S737e rVh &: ,y** 4 1 if. J k^v(/ AN ESSAY MADNESS CONTAINING THE OUTLINES NEW THEORY, .U- BY ROBERT SPEAR, BACHELOR AND LICENTIATE OF MEDICINE, OF THE UNIVERSITY OF CAMBBIDGI; MEMBER OF THE ROYAL COLLEGE OF PHYSICIANS, LONDON TORONTO: H. & W. ROW SELL. 1844. ' .A A A* >x F* ^L ^^ ROWSELL9 AND THOMPSON, PRINTERS. AN ESSAY ON MADNESS. 1. My object in this essay is not to consider the peculiarities of one madness from another, except in so far as such considerations may lead to the solution of the question, What is the nature of a mad fit ? and when madness in a man is mentioned, unless otherwise expressed, the actual invasion of a mad fit is meant, and not a latent madness, as in a madman asleep, or talking rationally and acting with propriety and in concert with sane men. A latent madness would appear to refer, either to the bodily type of the disease supposed to be running on, but masked; or to the very high probability that a particular man is in a fit state, and from the slightest exciting cause, to shew madness. For it by no means follows, that because a man is mad all his discourse is absurd, or that all his actions indicate madness: he is reasonable enough at times, and on certain subjects ; and when they alone are before his mind, he will often shew discrimination and accuracy in his discourse ; or if they lead to B 2 action, he will act like other men. It may sur- prise us that a madman should have this power, that he should be able to think on any other subject than the one on which he is beside him- self ; that he should, for instance, one moment consider himself miserable in hell, and shortly after be talking reasonably with those about him, and acting in many respects as they do; or that his companions or keepers should be able, by barely introducing other subjects, to lead him off from the consciousness of torments which a moment ago he considered real and everlasting. Still, if we consider our own ideas and feelings, how the most pleasant and painful of them make way for others to which we are indifferent; how the most delightful and bitter passions have their ebb as well as flow; and that the mind appears subject to a law which renders it unable to fix itself for any considerable time to the contemplation of one invariable idea; then perhaps we may be able to conceive how it is that madness should become latent in a man, and that he should appear to be free from his madness for a while. This state to which we have alluded, must not be confounded with that in which the disorder has disappeared or is over-ruled for a time, and in which the mind is itself again ; for if such an one were mad because he conceived himself to be imperatively called on to kill his neighbour or himself, he is then sane when he considers 3 such a murder as unjustifiable and with repug- nance, and when all his actions indicate a deter- mined and altogether sufficient self-possession. Taught by experience, however, that such is not in very many cases a durable sanity, so when it terminates, or when it is supposed that it will terminate in another fit of madness, it is called a lucid interval. A true lucid interval from madness (as from an incurable epilepsy) cannot therefore be con- sidered as the same with a perfect sanity, and also it differs from a latent madness : it is some- where between these. These states, however, in great measure depend on the physical consti- tution of the mind, which is unknown. 2. Whatever amount of injury a man's body may have received, or whatever natural defect thereof may exist, the diagnostic mark of mad- ness is not looked for either in the one or in the other, but in the actions springing from, or imparted through the mind: hence madness cannot be traced in infants. Moreover all obser- vations prove, that a man must have exercised his mind rightly before he can shew madness, and in this it differs from idiocy. A natural defect of parts may in one human being give idiocy, but the same natural defect of parts in the same human being cannot also give madness; to produce this, other influences must be added which are acquired, and which are developed in the man at a stated period of his existence, and 4 we therefore assume that idiocy and madness differ in kind one from the other. 3. As in the sane mind we have the two chief powers of the understanding and the will, so also we have a derangement of the under- standing and a derangement of the will. This two-fold division of the disorders of the mind appears, in a medico-legal sense at least, to be requisite and sufficient. For the ideas in a man's understanding may be so few, or his associations of them so arbitrary and peculiar, or the signs or terms he makes use of, so mis- applied, or his identity so lost sight of, or con- founded with another person, thing, or quality, that he cannot perform ordinary matters, or discourse rationally, or distinguish between what he is and what he is not, or between that which is real and fantastical, and therefore is con- sidered incapable of managing his own affairs; or on the other hand he may have lost all con- trol over his volitions, and the impulses to unlawful actions may be paramount or irre- sistible. But this division evidently includes other disorders, so called, of the mind, besides mad- ness ; therefore