I knew not why. I got out of bed, lighted a candle, and sat in a chair in a state of extreme mental and muscular agitation. On the following morning I first began to hear voices speaking to me. Occasionally the words they uttered wTere those of comfort and consolation; then texts of Scripture were repeated ; verses from hymns that were familiar to me; favorite pieces of poetry—all, happily, of a con- soling character. I was certain that the voices were internal— that is, originating within, and did not proceed from persons external to myself. But, alas! the character of the voices changed in about a week. They then gave expression to the most foul, coarse and abusive epithets. I was charged with having committed the most abominable sins, and the most re- pulsive and morally degrading crimes. At other periods I was told I had better cut my throat, hang myself, take prussic acid, and thus save myself from some dreadful punishment; and, strange to say, particular instructions were given to me how I could best destroy myself without detection, where I could pro- cure the fatal poison, mentioning the name of the chemist, as well as street, in which he resided. Now and then I appeared to be better, and my mind was quite free from such distressing illusions. For several days, to my great delight, the happy voices returned, and again passages from the Bible were re- peated, and comforting hymns were sweetly and melodiously sung to me. During the whole of this time I was fully per- suaded that the voices were only suggestions of my own mind, and did not proceed from other persons; nevertheless, they gave rise, at times, particularly during what I term my ' bad days,' to great mental suffering. This state of mind existed for three years and eleven months. At the termination of this time I heard of the brutal murder of a near elative. This was a great mental shock, and produced severe distress of mind, ending in an attack of jaundice. The voices then came back to me in great force, and the suggestions made by them were too horrible to narrate. In about a fortnight I became extremely nervous, fan- cying that I was to be sacrificed (' crucified,' the voices said) in order to bring my poor murdered relative back again to life. I then conceived that I heard strange noises in the house at night, and on more than one occasion I imagined I saw an assassin en- ter my bed-room and point a knife, covered with blood, directly at me. I'then began \p believe that a number of persons, dressed in the garb of priests, were actually speaking to me. I replied to them and prayed that they would leave the room, but the more I expostulated with these spectral images the louder they talked, and the more violently they gesticulated. It is impossible for me to repeat the filthy, obscene and blasphe- mous language they used. Then some women appeared among CONFESSIONS OF THE INSANE AFTER RECOVERY. 65 the priests, and they commenced to dance most lasciviously; men and women trying to outdo each other in the most gross and sensual attitudes. My mind at this period wras in a state of wild delirium. I remember two or three gentlemen coming in to see me, and a strange man, I recollect, always sat in my room. The gentlemen I refer to were two surgeons, and the man was a respectable person from the village, who acted as an attendant, I remember being driven away from home in a carriage, and entering a large house (an asylum), where I saw a number of singular men (patients). I then fancied that I was dead, and re- fused to eat. In consequence of this delusion I had food forced into my stomach. My mind continued in a fearful state of de- rangement for more than sixteen months. I then began to re- cover, and at the end of two years from my being placed under treatment, I was discharged, cured. I have now been well for more than seven years. My mind has been, ever since, quite free from all symptoms of insanity. I am not, however, in in- tellect as I was before I became subject to the illusions. I find it difficult to fix my attention to any subject requiring for its comprehension an effort of mind. If I attempt to read a book on an argumentative and philosophical subject, I am obliged to put it aside in about ten or fifteen minutes. This was not the case before my mental indisposition, for then I indulged freely in most abstruse reading, rarely looking at the light literature of the day. My head aches, and the mind gets confused, if I try to follow a complex train of reasoning, and I, therefore, now do not read any work that is likely to produce tension of thought." The following letters1 were written by patients who had been confined in an asylum for the treatment of the insane. They illustrate the subject under consideration: " I am now engaged in writing to some of my friends at the asylum; and though you may not be expecting a letter from me, yet I must ever consider myself under obligations to you, as the instrument, in the hands of Providence, in restoring me to health, reason, and my family. Of course you do not rank least in my affections, when I remember my friends at that truly benevo- lent institution, for I am fully confident, that had I not been placed there, I should never have recovered from the torments of a deranged mind. " Should I undertake to describe to you the anguish which I suffered before, and for several weeks after I became your pa- tient, my language would fall so far short, that I should convey no idea of it; but in our hall I found those that were under the same delusions that I was. One would say her children were murdered, and she had eaten them. Another would say, she was to be burned alive, and she was brought there to be boiled, 1 Addressed to Dr. Awl, Physician to an American Lunatic Asylum. 5 66 STATE OF MIND DURING INSANITY. and the doctors were to make an anatomy of her, &c. All these, together with hundreds more of the most horrid delusions that can possibly enter the imagination of the crazed brain, had haunted me for months. My brother, my husband, and even my own son, a child of ten years, I was afraid of. I thought everybody on earth knew my thoughts, and that I was not a hu- man being; that I wTas the devil! and that I ought to kill my- self and children. I once told my husband I would kill my boy, for he had already been murdered, and he was only the ghost of my child. The poor boy cried, and came to me, and said, ' Yes, mother, I am your boy;' so I could not do it then ; but myself I was fully determined to murder, before I got to the asylum ; for I believed the people of------had called a meeting on my ac- count, and had resolved to send me to Columbus to be burned, and made an anatomy of; but when I found others in the asylum, who seemed to suffer in a degree the same fears and torments as myself, I was led to try to think I might be wrong in some things, until gradually reason returned and with it the affections of the heart. " When I entered the asylum my sufferings cannot be de- scribed; and though I do not believe that any being on earth ever suffered anything to be compared with my anguish and torments, yet if persons who are deranged do suffer even a thousandth part as much as I did, I am sure I pity them from my very soul." After recovery this lady says : " I arrived safe home, and found my children andfriends well, and not a little astonished to see me so soon—and so well, too ; I could scarcely make them know me. Before I left them and since last February I scarcely ever spoke to any one of them, and they seemed surprised to hear me tell how much I ,suffered; and they wonder when I try to convey to them some faint idea of the many awful and horrid delusions I was under. What a dreadful thing it is to have had my children afraid of me ! Now they are so happy, and say to the neighbors, ' My mother has come home, and she is not crazy at all.'" Another patient writes, " As you desired me to give you some account of the manner in which I was taken sick, and the cir- cumstances attending my long affliction, I will now endeavor to state them as near as my recollection of things will permit: " In the fall of 1839 I was much exposed and labored exceed- ingly hard, which brought on an attack of fever that seemed to spend its force principally in my head. I also had a severe cough, and at one time spit blood. As the fever increased I ex- perienced a kind of stupor and derangement of mind. In this state I had the most singular dreams, or visions of thino-s. One peculiar thought that entered my mind was that my body was divided into four parts, the legs being cut off at the knees, and my head and breast severed from the body, which appeared to CONFESSIONS OF A PATIENT AFTER RECOVERY. 67 be real and true; and I suffered great anxiety as to how the parts of my body should be reunited, and made to grow to- gether again. A physician was employed, and he ordered plas- ters to be applied to my ankles, and a blister to my breast, and one on the top of my head, and gave me several emetics; and the pain of all these, and the distress of the fever in my head, was enough to render the strongest man, with the best consti- tution in the world, senseless and delirious. " I continued in this condition some time, sometimes pretty sensible and others indifferent to what presented itself before me. At length, through the advice of some friends, I believe, I was taken to the asylum. As near as I can recollect, I was taken twice. The first time there was no room for me, and my father had to take me home again. I remember, on my first visit, seeing the four round pillars in front of the building, and walking up the steps into your room. At this time I enter- tained the opinion of having just landed in the city of Rome; and from the circumstance of noticing these pillars, and the im- mense size of the building, I was induced to entertain the be- lief of its being a house used by the Roman Catholics for their religious services. I thought it was a monastery. I also thought the piece of ground in front of the building was holy and con- secrated ground, and used by them for the interment of the dead. I suppose the reason why I thought so was because the ground between the gate and the house had been fresh ploughed, and it looked yellow. I had an idea that the Romans and some other denominations were exercising their authority upon young and old; and I thought I was brought here to be scourged and taken through purgatory. After I arrived the second time, I thought that the building was used for a medical college, and the inmates were going through a certain preparation, or process of experi- ments, rendering them fit subjects for dissection and investiga- tion. After that I concluded it was a kind of fort for the pro- tection of the people of the country, for I expected that France had united with the southern parts of the United States, and we were suffering the unpleasant consequences of a war. These, and a great many other curious and singular notions, not neces- sary to mention, I entertained through the winter and spring and .until I began to get better. " My greatest trouble was as to the place in which I was, and the true use made of it. I made various inquiries of my com- panions (the other patients) for correct information. I asked them often, where I was, but the answers which they gave in- duced me to disbelieve every word they said; and it was a long time before I could credit anything I was told. When I reflect on the many incidents connected with my sickness and recove- ry, I am amazed." "I was born," writes another patient, "in the State of Mary- 6S STATE OF MIND DURING INSANITY. land, and am forty-four years of age. From my earliest recol- lection, I was of a quiet'and steady turn of mind, and have seen nothing but hardship and trouble all my days. I was married in my twenty-fourth year, in opposition to the will of my pa- rents, but was devotedly attached to the man of my choice. He received an injury in his shoulder, some time after our mar- riage, and I was in the habit of assisting him with his work, on tin"farm. I worked uncommonly hard at making fence, burn- ing brush, and clearing up the land. The stooping, heat of the sun, and hot fires of the burning brush, appeared to affect my head very much. On a certain day, while engaged in the field, I was suddenly struck almost blind, and felt an uncommon stiff- ness in the back of my neck, accompanied with a drawing down of the skin over my eyes and forehead, and the sensation of tight cords passing through my head. It was some time before I felt able to return to the house, and attend to my domestic duties. I had lost much sleep, for two or three weeks, previous to this attack, and felt troubled in my mind on account of our difficul- ties in getting along in the world. On the following night, I was greatly distressed, and thought somebody was coming to kill me. I could not go to sleep, and, by morning, I believe I was completely deranged. I continued out of my head for three or four months, and suffered much distress and anxiety of mind, from the apprehension that I was to be killed; but through the attention of the physicians, and kindness of my husband, I be- gan to recover by degrees, and eventually got entirely well. " After I got well, we concluded to come out to the State of Ohio. We were very poor, and the journey was accomplished on foot. It was in March, and the three children and myself suffered greatly from cold and fatigue. Husband had taken to drink, and we had hard work to get along; and in the month of November following, I had another attack of derangement. I forgot to tell you, that my health began to fail previous to my first attack, and I think this brought on the second attack also. I continued ill for several months, during which time we removed to the northwest part of the State. I did not know what was to become of me; my distress was so great, that I longed to make my escape, and hide where no mortal could find me. We again had to make our journey on foot, and I cried and fretted most of the road. I wished I never had been born, and often said to my husband, ' There's my poor children, and I've got to go to hell for having them;' he would scold me for talking so, but I could not help it, such dreadful thoughts would come into my head, in spite of all I could do. I sometimes tried to drive it out of my head, by beating it against the fence. Frequently it appeared to my mind as if it would rain hail and fire upon my head, and I should be beaten to pieces with thunder and light- ning; and when I did, once in a great while, fall into a troubled CONFESSIONS OF A PATIENT AFTER RECOVERY. 69 sleep, I would suddenly start up in a fright, with my hands be- fore my face, to keep the awful danger off. It was all, however, respecting myself and my children; I did not think that any- thing was to happen to their father. " At this time husband was sometimes a little crabbed, but he could not get any liquor in them parts, and did not get drunk. I was as much attached to him as ever, for he was a kind and good man to me. I don't think two persons could be fonder of each other. At last, however, I took it into my poor head that he was going to kill me ! This painful idea continued to tor- ment my mind for two or three weeks. It was dreadful. We had lived together so many years, and wdry should he want to kill poor me ? " One Sunday, I was full of this idea the whole morning, and about twelve o'clock ran off on to the wild prairie, where I wan- dered about during the whole afternoon, and did not think of returning until near night. I met husband coming after me, with one of the children, and we all returned to the house to- gether. I got the supper, and the family went to bed as usual. I could not sleep. It was a terrible night to me. About day- break, I got up and built a fire. Something appeared to tell me there was dreadful work to be done. I was very much agi- tated when the thought came into my head that I must kill him; but my mind was so much excited, I cannot tell anybody exactly how I felt. The same thought came into my head in the night, but I succeeded in putting it down. I had a confused notion that I was born to be lost; it appeared like a hidden mystery; but the thought that I was born to be lost was uppermost. At the same time, I supposed he would be saved. I often thought that everybody was made righteous beside myself. " I stood alone by the fire. All were sound asleep. Husband partly wakened when I first got out of bed; he merely opened his eyes, and then went to sleep again immediately. I knew he was sound asleep, and I felt that I must kill him to save myself. I accordingly went to where the children lay, and drew out a broad axe "from under their bed, that he had borrowed from a neighbor. I went right to his bed, with the axe in my hand, trem- bling like a leaf. He was laying on his right side, with his neck bare, and I immediately struck him the one fatal lick across his neck! He kind o' struggled, and partly raised himself to his knees, and wakened the children, a dying. My daughter came running to me in a fright, and took the axe out of my hands, screaming that I had murdered father! and sprang to him, and kissed him on his forehead, crying,' Oh! he's my poor, poor father!' "As quick as they could get their clothes on, the children ran off to the neighbors. I sat down, and stayed in the house alone, until the neighbors came. A gentleman first looked in at the door, and asked me what I had done. I said (evasively) that I 70 STATE OF MIND DURING INSANITY. had not done anything; that I had to go to hell, and that I would have something to go thpre for. He came in, and said he must tie me. I tokf him I did not want to run away, and would go along with him without tying. He first took me to the next house, and in three days they sent me to jail. I was as distracted as ever; and what I had done gave me no relief nor satisfaction. I think it was as much as three months before I began to come to myself. I was not tried for the murder, which I never at- tempted to deny, but sent here to the lunatic asylum. I sup- posed they would hang me, and did not expect anything else for a long time. My mind now appears to be entirely clear, and I want to go home to my children. I feel much better, though very weak. I am thankful they brought me here. My mind is altered now about going to hell; I have hopes, and think, when I die, I will go to rest. I like to go to your evening worship very much, when I am able to walk up stairs," &c. " To our question, ' Well, Mrs. S., you say your mind is now clear; don't you know it was wrong for you to kill your hus- band?' 