OBSERVATIONS ON MENTAL ALIENATION1, APPLICATION OF ITS PHENOMENA ILLUSTRATION OP SUBJECTS CONNECTED WITH sarnies, vw&xaw&WDssroB* BY THOMAS Y~. SIMONS, M. D. Extraordinary Member and formerly President of the Royal Physieal Society nf Edinburgh; late Preisdent of the Charleston Medical Society of Emulation ; and Vice-President of the Medical Society of South Carolina, fyc. fyc. Thc exercise of our intellectual faculties is the noblest prerogative of our nature- CHARLESTON: ^^gARl PHINTED BIT A. F. CUNNINGHAM, No. 36 QUEEN-STREET. 1828- Class. Q> Sk . Book. LIBRARY OF THE '/ $\3 Medical Society of the Co.. of Kings. Given by ' ^'^-r ^..^.r...^_...:E^fe^7rill the cure of Democritus be acceptable. Since, therefore, Hippocrates, you see a most excellent person falling into madness, and a whole people into distress, hasten we beseech you to us. It is strange that the exuber- ance of good should become a disease ; that Democritus, by how much he ex- celled others in acuteness of wisdom, should so much the sooner fall into mad- ness, while the. ordinary unlearned people of Abdera enjoy their wits as for- merly ; 'and that even they, who were before esteemed foolish, should now be most capable of discerning the indisposition of the wisest person. Come, therefore, and bring along with you Esculapius, and Epione, the daughter of Hercules, and her children who went in thu expedition against Troy ; bring with you receipts and remedies against sickness : as the earth plentifully af- fords fruits, roots, herbs and flowers to cure madness, she can never do it more happily than now for the recovery of Democritus. Farewell." History tells us, that in place of curing a madman, Hippocrates received instruction from a philosopher. 2 lO Observations on history. Pythagoras believed that he had lived in prior age% and inhabited different bodies, and that in the shape of Euphor- bus he had assisted in the siege of Troy. Tasso fancied himself visited by a familiar spirit, with whom he conversed aloud. The hero of the celebrated romance of Cervantes exhibits a well drawn picture of this species of insanity; and, although in a less attractive form, how frequently do we recognise Don Quixotte in every rank and description of society? 'If,' says a celebrated writer, ' the circle in which this absurdity revolves is so small as to touch nobody, a man is then only what is called singular in that respect; but if its orbit is extended so as to run foul of other people, he is then called a madman.' n Men who devote themselves to poetry, and works of fictiorij become almost wholly abstracted from the realities of existence^ and in soaring in imaginary regions, almost forget their individu- ality. The eccentricities, therefore, which they exhibit, are by no means extraordinary: always conversing with creatures and objects of their own making, it is not surprising that their views-of many of the ordinary transactions of life are so unreasonable and absurd. It is important, therefore, for us, when examining the opinions of such writers, to discriminate between that which is, as it were, the mere effervescense of a morbid imagination, and that which is deducible from calm reflection and profound ob- servation. I know no author who will illustrate so well my ideas as Rousseau. Possessed of a powerful and luxuriant imagination, the most common objects could, at once, be clothed in the most splendid and illusory forms. In every line we can trace the evidence of a great and predominant genius, but, like- wise, of an intense morbid imagination. His opinions, for in- stance, where he attempts to convince us of the superiority of the natural over the civilized man, (his favourite dogma,) clearly demonstrate this. Immersed in the gloomy and filthy purlieus of an over-populated city, where all the worst passions and feel- ings of human nature were continually exhibited before him, and observing the depravities of a licentious and corrupt Court, he became disgusted with these realities, gave a loose to his imagi- nation, and associated with savage or primitive life every thing that was virtuous, delightful and happy. Their insatiable revenge and deadly animosities were all forgotten, and the poet thought of nothing but elysian fields, ease, quiet, and ignorance of vice and deceit. He gave a positive enjoyment, if I may so express myself, to a negative ; he supposed them capable of estimating all the exquisite pleasures of refined sensibilities, without any of the jarrings or collisions which occur in civilized life. Had he, however, been compelled to live among them, his visionary day- dreams would have been quickly dispelled. He would have found, that if they had few cares they had fewer enjoyments: Mental Alienation. 