a little further insight is required, that we may understand in what madness con- sists, and in what respects it differs from other actions of the mind apparently allied to it 4. It is not the existence of an idea or doc- trine in the mind, however vague, extravagant, 5 bad, or false, which constitutes madness. To this must be added, discourse or conduct which, springing from such idea or doctrine, proves the hold of either on the mind and actions of the man, to be the result of confirmed disease, over the manifestations of which he has no control. If this be so, it will be useless for us (following others) to look for madness in a man's under- standing alone. For example, suppose first, a man who believes that he perceives an apparition, yet his mind is sufficiently itself, to counteract the influence of that apparition on his conduct, since he is aware that it is only perceived by himself, and more- over he is assured by his other senses that the apparition has no external reality ; still the sen- sation or phantasm, from some alteration in the brain, or from some irregular motions in it, is at times present, although he is convinced that the object is brain-real merely. Let us suppose, secondly—that the man feels assured of the reality and external existence of that phantasm ; that he flies from it, is caught by it, converses with it, as it may happen. In the first supposi- tion the man was not mad ; that is, so long as his mind had sufficient power to consider the phantasm as the result of some bodily infirmity; but in the second supposition he was mad—that is, when this power failed him, and when con- sidering the object as external and present he acted accordingly. 6 So a man who in his reasonings draws con- clusions which contradict the knowledge of mankind, or which contradict those principles which the man himself previously allowed, is judged to be mad only when his actions indicate derangement. And when a man's reasonings have an immediate reference to action, and con- tradict our perceptions and belief of things—if his will be uninfluenced by his doctrines—if he act precisely like other men—we make no ques- tion of his perfect sanity ; and although he demonstrates that there can be no motion or matter, time or space, good or evil, mind or idea, &c, in the world, still it suits him to act as if all these things did exist: it is only when a man's actions coincide with such doctrines that he is considered to be insane. Occasionally we find that a man has such obstinately rooted belief in his own absurd fancies or principles, that it is impossible to divest him of it. And it may be asked, how he is to be distinguished from a madman who holds the same doctrines? The difference between them consists in this, that such belief in the mind of the former, has some restraints over it which are derived from other determinations of the mind influencing the will, and by these the man is enabled to keep his belief within such limits, as to prevent its determining, on all occa- sions when it maybe before him, that sort of action which it requires of him : he is from first to last 7 aware that he views some things differently from other men, and he is also able to perceive those things as other men perceive them; and with this knowledge he curbs his volitions, and he acts in a sort of medium, giving some deference to the opinions of others, and reserving to him- self at convenient opportunities to let loose the full flow of action which his belief sanctions. But a man who can so bend to the opinions of others, how extravagant soever his belief, having perfect command over the enunciation of that belief and over the actions which it entails, knowingly differing from other men, and seeing well enough his own peculiarities, cannot be a madman ; unless indeed a man can assume a fit of madness and throw it off again at will, which is scarcely to be conceived, and which, if our theory be correct, cannot be in the power of any one unaided to accomplish, who is not either on the very verge of madness, or at the precise period of his release from it; and then, and in either case, it would be the product of new or altered motions going on in the body, which would have gone on and established or blotted out madness, if the man at the time had been thinking on something else, or had been asleep and not thinking at all. Locke strongly insists on madness being the result of wrong associations in the mind, brought about by custom or by chance, and which are looked on as naturally and truly connected—that 8 in this way fallacies are taken for truths, and fancies for realities. But whatever wrong asso- ciations the bad or the good, the ignorant or the learned man, may possess, they have not, neither are they considered to have, the same sort of force which they have in the insane. Moreover very many wrong associations give way, and the mind forgets them in madness, and the cha- racter is changed; also in other cases the asso- ciations were produced at the same time with madness, and are not recollected after recovery. And in the example given by Locke of a wrong association, where a madman takes himself to be a king, and acts as if he were a king, it will surely be allowed, that were we to do all in our power to make this a right