'Yes, doctor, I know it was wrong.' 'And are you sorry that you did it ?' This question appeared to touch the very chord that had been so long diseased. Her eyes flashed; the pupils contracted ; and her wdiole frame shook, as she raised herself up, and emphatically replied—' No, doctor, no ! I'm not sorry for it! It was God's will—why should I be sorry? He made me do it to show me His power, and I was willing to do something to go to hell for!' It was but the flash of a moment, and all was calm as before."1 I append another interesting account of the operations of the mind during an attack of insanity, written by a lady after her recovery.2 This patient possessed great accomplishments. Her imagination was active, and her character was most marked in its disposition to conceive projects and abandon them as soon as formed. Her insanity is said to have resulted from a misunder- standing that arose at a moment when she was already the vie- ' tim of disappointed hopes. The conjunction of these circum- stances became the exciting cause of her mental affliction. She had in Holland claims to a large sum of money, but the date of her right was at a remote period, while another family, and with all the appearance of justice, had made good their titles to the same possession. Advantageous offers and the expectation of suc- ceeding, by being present on the ground, urged her to proceed to Holland. After many useless plans, and after having seen all her efforts fail, she returned one day home with her feet very damp. The succeeding day she felt out of order, suffering much from cold feet and pains of the head and throat. Instead of re- posing in her bed, and promoting perspiration to recover her 1 " The American Journal of Insanity." 2 " Annales d'Hygiene." CONFESSIONS OF A PATIENT AFTER RECOVERY. 71 health, she sat at her desk to arrange a very long paper on her business, to which she devoted all her mind and means, so as to prove the justice of her claims. But notwithstanding the paper was written with great power, and she had presented'the subject under every variety of aspect, it had no better success than the preceding memoirs. No answer was made to it, and when she called on the people, to whom it had been transmitted, they al- ways contrived to escape seeing her. Impatient, soured and irri- tated at this cruel treatment, she had determined to return home, and had proposed leaving her lodgings, when she received a let- ter from her family, which induced her to protract her stay some time longer in Holland. The memorial which we have men- tioned was the chief subject which engaged the disordered mind of this lady during the illness she had at that period. W"e now append the written detail which she gave of her feelings during her attack. Some few points in her history have been sup- pressed. " During these transactions I hired more retired apartments, and less dear. My landlord, a shoemaker, and all his family were worthy people, and obliging. I took them for Christians, though they were Portuguese Jews. When I was informed of that circumstance, I became painfully afflicted. I began to be under constant apprehension that they would rob me of my mo- ney. This fear increased to such an extent as to deprive me of my rest. At last I fancied that my host might some day make me swallow a narcotic draught, and assassinate me, along with my daughter, during the night, to get possession of my money. My suspicions received additional confirmation from the circumstance that these persons had prevailed on me to inscribe my name at the police-office as Madame H. A., and not Madame H. B. Tor- tured by fear, for the period of eight days I scarce slept for a few instants. My food was composed of eggs, fruits and tea, and one day, after having partaken of some bread which my landlady brought me, I was immediately attacked by a severe diarrhoea, and I had no more rest. " My hostess explained the accident by a statement that the po- lice, in order to prevent an epidemic with which the country was threatened, had directed the bakers to introduce into the bread designed for the lower orders, medicines which would act as a general purge. " My body and my head broke down, weakened by the low diet and by the continual watching. Fear carried them away. I felt my judgment going apace along with the power of reflec- tion ; and at last I was unable to draw from any given fact con- clusions in accordance with the relations of that fact, The per- sons around me became still more fully suspected by me; and the end was the loss of my reason. " Two dreams, one of my daughter, the other about myself, 72 STATE OF MIND DURING INSANITY. occurring in the same night, brought my disease fully out. My daughter told me that she had witnessed me throwing myself into the street from the third flat of a house in the town, and that I remained stretched on the pavement broken in pieces and dead. We went to try and discover the house which she had seen in her dream; it was the Court of Judicature. As for my dream it was that a man, bearing a purse, had entered the house of the Portuguese Jew, and had cut my throat. The day after I was busy washing some clothes, when raising my eyes I saw (and I was wide awake) a long knife passing over the ceiling of my room. Struck with alarm, I bade my daughter to be silent. In great haste I placed all my money in my work-bag, I closed my trunk, and hurried my daughter into the street, taking with me all most important papers. I cannot say whether some person had not, by way of joke, passed a knife through a slit in the ceil- ing, or whether it was not altogether a vision, the creation of my excited imagination. This, however, is undoubted, and I was quite awake, and in full possession of all my wits, when I saw the instrument of death. I had met shortly before, in descend- ing the staircase, a man with a large purse under his arm, pro- bably a barber. The appearance of that man deprived me of my self-possession; and once out of the Jew's house, reason completely deserted me. I then went to one of the body-guard. I addressed a young officer, and begged him with fervor to carry immediately to the king the packet of letters on me; but as he hesitated, and left me under the pretext of calling a superior of- ficer, I hastened away from him, and went to the German Chan- cery, where I compelled the worthy keeper of the records, M. Z----, to take my packet and preserve it for me. I also told him of my cause for alarm, and made him acquainted with the dan- ger I dreaded. H3 took leave of me after having offered some commonplace consolations, and I fouud myself again in the street. Here, however, everything was changed as far as regarded me. The city,_ so tranquil but a moment ago, was in the height of an insurrection. The regiment quartered in the garrison was Jew- ish. The prince royal and the king had been made prisoners and condemned to death. The enemy had broken ground at Schevelingen. The Asiatic hordes were commanded by the Jews. Of what use could the gold be to me ? I said to myself, and I returned to my landlord's door. I called his wife. I threw my money down on the work-table, advising her to begin a petty trade with it; and I concluded by a humble request for one louis that I might return to Germany. " The face of the poor Jewess must have actually been seen at the instant when she received so unexpectedly a large gift to conceive the astonishing effect it had on her countenance__it act- ually became purple. She could not divine how to explain the matter; but she concluded in offering me a piece of gold and CONFESSIONS OF A PATIENT AFTER RECOVERY. 73 would have allowed me to go away without any further remark, had not her husband come in. He took a handful of the louis, and slipped them, almost without my consciousness, into my bag. The louis, however, were restored, from which cause I was led to believe the family highly honorable. Having in this manner, as I supposed, got rid of my money, my dread of being assassi- nated vanished, and I reasoned with tolerable precision for an insane person. I said to myself the people would have killed you on account of your money; let them have it; they will coun- termand the assassin, and you may return home without any fear. I made this all clear to my daughter, and I took the road to Delft. I wished to pass the night in that town, and travel by the boat to Rotterdam, whence I would have proceeded to Munster by Arnheim and Emerich. I was desirous to see Madame II----, at Munster, and explain to her that it was a sacred duty she owed to her husband to recall him immediately from Holland, as he ran the hazard of being branded, as one individual had al- ready experienced, who had put in his claims for a property. "I had changed my louis at the banker L----'s, and I was already close by the gate of the city, when I saw a young Jewess following me; and though I had made different turns to avoid her, she nevertheless hung close on my footsteps. I then went up to her, and exclaimed, in a menacing tone, ' Accursed pagans! you have already crucified Christ, and this day you vent your wrath on the prince royal!' The Jewess saved herself from this dreadful apostrophe, and from that moment I was fully satisfied that the prince, who was universally beloved, was in imminent danger. I then came in contact with an inclosed palisade. I asked what was the purpose of it? Being answered that it be- longed to a Jew, I persuaded myself that it was the prison of the royal family. The absurd thought excited so much pain and sympathy in my heart, that I deserted my daughter, and desired with my nails, using all my force, to make an aperture in the inclosure, that I might save the prince, and bring him out along with me. Nothing could withdraw that fixed idea from my mind, which led me to the belief of war. "This idea was further substantiated by two new visions, which existed nowhere but in my disordered brain. I saw then on the canal a little boat, with black sails and colors. My eldest daughter, whom I had left at C----, had taken refuge there, and was miserably clad. The boat, however, could not move, as the King of the Jews, under the penalty of death, had forbid any of the boatmen weighing anchor. That I might not betray her, and let her understand that she was my daughter, I returned silently; and soon after I recognized the face of a young lady of H----, in full dress, coming out of a beautiful coach, and pro- ceeding to an adjoining house. I followed this lady to address her, but those whom I spoke to said that they had seen no one. 74 STATE OF MIND DURING INSANITY. In all haste, I then took the road to Delft, where I arrived at eight o'clock in the evening. I looked out for a respectable house for lodgings, but they would receive me nowhere. Finally, I was received into the house of Captain B----, whose lady was sick and confined to bed. Nevertheless, the people of the house showed a great interest for me, and treated me with great kind- ness and humanity. A new accession of fever came on, and a host of visions, more or less fantastical, all relating to the im- prisonment of the prince royal, excited a furious delirium of the most extravagant nature, in consequence of which the persons with whom I resided carried me, in the course of the night, to another house. On the subsequent day, a letter wTas despatched to the keeper of the records, M. Z----: he came to me in a closed carriage, and took me to an establishment at a distance from the street, where I was put under the care of an old ser- vant of M. II----. A physician was called in, and at the expi- ration of three weeks I was so far recovered, that my guardians no longer could trace my thoughts, though my ideas still clung to the same subject. ' " After having left the house of M. B----, at Delft, I fell into a state of profound melancholy. I fancied myself to be in posi- tions which only the extreme of madness can conceive. My recollections are by no means very clear of what occurred when we were at the hotel, where wre had to pass three days; still, I have a floating idea of having conversed with different people, and that I answered different questions. I think, also, that when I went to bed, a great many people came to observe me, and they talked together about my condition, but all the rest was a dream. "The condition, however, in which I spent the first night seems worthy of attention. I thought myself abed, perfectly conscious, but totally unable to make any movement, in an im- mense abyss, in which I believed I had been buried alive, and had now awakened in the tomb, in the condition I was to live for all eternity, with the perfect consciousness of my condition, to reflect on myself. My mind, which, when awake a few hours previously, had been carried away by the most extravagant frenzy, still enjoyed all its perceptions clear. I discussed with myself whether I deserved so stern a fate, and as I was uncon- scious of any crime done with premeditation, I concluded by supposing that this severity of punishment had been awarded to me because, though I had fulfilled my duties as much as lay in my power, I had yet neglected to do any good beyond mv 'line of duty, &c._ In other respects, I was in the same condition as a person affected with tetanus. "I recovered myself, however, though I was in a state of extreme debility, not having sufficient strength almost to sup- port the weight of my body. Scarcely was I awake ere I CONFESSIONS OF A PATIENT AFTER RECOVERY. 75 relapsed into my illusions. I began to scrutinize my room, that I might discover whether I had not fallen into the house of a merchant of souls. The burlesque motions with which I prose- cuted this search would undoubtedly have provoked a smile in the most serious person, and at lastl went into the chimney, reasoning thus with myself, that as it was made of stones, it could not be thrown down when the house was demolished. My fears were further augmented by the pictures which orna- mented the walls. Li that posture I waited in trepidation the approach of the inmates of the house. A young girl appeared, who gave me some confidence, but when I saw my old landlady enter, my emotion could not be concealed; and lastly, when two keepers were brought into the room, who were not to leave me, my wrath was fired anew, and I broke a window that I might escape. "After some time I was permitted to go to the garden; the open air soothed me, and yet everything around me was a source of illusion to me. The houses around the garden seemed to me to be prisons filled with prisoners. I fancied the kitchen of my landlady, in which a large pot was boiling, the place where the prisoners were put to the torture. The water of the pot in which they were going to throw me, I thought was boiling oil. Full of that notion, I tore the sleeve off my daughter's robe, desirous to retain it that she might not incur the hazard of being boiled alive. "All this receives its explanation in the condition of a phrenetic lunatic, all whose actions are influenced by so many dreadful fancies; so it is always with me, that it is impossible to alleviate, even a little, those agonies, except I am completely enlarged from them. For if I had been shut up on that day, or even bound down by chains, either fright would have stopped the flow of the blood in my veins, or it would have circulated with such intense rapidity, that, with undoubted certainty, all the arteries would have burst in my brain. Most luckily I was left in the garden, though a violent storm was approaching. I felt myself very well when my keepers were forced to retire by the rain, under the protection of the alley of the house, leaving me at full liberty to contemplate the rising storm. But how different was that storm from that I had seen before, and those I have witnessed since. The clouds which rolled up from the horizon appeared to me to be the billows of the deep, rising o'er the banks of the 'Schevelingen to the skies, fighting in the air to- gether over my head; wdiile «a flotilla of the enemy, on the mar- gin of the river, carried on a deadly combat against the inhabi- tants. The last hour had struck for the prosperity of Holland. I did not hear any thunder; I did not witness any lightning; but I perceived the explosion of a hundred blazes of fire, the cannonade, ceaseless, reverberated in my ears; from which we 76 STATE OF MIND DURING INSANITY. may infer, with all certainty, that the ear and the eye of the insane amplify and enlarge whatever is heard or seen. " The same remark occurred to me afterwards. As my symp- toms appeared better, my linen and my property were restored to me. I took them out of my trunk, and arranged them on my table. I was struck with their great number, and even with the appearance of a cloth and towels, which, however, I had left behind at C----. But this joy did not continue long; and when the following day I again examined my linen, a great many ob- jects appeared to be wanting, which I had fancied to have had in my hands the previous evening; so much so, that I supposed I had been robbed. I did not, however, communicate my sus- picions to any one. " These two circumstances justify me in affirming thatthe luna- tic fancies he sees and hears objects which have no real exis- tence. But what I am now going to mention proves the impor- tant influence of an individual, opportunely seen, in giving a proper degree of assurance to the sick person; for the earliest symptoms of my recovery take their date from the day when I saw, amongst a great many others, a form that particularly caught my attention. "I cannot well say whether it was the second or third day, several persons came to talk with me in the garden, but I was extremely insolent to every one, even to Captain B----, to whom I owe my life. At the end two men opened the gate, and looked on my side of the garden; one w*as dressed in a deep blue over- coat, and he almost immediately withdrew; the other was dressed in very beautiful uniform; he also retired. After that a young man of a very good expression entered, having all the outward appear- ances of perfect health; he spoke to me in French, and I an- swered him in the same language. I took this person for the prince royal, and the bandage fell from my eyes. 1 felt myself all of a sudden in great confusion for appearing before the prince in a costume so unsuited for the occasion. I was surprised^that he was still alive, and as he appeared in perfect health, the anx- ieties I had experienced on his account, conceiving that the enemy, which had beleaguered the country, had made him suffer great torment, all vanished in a moment. I felt myself as if inspired with a new life, and from that hour the visions of horror were no more. "It will be easily understood that this young person w^as not the prince, though he was a little like him. What an infinity of good would be conferred on the lunatic could his thoughts be anticipated, and scenes of a nature to affect him favorably be brought before him. Had permission been given me to leave that day, I assuredly would have committed nothing either that was ridiculous or attended with injury to any one. But there were still more cruel trials in reserve for me, from which I was CONFESSIONS OF A PATIENT AFTER RECOVERY. 