11 and that all the splendour of his genius would have been unfelt and unobserved, and he regarded with indifference and con- tempt. In short, the productions of Rousseau, however they may have astonished and excited the admiration of many, must be considered only as splendid rhapsodies. In every department of mind we will observe how the imagination usurps domination over reason and reflection, and continually some master genius gains an ascendancy over ordinary minds, collects around him innumerable disciples to his dogmas, who either do not, or can- not dispassionately analyze their truth. In this manner a preju- dicial influence is often exerted upon individuals, and upon na- tions, by the promulgation of doctrines false in their nature, and dangerous in their consequences. What an extensive influence do works of the imagination frequently have upon the con- duct and happiness of individuals, and how many erroneous and false impressions are thereby created ? The enthusiast inva- riably converts these airy fabrics of the imagination into realities j and that which should be regarded as the effect of a morbid mind, has been frequently extolled as magnanimous, and from constantly viewing it through a false and delusive medium, be- comes, ultimately, to be regarded as a settled position. In exem- plification of this, I refer to the practice of self-murder, so openly committed by some of the most distinguished of the Greeks and Romans, and which some moderns have applauded as magnani- mous.* The opinions on this point are wholly made up from the influence of the imagination, and are only supported in strains of poetry or declamation. In a moral point of view, it is important to attend to this sub- ject. False notions and opinions thus imperceptibly take pos- session of and influence the conduct of individuals and commu- nities. In this manner great crimes have been committed, which the perpetrators have regarded as magnanimous and praisewor- thy : as, for instance, the death of Czesar by the hand of his friend Brutus; of Henry IV. by Ravaillaic ; and the unfortunate Kotzebue, in our days, by an infatuated German student. Thus, likewise, tremendous convulsions are produced in countries. Beginning with truths, and claims to unquestionable rights, de- signing demagogues, having once aroused the people, and finding the operation of reason unsuitable to their purpose, address the imagination and passions, disseminate among them doctrines and opinions suitable to the attainment of their ends, and awaken those terrible excitements which have terminated in the wreek of empires and the sacrifice of millions of human beings. Does not history demonstrate to us, that no dogma was too ex- travagant to be believed and imitated, if given out with an air of * Cato committed self-murder, and Addison, who called himself a religious Christian, eulogized him 12 Observations on philosophy ? Have we not wondered at the many, to us, extraor- dinary absurdities of the ancient philosophers; of the necromancy of the astrologers ; the delusions of alchemy; the farcical, nay, almost mad subtleties of some metaphysicians, especially, such as believed, or pretended not to believe in the existence of mat- ter ; of the ridiculous follies of chivalry, and the more awful ef- fects of duelling which followed ; of the numberless sects which have arisen among Christians, with feelings towards each other repugnant to Christian charity, and directly contradictory in opinions : and all these things produced by the predominating genius and ascendancy of a few individuals. Mankind are prone to delusion, and it is not to be wondered a!. that some few, by certain powerfully exciting causes, have a total intellectual derangement. I have made these preliminary remarks before entering upon the consideration of Actual Insanity, believing them not wholly irrelevant to our subject. I will now consider the various kinds of Mental Alienation. INSANITY. Insanity may be regarded as a total or partial perversion of the intellects, wherein the concatenation of ideas or train of thought is broken; thus, as in dreams, producing those strange and in- congruous combinations of id^eas which arc repugnant to reason or reflection. Where the judgment becomes wholly impaired, although the operations of the mind are either partially or wholly perverted, the insane cannot always be said to have lost their reasoning power ; for they often reason with extreme ingenuity : but they are in every case deficient in judgment, and reason on false premises. There are, however, many sane persons who commit this error. Most generally, the imagination usurps pre- dominant sway, anfl with its impetuosity overwhelms the calm operations of reason and reflection. Hence it has been said, that the septum between the man of great geuiuy, who is, of course, possessed of great imaginative power, and the insane, is very slender; and should the imagination usurp the mastery, the ba- lance of the intellectual powers becomes lost, and like a ship in a tumultuous ocean, without helm or guide^ he is tossed to and fro by every emotion or passion. Insanity assumes a variety of aspects, according to the cause or causes which have produced it, and the character and tempera- ment of the individual. Some are gay and seemingly happy; pleasing anticipations and feelings are continually flitting before them. They imagine themselves kings, or other great men, and assume all the importance of their supposed station. Some are de- lighted with flowers and gewgaws. Some, furious and revengeful; Menial Alienation. 13 while others, silent and moody, drag out a miserable existence of mental anguish. In one respect they are, however, (whatever may be their shades of difference,) alike, viz. they have an inco- herency of conception, and incongruous ideas on all, or some subject, which may be the cause of their malady. It has been believed by some, that the insane are all miserable, and that they resort to the various tricks which they exhibit, to drive away their terrible anguish of mind.