association, by placing him on a throne, he would continue to be a madman still. Giving then to wrong or sudden and overpowering associations their ful- lest scope in some cases of madness, we have still to account both for the change in the sensations and character of the man, and also for that loss of power in the mind to think on other and wonted objects; in other words we still have madness to account for. Thus, a mother from the death of her child becomes at once insane ; she perpetually raves about it,, nor has she apparently any power to think on other ideas, or to notice objects ; her dearest relations are as strangers before her, and her volitions may have reference to her dead and buried 9 child as talking to it, caressing it, suckling it, laying it out, &c. Ask her to perform other actions, and she appears as much at a loss as if she were laboring under a paralysis, or under a total forgetfulness of the world without her: this is not a great sorrow, or the association of a present suffering with previous joys, for were her child brought to life again and placed before her she would not know it. In such a case there is an insensibility to impressions, which can only be accounted for by the mind's having lost its directive power; it still thinks, but it thinks in one direction, and all objects appear as if viewed through one medium. Again, a man may be at issue with the rest of mankind on a particular belief or association, and for all that he may be considered sane. Thus the mayor of Queensborough, a man of learning and a friend of Locke's, took himself to be the same person with Socrates of old. Still how could a plea of madness be founded on this most extravagant belief, if he thought and acted judiciously in his capacity as mayor of Queens- borough, and was not constrained by his belief to go back two thousand and odd years for the sake of adopting the life and death which hap- pened to Socrates ? It is reported of the great Pascal, that from a sudden fright, he afterwards at intervals during his life had the sensation of a precipice on one side of him, nor was he for the time at ease till he had placed his chair, or his c 10 foot, where the precipice appeared. This associa- tion Pascal had sufficient command over himself to correct, and it did not in other respects influence his conduct or actions.* These examples will suffice to shew, that a man with wrong associations merely, is still linked with the rest of his fellows, who on some subjects are all of them prejudiced ; but a madman while in his fit is a man apart, incapable of rationally discoursing, or of acting in harmony with the wise or with the foolish on the subject of his madness. In fine, there are many cases in which the manifestations of madness are so directly and indisputably connected with physical causes, that there can be no suspicion of wrong associations having had any share in their production. Thus insanity of one or other sort often results from injuries to the head, from the so-called metastasis of diseases to the brain, from the suppression of an habitual discharge, from the operation of cer- tain medicines, from the puerperal state, from exposure at sea to the strong heat of a tropical sun__as in the madness termed calenture, and * One of the most extraordinary mathematicians that perhaps ever took a senior wrangler's degree at Cambridge, told me that he was puzzled how to get rid of an odd association that he often had while over his books and at other times, viz.—of driving a coach and four. The same association has been known to exist in a mad- man : the whole conduct was influenced by it; it was not only a sort of belief but a reality; and he went about the streets chirping and whistling to his horses—now drawing his reins on this side, now on the other, and thus walking, convinced that he was driving his coach and four. 11 more rarely from some unknown constitution of the air rendering it epidemic, as mentioned by Morgani, &c. Further, we may suppose the understanding in a man to be in a state of integrity, or secondarily affected, and yet that man may be mad ; because he may have lost the power to turn his mind from one thought to another thought, to do or to forbear from doing particular actions; and he may be constrained to think on a particular thought, and to do a particular action. So if one idea be exclu- sively or for the most part the subject of a man's discourse—if he cannot turn his mind to the con- templation of other ideas or objects, but is ever and anon harping on that one idea, associating it with the circumstances of each moment, and of every place—he would be mad. So also if those actions which the sane man can, save in extreme cases, command the doing or not doing, such as eating, drinking, or the actions proceed- ing from anger, fear, lust, &c.; if any one of those be indulged in beyond all measure of con- trol—if the will be rivetted to the performance of any one of them day after day, at intervals, and in all places alike—that man would be mad ; for in cither case the man is unable to perceive Objects disassociated from that particular object which occupies in chief his consciousness—the only power which could unshackle, so to speak, his consciousness, so that he might perceive other objects of sense or of