77 not to escape until I had gone through the ordeal of three addi- tional days' illness. "A coach was ordered, in which M. Z----, the keeper of the records, conveyed me to La Haye, where I was placed in a house near the castle. I then had a difference with M. Z----, as. we did not leave the town by the same gate we had entered. I attempted to show him that he had mistaken the road, and I felt much offended in perceiving that he, with a smile on his lips, continued the same route, without paying any attention to my observations. When we stopped, this irritation was further in- creased on perceiving a child looking at us. I said to it that it deserved the rod, which caused it to run away. As I ascended the stairs I counted the steps; and I was again thrown into dis- tress on getting to my room, when I saw that the door could not be locked from within. "My alarm, however, became extreme, when I firmly believed that I thought I recognized in the person of my nurse an indi- vidual whom I had seen hanged some time before at La Haye, along with another criminal, and whom accordingly I took for a spirit. In the solitude of night, I perceive myself alone in com- pany with this person, full of the most agonizing apprehensions. I would not allow the shutters to be closed at nightfall; and as, when I thought I had seen the prince, I had no longer any dread of war, I wTas fully persuaded that our soldiers had been victorious, so this idea stirred up in my breast the fears of being assassinated. When the pump was worked in the yard I fancied that they were going to throw the water into my room, and I looked every moment to see it rushing in. Noticing three nails in my room, I supposed that they intended to hang us on them, myself, my daughter, and my nurse, because the latter had been condemned to death. " Resting on my couch one evening, but quite awake, I watched every step of the nurse with my eyes, as I thought her a spirit; the candle ran, but I did not observe the tallow flow from that candle, but from a hole in the wall, whence it was discharged in an enormous quantity, resembling a furious torrent which has burst through its banks, so that I screamed aloud, and pretended that they were going to suffocate me. The incident made me suspect that they had the intention to poison the atmosphere, and ever from that moment I constantly experienced a disagreea- ble though sweet smell. All the viands offered to me had that taste. I thought that the meat they brought was human flesh, and insisted on the idea that they desired to poison me. Since my.complete restoration to health I have discovered, in one of my walks, a poisonous plant, wdiich had the disagreeable odor I allude to. " The circumstance I have referred to, of the tallow running down the wall, is a convincing proof to me that persons labor- 78 STATE OF MIND DURING INSANITY. ing under disorder of the mental faculties, perceive objects which have no real existence, and that the sight of particular matters produces, spontaneously, images in the eye of the dis- eased person. "Even at a later period, when I was improving, I still saw Dr. T----; then my brother-in-law ; I heard the voice of my sister, as also another voice, which, speaking to me by name, bade me ' lay down the petition.' " I often requested of my keepers to have my clothes, my pa- pers and my money; but they answered me that they were to be kept till my husband appeared, who ought to come and inquire for me. On several occasions I objected to this arrangement (pleading the expense it would be attended with) to interest the persons who detained me to permit me to travel alone; this, however, they would not accede to, though I had become much more calm. Several dreadful dreams broke in on this state of tranquillity, tallying, however, very appositely with my condi- tion. There I was, in the realms of Pluto below, which I ex- amined with a remarkable degree of firmness and self-posses- sion. I saw, moreover, the aqua tolena prepared. I had read an account of this horrible torture, the frightful details of which were all reproduced in a dream, and my children were the un- happy victims of this barbarity of the Italiani. I would rather suffer in reality every kind of imaginable torture, than again ex- perience that horrible dream. On being awakened I found that I had been dreaming, but still one uneasy idea succeeded an- other, and the last of the kind was on my return, after having been in a diligence. "We might be almost persuaded to conclude from these facts that every visible object should be withdrawn from the eye of the lunatic ; but if what I witnessed gave rise to misinterpreta- tion on my part, those things which were concealed from me ex- cited still more extraordinary conjectures. " I converted the office in the house into a chamber, where the torture was performed; every time I heard a packet sealed I thought it was the coup-de-grace of some unfortunate wretch. An old apartment, always closed, containing ancient records, and full of armories, was the charnel-house, and the armorer represented the coffins. I firmly believed that the story above me was a conservatory for the remains of those who had been assassinated, until one day, finding the door open, and all beino- still in the house, I went up quietly myself to ascertain how far my painful suspicions were well founded. Great, then, was my happiness, when, instead of bones, skeletons and carcases, I saw nothing but torn old waste paper. My curiosity was wound up to the highest pitch, and yet I had not courage to touch one of the leaves. I opened a window which looked into the royal gar- den; the windows of the apartment of the king also commanded CONFESSIONS OF A PATIENT AFTER RECOVERY. 79 a view of the garden. I noticed at one of the windows a tall lady in white robes; the moment I saw her she arose from her chair somewhat hastily, and I supposed she was the princess. From that moment all my fantastical notions were centred in that princess, as I thought she was detained as a prisoner in that room. " I looked then by the windows in the front of the house where I was, and I noticed a range of buildings, which surrounded the castle m the form of a circle. It would be interesting to ascer- tain whether, from the windows of that roof, the view which I describe here can be enjoyed in perfection, to determine whether my senses were not under the sway of an illusion, when I saw a crowd of magnificent mansions all around in that quarter. The front buildings could be perceived from my bed-room. I saw distinctly a small earthen pipe, which passed by the chimney of the house nearest the court of the castle; and it was not a long mental operation for me to conclude that the tube of that pipe was the only mode of the air having access to the house. So I likewise int'ersed that all the individuals who entered the house would be suffocated. " On the day of my husband arriving, and in his presence, my whole system underwent a special change. Instead of feeling a satisfaction that I had in him a protector, I was harassed by the idea of being considered insane by him, and being placed under the control of a person whom I distrusted. Under the influence of that fear, I exercised all my self-control, that he might not suspect my insanity, though I was still far from being in full possession of my wits. I also adopted the precaution to procure secretly a strong dose of rhubarb. I swallowed it all at once, and felt myself much better after. I had done so formerly with benefit. " Some days after the arrival of my husband, we began our arrangements to return home. We secured places in the dili- gence, though we would have done better by hiring a carriage, as we had to pay for three seats. We were then fairly on our road, and the shocks and jolts of the wretched vehicle in which we travelled were of no small service in restoring my addled brain. I soon found that my reason was restored. " We arrived for the night at a town beyond A----, where we were to stay till the morning. We had a bed-room, but there was no lock to it. When my husband had undressed and gone to bed, I noticed that he had left his pantaloons near the door, which was ajar, and I was afraid lest he had left money in his pockets. I searched them, and found, to my great delight, thirty-two double louis, of those which I had taken with me; and, in addition, the sum of two hundred reichsthaler, in single louis. I immediately concealed the thirty-two double louis in my clothes, intending, if my husband did not adopt better ar- 80 STATE OF MIND DURING INSANITY. rangements for our journey, to start alone on foot, and manage the gold coins myself. This money, which I had worked hard for in my early life, and which I had recovered, imparted to me a new spirit, so that, from that instant, I felt that I had entered on a new life. My fears all vanished, and everything about me appeared under a new light. Desirous to give my husband some little annoyance, as a punishment for his want of prudence, I placed in his bed the money which belonged to him, retaining my own. The following morning his alarm was great when he found his pockets empty, though his pantaloons were on the chair he had put them on the previous evening. I comforted him, restoring to him the money, and told him that his manner of travelling, though it was highly extravagant, was not the more pleasant on that account; that I would not contribute any more to the general expenses, but pay only for myself and my daugh- ter. Notwithstanding my remonstrance, as he persisted in tra- velling by diligence, I left him in a village, and proceeded alone as far as the gates of Westphalia. I should undoubtedly have lost my way had it not been for an incident which has much the ap- pearance of the marvellous. " Arriving at a place where three roads cross, I was going to follow that which would have brought me back to the point whence I had started, when I noticed the tracks of a man who had probably conveyed corn to the town of Minden; a sack had burst, and a considerable amount of the corn had escaped. My head was still feeble, and I had an explanation ready for this ad- venture : I conjectured then, and very luckily this time, that this corn had been spread on the road to enable me to escape from the labyrinth in which I was involved. I followed the marks with perfect confidence, and treading steadily on the corn, I passed over roads almost impracticable, and through several vil- lages, getting finally into the high road, where I met the dili- gence, which, taking that route, had made a long circuit: there I joined my husband and my daughter. "At Minden, I took the arrangements for the continuance of our journey into my own hands, and hired a private carriage for ourselves. Notwithstanding this, the most trivial circumstance suggested erroneous fancies; but as I was in a state of perfect liberty, I examined very attentively the subjects which had awakened surprise in my breast, and I gradually became conscious of my errors. I still recollect several of these very singular visions. " At the period of which I now speak, I was in no way uneasy as to my own fate, or that of my family, but I was distressed by a feeling of sympathy for the Jews, discomfited, as I thought, in Holland, and scattered in the woods in the neighborhood' of C----, where they were perishing of hunger and cold, along with their wives and children. I daily resorted to the wood's CONFESSIONS OF A PATIENT AFTER RECOVERY. 81 and deposited bread and money, particularly near the cross- roads. " Two regiments passing through the city at the same time, had a coffin in their escort: this circumstance affected me with alarm, for I thought that their king was in the coffin. To convince myself of the truth of the circumstance, I ran across the garden to meet the procession; but the body had disappeared, and after- wards I understood that the coffin was tenantless. I called a young soldier, who was following the regiment at a distance; I made several questions to him on the subject, but he did not answer me, but went away, without saying one word, to a hillock covered with verdure and thorns; he "there made a hole in the midst of the thorns with his cane. He still declined answering me, when I asked him whether a king had not been buried on one of the banks of the Rhine ? I was soon, however, satisfied that the silent soldier was a spirit, which idea made me exceed- ingly uncomfortable. " Fear, probably, and the stormy season to which I had been constantly exposed, again disturbed the harmony of my intel- lectual powers. From that day, as soon as I arrived in the country, I observed on the summit of all the mountains which circumscribe the horizon, machines which appeared to me to be telegraphs, and I fancied, at the conclusion, that the enemy, after having cut a canal, had beat back the Prussian army as far as the Rhine, driving it into the deep, and that they were anxious to preserve the vessels and the corpses of the bodies so destroyed, as trophies of their victory. This idea excited in my mind a determined hatred against the barbarous men capable of so atrocious a deed: and to show that I could not be blamed for being a party to its execution, the strange notion came into my head to send some loaves and a bottle of brandy to several de- tachments of recruits on their route through the town: they took the brandy, and handed the loaves over to the poor." Since this lady returned to her native city, her visions, though not exhibited by outward signs—as she has now acquired suffi- cient self-control to conceal them from the world—are still frequently renewed. She retained the notion for a long time, that the Jews had resolved to destroy the Christians. She also saluted with much courtesy and humility all the Jewesses; if they were clothed in rags, she addressed them in terms of extreme politeness, offered them her kind offices, and endeavored to com- fort them. She sometimes gave the poor Jews a piece of money, in which she conceived there was some particular virtue. At last, she gave up this notion, as she became daily convinced that her apprehensions were altogether chimerical; but she adopted a notion exactly the reverse. This contrast is often noticed in the dreams of the insane. She fancied that a great number of Jews were encamped m an immense forest behind a 6 82 STATE OF MIND DURING INSANITY. mountain in the vicinity of the town where she lived—that the Government kept them prisoners there, and watched them, and that they were condemned to perish a wretched death by hunger. Actuated by sympathy for those unfortunate beings, and indig- nant at the cruel measures enforced against them, she ventured several times out near the forest, and placed at different parts by the wayside, all kinds of food, such as loaves, fruits, eggs, &c, so that these unhappy creatures might pick them up, and that some of them at least might escape from the dreadful death to which they had been doomed. The following is an account, written by a physician, of his own case. When deranged, he imagined himself to be pursued by a de- mon. He had also other delusions. He fancied himself transported from street to street, and his imagination was active enough to exhibit to him every moment, some different public place, in which his guards detained him on his bed. " I almost con- tinually supplicated," says the author, " to be only carried to my house in Holy Ghost Street." The persons about the patient, in endeavoring to pacify him, without complying with his wishes, only confirmed the delusion under which he labored. Their cry was, " It shall be done in a few hours, or early to-morrow, as it is now night." He lay pining in vain for the end of these few hours, and during the time, his fancy created places not the most agreeable for his residence. Sometimes it pitched him between two walls, so close that he could not heave an arm; sometimes on a burial-ground; sometimes on the court before the hospital he attended. All the arguments of his friends availed nothing to prove to him that he was really in his own room. When-they pointed out to him his own books, close beside which he lay, or the prints that hung opposite, he took it for a trick. Sometimes he did not recognize them for his own; and sometimes he con- ceived they had been removed to his present place of abode. It was observed that the sound of a horn transported him in imagination to a public place for music and dancing; the neigh- ing of a horse in the street, to a stable; the bad odor of his own exhalations, to a burying-ground. • He was under a delusion that he was hated and deserted by the whole world, that all his friends had forsaken, and his patients renounced him. The foundation of fact on which this super- structure of despondency was raised, arose from his missing three of his most intimate friends, who were absent or incapable of attending upon him. With this must be considered a natural mistrust he entertained towards mankind, which his friends told him they had observed when he was in health. The number of unpleasant things he experienced from those about him, such as their refusal to let him quit his bed, forcing him to take medicines applying blisters, must have added force to his morbid impressions. "My"other fancies were," ke observes, "probably those most <* CONFESSIONS OF A PATIENT AFTER RECOVERY. 