* Of this I shall not pretend to judge. They are frequently seen laughing, screaming, and occu- pied in a variety of extravagancies. The insane are almost all particularly fond of ardent spirits and tobacco. I have seen ma- ny who were previously silent and gloomy, become lively and loquacious as soon as tobacco was given them, or they were pro- mised ardent spirits. We will, in the progress of our inquries, discover, that the insane are suspicious, cunning, alive to injury,, and quick in avenging it. The physical peculiarities of the insane are, great torpor of the alimentary canal, arising, no doubt, from the atony of the chylo- poetic viscera, produced, probably, by a primary derangement of the appropriate nerves of these viscera. It frequently requires large doses of medicine to produce an action. The skin is gene- rally swarthy and dry. Dr. Haslani has remarked, that of two hundred and sixty-five patients under his care, two hundred and five were swarthy, with black hair; the remaining sixty wTere fair skin and light brown or red haired. The arterial action is gene- rally increased, and Dr. Rush tells us, that the secretion of the nose is stopped. Two thirds of the maniacs in the Pennsylvania Hospital exhibited this peculiarity. Insanity is divided into various grades, which shall be separ- ately explained. Mania.—Maniacs have all the operations of the mind perverted; reason and judgment are overcome by the intense and powerful action of the passions. The sensual assumes the supremacy over the intellectual, and the depravities of'our nature are exhibited ia * " The tearing of clothes,"' says Dr. Rush," so common in this disease, was one of the instituted signs of deep distress among the Jews, and it was so, probably, from its being one of its natural signs among the nations of tlfb East. The hallooing, the stam'ping with the feet, and the rattling of chains, so frequently practised by mad people, are all tesorted to, in order to excite such counter impressions upon their ears, as shall suspend or overcome, by their force, the anguish of their minds. They wound and mangle their bodies for the same purpose. Even in those solitary cases of general madness, which are accompanied with singing and laughter, there is good reason (o believe the heart is depressed with sadness. Nor are the silence and seeming apathy of manalgia, always signs of the absence of misery. ' The willow weeps,' says the poet, * but cannot feel; the torpid maniac feels, but cannot weep.' [ have heard one insane person, who had recovered, declare his suffering's and apprehensions from imaginary evils, were infinitely greater than any real evils could possibly have made him." u Observations &; their most degrading and appalling forms. Tiiose who, wh_-.u sane, are moral and religious, when maniacal, become blasphe- mous smd licentious ; at once evincing the loss of reason and'the domination of the passions. Maniacs are influenced by sudden alternations of feeling, which are always intense. Thus love, hate, revenge, are pourtraycd in all their ardour, or all their horrors. The countenances of maniacs strongly denote their malady. Their eyes, which are the first of the organs of sense that give evidence of the approaching paroxysm, suddenly kindle up, be- come wild, penetrating, and flash with fury; an index of the terri- ble emotions and passions which are raging within. The whole of the organs of sense seem to be perverted ; they appear to be unaffected by the most violent noise or offensive effluvia, and are inattentive, generally, to external impressions ; their appetites and tastes are completely vitiated ; they seem indifferent to hun- ger or cold, and their long watchfulness, at times, almost exceeds credibility ; every thing seems engulphed in the raging fury of the passions. The whole of these symptoms are not observable in every maniac. Melancholia.—Here the unhappy victim, the object of pity, and the solemn and feeling lesson of self-humiliation to all of us, how- ever strong or clear our intellects, exhibits signs diametrically opposite. The melancholic is generally silent and abstracted, dreading the vengeance of mankind, and believing the whole or a portion of his fellow beings arrayed against him. Instead of committing aggressions, he is fearful of aggressions ; and if ever he becomes an aggressor, it is under the influence of the hallu- cination that he was acting in self-defence against an attack. In this manner the melancholic madman is extremely dangerous, and whenever his mind is impressed with the idea of oppression from some particular individual, however apparently calm in other respects, he should be carefully watched. This class of insane persons frequently conduct themselves so well as to induce us to believe them sane, when they are far from being so. The cessation or diminution of the paroxysm has been, by many, aalled a lucid interval, a term which we will have, in another place, to consider. The melancholic has his attention principally directed to things of the world, and is generally fearful of a conspiracy against him- self; he is, therefore, extremely suspicious, and questions the character and motives of every one. He is a greater enemy to himself than his fellow beings, but believes them to be his ene- mies, and the cause of his distress. Hence these unfortunate beings frequently commit suicide under the apprehension of po- verty, or being the objects of revenge or hate. The following case, given by the brother of the person affected, well illustrates thi? Mental Alienation. 