memory disassociated 12 from that one, is held during the fit subject to that one object; all his discourse runs on it, and it is the only standard of ideas, whether real or unreal, and of actions, whether good or bad; it is for him an object of sense, because objects of sense appear to tally with it, and to be related to it; or it is a familiar friend, taken as an enemy ; or it is the thunders or the happiness of heaven within and about him ; because he has no power to rid himself of that anger or fear, or religious enthusiasm, which one or other, as it may hap- pen, draws as into a vortex all other objects. Nay, oftentimes, according to the object which has fastened on the madman's consciousness, his bodily state is lost sight of, he is a dead man or a murderer, &c.; the idea has given its peculiar coloring to every object without him, and to every idea in his memory ; hence any other object is either not noticed, or if noticed is con- sidered as part of that idea, or train of ideas, from the contemplation of which his mind has no power to shift his consciousness ; he must inevitably then, if he perceive other things at all, perceive them as forming part of or associated with that idea which constitutes for the time his conscious self; and some of these things have often been observed in a well-marked fit of mad- ness. Still further, and very analogous to, and often conjoined with the last-mentioned forms of mad- ness, is one long-continued and unvaried bodily 13 action (the body being in an apparently healthy state): the man stands or sits, or lies down stock still, or he looks in one direction, or listens as if to one sound ; or thinking on an object, he keeps it with a tight grasp ; or he performs one feat, or sets himself to accomplish one particular work, unmeaning or otherwise; and at times and in cases the actions which the thoughts of the mad- man entail are full of danger, being bent on murder, theft, destruction of property, &c. In all these and the like cases the fixity of the will appears to extend equally over the madman's ideas and over his voluntary actions. Moreover, the understanding appears to be secondarily affected, in other cases of madness opposed to the above; and instead of the mind being fixed, and immovable as it were, it cannot fix itself on any one or other contemplation, but is in perpetual motion and rapid change from one idea to another idea, and the man's discourse is altogether incoherent, or at any rate perfectly unintelligible to others. With this sort of dis- course co-exists a corresponding sort of other bodily actions : for the most part, he is unstable as water ; he is all in a hurry—runs one way, stops short, then back again ; begins an action, then leaves it off, goes to it again—again to do something else, and so on perpetually. If you can get him to do anything for you, as for instance to put out his tongue, it will be thrust out and drawn back again in a twinkling, and so 14 on for three or four times ; get him to lie down, and in a moment he will be on his legs again, discoursing or acting characteristically as before. 5. What, then, characterises a fit of madness of any sort ? We have to guide us (1), The irre- sistible hold of consciousness to some object or objects in the mind ; and (<2), in the same, or in other cases, the irresistible impulse in the mind to perform some bodily action or actions : or, and just the opposite of both these, we have (3), in other cases, the total incapacity of con- sciousness to fix itself to the contemplation of any object; and (4), the total incapacity in the mind to order the performance of bodily actions to any definite purpose. In each of these there is an act by or through a faulty organ of the will; for the will is well defined by Locke "that power which the mind has to order the con- sideration of any idea, or the forbearing to con- sider it, or to prefer the motion of any part of the body to its rest, and vice versa." We conclude that the organ of this power in the madman's fit is in fault; and this theory we also reduce to practice in the moral treatment, for we do not endeavour to reason him out of his madness, but we endeavour to act on the will to direct it, by imparting to it an easy compliance, or a requiste fixity, as the case may require. This theory is also, and justly, acted up to among the most civilised nations ; for he who is mad is not held accountable for those his actions 15 which proceed from madness, for these are sup- posed to arise from an unhealthy condition of his physical being, arrived at that degree of inten- sity, that it acts on and governs the will; they are not supposed to arise from the depravity or purity of his moral principles, or from the deli- berate choice of evil or of good. And if, as in many cases (the disease acting in a determinate way on the mind), the madman is under the influence of a supposed divine law, or a law of his own being, requiring him to do an act, which he does—an act which the laws of his country, by the strongest punishments, forbid—he is not held responsible for the act under such influence committed, because he by or through the disease has such volitions forced on him, and is at the time totally unconscious of, or totally unable to keep the true laws of God, and of his