83 common in every form of delirium. The flowers on my curtains and tester, I took for men in continual movement. They all went towards the wall; and as there were none but my acquaint- ance, I often joined them. We found ourselves in'large illu- minated subterraneous chambers, where I learned such family secrets as every man in the world above keeps close locked up in the recesses of his bosom. Once, I really called my wife to my bedside, and told her a shocking transaction, involving two of our friends, which I had learned in these subterran eous assemblies. I related the story with so much consistency, and gave it such an air of probability, as to make her take it for a real fact, which I must have known before my illness." A patient, who had passed through a painful attack of insanity, was requested by the medical gentleman who had charge of the ease, to put in writing an account of the sensations he experi- enced at the commencement of his illness. I should premise, that the patient imagined that among his friends and relations there existed a grand conspiracy against his life. He was also under the delusion, that poison had been administered to him in his tea, and that he had escaped death only by drinking a small portion of the liquid. He thus describes the fancies he entertained in reference to a person under whose supervision he was tempo- rarily placed. He says: "The attendant sometimes affected to smile at me writh pity for my unhappy state of mind. Then he would lean back on the couch, close his eyes; open them a little, so that the eye could barely be seen through the lashes, and so as to prevent his being observed, as he thought. At those times, he would cast the most infernal looks at me, and afterwards round the room, for some weapon or other to finish what he had begun : the latter I could see not only from his looks, and the hardness his muscles used to assume, but also from the posture he would put himself into, ready to jump, if he discovered what would answer his purpose." " From July, 1847, to November of the same year," says the Rev. Mr. Walford, when describing his attack of insanity, " I was highly nervous, and experienced a considerable loss of strength and flesh. I spoke sometimes so sharply to those around me as to startle them, and make them fear me. About this time (the beginning of the attack), I felt great anxiety for the eternal salva- tion of my employer. His brother was lying ill, and I begged that I might visit him, but my offer was refused. I, therefore., prayed earnestly for his recovery, and had the satisfaction of hearing next day that he was better. Strong hope, mingled with fear, now took possession of me. When at prayer, something would pull at my back, blow in my face, as if in derision, and, hovering round my mouth, try to snatch the words from my lips. At night, when in bed, I felt something press upon my chest, and awoke in great trepidation in the middle of the night, when 84 STATE OF MIND DURING INSANITY. I sometimes heard music at a distance. These impressions terri- fied me so much, that I dreaded to lie down. Then, again, I was afraid of forfeiting God's confidence by committing some undefined sin that I could not resist. Therefore, I felt a strong inclination to leave the house of my benefactor, which desire was increased by my imagining that the persons in it would fall into apostacy. Hence, I had recourse to prayer with all my heart, and all my power; and while praying, I nearly fainted. It next occurred to me that my employer had become rich by unjust gains, and that he and his wife would be trodden down in the streets, and trampled to death. One evening, while at prayer, I saw a circle descend slowly on my head, and afterwards told my wife that I was the anointed of the Lord, but she did not appear to understand my meaning. Felt that I was very ignorant of the Scriptures, but expected every day that the power of God would instruct me, and that I should be commanded to leave the house on a sudden : so I put all things in order for my departure. On the 9th of March I left; but I was greatly agi- tated, and wept frequently, being unable to restrain my feelings. About this period, I began to see objects, like gnats, floating before my eyes, and thought they were wicked spirits watching me; however, I felt satisfied that I was anointed in a very high degree, and that my mission from the Holy Spirit was to walk incessantly about, and convert the people I met with. As I passed near to them I believed the Holy Spirit transferred itself from me to them; so I selected the most crowded throughfares in the metropolis for the work of conversion, and extended my walks daily, sometimes even into the adjoining counties; and I thought the people often turned round, and looked at me as I passed, with great satisfaction, as if conscious of the blessing I had conferred on them. To see the crowds I had converted, greatly encouraged me in my labors; and now, delighted with my office, I had special revelations. One night, while in bed, I saw the glory of the moon. It was like a horizontal pillar across the moon, which increased in size and radiance as it approached my bedroom window. I now believed that I was to be a prince, and the high-prince, of our Saviour. Upon the approach of the morning, I felt a burning flame around me, and conceived that it was the glory of God sanctifying me for the work I had to perform. My sensations frequently alarmed me. More than once I was afraid I should go mad, and then I alternately laughed and wept. One day I heard my feet speaking to me, tellino- me that I should he a king, and reign at Jerusalem; and I&also heard other voices, telling me that I was Dan, the son of Jacob and should have large possessions at Jerusalem. Thus, having left my home, I wandered over miles of ground, imagining that I was forbidden to sit down or stand still; and, after havino- walked the whole night, one morning I arrived in Sion Lane, and CONFESSIONS OF A PATIENT AFTER RECOVERY. 85 was, by one of the cottagers, conducted to the house, where I expected to find food and rest. The proprietor, I supposed, was a high churchman; and I expected all the inhabitants would come while I was asleep, and look at me, in order that they might be converted. During the first few weeks of my residence there, many strange fancies came across my brain; with my new companions, and the medical gentleman, I conversed freely, and gradually became quite conscious that I had been under delu- sions, which have happily passed away, and my mental health is now, I am grateful to believe, quite restored." The following interesting account of the mind when in an in- sane condition is from the pen of a patient who was confined in the Gartnavel Royal Lunatic Asylum, Glasgow; an institution under the kind and able medical superintendence of Dr. Alex- ander Mackintosh: " It is a fearful thing for a man to be mad, and to be conscious that he is so. I am convinced, that a thought of an intensely exciting nature, passing through a brain in this state, or through one very easily excited naturally, can kill as quickly as a shock of electricity from a thunder-cloud, and that the death-bearing messengers, in both cases, are nearly allied. " I have, while recovering from an attack of mania, not once, but several times, been struck down as utterly senseless by a thought, as I could have been by a blow. My father was a man in whom the organ of veneration must have been developed to a degree, which many of our mercantile professors of religion now would consider amounting almost to insanity. In the midst of youth, health, and usefulness, he fell dead from his chair, with a book in his hand. My mother kept that book, and held it sacred, as a memento of her irreparable loss. I was a young child then, but many years after, when I had learned, by fearful experience, the power of imagination, that book came into my hands, and I looked upon it then, as I do now, as the instrument which had left a family of infants fatherless. I have no doubt but some of those sudden deaths, for which no cause can be assigned or seen, are the result of this silent thunder, which bursts from the imagination when in a. state of excitement or disease. " There is fearful danger in allowing the mind to dwell ex- clusively, or nearly so, upon any one subject; variety is abso- lutely necessary to keep the mind in health—to keep it from rising above, or sinking below, the level of calm, right-judging rationality. There are subjects which, if followed to excess, must rouse the spirit to madness; there are others which must sink it to apathy, or idiocy. There is a plain physical reason for this— if one portion of the brain be constantly acted upon, that portion gets either benumbed or inflamed. A young girl falls in love with a young man—her every faculty is absorbed in this first 86 STATE OF MIND DURING INSANITY. and fearful love, his image is branded upon her brain, and re- flected in the crimson streamlet which flows from her warm heart; he dies or deserts her, and she goes mad. This is a com- mon case. Every female ward in every lunatic asylum proclaims it, and tells also,'that it is a forrn of the disease over which, in many cases, treatment has little control. " For many years I was deeply impressed with the belief that I was possessed of talents of a high order for a particularly ex- citing department in science; and for the development of the fancied gift, I threw my whole soul into the study. I nursed it till it became a mania. Working, eating, or sleeping, it was ever there. The everlasting reflection of its fiery form inflamed my brain—every thought became agony, and I went mad. My spirit was impaled upon the instrument on which it had so sin- fully leant,—hope fled, and in her place reigned that sleep-hating demon, despair. Agony-driven, I hurried ceaselessly on through that room, till every footmark of my bruised and blistered feet could be traced in blood and water upon the floor. Sleep, that oil, that priceless balm for the weary soul, had entirely departed; and my parched brain glowed like a furnace. Were any one to ask me hoW long I travelled upon these bruised and bleeding feet—how long my glaring eyeballs refused protection from lids that felt like fire, my answer would break his faith in my vera- city forever. " I purpose to note down a few of my recollections concerning my thoughts and actions while under the influence of the dis- ease, in the hope that they may be useful to those whose busi- ness it is to watch over the insane, and a warning to those who, through ignorance or recklessness, abuse their minds, till the tortured spirit, like a fire-begirt scorpion, turns upon itself and stings. "One night, after a number of weeks of fearful suffering, as I was lying in bed tossing, sleepless and despairing, a most hor- rible impulse seized upon me, an impulse impelling me to de- stroy one who, of all living beings, most deserved my love. I buried myself under the bedclothes, and struggled with the hellish impulse till the bed shook. It still gained strength. I sprung up, clung to the bedpost, and sunk my teeth, in the agony of despair, into the hard wood. It was uncontrollable. I shut my eyes, bowed down my head, for fear that I should see her, and rushed out of the house. Barefooted, with no cover- ing save a night-shirt, I ran through the streets to the police- office, and implored them to lock me up. Fortunately the officer on duty was a humane and sensible man. He gave me a watch- coat to wrap around me, kept me under his own eye, and, I suppose, sent notice to my friends, for my wife and sister came with clothing. The paroxysm had passed, and gasping, panting CONFESSIONS OF A PATIENT AFTER RECOVERY. 87 for death in any form, I accompanied them home, steeped to the lips in despair. " I had a little sickly boy, a special favorite on account of his helplessness; and after I was removed to the asylum, night and clay the weeping and wailing of that child rung around me, and the cry, ' I'm hungry, father, I'm hungry,' scorched my heart like fire. This, to me, soul-harrowing cry, broke down what little reason I had remaining; and when my wife came to see me, I insisted on taking my clothes off to give her in order to procure food for the children. I inquired wildly for that child; she told me he was at home and well. How could I believe her, when I heard him distinctly while she spoke, sobbing' and cry- ing, 'I'm hungry, father, I'm hungry?' I became convinced that the child was in the asylum, although I could not see him; and I was in the constant practice of putting a portion of my food, at every meal, into a corner, in the hope that he might fall in with it in his wanderings. His voice became weaker; and then the wail changed to—'My father does not care for me now.' The whole of my food was laid into corners for him now—I could not taste it. This was allowed to go on till it was evident that it would end in death, and then I was shut up in a room by my- self, and food of the most savory description offered me, and left with me. I tried to take it, when—'I'm hungry, father, I'm hungry,' from that now weak, dying infant voice, again pierced through my soul. I felt the blood rushing to my head—flames seemed to issue through my eyes, and then comes a blank in memory's book, the only blank that in all my sufferings I have ever known. "I have reason to think that about a fortnight elapsed before memory awoke from that deathlike slumber. How I behaved during that time I never knew; but the first thing I remember was awakening as out of a horrible dream. I think they had been trying w7hat cold and darkness would do for me, for I wxas chilled to the marrow, and the place was dark. I thought to myself, without speaking, how long have I been here? when in- stantly a voice within me replied, 'A thousand years.' Impos- sible; I could not live so long, I thought, when the voice again replied, ' Thou shalt never die.' The idea of never dying struck more terror to my soul than ever sentence of death did to the veriest coward that ever crawled, and crouched, and begged for leave to live. I thought I saw a chink in the wall, through which light was streaming. It was imagination, for it must have been a solid wall. I looked through it, and there was a paved court, with stables all round, and troop-horses tied to rings in the wall. Some soldier-like men were grooming them, while others were cleaning carbines, holster-pistols, and swords. I knew now, what I had before suspected, that the asylum was a barrack for banditti—the pretended patients a band of brigands, 88 STATE OF MIND DURING INSANITY. and that there was not an insane or an honest man in the estab- lishment. This idea continued for a long time in full force, and I had not got rid of it when I left the asylum. It received rather a startling confirmation the first day, I think it was, after I was brought down from seclusion. They were at that time furnish- ing the west house, and two or three carts of furniture were driven past the window of the gallery in which I was placed. I recog- nized this at once as plunder, and could distinctly see a number of valuable articles belonging to a friend of mine, who resided at no great distance from the asylum. " To many a day of agony did that delusion doom me, for I was in terror for the fate of any friend who came to inquire for or to visit me; and the very communicative spirit wThich had now taken permanent lodgings within me, assured me that if I gave my wife or any other friend the slightest hint about the character of the place, they never would be permitted to leave the asylum alive. Had it not been for this, I would have posi- tively prohibited my wife from visiting me, although I knew that by so doing I would have opened the floodgates of utter de- spair. These visits were the ' be all and the end all' of my ex- istence ; and, perhaps, assisted by the agony thus mingled with them, kept my spirit alive, and saved it from sinking into that death of the intellect, idiocy. Many a dark hint I gave her; and one time after she left me, the idea that I had spoken too plainly, and that they had killed her in consequence, roused me into madness again. What a fearful week of sleepless suffering! Could I have got at that magazine of gunpowder, which I be- lieved these robbers had stowed away in the cellars, under the asylum, how eagerly would I have applied the match which would have blown us all to destruction. My wife, however, came on the appointed day as usual, and brought the child with her, whose hunger-stricken cry had so tortured me. He had been in the country, and had greatly improved in health and appearance ; and as the little fellow clung round my neck and kissed me, I could not help thinking that he could not have been quite so hungry as he had said. It would appear that nothing short of the utter destruction of itself can satisfy the insane mind; for they had not long left me till I fancied that the child was still in the asylum, and that he had been fattened up by some infernal process for the purpose of deceiving me, and that his mother had been compelled to join in the conspiracy against her child and me. " I often could not get sleep, or even attempt to sleep, for the spirit had taken up his lodgings in my stomach, replying to every thought, and most pertinaciously insisting that I should listen while he read to me out of a book, the words of which alter- nately fell cold as hail-drops on my brain, or flowed upon it like a stream of molten fire. Strange to say, circumstances which CONFESSIONS OF A PATIENT AFTER RECOVERY. 