15 disorder.* u My poor brother," says the writer, '• seems to have fallen a victim to a morbidly keen sensibility, aggravated by dis- appointments. The natural delicacy of his own feelings had created in him the tenderest regard for those of others ; indeed, he would not have injured the meanest reptile. In all his trans- actions he was scrupulously conscientious, and as the superin- tendant of an extensive manufacturing concern, he had displayed great intelligence, mental energy and activity. The few hours which he could snatch from business, were devoted to literature, philosophy, and science, especially mathematical science, and metaphysics. Being on a visit to London, some years before his death, he complained, severely, of having experienced neg- lect from those who ought to have been his friends, and rpoke of private enemies; but no irrational sentiment escaped him, except, perhaps, his avowal, that having been all his life incredulous on the subject of supernatural appearances, he at last fully believed, from occular demonstration, in evil spirits and apparitions. On his return to the metropolis, two years afterwards, he strongly and anxiously asserted the existence of a foul conspiracy, exten- sively ramified, against his reputation and happiness ; almost every person with whom he had the least intercourse was a con- spirator, and even the passengers" in the street were agents or abettors. He could not enter a house without meeting a foe ; and at all hours of the day and night he was annoyed in his apartments, which he was obliged to change seven or eight times in the course of a few months. He had frequent quarrels with strangers, who were constantly assailing him, as he fancied, with taunting gestures and language. His character, conduct and motives were so malignantly impugned, that he found it expedient to show his own sense of his integrity, by adopting the motto— 'Mens conscia recti,1 and having it engraved on his seal. If he proposed an excursion to any part of the environs of London, he wras compelled to relinquish his design in consequence of his in- defatigable persecutors having become acquainted with his inten- tion ; and from every place-of public resort he was debarred by their malicious interference. He expressed a desire to consult the late Dr. Colquhoun, the magistrate, and Sir Samuel Romilly, as men of virtue and discernment; but finding the odium against him to have assumed a national character, he secretly embarked for America! So little apparent was his malady, that he obtained a respectable situation in New York. Thither, however, he was pursued by the i gang,' the ' infernal crew,' and he re-crossed the Atlantic and returned to----shire, where, in 1820, nature sunk exhausted, according to his own prediction, that his case must terminate fatally. During the whole progress of his disease, his * See Dr. Gordon Smith's work on Forensic Medicine, 16 Observations On reasoning faculties remained unimpaired. He conversed agree* ably on a variety of subjects; and could argue ingeniously, for- cibly and correctly. With reference to himself, ivhile he admit- ted the improbability of such a system of persecution, a priori, he maintained the impossibility of resisting the strongest of all evidence, that of the-senses. .' What I sec and hear must be true.1" In this case Ave see how an illusion can overcome all other operations of the mind, although strong. Another instance of melancholia was in the celebrated poet Cowper: some of whose poems exhibit the most exquisite specimens of the ludicrous in human nature, and abound in wit and satire. Yet the author of "John Gilpin," and "The Task," was an unhappy victim of melancholia, and was, at times, completely deranged. Hypochondriasm.—This disorder is very apt to be confounded with melancholia ; a mistake resulting from which might be of the most serious consequence : for, to act towards a hypochondriac as if he were a melancholic, might so exasperate him as to pro- puce that disorder; the transition from the one to the other not being so uncommon. I shall, therefore, give the distinctive cha- racteristics of these affections of the mind. In melancholia the mind is always directed to, and employed in the objects of the world ; such as property, or dread of the ani- mosities of others, (as has been already shown,) and the physical health or convenience is disregarded and neglected. In hypo- chondria, on the other hand, the, mind is always resting on the physical derangements of the system, and is inattentive to, and regardless of the cares and anxieties of the wrorld. The melan- cholic dreads—the hypochondriac despises the world. The me- lancholic frequently seeks self-destruction ; the hypochondriac always self-preservation. These distinctive marks I conceive important to be borne in mind. Hypochondriacs, although performing the ordinary duties of life exceedingly well, and sometimes exercising most important and responsible duties, have notions and conceits most strange, and sometimes most ludicrous. Some imagine themselves tea- pots, glass bottles, clocks, &c. &c. and similar ridiculous notions have got a temporary mastery over them, although the operations of the mind are otherwise strong, and the powers of ratiocination perfectly clear and comprehensive. What is singular, it most frequently happens that the most learned and intelligent are af- fected with this grievous disorder. A very learned man fancied himself a grain of corn, and was afraid the fowls or hogs would pick him up; yet, while labouring under this miserable delusion, he would discuss an abstruse question of metaphysics with force and perspicuity. Another fancied himself a clock, and made his arm the pendulum, and continued keeping time. Others have fancied themselves bottles, and were afraid to sit down, lest they Mental Alienation. 