country, and of opinion, &c, and thus is deemed for the action amenable to none of these. For all laws, and in each case of their applica- tion, must appeal to principles of action under the command of the man himself, without which he is no more to be punished for not keeping them than a blind man is punishable for not seeing, or a paralytic in his limbs for not walking, &c. ; this being so, it is evident that a madman in his fit is either altogether removed out of the pale of criminal laws, or if not he must be judged either bv those supposed, and to him imperative laws, occasioned by the disease, which determine 1G his actions in the fit—or by those bad habits to which in some cases we can trace the first symp- toms, and after increase of disorder in the mind, as drunkenness, dissipation, &c. If he be judged by the former, he would be deemed culpable, because he had broken a law which the disease had rendered him for the time totally unable to fulfil; if by the other, then he can only be pun- ished by those punishments awarded to those bad habits which occasioned the disease, and for which the disease itself is considered a sufficient punishment. Society, therefore, placing itself in opposition to the law which in such cases deter- mines the madman's actions, incarcerates him to prevent further mischief; and not as a criminal, or to deter others from crime, for as an example it would have no force, seeing that others could not place themselves in the condition of madness. And hence, if a criminal, after conviction for a capital offence, become a lunatic, he is not executed. 6. All of those causes* which conspire to produce madness and other disorders of the * Hereditary madness is a somewhat complicated subject, and it is not very easy to find out its true value. This, at any rate, may be taken for granted,—that it is illogical to conclude, because six out of ten individuals, born of parents who had been insane, become at certain ages insane, that all these are to be considered as cases of hereditary insanity; unless it can be proved, either that those individuals were not aware of the insanity of their parents— or that, being aware of it, they did not regard it as prejudicial to themselves—or that the knowledge of the supposed fact (that the insanity of the parent increases the chances of insanity in the 17 mind, can only be conceived of as acting on it through the medium of its organ ; and our ideas result from those impressions on this organ, which the mind is conscious of. Pure powers of the mind, the understanding and the will, we lose sight of, apart from those objects which solicit them; it is according to these objects, and to their influence, that a man is learned or ignorant, good or bad, sane or insane. We cannot conceive of these powers being altered in their nature by disease, nor yet by any other physical causes. They must be for us that offspring), and the dread which, for the most part, accompanies it, has no sort of influence in the production of insanity—or, that those exciting causes which might produce it in others, were absent in these. But this last case can scarcely happen, because the doctrine of hereditary insanity fosters the very strongest of these exciting causes. Many of the cases spoken of by authors as hereditary, seem to carry great doubt with them ; thus, a daughter goes mad at the precise age at which her mother went mad. And, again, in a large family, in which insanity is supposed to be here- ditary, we often find, that the first individual afflicted is quickly followed by two, three, or five cases more. Again, it is supposed that if the insanity be on the side of the mother, the sons escape; and, if on the side of the father, the daughters escape. And so we have more daughters insane, when their mother has been so; and more sons when the insanity was on the father's side. But, does not this look like a popular prejudice ? We well know how injurious an influence any idea of a melancholy cast fixed in the mind, and reverted to day by day, has over us. And yet physicians give out to the world that the chances are greatly in favour of the children becoming insane, when their parents have been so. Thus, a sanction, and a scientific foundation (as it were) is given to their fears of the disease. And so, when one of a family in which this hereditary disposition is supposed falls mad, others in the same family quickly follow; for all of them have been taught that it is in their blood, and that, if they do not become insane, they are the exceptions to a general rule. D 18 power which is conscious, and that power which directs or wills. But the objects which come before these powers may either be such that the mind is rendered unconscious by them, or they may have that appearance to, and that influence over, the mind, which they have not in a properly working and sane organ of the mind. By impres- sions, then, on the brain, not only are the powers of the understanding and the will drawn into action, but often the brain receives actions which militate against, or even destroy perceptions and volitions. Thus, in a fit of epilepsy, the mind is apparently unconscious. It is reported of a young and learned Englishman, that after his recovery from a fever, he had forgotten all his Latin, which