89 could only have been seen or known by me in my infancy, and of which I was entirely ignorant, but which, by after inquiry, I found to be true, were mingled with the most horrible lies. The truths must have lain forgotten and illegible in some dark cor- ner of the brain, till lighted up and rendered readable by the wild glare which madness throws on everything around. Stung to the quick by a fearful lie which the spirit was reading about my father, I demanded the name of the book. ' It is the text- book of hell, the bible of the damned,' was the instant reply. After this, let him do as he liked, I would listen no more to him or his book ; and by persevering in this the entire delusion slowly faded away. "During the whole period of my residence in the asylum, my wife visited me upon a stated day of each week; and except at the time of my seclusion, when she was told that I was too ill to be seen, no week passed without her seeing me. During a portion of the time she had to travel from Ruther Glen, seven miles distant from the asylum. There was no conveyance be- tween these places in those days; yet, let the day be ever so stormy, there she-was, true as the sun to her time. To this, to her I owe my preservation from suicide or idiocy. These visits gave me something to think upon; they were, as it were, a solid spot in a troubled ocean, whereon the spirit could occasionally rest. Often when I felt mad feelings arising, or a cold icy feel- ing of stupor creeping over my brain, I have been soothed or roused by the thought of seeing her, and hearing from my chil- dren, my love for whom madness had only inflamed. Before the close of my confinement, I believed that all my children were in the asylum, and I heard their different voices from under the floor, screaming to me to save them from tortures which I dare not name. It would have required a brain of brass to have with- stood this; mine was never composed of any such material, and I would stand motionless as a statue for hours, feeling little, thinking little, and only possessed by a dreamy consciousness that I existed; and then a cry of agony, from some much-loved voice, would ring through my brain, like the last trumpet sound- ing the resurrection, then instantly that corpse-like form was raging with mad life, and that dark mental sepulchre was gleam- ing bright with fires that glowed like hell."1 i " The Philosophy of Insanity," pp. 20-25. 1860. 90 STATE OF MIND WHEN RECOVERING FROM INSANITY. CHAPTER V. STATE OF THE MIND WHEN RECOVERING FROM AN ATTACK OF INSANITY. How deeply interesting are the descriptions sometimes given by the insane of their state of mind when passing out of a de- ranged into a sane condition of intellect. In some cases the reason is restored suddenly to its sovereignty. In many cases, however, the mind appears gradually, and almost imperceptibly, to awaken, as it were, out of a fantastic and fairy-like dream, into a state of healthy consciousness. In one case the patient described his mental condition during the period when it was considered to be in transitu, as follows : "I felt as I was recover- ing, the delusions gradually losing their hold upon my fancy. I then began to entertain doubts as to their reality, and was dis- posed to listen patiently to the judicious advice of my physician. I was no longer irritated at being told that my perceptions were false, and began to appreciate the absurdities of other patients associated with me. One man, who firmly believed that he was endowed with supernatural power and divine authority, and whom I had always considered as sane, and improperly confined, and had invariably treated with great awe and deep reverence, I now thought, must be mad!" The dark clouds that had so long ob- scured, enshrouded and embittered his mind, were gradually dis- sipated, and the bright sun of reason shed its joyous and efful- gent light upon his hitherto darkened and bewildered under- standing. As he progressed towards recovery, his mental per- ceptions became daily more clear and intelligible. Whilst in this intermediate phase of morbid thought he was forcibly re- minded of Milton's majestically poetical, and profoundly philo- sophical passage, in which he makes Adam relate to the angel what passed in his mind immediately after awakening into life : "Whilst thus I call'd andstray'd I knew not whither, From where I first drew air and first beheld This happy light, when answer none return'd, On a green shady bank, profuse of flowers, Pensive I sat me down ; there gentle sleep First found me, and with soft oppression seiz'd My droused sense ; untroubled, though I thought I then was passing to my former state Insensible, and forthwith to dissolve." .... " Paradise Lost," b. 8, 1. 283. ILLUSTRATIVE CASES. 91 Another patient described his state of mind, when recovering, as follows : "During the whole of my illness, which lasted for eighteen months, I fancied myself surrounded by a dark cloud. I never could appreciate that "there was any difference between day and night. Even when the sun shone most brightly, it pro- duced no alteration in my feelings. I fancied that I was doomed to live for the rest of my days in a state of perpetual gloom and never-ending darkness, as a punishment for sins I had commit- ted in early youth. Xo bright object, alas ! looked so to my mind. I found that I could gaze, without the least inconveni- ence, at the sun, even when at its height. It did not, in the slightest degree, dazzle me. " I date the commencement of my recovery from the time when this mysterious darkness began gradually to fade away." " When I was getting well," the patient continues, "I fancied I saw objects more clearly and less through a haze. My mind ap- peared during this distressing illness as if it were covered, if I may so speak, by a dark veil. This is the only comparison that occurs to me. It was as if I were looking through a piece of green glass at every object. This cloudy condition of mind did not disappear entirely for some months, but as I began to see things with my natural vision, I felt that I was recovering. This state of progressive improvement continued until I saw every- thing through a clear and sunny atmosphere, and then my hap- piness and peace of mind were restored; in other words, I was well." A gentleman who imagined, without the slightest foundation for such an impression, that his wife had been unfaithful to him, persisted in entertaining this delusion for a whole year. He de- clined, during the greater part of his illness, having any com- munication with, and rarely speaking civilly to her when she called to see him. His general health was much shattered by a sedentary occupation and neglect of the ordinary rules of hy- giene. His mind had also for a long time undergone much anxi- ety. At times he suffered from severe mental depression. His general health, in course of time, became greatly improved, but there w^ere symptoms of local disturbance in the head that at first led to the suspicion of the existence of some form of organic disease of the brain. A few months before his recovery, a large carbuncle made its appearance in the lumbar region. This caused great pain, and confined him to his bed for some weeks. Subsequently, nume- rous furunculi broke out in various parts of the body, attended with general irritation and serious disorder of the assimilative functions. He was invalided for many months. He, however, entirely recovered, still, however, entertaining the delusion with regard' to his wife, but in a somewhat modified and less acute form. At first he began to reason with himself as to the reality 92 STATE OF MIND AVHEN RECOVERING FROM INSANITY. of this impression. He asked himself the following questions: " Is my suspicion founded on fact? What proof have 1 of the infidelity of my wife? Could I establish an accusation of the kind against her in a court of law? If I were to apply for a di- vorce on the ground of infidelity, who would be my witness?" Up to this time he had resolutely maintained a firm belief in his wife's acts of gross immorality, and it was not until after his se- rious bodily illness that he began to waver on the subject of his delusion. For nearly three weeks a contest of this character took place in his mind. It was a struggle between healthy and disordered impressions. Occasionally he appeared entirely to lose sight of the delusion. It then recurred, but much less acutely than be- fore. I advised a complete change of air and scene, and sug- gested a residence at Boulogne for a few weeks. He obeyed my instructions, went to this place, participated in the amusements it afforded, had a course of sea-bathing, and returned in a few weeks to England, in the full enjoyment of the umens sana in corpore sano." He informed me that one day when returning from a tepid salt-water bath, which had greatly exhilarated him, all idea of his wife having behaved even with indiscretion, van- ished entirely from his mind. " I felt," he says, " a gush of joy- ous feeling take possession of my thoughts, that produced an inde- scribable state of happiness, which made me almost leap for joy." A lady who had been for a period of nine months insane, believing that she was forsaken of God, appeared suddenly to recover. Her restoration to health of mind, however, was not so rapid as her friends were at first led to suppose. She gave her husband, after she returned home, a detailed and deeply interesting account of the gradual return of reason, and of the steady battle she had been fighting for two months with insane delusions. For more than eight weeks she had been struggling with the morbid impressions which had so poisoned her mind. The commencement of this contest occurred contemporaneously with a return of the uterine functions, which had been suspended for a considerable period. This improvement in her general health appeared to shake her belief in the existing delusion. At that period, she said, " I, for the first time during my long illness, asked myself seriously the question, ' Am I under a de- lusion?'" For some days the morbid impressions caused her less mental distress, but having, owing to an attack of stomach disorder, passed two or three sleepless nights, the delusion re- turned in full force to her mind. After the lapse of a week, she again began quietly to reason with herself as to her insane reli- gious notions. She then went regularly to church, without feel- ing, as she did previously, that " she was only mocking God by so doing." "I felt," she said, "a comfort in the prayers, and could listen with repose and satisfaction to the sermon." ' But CASE .OF THE REV. MR. WALFORD. 93 even at this time, her mind was occasionally much distressed by some, but less acutely manifested, morbid and gloomy apprehen- sions as to the salvation of her soul. She continued, however, gradually to recover a sane state of thought. She no longer persisted in refusing to adopt the remedial measures suggested for her cure, and pari passu with an improvement in the physical, did I witness the return of a healthy state of the intellectual and moral functions. She informed me after her recovery, that she was impelled by an internal voice to refuse compliance with everything that was proposed by myself in the way of treatment. She fancied that she was doing God service by resisting all the attempts that were made to improve her bodily and mental health. I have, in a previous page, referred in detail to the deeply interesting history which has been published of the Rev. Mr. AValford's state of morbid religious despondency, as described by himself after his recovery. It will not be out of place here to put upon record Mr. Walford's account of his gradual restora- tion to mental health. He says : " The blissful recovery which I experienced was not to be ascribed to any medical process whatever. I had, indeed, much against my own inclination, been so importuned by my friends as to consent, three or four years before my recovery took place, to consult one or two medical advisers; but the effect proved, as I fully expected, that nothing was to be hoped for from this expedient, and I positively refused to see any other medical per- sons. About the same time, I was over-persuaded, on account of my general inability to sleep, to keep laudanum by my bed- side, "and to have recourse to it when sleep was found to be im- practicable. I tried this measure two or three times, without any sensible effect, and firmly resolved to take no more. I ad- hered to my purpose, and no other experiments of the kind were ever adopted. A few months before any symptoms of improve- ment appeared, I now and then prevailed on myself to walk up and down a few hundred yards in the road adjacent to my house, when I was concealed by the darkness of the night from the notice of any one who might pass me. Soon after, I went seve- ral evenings, when the light of day had departed, into my gar- den, and paced up and down for some time. On these occa- sions, I sometimes felt an impulse, during my walks, to pray with deep fervency, that some measure of relief might be afforded to me. These prayers were short and broken, yet I trust they found acceptance in heaven. " Some weeks or months after these occurrences, an old friend from Suffolk, a most worthy minister, came to see me, and stayed a day or two. I had formerly smoked many a pipe of tobacco in company with my friend, though for the preceding five years I could not bear the sight of a pipe. My wife, aware of his hab- its, had the materials for smoking set before him, which he em- 94 STATE OF MIND WHEN RECOVERING FROM INSANITY. ployed, and earnestly pressed me to accompany him, which I passionately refused to do. On the evening of his departure, when, as usual, I was the only person sitting up, it occurred to me to try if I could smoke, which, for four or five years, I had discontinued, on account of the manifest bad effects it produced on my pulse. I instantly procured for myself the smoking ap- paratus, and found I could perform the operation without the injurious results which had induced me to relinquish the prac- tice. Soon after this experiment, I resolved to try if I could read, though I was under a great difficulty to select a book that did not seem likely to awaken painful associations, and I especially shunned all such as treated of religious subjects. Accident de- termined my choice. I had not relinquished a book society of which I was a member, though the books that came to my house were carefully concealed from my notice. At the time of which I am now writing, I found that a 'History of the Cotton Manu- facture,' by Mr. Baines, was brought to my house, and as it seemed not very likely that anything in it would excite my feel- ings, I resolved, though with extreme apprehension, to try this book. In a day or two, I found nothing in it that much dis- tressed me, and I perused it to its close. It amused me, and after reading it again, I wrote out a pretty extensive abridgment of it. I then attempted a work by Mr. Babbage, the title of which is, I think, 'The Economy of Manufactures.' " After reading and epitomizing these works, I was so much quieted as to regret I had no others of similar character: and I then engaged in writing a translation of the history of Herodotus. Before I had completed my translation of the first book of that history, the spring brought the month of May. My son entreated his mother to take a ride in a carriage with him, and I joined in the entreaty, as I greatly wished she should enjoy some re- freshment of this kind. The carriage was brought to the door, when my faithful wife positively refused to go, unless I would accompany them. This, I both thought and said, was impossi- ble. She, however, persisted in her refusal; and for some time I warmly remonstrated with her, and urged her going. While I was thus engaged, a sudden inquiry offered itself to me: Why could I not go ? I could discover no reason; and calling for my hat, I jumped into the carriage, when I directed the driver to take us to Epping Forest, through Wanstead and Woodford, a ride which, in former years, I had often taken with great pleasure. The verdure of the grass, trees, and country in general, with the fine- ness of the weather, so affected me, that all my fears, disquietudes, and sorrows vanished as if by a miracle, and I was well, entirely relieved, and filled with a transport of delight, such as I had never before experienced. My hope and confidence in God were restored, and all my dreary expectations of destroying myself or others were entirely forgotten. On my return home from this CASE 0*F THE REV. MR. WALFORD. 95 reviving excursion, every desire to shut myself up and exclude my friends was departed, and I could with difficulty restrain my- self from being always abroad. " This extraordinary change of feeling took place, as I have said, in May; and on the first day of the following August, I set out m company with my son and an active friend, who had be- fore travelled on the continent, for France, Switzerland, and Ger- many. ^ The delights of that journey were so enhanced by con- trast with the events of the five preceding years, that I was in a species of rapture throughout the whole. I felt no apprehen- sions of danger in going so far from home; and the glorious scenes I witnessed so enchanted me, that my pleasure overflowed the limits of ordinary enjoyment. One only regret was occa- sioned by the unavoidable necessity under which my compan- ions in travel were placed, of returning at the end of the month to business; by which I was hurried from scenes of surpassing grandeur and interest, before I had half gratified myself with gazing upon them. Enchanted and fascinated as I was with this tour, I attribute no part of my recovery to it, as I had been entirely free from my sad condition, both of body and mind, be- fore it took place; if this had not been the case, no wishes of my own, nor any entreaties of my friends, would have had power to persuade me to set out upon it, so deeply was I affected by the remembrance of former disappointments. Immediately after my return, I was seized wTith a most unexpected and severe diarrhoea, which I thought would terminate my joys and sorrows alike: it yielded, however, to skilful medical treatment, after some days; and one of my medical attendants, who had been long acquainted with my constitution, assured me when the ve- hemence of the paroxysms was abated, that the effects of it were far more beneficial than any medical treatment could have pro- duced, and he anticipated a perfect freedom from the return of my distressing nervous disease. This anticipation has been veri- fied by several successive years of established health; and though I am now occasionally in some measure disturbed by some of the minor symptoms of my disorder, for short periods, chiefly during the hours of night, my general health is remarkable for my years; and the condition of my feelings tranquil and cheerful, though seldom much elevated."1 1" Autobiography of the Kev. William Walford." Edited by the Kev. John Stoughton (of Kensington). 