17 should be crushed to pieces. All of these persons complain of being in bad bodily health, and are always using remedial agents. Their seeming health and strength of intellect associated with such absurd notions and conduct, excite, most generally, contempt and ridicule; but they are more frequently deserving our sympa- thy, for their conceits carry with them a misery almost insupport- able ; and independent of this, they are always suffering under a derangement of the digestive organs, which, although not suffi- ciently extensive to prevent the ordinary actions of the system . from going on, is yet sufficient to produce much inconvenience and much misery. Nothing is more apt to injure the temper or affect the mind, than the deranged state of the digestive organs; and there are more cases of this disorder than is generally imag- ined. The symptoms are frequently obscure, and the effects of this disorder are constantly mistaken for other affections. I shall close my remarks on hypochondriasis with the following obser- vations of Dr. Cullen. "Hypochondriasis I would consider," says this great physician, " as always attended with dyspeptic symptoms ; and though there may be an anxious melancholic fear arising from the symptoms, yet while this fear is only a mistaken judgment with respect to the person's own health,'and to the danger from thence to be appre- and as distinct from the-proper melancholia; but when an anxious hended, I would still consider the disease as a hypochondriasis, fear and despondency arise from a mistaken judgment with res- oect to other circumstances than those of health; and more es- pecially when the person is at the same time without any dys- peptic symptoms, every one will readily allow this to be a disease widely different from either dyspepsia or hypochondriasis. Mono-mania.—This is where the mind is unsound on one par- ticular point, although the individual is rational on every other subject; for example, one man believed his soul was annihilated by the Almighty, and no power could save him from eternal ruin ; he wras yet, in other respects, well enough. Another man fan- cied himself Jesus Christ" A third believed he was to be crush- ed like Sampson, by the fall of the building he was in, which was prevented only by his placing his shoulder against the pillar, and nothing could induce him to quit his position until overcome by sleep. I knew a lady who fancied her relations had de- frauded her out of property, and. on this point was outrageous, although her suspicions were groundless, while, on all other matters, she was discreet and sensible. In the course of these inquiries, cases will be particularly introduced, evincing the diffi- culty of detecting this modified form of Insanity, when under judicial investigation, and how much perplexity itrhas created in a Court, to decide, as well as a physician to prove, the existence of mental malady; for persons of this kind, on other points, are is Observations on sometimes extremely rational, and it is'very difficult to detect the malady, unless the subject, upon which the mind is insane, be touched upon. • • Mono-mania is sometimes confounded with melancholia and hy- pochondriasis, the diflercnces between which I will endeavour to point out. 1st. Mania is a total hallucination on all subjects, or a total perversion of the intellectual faculties, accompanied with furor. 2d. Melancholia is a total or partial hallucination, accompanied with extreme dejection, fear, and false apprehensions. 3d. Mono-mania is a false reasoning or conception on one sub- ject, which, when it completely overcomes the other operations of the mind, produces either melancholia or mania, according tc the cause and the temperament of the individual. 4th. Hypochondriasm is a continued apprehension of the phy- sical health, regardless of worldly affairs, connected with dyspep- tic symptoms. It will here be seen, that there are regular series or grades, and from being affected at first by one, .an individual may ulti- mately be led through every stage. Thus, for example, the mind may be directed only to the physical health— hypochondriasm h the result. Accustomed to indulge in false notions and conceits on this point, the mind, from slight causes, may imperceptibly be led to reason falsely on matters disconnected Avith health : it then assumes the form of mono-mania. Indulging in these false rea- sonings, they ultimately become habitual; other operations of the mind, from want of proper exercise, become impaired, and the mind reasons falsely on all subjects, and assumes the character of melancholia or mania, according to the predisposition and tem- perament of the individual. This may, by some, be regarded an-- only an imaginary line of distinction; but any one accustomed to observe the operations of the mind, the facility with which it contracts a bias for certain subjects, and how quickly it becomes absorbed, will readily perceive the truth of