language before the fever he knew per- fectly (at the same time his knowledge of the English language remained unimpaired) ; at the end of the third week, and all at once, his know- ledge of Latin returned. So some idiots have recovered their knowledge during a fever, and when the fever has ended, their idiocy, in many cases, has returned. Other persons have, during a fever, spoken in a language which when children they were familiar with, but which they had appa- rently to themselves and to others long since forgotten, and which they generally again forget when the fever declines. And some madmen, when attacked by another disorder, have at once become sane, Again, bodily actions of which we are not immediately conscious, alter the mind 19 from day to day; and in our walk through life, from the cradle to the grave, many of our desires, associations, feelings, pleasures, &c, are changed; and others arise by the play of bodily actions, and independently of any volition or idea on our part; for facts like these, we can give no other reason than our experience that we are so con- stituted and so transformed. These examples shew that certain species of actions are and per- sist in the organ of the mind, of which it is not conscious, which are not ideas—therefore that this organ possesses a receptive, different from the mind's perceptive power; the former may not only receive an action of which the mind is, but also one of which it is not conscious; it may receive an unconscious action, which may add greatly to the mind's stock of knowledge, or which may make the mind almost a blank. Now, is it in certain cases, as regards the organ of the mind, as we experience it to be in other parts of the body ? For instance, an unshackled limb which does not move when we will that it should move, is said for the time to be paralysed; or a limb which will not follow our volitions, and keep at rest, but continues to move, by virtue of voluntary muscles, any way as it may happen, is said to be convulsed. Is it also in some disorders of the mind, that the organ by which it wrorks, and of the impressions on which it is at times conscious, is paralyzed or convulsed, or something similar ? Indeed, in insanity, the 20 " I cannot think on a particular thought," or the " I cannot do a particular action," would appear to approach somewhat to a paralysis ; and the " I must think on a given thought," or the " I must do a given action," would appear in some respects analogous to a convulsion. Thus, in the famous and often repeated experiment of Majendie : he cut down on a determinate part of the brain in a living animal, and forthwith it ran round and round till it wTas held still or exhausted. In what respect does this action differ from the irresistible impulse in the madman, to perform a, particular action ? So in chorea, the mind can- not achieve through voluntary muscles wonted actions, nor yet can it put a stop to the convul- sions ; so, in incoherent insanity, the mind cannot fix itself on any contemplation. Further, the complication of many, the worst cases of mad- ness, with paralysis, epilepsy, and other convulsive disorders, seems to point to the conclusion, that there is between them all an intimate connexion ; and that they are, in all probability, the results of similar disordered actions in different parts of the nervous organs. 7. Again : in our passions different bodily actions, which indirectly solicit consciousness, have play; which actions, according to their peculiar nature, render one man prone to anger, another to fear ; one to lust, another to chastity, &c. Nor can the angry man, by willing it, change places with the pusillanimous man, and 21 become a coward ; nor the coward become coura- geous ; nor the chaste man lustful; nor the lustful chaste ; so long as that state of body endures, on which each passion in great measure depends. These bodily actions constitute the in- voluntary part of our passions. But we are angry, for some reason, with one or other object present to the mind's consciousness, which we are inclined to hurt or to destroy. In like manner, we fear, for some reason, one or other object, from which we anticipate injury or destruction. The volun- tary part of our passions arises out of both these; and the angry man will attack his foe, and the coward will run away, or be fascinated. These and other passions exist both in the sane and in the insane; for both are angry, fearful, lustful, &c.; but the sane man can for the most part command his passions, and he is continent or incontinent, temperate or intempe- rate, according to that degree of command which he imposes over them. Whereas, in the madr man, the bodily action is so intense that, while under its influence, he is like one possessed.