96 MASKED AFFECTIONS OF THE MIND. CHAPTER VI. ANOMALOUS AND MASKED AFFECTIONS OF THE MIND. Before analyzing the various stages of incipient insanity, pre- viously referred to, I propose to consider briefly, certain anoma- lous, and unobserved, because masked conditions of brain and mind. I would, however, premise, that in the majority of these cases it is difficult to trace to its origin, the first inroads and dawnings of morbid and insane perception, to demonstrate when the boundary-line between healthy and disordered idea has been traversed, at what precise period certain normal states of eccentricity of thought, singularity and oddity of conduct, have passed into actual insanity. Unfortunately, there is no psychical test to which we can with safety and satisfaction judicially and psychologically appeal when difficult, doubtful, obscure, and subtle conditions of suspected mental disorder are submitted to us for medical, metaphysical, and legal analysis. Each case must* be examined by, and in relation to, itself, and not in reference to any preconceived definition, or a priori hypothesis of insanity. The vain attempt to frame a definition of this disease, will, in a measure, account for the great difference of opinion, as well as unhappy conflict of testimony exhibited in courts of law by medical men supposed to be conversant with the phenomena of disordered mind. Before enumerating the symptoms characteristic of the com- mencement of insanity, I would premise that mental disorder often first manifests itself in a significant manner at an early period of life. Decided paroxysms of insanity have occurred in young children when at school, and in persons more advanced in 1 When speaking of the degrees of departure from presupposed conditions of health, either of body or mind, perhaps the term latitude would be a more philo- sophically correct expression than the phrase standard, now commonly adopted. How imperceptible and shadowy are the gradual transitions from a state of health to one of disease 1 Who can accurately define their characteristics ? We are able, however, to appreciate when there is any positive deviation on either side of the line. In the case of colors, it has been well remarked, "that we know blue and red perfectly well, but they may be blended together, in an infinite variety, in forming a purple color, and it may be impossible to say where the red and where the blue prevails. Yet this does not deprive us of the power of forming a very distinct conception of both colors, apart from each other." The experi- enced physician is able to appreciate when the boundary-line between reason and insanity has been traversed, although he is not competent to frame a definition that can be referred to as an unerring test in all doubtful cases of mental disorder. INSANITY AMONG CHILDREN. 97 age whilst at college, and then all traces of the transient attack have passed, like a dark cloud, entirely away. Several remark- able cases of this kind have come under my observation. In one singular instance, a young gentleman whilst studying for uni- versity honors had an attack of insanity. He was sitting up late at night, busily occupied in reading, when he was suddenly seized with an impulse to destroy everything within his reach. He first broke the lamp on the table, then a pier-glass. He subsequently tore up and destroyed a number of books, and did great injury to several articles of value in the room. He left home about three o'clock in the morning, and came back at eight, covered with filth, apparently in full possession of his senses ! He refused to give any explanation of his conduct, or to say where he had been. When pressed upon the subject he became irritable, sullen, and morose. This gentleman continued mentally well for twelve -years, when insanity again developed itself, and he has remained from that period in a deranged state of mind. A pa- tient, now insane, manifested at the age of ten decided symptoms of mental aberration, and to such an extent, that, occasionally, for days it was deemed necessary to confine mechanically his hands, so mischievous were the child's tendencies. At the age of fifteen, he, appearing like other boys, was sent to a public school, and it was not until he was thirty that his insanity again manifested itself, when it was considered necessary to place him under restraint. "V\ nen referring to the possibility of insanity commencing at a very early age, then becoming arrested, and even remaining dor- mant for/foe, ten, twelve and twenty years, Esquirol remarks, "I am more than ever convinced that the existing causes of insanity do not act abruptly, except when the patients are strongly predis- posed. Almost all the insane exhibit, before their disease, some alterations in their functions, alterations which commenced many years previously, and even in infancy. The greater part had had convulsions, cephalalgia, colics, or cramps, constipation and menstrual irregularities. Several had been endowed with great activity in the mental faculties, and had been the sport of vehement, impetuous and angry passions. Others had been fantastical in their ideas, their affections, and passions; some had had an extravagant imagination, and been incapable of continuous study; others, excessively obstinate, could not live, except in a very narrow circle of ideas and affections, whilst many, void of moral energy, had been timid, fearful, irresolute, indifferent to everything. With these dispositions, a mere accidental cause is sufficient to make the insanity break out."1 M. Pinel was acquainted with a case of insanity that had been going on unnoticed for a period of fifteen years! In several other 1 " Dictionnaire des Sciences Medicales." T. 16, p. 195. 1 % 98 MASKED AFFECTIONS OF THE MIND. cases, the maniacal and melancholy state had begun four, six, ten, fifteen and twenty years previously. It is often easy to go back months or years in this way, and we finish by discovering that cir- cumstances taken for causes by the friends, are frequently only the consequences of unobserved disease. It does not, however, necessarily follow that when symptoms of insanity appear in early life, that the disease will recur at a subsequent period. Children, as well as adults, are subject to sudden, transient attacks of temporary mental disorder, which pass entirely away, the mind retaining its healthy state for the remainder of life. Dr. Brierre de Boismont has recently published some remarks upon the insanity of early life, when reviewing the dissertation of Dr. Paulmier on this subject. This able and accomplished physician (Dr. Boismont) accounts for the comparative exemption of childhood from mental aberration, by the absence of many of the causes so potent in its production in adult life ;, not that children do not feel acutely, but their sensations are of a fleeting nature, and in this lies their protection. Nevertheless, children who inherit a disposition to mental disease, or who possess a highly nervous temperament, and who are exposed to favoring circumstances, occasionally manifest undoubted symptoms of the malady. Haslam, Perfect, Franck, Burrows, and Spurzheim, have recorded cases of insanity occurring in children under eleven years of age. Greeding gives an account of a child of eighteen months, who died of marasmus. She was brought into the asylum at Wuldham with her mother (who was insane). The child was then scarcely nine months old. She was subject to paroxysmal nervous attacks, which ended either in an inde- scribable laugh, or in a fit of mania, during which the little crea- ture tore everything she could lay hands upon. Jacobi refers to several cases of insanity in children, then in the asylum at Sieg- burg. Esquirol treated two children, one of eight and another of nine years, and a girl of fourteen, all laboring under attacks of mania; he was also consulted about a child of eleven, in whom the disease assumed the form of melancholia. Marc gives an account of a little girl of eight, who freely ad- mitted that she wished to kill her own mother, grandmother, and father. Her object was, to be possessed of their property, and to have an opportunity of indulging her animal passions. The child was morose, pale, and silent, and when spoken to, her answers were very abrupt. Her health was improved by a residence in the country, but on being brought back to town, she became again pale and melancholy. For a long time the cause remained undiscovered; at length it was found that she was addicted to bad habits, which she openly avowed, regretting at the same time that she had not the opportunity of indulging her animal passions. Dr. Brierre de Boismont noted four cases of children of six, seven, and ten years of age, in whom the symptoms of INSANITY OF EARLY LIFE. 99 mental disease were manifest; and at present he has under his care a female child of three and a half years old, born of a pa- ralytic father, which shows the strangest caprices; at one time sad and melancholy; again in the most violent fits of rage, with- out any cause, and not to be appeased. The intelligence of the child is far beyond its years. The cases of insanity brought under notice by Dr. Paulmier cannot be said to belong to child- hood ; his children are young people; for of thirteen examples, three are fourteen, two fifteen, three sixteen, and five seventeen years of age. Before, however, analyzing Dr. Paulmier's work, Dr. Brierre de Boismont turns to English, French, and Ameri- can authors for information on the subject. In a table of 21,333 cases of insanity, there are recorded eight cases under ten years, and 1161 cases are noted occurring between the ages of ten and twenty. The greatest number of cases of insanity occurs be- tween thirty and forty. In the United States, however, physi- cians have remarked that the disposition to mental disease is stronger between twenty and thirty than between thirty and forty; and this is fairly ascribed to the earlier age at which young men enter the world and engage in business and politics. One of these beardless men of business said to his physician, " I am convinced this kind of life which I lead will drive me mad or kill me; but I must go on." In four American asylums, which contained 2790 patients, 33.73 per cent, were between twenty and thirty, and 24.41 per cent, between thirty and forty years of age. That the kind of education which the youth in the United States receive has a powerful influence on the de- velopment of insanity is proved by Evans and Worthingtem, in their reports of the Pennsylvania asylums. Dr. Wigan gives, in his unpublished writings, an account of crimes committed by young people without any object. The age of the youthful male- factors was between sixteen and seventeen for girls, and between seventeen and eighteen for boys. There was this in common, that there had not previously existed the slightest animosity towards the persons against whom they perpetrated outrages. According to Wigan, the great number of these young people had epistaxis, which, among the females, appeared with the regularity of menstruation. The crimes were generally com- mitted after the temporary cessation of this habitual flux.1 The statistics of Dr. Boutteville exhibit insanity amongst chil- dren in no insignificant proportion. The maximum is presented between the ages of thirty and thirty-four. From five to nine, 0.9 per cent.; ten to fourteen, 3.5; from fifteen to nineteen, 20 per cent. Drs. Aubanel and Thorpe observed in the Bicgtre, in the year 1839, eight cases of mania in children, and one of melancholia, from the age of eleven to eighteen years. The 1 " Psychological Journal," vol. xi, p. 497. 100 MASKED AFFECTIONS OF THE MIND. diagnosis of the mania of children is at times difficult; menin- gitis may be confounded with it; but, in general, the headache, the dilatation of the pupils, and the nausea and repeated vomit- ing, afford means of fixing the line of demarcation. Mania with stupor (d'une sorte du stupeur exaltique) approaches closely certain forms of mental alienation which occur after epileptic seizures, and in which the excitement is associated with obtuseness and hallucinations (obtusion hallucinatoire). Out of forty-two young persons in whom the mental disease commenced between fourteen and sixteen years of age, eighteen inherited the affection from their parents; and in by far the greater number of these cases, the disease manifested itself con- temporaneously with the age of puberty and menstruation. On inquiring of the parents the character of the children, the answer has almost always been, that they were, without any cause, some- times sad, and at other times wild and ungovernable. They could never apply themselves steadily to work. They had no talent, or if it existed, it only flared up brilliantly for a moment. They would submit themselves to no rules. Some were apa- thetic, and not to be excited by emulation. Others exhibited a volatility which could not be restrained. Many had been sub- ject to spasmodic attacks. The incubation period was often protracted. In eighteen instances recovery took place, but the persons were liable to relapse, and the conclusion is, that though in a certain number of cases recovery takes place, the mental alienation of children and young people is a most serious disease, partly from their antecedents, and partly on account of the im- perfect development of the cerebral and other organs.1 At the commencement of insanity, the derangement of the intellect may be so slight and transient as to render its recogni- tion, as a formidable impending malady, a task of grave doubt and great difficulty, especially in the case of children. To the unskilled, untutored, and untrained eye, the disease is, in its early stages, occasionally altogether invisible. Even to the prac- tical apprehension of the experienced physician, it is almost indiscernible, or at least of a dubious and uncertain character. In its incipient stage, mental disorder is characterized gene- rally by acute morbid sensibility, physical and mental, accompa- nied by a difficulty of fixing and concentrating the attention. Often the patient complains of being very ill, and exclaims that he is losing his senses, pertinaciously asserting that his mind is not his own. On investigating the history of the insane, it will sometimes be discovered, that long before any mental disease is apparent, they were subject to fits of apathy, had been in the habit of sit- 1 Dr. Brierre de Boismont, in the "Psychological Journal," No. XIII. (New Series.) INCIPIENT SYMPTOMS OF INSANITY. 101 ting for hours together in a state of moody abstraction, or brown study, and this, too, at a time when they had important domestic and other duties to occupy their attention. Upon analyzing the patient's antecedents still more closely, it will perhaps also be found that, for a long period, there has ex- isted much irregularity and absurdity of thought, eccentricity and singularity of conduct. He has been considered as an oddity in his family, being rarely seen in the domestic circle. When his friends and relations are engaged in social union and con- verse, he retires quietly to his own room, where he is discovered abstracted, brooding, and muttering nonsense to himself. At other times, he is forward and obstreperous, loud and vociferous, wild, ungovernable, and untrainable. On these occasions, the eyes exhibit a bright, brilliant aspect, and the physiognomy is lighted up by an unnatural degree of intelligence. At other times, the patient is restless, abstracted, and moody during the day, and at night slumbers and sleeps uneasily, often, when awaking, complaining of headache, mental confusion, or vertigo. During his sleep, he is occasionally subject to slight attacks of muscular convulsion, somnambulism, temporary illusions of the senses. He is liable to frightful and distressing dreams. All these symptoms are often indicative of the commencement of organic disease of the brain, as well as of alienation of mind. In the early period of insanity the most material elements of character undergo strange transformations. A person naturally remarkable for his caution and circumspection, becomes reck- less, extravagant and imprudent. If orderly and economical, he is confused and prodigal. If noted for his preciseness, he ex- hibits great carelessness and negligence. If gay and commu- nicative, he is sullen and morose. If previously neat and par- ticular in his dress, he becomes slovenly, dirty and indifferent as to his attire. If timid, he is brave, resolute, overbearing and presumptuous. If kind, gentle and affectionate, he is rude, austere, irritable and insulting in his intercourse and communi- cations with others. If benevolent, he becomes parsimonious and miserly, hoarding up with the greatest care the smallest sums of money, sometimes under the insane apprehension that he will eventually be obliged to go into the workhouse. If, when in health, the patient is known for his attention to his religious du- ties, he is, when insanity is casting its dark shadow over his mind, sadly neglectful of them, not paying even decent respect to the ordinances of religion. The man of business, who never, when well, was found absent from his counting-house, or known to neglect his vocation, now shows great indifference as to his af- fairs, and refuses to take any part in, or even to converse about them. Insanity often manifests itself in a morbid exaggeration, a dis- eased excess, of normal healthy mental conditions. The natu- 102 MASKED AFFECTIONS OF THE MIND. rally timid and reserved man shuns society, isolating himself al- together from the companionship of his family and friends. The bold man is boisterous, noisy, presuming. The courageous, of- ficious and talkative. The strictly conscientious person exhibits an unhealthy exaltation of conscience respecting his moral, so- cial and religious duties, and, when insane, or becoming so, will manifest the acutest misery at the notion of thinking or doing anything, in the remotest degree, at variance with his strict and literal interpretation of Holy Writ. In this condition of mind the patient, suffering from pseudo-religious feelings, wall refuse to comply with any instructions that are opposed to his own mor- bidly conscientious and sadly perverted notions of right and wrong, good and evil. The naturally cautious and suspicious man manifests an excess of these mental qualities, when in an abnormal state of mind. He will weigh with scrupulous exact- ness, cautious prudence and watchful vigilance, everything that is said and done, surmised and hinted at, in his presence, hesi- tating and doubting as to the tendency, truth and sincerity of all remarks addressed to him. In a more advanced stage of this type of morbid thought the patient often has delusions as to his food being poisoned, re- fusing for a time all sustenance, and occasionally resisting (as I have heard patients confess after recovery) the efforts made to in- duce them to eat, at a time when they were tortured and ago- nized by the acute cravings of hunger! The naturally jealous man exhibits his insanity by suspecting his wife's affections, and even fidelity; the man of active poetic imagination manifests in his disease a disposition to indulge in the most wild and fantas- tic excursions into the regions of fancy, often, in his paroxysms of morbidly excited imagination, seeing "More devils than vast hell can hold." " In investigating," says an acute observer, " the nature of in- sanity, the first caution to be observed is not to confound disor- ders of mental functions with natural qualities, which sometimes strongly resemble them. Many men, in the full enjoyment of health, are remarkable for peculiarities of character and idio- syncrasies of thought and feeling, which contrast strongly with the general tone and usages of society; but they are not on that account to be held as insane, because the singularity for which they are distinguished is with them a natural quality, and not the product of disease ; and, from the very unlikeness of their manifestations to the modes of acting and of feeling of other men, such persons are, in common language, said to be eccen- tric. It is the prolonged departure, without an adequate exter- nal cause, from the state of feeling and mode of thinking usual to the individual when in health, that is the true feature of dis- order in mind, and the degree at which this disorder ought to be EXAGGERATION OF NATURAL STATES OF MIND. 103 held as constituting insanity, is a question of another kind, on which we can scarcely hope for unanimity of sentiment and opinion. Let the disorder, however, be ascertained to be mor- bid in its nature, and the chief point is secured, viz., a firm basis for an accurate diagnosis; because it is impossible that such de- rangement can occur, unless in consequence of or in connection with a morbid condition of the organ of mind; and thus the ab- stract mental states, which are justly held to indicate lunacy in one, may, in another, speaking relatively to health, be the strong- est proofs of perfect soundness of mind. A brusque, rough man- ner, which is natural to one person, indicates nothing but men- tal health in him; but if another individual, who has always been remarkable for a deferential deportment and habitual politeness, lays these qualities aside, and, without provocation or other ade- quate cause, assumes the unpolished forwardness of the former, we may justly infer that his mind is either already deranged, or on the point of becoming so. Or, if a person who has been noted all his life for prudence, steadiness, regularity and sobri- ety, suddenly becomes, without any adequate change in his ex- ternal situation, rash, unsettled and dissipated in his habits, or vice versa, every one recognizes at once, in these changes, accom- panied, as they then are, by bodily symptoms, evidences of the presence of disease affecting the mind, through the instrumen- tality of its organs. It is therefore, I repeat, not the abstract act or feeling which constitutes a symptom, it is the departure from the natural and healthy character, temper and habits, that gives it this meaning; and in judging of a man's sanity, it is conse- quently as essential to know what his habitual manifestations were, as what his present symptoms are. Just as, in investigat- ing stomachic affections, we do not compare the variations of ap- petite, or the strength of digestion, with any fixed or imaginary standard, but always judge of their value, as symptoms, in rela- tion to their former state; because the moderate appetite, which is natural to one constitution, occurring in a person who had previously been remarkable for keenness and power of digestion, would justly be considered as an indication of loss of health, while the voracious appetite, natural to a third, would, in a dif- ferent constitution, be as sure an index of stomachic disease."1 In the ordinary practice of medicine we occasionally meet with cases of bodily disease at variance with past experience, and set- ting at defiance every attempt to embody them within the noso- logical chart. These affections are anomalous or pseudo in their character, are with difficulty defined, not easily diagnosed, occa- sionally altogether escape observation, and often resist, too suc- cessfully, the operation of the best directed remedial measures. If, then, among the diseases more particularly implicating the i Dr. Andrew Combe on "Mental Derangement," 1831. 104 MASKED AFFECTIONS OF THE MIND. ordinary organic functions, we witness these pseudo or eccentric deviations from the recognized pathological character, a fortiori, are we not justified in anticipating that in the subtle, compli- cated, varied, and often obscure affections of the cerebral struc- ture, deranging the operations of thought, we should have brought within the sphere of our observation extraordinary, anomalous and eccentric deviations from certain recognized, morbid, cerebral and psychical conditions? It is an admitted axiom that the mind may be disordered with- out being insane, using this phrase in its strictly legal acceptation. These conditions of morbid intellect may be considered by some as only degrees of insanity; but I would suggest that this term be restricted to those mental disorders, accompanied with posi- tive loss of control, clearly justifying the exercise of moral re- straint, and to those morbid conditions of the intellect which sanction an appeal to the protective influence of the law. In other words, I would confine my remarks to those cases in which the mind may be said to be pathologically disordered, but not legally insane. Have we in practice sufficiently appreciated this distinction ? Fearful of committing ourselves to an opinion that might author- ize an interference with the free agency of the patient, and justify the use of legal restraint, there has existed an indisposition to admit the presence of mental disorder, even in cases where it has been obviously and painfully apparent. This excessive cau- tion, originating in motives that do honor to human nature, has often, I fear, been productive of serious, fatal, and irremediable mischief. The subject under consideration is one, I readily admit, of extreme delicacy, but, nevertheless, of incalculable importance to all sections of the community. It is, I allow, beset with diffi- culties and surrounded by dangers. In the hands of the inex- perienced, the ignorant, indiscreet, and wilfully designing, the facts that I have to record, and principles which I am about to enunciate, might be productive of much mischief; but, I ask, ought any apprehensions of this nature to deter the physician from entering upon so philosophical an inquiry? The subject of latent and unrecognized morbid mind is yet in its infancy. It may be said to occupy, at present, untrodden and almost untouched ground. What a vast field is here pre- sented to the truth-seeking observer, who, to a practical know- ledge of human nature, adds an acquaintance with the higher departments of mental and moral philosophy, as well as of cere- bral pathology. How much of the bitterness, misery, and wretchedness so often witnessed in the bosom of families arises from concealed and undetected mental alienation! How often do we wntness^ ruin, beggary, disgrace, and death result from such unrecognized morbid mental conditions ! It is the canker- LATENT AND UNRECOGNIZED INSANITY. 105 worm gnawing at the vitals, and undermining the happiness of many a domestic hearth. Can nothing be done to arrest the fearful progress of this moral avalanche, and divert the course of the rapid current hurling so many to ruin and destruction? This type of morbid mental disorder exists to a frightful extent in real life; and as it is unhappily on the increase, it behooves the membereof the medical profession, as guardians of the public health, as philosophers engaged in the loftiest and most enno- bling of human inquiries, as practical physicians called upon to unravel the mysterious and complicated phenomena of disease, and administer relief to human suffering, fearlessly to grapple with an evil which is sapping the happiness of families, and to exert their utmost ability to disseminate sound principles of pathology and therapeutics upon a matter so intimately associ- ated and so closely interwoven with the mental and social well- being of the human race. These unrecognized morbid mental conditions most frequently implicate the affections, propensities, appetites, and moral sense. In many instances it may be difficult to distinguish between normal or healthy mental irregularities of thought, passion, appetite, and those deviations from natural conditions of the mind, both in its intellectual and moral manifestations, clearly bringing those so affected within the legitimate domain of pathology, yet there are unfailing diagnostic symptoms by means of which the expe- rienced physician may detect these pseudo-forms of mental dis- order with sufficient exactness, precision, and distinctness to justify the conclusion that they result from diseased cerebral con- ditions. The phases of mind of which I speak, though obscure, and, unlike the ordinary cases of mental aberration of every-day occurrence, frequently manifest themselves in either an exalted, depressed, or vitiated state of the moral faculties. The disorder frequently assumes the character of a mere exaggeration of some single predominant passion, appetite, or emotion, and so often resembles, in its prominent features, the natural and healthy ac- tions of thought, either in excess of development or irregularity of operation, that the practised eye of the experienced physician can alone safely pronounce the state to be an abnormal one. ^ I do not refer to ordinary instances of eccentricity, idiosyncrasies of thought and feeling, or to cases in which the mind appears to be absorbed by some one idea, which exercises an influence over the conduct and thoughts quite disproportionate to its intrinsic value. Neither do I advert to examples of natural irritability, violence, or passion, coarseness and brutality, vicious inclina- tions, criminal propensities, excessive caprice, or extravagance of conduct, for these conditions of mind may, alas! be the na- tural and healthy operations of the intellect. These strange phases of the understanding, bizarreries of character, vagaries of the intellect, singultrities, irregularities, and oddities of conduct, 106 MASKED AFFECTIONS OF THE MIND. common to so many who mix in every-day life and pass current in society as healthy-minded persons, present to the moralist and philosophical psychologist many points for grave contemplation and often suspicion. Such natural and normal, although eccen- tric states of the intellect, do not, however, legitimately come within the province of the physician unless they can be clearly demonstrated to be morbid results, and positive and clearly estab- lished deviations from cerebral or mental health. These forms of unrecognized mental disorder are not always accompanied by any well-marked disturbance of the bodily health demanding medical attention, or any obvious departure from a normal state of thought and conduct, such as to justify legal interference; neither do these affections always incapaci- tate the party from engaging in the ordinary business of life. There may be no appreciable morbid alienation of affection. The wit continues to dazzle, and the repartee has lost none of its brilliancy. The fancy retains its playfulness, the memory its power, the conversation its perfect coherence and rationality. The afflicted person mixes as usual in society, sits at the head of his own table, entertains his guests, goes to the stock-exchange, the counting-house or bank, and engages actively in his profes- sional duties, without exhibiting evidence, very conclusive to others, of his actual morbid mental condition. The change may have progressed insidiously and stealthily, having slowly and almost imperceptibly induced important molecular modifica- tions in the delicate vesicular neurine of the brain, ultimately resulting in some aberration of the ideas, alteration of the affec- tions, or perversion of the propensities and instincts. A man may be an unrecognized monomaniac, and, acting under the despotic influence of one predominant morbid idea, be bringing destruction upon his home and family. His feelings may be perverted, and affections alienated, thus engendering much concealed misery within the sacred circle of domestic life. His conduct may be brutal to those who have the strongest claims upon his love, kindness, and forbearance, and yet his mental malady be undetected. He may recklessly, in opposi- tion to the best counsels and most pathetic appeals, squander, •in a state of unobserved insanity, a fortune, which has been ac- cumulated after many years of active industry and anxious toil. He may become vicious and brutal, a tyrant, criminal, drunk- ard, suicide, and spendthrift, as the result of an undoubtedly morbid state of the brain and mind, and yet pass unobserved through life as an apparently sane, rational, and healthy man. We witness in actual practice all the delicate shades and grada- tions of such unrecognized and neglected mental alienation. It often occurs that whilst those so affected are able to perform with praiseworthy propriety, scrupulous probity^ and singular exact- ness, most of the important duties of life, they manifest extraor- SYMPTOMS OF LATENT INSANITY. 107 dinary and unreasonable antipathies, dislikes, and suspicions against their dearest relations and kindest friends. So cleverly and successfully is the mask of sanity and mental health sometimes worn; so effectually is all suspicion disarmed, that mental dis- order of a dangerous character has been known for years to be stealthily advancing without exciting the slightest notion of its presence, until some sad and terrible catastrophe (homicide or suicide) has painfully awakened attention to its existence. Per- sons suffering from latent insanity often affect singularity of dress, gait, conversation, and phraseology. The most trifling circumstances stimulate their excitability. They are martyrs to ungovernable paroxysms of passion, are inflamed to a state of demoniacal fury by insignificant causes, and occasionally lose all sense of delicacy of feeling, sentiment, refinement of man- ners, and conversation. Such manifestations of undetected men- tal disorder may be seen associated with intellectual and moral qualities of the highest order. Occasionally the malady shows itself in an overbearing disposition. Persons so unhappily dis- ordered, browbeat and bully those over whom they have the power of exercising a little short-lived authority, and, forgetting what is due to station, intelligence, reputation, and character, become within their circumscribed sphere petty tyrants, aping the manners of Eastern despots. They are impulsive in their thoughts, often obstinately, unreasonably, and pertinaciously riv- eted to the most absurd and outrageous opinions, dogmatic in conversation, litigious, exhibiting a controversial spirit, and op- posing every endeavor made to bring them within the domain of common sense and correct principles of ratiocination. All deli- cacy and decency of thought are occasionally banished from the mind, so effectually does the spiritual principle in these attacks succumb to the animal instincts and passions. The naturally gentle, truthful, retiring, and self-denying, be- come quarrelsome, cunning, and selfish, the diffident bold, the modest obscene. We frequently observe these pseudo-ment&i conditions giving undue prominence to a particular faculty, or seizing hold of one passion or appetite. Occasionally it mani- fests itself in a want of veracity, or in a disposition to exagger- ate, and tell absurd and motiveless lies. It may show itself in disordered volition, morbid imitation, in an inordinate vaulting ambition, an absorbing lust of praise, and an insane craving for notoriety. The disorder occasionally manifests itself in morbid views of religion, and a paralysis of the moral sense. Many of these sad afflictions are symptomatic of unobserved, and, conse- quently, neglected cerebral conditions, either originating in the brain itself, or produced by sympathy with morbid affections existing in other tissues in close organic relationship with the great nervous centre. The majority of such cases will generally be found associated 108 MASKED AFFECTIONS OF THE MIND. with a constitutional predisposition to insanity or cerebral dis- ease. These morbid conditions occasionally succeed the febrile attacks, more or less implicating the functions of the brain and nervous system, and are often known to follow injuries of the head inflicted in early childhood. Modifications of the ma- lady are seen allied with