— Thus, he starts from a sleep or a reverie, or at the sight of a person or thing, or for a trivial remark or circumstance, with his body fraught with those actions which are peculiar to him who is angry, fearful, lustful, &c, ; and any object before the mind arrests and fastens on the will, and the impulse to consummate the particular passion becomes irresistible. And the madman 22 perhaps, like Ajax, kills a flock of sheep, taking them for his enemies ; or rushes with rage on his dearest friend, &c.; or is horror-struck by some imaginary, that is, brain-real objects ; or is fearfully persuaded that heaven and mankind are leagued against him, &c. ; or he is lost in the fury of a satyriasis or nymphomania, &c. It is not, however, said that the madman is intem- perate on account of these things, because he has no power to be temperate, and no preference for intemperance ; the will is led captive. Doubtless there are many other disorders in which the will is constrained to particular voli- tions. He who ig suffering under a severe peri- tonitis, or asthma, or painful ophthalmia, &c, is.forced to perform certain actions by voluntary muscles ; and it is just as much out of a man's power in the first of these diseases to walk erect —or, in the second, to breathe at ease—or, in the third, to look at an object in a strong light stedfastly—as it is out of the madman's power, in the fury of the disorder, to think or to act in opposition to that madness wdiich at the time oppresses him: and, as in the bodily disorder, we note as symptoms the results of such volitions; so, in the mental disorder, we note as symptoms the volitions themselves, expressed or acted up to. 8. A madman's actions, then, so far as his madness extends, are involuntary; but not in the same sense that a sane and . healthy man's actions are sometimes so. For what the sane 23 man does, he does for the most part voluntarily; but other things which he cannot command, or is ignorant of, mar the result,—as when a fond parent permanently injures his child by a slight chastisement—as when a man who has under- taken a journey falls and is crippled by the way —as when one taking his accustomed food is choked therewith, &c. But a madman's actions, in the commencement, and as regards the causes which produce them, are involuntary. Thus, one of them, foreseeing the return of a fit, exhorts his friends to get out of the way or to strap him down, or he straps himself down, in the horrid conviction that otherwise he may kill some of them : thus, another taking himself to be a dead man, acts as if he were so ; and another, being poor, enjoys wealth ; or, being moral and chaste, he is licentious—in his madness. These thoughts and actions, although in the above sense involuntary on the part of the mad- man, are nevertheless often accompanied with pleasure or pain, and he is not in some cases ignorant of their tendency, else he could not knowingly accomplish those actions which, in sane men, and being voluntarily performed, are worthy of praise or blame; but he is held or driven by those causes which turn his thoughts in a way peculiar to madness into strong deter- minations of action, and which surpass all the efforts of his conscious nature to get rid of. So that the particular action, whatever that may be, 24 which he feels he must accomplish, is in a manner inevitable, it being, so far as the mind is con- cerned, already determined on and completed. Hence, the difficulty, in some cases, of discover- ing the madman in his actions, for these appear to be voluntary; he makes use of voluntary muscles, of proper instruments, with a definite end in view, which he, like other men, may or may not accomplish. Here the circle of volun- tary actions appears complete ; and if we con- sider these things merely, he would seem to be a good man, or a bad man ; that is, to have acted from the deliberate choice of evil or of good. But the causes which made these actions invo- luntary, are for the most part sudden, fitful, and obscure. One moment the madness is considered latent, the very next moment it is in full play ; an over excitement—an opportunity—an object of any sort—a mere sound, as of a clock at a given hour—or sight as of a razor—a change of position, &c, has developed it. Contrariwise, it is again made latent by similar slight and, for us, almost inappreciable causes to so great results : the voice of his physician or keeper—the dinner bell—a kind word—the attempt, successful or abortive, to perform an action, &c, has eclipsed it. In such cases, the will would appear as if on the confines of, and oscillating between, two forces—the voluntary and the involuntary : any, the least increment, on the one hand, making a latent madness evident; and, on the other hand, 25 any, the least decrement, making it again latent; or the bodily disease now increases on the mind, so as to force the madness to appear, and now again decreases, so that the madness becomes latent. It often happens, that the impressions on the organ of the mind given by the disease, partake so much of it, that the man's consciousness can make very little out of them; and they are well termed by the madmen themselves, in their sane intervals, as mere impulses, urging the will to particular actions, such as a roar, a run, a noisy gabble, &c, continued throughout the fit. It is no wonder, then, in these cases, that the madman should do an action whether he will or no, seeing that the disease in the organ is, in great measure, doing it for him—is acting in lieu, as it were, of his determinations. 9. In conclusion, a fit of madness appears to be a disease of the organ of the mind, arrived at that degree of intensity, that it determines the will. THE END. / Preparing for Publication, BY THE SAME AUTHOR, THE STATISTICS OF INSANITY. NLM041421825