genius. The biographies of Cowpcr, Burns, Byron, Johnson, Pope, and Hay don establish, that the most exalted and highly-gifted intellectual conditions do not escape unscathed. In early childhood this form of mental dis- turbance may, in many cases, be detected. To its existence is often traced the motiveless crimes of the young, as well as much of the unnatural caprice, dulness, stupidity, and wickedness often witnessed in early life at our public and private schools, as well as national universities. I cite a few illustrations of this type of undetected mental disorder. A lady, who up to the age of forty-three was never known to manifest anything resembling a passionate disposition or a bad temper, became, after the birth of her last child, subject to paroxysms of overpowering and ungovernable passion, induced by the most trifling and apparently insignificant causes. This continued for several years, her state of mind never having been considered otherwise than sound. ' I had several opportunities after her morbid condition was recognized of observing her fits of rage, and certainly I never witnessed any demonstration of anger so truly appalling. There was no aberration of the ideas in connection with the case, appreciable delusion, perversion of the affections, or hallucinations of the senses. Her mental affection showed itself exclusively in sudden paroxysms of intense passion. These attacks generally occurred once a week, sometimes only once during the month, but for a short period she had them more frequently. They were almost invariably preceded by vertigo, pain in the occipital region, and a dimness of vision. It was the presence of these physical symptoms that led to the supposition of the existence of some undetected cerebral mis- chief. I ordered leeches to the head, a few days in advance of the expected paroxysms, the bowels and secretions were regulated, and this treatment greatly diminished the intensity of the pas- sionate excitement, but failed in curing the case.1 A friend of Dr. Cheyne was one day riding with a clergyman of refined manners who for many years had been devoted to the service of God. To his amazement his companion without any adequate 1 Pinel observes, " That he who has identified anger with fury, or transient madness, has expressed a truth, the profundity of which I am more or less dis- posed to acknowledge, in proportion as my experience on the subject of insanity has been more or less extensive. Paroxysms of insanity are generally no more than irascible emotions prolonged beyond their ordinary limits ; and the true character of such paroxysms depends more frequently upon the various influences of the passions, than upon any derangement of the ideas, or upon any whimsical singularities of the judging faculty." MORBID PAROXYSMS OF PASSION. 109 provocation had a paroxysm of ungovernable fury, swearing at a wood-ranger and threatening him with vengeance, because he had been dilatory in obeying an order which he had received relative to a matter of little importance. Had this fact become public, all the devotedness to his profession for which this excellent man was distinguished would by many have been considered as assumed, and his habitual humility of demeanor, arising from a sense of his own unworthiness, as the result of hypocrisy. It appeared that this gentleman had a short time previously under- taken a duty which produced over-excitement of the brain. He was quite conscious of the incongruity of his conduct. It appears that his only brother had died in an asylum. I had a young child, twelve years of age, under my care, whose only appreciable morbid condition was that of being sub- ject to violent and uncontrollable fits of passion. These attacks frequently occurred during the night. The poor little creature was painfully conscious of her sad infirmity, and assured me that she struggled heroically against it. We occasionally in practice see a modified form of this dis- order exhibiting itself in a bad, morose, and capricious disposi- tion, called by the late Dr. Marshall Hall "temper disease."1 This affection is not however confined to women. A member of the House of Commons, many years deceased, had periodical attacks of this nature, particularly after his brain had been over- wrought. I was informed by a particular friend of the gentle- man to whom I refer, that he once saw him in a terrible paroxysm of fury after making an electioneering speech, being perfectly conscious at the time he was temporarily deranged. He wTas in the habit of dashing cold water over his head during these fits, and occasionally, when suffering from much physical exhaustion, he has been known with great benefit to drink at a draught a pint of port wine. Galvez, the Spanish general, was subject to attacks of violent and ungovernable passion. A bottle of claret 1 "The most frequent, yet the most extraordinary, of these perversions of temper, are seen in young females. It is a species of aberration of the intellect, but short of insanity—real enough, but exaggerated, fictitious, factitious, and real at the same time. It frequently has its origin in dyspepsia, hysteria, or other maladies, and in emotion of various kinds—such as disappointment, vexa- tion, &c. Its object is frequently to excite, and to maintain, a state of active sympathy and attention, for which there is, as it were, a perpetual, morbid, and jealous thirst. It was rather aptly designated, by the clever relative of one patient, an ego mania. I do not regard it as entirely a feigned disease. It is, originally at least, the result of malady, or of some mental or bodily affection. It is allied to hysteria; and hysteria—hysteric palpitation, for example—is a real disease. It is best illustrated by the effects of derangement of the stomach and bowels in infants—and who would think of correcting a child for temper, which was the immediate, natural, and inseparable effect of bodily disorder? It is a perversity, an insaniola, originating in bodily disorder or mental affection, and perpetuated by a morbid indulgence of temper, and desire for sympathy and attention."—"Observations in Medicine," by Dr. M. Hall. Series No. 1. P. 87-9. 110 MASKED AFFECTIONS OF THE MIND. cured him, probably, as Dr. Rush suggests, by overcoming a weak morbid cerebral action, and producing agreeable and healthy excitement of brain. Would not, adds this physician, a dose of laudanum have been the appropriate remedy ? A young gentleman was thrown from his horse and fell upon his head. For ten minutes after the accident he continued in a state of coma. Since his recovery he has been subject to furious fits of passionate excitement. These attacks are generally pre- ceded by severe headaches. His mental faculties do not appear much if at all impaired, but he continues to suffer from these morbidly painful ebullitions of temper. Prior to the injury he exhibited the most extraordinary degree of self-control and equanimity of temper. Dr. Beddoes refers to the case of a lady who after her recovery from an attack of brain fever became extremely irascible. This was the reverse of her natural dispo- sition. She made herself so offensively disagreeable to all her family that her husband, a most amiable and self-denying man, was compelled to separate himself from her and abandon his once happy fireside. A lady was in the habit during her paroxysms of passion of seizing hold of her husband's hair and tearing it out by the roots in large quantities. He has often applied to me in great distress having a full assurance of his wife's insanity, beseeching me to protect him from her acts of insane violence. She was clearly disordered in her mind, but during my examination of her case I could not perceive sufficient to justify me in signing a certifi- cate authorizing her being placed under control. I have referred to a certain morbid mental condition exhibit- ing itself exclusively in acts of cruelty and brutality. This form of unrecognized disorder may exist unassociated with delusion. There is much of this undetected alienation of mind in existence, producing, within the sacred precincts of domestic life, great irregularities of conduct, a fearful amount of discord, disunion and misery. It often coexists with great talents and high at- tainments, is compatible with the exercise of active philanthropy and benevolence, and is so concealed that the ordinary actions or conversation of those thus affected would not in many cases lead to a suspicion of its presence. Howard, the celebrated phi- lanthropist, affords an unhappy illustration of this type of dis- order. He is represented to have been a tyrant in his own house. His cruel treatment caused the death of his wife. He was in the habit for many years after her death of doing penance before her picture. He had an only son whom for the slightest offence he punished with terrible severity, making him stand for hours in a grotto in the garden. The son became a lunatic as the re- sult of this brutal treatment. A lady, moving in good society, happily married, accomplished, well educated, of sweet temper, and with a mind under religious INSANITY SHOWN IN ACTS OF BRUTALITY. Ill influences, manifested at the age of forty-five a sudden and an extraordinary change of character and habits. She became irritable from trifling causes, was continually quarrelling with her husband and servants, discharged her tradesmen, accusing them of acts of dishonesty, and offended many of her most inti- mate friends and relations by her frigid and often repulsive manner. This state of mind continued for two years, during which period she played the capricious tyrant within the sphere of the domestic circle. Her husband became nearly broken- hearted, his friends and relations could not enter his house with- out being insulted, he neglected his business, and his health be- came from constant anxiety seriously impaired. A new phase of the malady however exhibited itself. She one day accused her husband of gross infidelity. Proofs were demanded. She immediately produced several anonymous letters which she had received containing a minute, circumstantial, and apparently truthful account of her husband's misconduct. These letters appeared to substantiate as conclusively as such documentary evidence could do her accusation. jSTo person doubted the genu- ine character of these letters. Her friends however refused to recognize even at this time her morbid state of mind. She sub- sequently had an epileptic seizure followed by partial paralysis. I then saw the case. Her cerebral condition being at this time apparent, she was removed from home. It was now discovered beyond a doubt that she had written the anonymous letters to herself accusing her hushand of infidelity, had addressed and posted them, and had eventually become impressed with the conviction that the letters were actually written by a stranger and contained a true statement of facts ! They had as it after- wards appeared been concealed about her person for nearly six months. I was requested to visit a lady who, after a painful and dan- gerous accouchement, exhibited, without any adequate exciting cause, an inveterate feeling of hatred towards one of her chil- dren. She treated this child with great and systematic brutality. To such an extent did she carry this morbid and unnatural feel- ing that her husband was obliged to remove the child from the house, and place it under the care of a relative in a distant part of the country. I had no doubt at the time that this person's mind was disordered. Such was my written opinion. The idea was, howrever, repudiated by nearly all the members of the family, who obstinately closed their eyes to her sad and melan- choly condition. The only evidence that existed at that period of mental disorder was her unnatural alienation of affection, and brutal conduct towards one of the children. This state of mind appeared unassociated with any appreciable delusion. Three weeks had scarcely elapsed after my first consultation when I was informed that she had made an attempt at suicide. It was 112 MASKED AFFECTIONS OF THE MIND. then obvious that she was not in a sane state of mind, and her family no longer hesitated in placing her privately under super- vision. We occasionally observe evidences of this morbid state at a very early period of life, consequent upon an original defect in the organization of the intellect. Thomas Pepper, fourteen years of age, a pot-boy, a clever lad, but of sullen and morose disposition, committed suicide by hanging himself in an arbor in his master's bowling-green. It appeared from the evidence that the mind of the deceased was peculiarly formed, his conduct frequently evincing a predisposition to cruelty. He had been frequently known to hang up mice and other animals for the purpose of enjoying the pain which they appeared to suffer whilst in the agonies of death. He would often call boys to witness these sports, exclaiming: "Here's a lark; he is just having his last kick!" He had often been known to catch flies and throw them into the fire, that he might observe them whilst burning. He had also been observed, whilst passing along the street, to pull the ears of the children, lifting them off the ground by their ears, and when they cried out with pain, he would burst out into a fiendish paroxysm of delight at their sufferings. Wit- nesses deposed that about four years previously, when only ten years of age, he attempted to strangle himself in consequence of his mother having chastised him. He locked himself up in a room, and when discovered life was nearly extinct.1 I refer to this as a type of mental depravity occurring in early life, arising from a congenital defect in the organization of the brain and intellect. I saw, some years ago, a youth whose whole moral character had become completely changed in consequence of a severe in- jury he had sustained. This young gentleman, when of the age of eighteen or nineteen, was attacked by fever. In a paroxysm of delirium, he sprung violently out of bed and severely cut his ankle; considerable hemorrhage followed. After his recovery, his whole moral character was found to have undergone a com- plete metamorphosis. From being a well-conditioned boy, kind and affectionate to his parents, steady in his habits, sober, and of unimpeachable veracity, he became a drunkard, liar, and thief, being lost to all sense of decency and decorum ! He was clever, intelligent, and sharp-witted, but his every action was perfectly brutal. This boy, prior to his illness, was known to hang with endearing affection round the neck of his mother, but after this sad change I have seen him attack her with brutal and savage ferocity. This patient was for some years in close confinement. He was subsequently sent abroad, but during a voyage to the East Indies he mysteriously disappeared one evening from the • From the " Times." PARALYSIS OF THE MORAL SENSE. 113 quarter-deck of the ship, and is supposed to have committed suicide by throwing himself into the sea. In another type of unrecognized mental disorder there appears to be a paralysis of the moral sense, a state termed moral idiocy.1 A young gentleman, greatly indulged and petted at home, exhibited shortly after going to school a morose, cruel, and re- vengeful disposition. He.quarrelled with the other boys, com- mitted several petty acts of robbery, accusing others of being the culprits. He pursued his studies with intelligence, and was generally at the head of his class. His conduct became so sys- tematically brutal, savage, and untruthful, that his father was requested peremptorily to remove him from the school. The gentleman under whose care the youth was placed was induced by the earnest persuasions of the parent to alter his determina- tion and retain the boy. For several days the youth was noticed to be unusually morose and taciturn. He was subsequently perceived to be busily occupied in writing. Being called sud- denly out of the room, his letter was examined, and it was found to contain the details of a plan he had carefully concocted, and ingeniously conceived, for the murder of one of the boys in the school towards whom he entertained feelings of rancorous ani- mosity. His letter was written to a boy who had left the school for misconduct, and who appeared to be in his confidence. He 1 Grave exceptions have been taken to the term, "moral idiocy,'' by writers who have entirely misconceived the medico-psychological import of the phrase, as well as by others who have never had an opportunity of becoming practically acquainted with this singular type of congenitally defective intelligence. A modern author thus refers to the popular prejudice on this subject: "To some minds, the idea of a moral idiot involves painful notions of the Creator. I may be permitted to remark, that they rest on the false philosophy of the Eudaimonist. So long as we consider happiness as the great end of life, and virtue only its instrument, so long shall we find difficulties to solve in the mischiefs wrought by beings whom ignorance or fatuity renders irresponsible. To the Eudaimonist such mischief appears a final evil; and, as he is forbidden to attribute it to the irresponsible agent, he is driven to attribute it to God. But the difficulty ceases when we perceive that the end of creation is the per- fecting of souls, and the production of happiness is altogether secondary thereto. Sin is now seen to be evil, not for the external mischief it produces, but for its own sake, as the most evil of all things. The outward act, be it ever so mis- chievous, is not sin—the Will constitutes the sin. Thus, when offences are com- mitted by an irresponsible agent, God does not become the author of any sin; for sin is nothing but the conscious, wilful delinquency of a free creature, and there is no sin without it any more than in the ravages of the storm and flood. The mischief done takes its place along with the suffering which is necessary to the end of creation; and, when the great drama is further advanced, we shall understand the reason of what seems unaccountable in the one short scene we now behold. To ask further, why moral idiots should have been created, is equivalent to asking why there should be intellectual idiots, children dying in infancy,