the existence of this concatenation of affections. If Ave examine the insane, we will find many exhibit, according to circumstances, all the different traits which I have attempted to delineate. These distinctions are not only interesting in a metaphysical, but likewise important in a practical point of view. We are thus taught the necessity of guarding against indulging too-freely in one train of thought to the exclusion of others, and to endeavour to abstract those who do so indulge, before the particular thoughts become too firmly fixed, that the spell may be broken, and a free exercise of all the operations of the mind be given. It is particularly important for those Avho have the mind engaged in abstruse points, to occa- sionally relieve themselves by light reading, where much reflec- tion is not necessary ; and on the other hand for those who-in- Mental Alienation. 1£ dulge too freely the imagination, to direct the mind occasionally to subjects which Avill bring into play the judgment and poAvers of ratiocination. Thus philosophers and reasoners of all kinds ■would find it much to their advantage if they would indulge more freely in reading, in place of despising, Avorks of the imagination ; and the poet would be a better or more judicious and influential character even in his own department, if he Avere made frequent- ly to restrain his fancy and become more intimately acquainted Avith the realities of existence. In truth of this assertion Ave have, but to recur to the lives of poets, and, as a general rule, (for ex- ceptions there certainly are,) those avIio have Avritten the ablest and sublimest productions will be found to have had the fewest eccentricities, and were able to reason on other subjects with force and precision. Having thus endeaA-oured to describe the various grades of in- sanity which ha>e a relation to each other, we will now con- sider the causes of insanity, deferring the consideration of some other species of insanity .to another place. Causes of Insanity.—The causes of insanity depend very much upon the predisposition and temperament of the indiA'idual; for Ave continually perceive the same causes applied to different in- diA'iduals, and producing different effects on each. Ardent spirits, for example, exhibits in different individuals very different effects. Exciting in some mania, in others mania a potu. Others again have apoplexy, and others Avaste aAvay until the Avhole excitabil- ity of the system is exhausted, and death ensues. The same thing is observable in other cases. Thus disappointments in love make the ardent or sanguine mad, Avhile the phlegmatic is unin- fluenced by its fascinating allurements. The loss of property and the dread of poverty will create in the phlegmatic despondency and melancholic madness, Avhile tha sanguine is regardless of its stings; but disappointments in his love Avill produce maniacal fu- ry. To illustrate this matter, let us contrast the general charac- teristics of the French and English people, without meaning any thing offensive tq either. The Englishman indulges his appetite, drinks his porter and port Avine, and becomes torpid and phlegmatic. He is distant in his manners, cautious in his friendships, suspicious in his charac- ter, Avrapped up in himself, and full of his own dignity and im- portance. His happiness is, therefore, principally dependent upon self-indulgence and the degree of consequence which he holds among his felloAV creatures. Whatever will product these will make him happy, and. as they are diminished, so is his happiness : he has few individual sources of amusement, and, generally speak- ing, Avould prefer the fear and respect rather than the love of his fellow beings; he is, therefore, the child of circumstances, and be- comes the sport of fortune. So long as he is fortunate and pros- 20 Observations on perousj it is well; but Avhen misfortune assails him, a slave to public opinion, he dreads the change in public estimation ; he shrinks from public gaze, desponds, falls into profound melan- choly, and, perhaps, destroys himself. The Frenchman, on the other hand, is familiar, talkative; a true disciple of the Epicurean philosophy of grasping the plea- sures of the present day. In prosperity or adversity, equally gay, he laughs at the fitful changes of fortune, and adapts his habit of life to his change of situation. He lives on light food, di inks light Avines, seldom or never gorges himself; he has, consequently, an elasticity of system and liveliness of manner. His constant study is to please and be pleased, and, the child of flattery, applause he seeks, no matter Avhat the circle into Avhich he is thrown. His imagination is as gay as the Englishman's is sombre. Love or eclat are his predominating feelings, and the slight of his mistress, or a failure in any pursuit after glory, may cause- him to bloAV his brains out or become raving mad. The English are a reflective, reasoning people. The French, observing, quick, of great practical tact, and full of imagination. Hence, the one is more generally seized with melancholia, the other with mania. Having made these general remarks as illustrative of what may be regarded as the predisponent traits of madness, we Avill noAv consider the various causes of insanity. Insanity may be produced either by physical or mqral causes. Physical Causes.—These may either be from an organic de- rangement of the brain, such as an abscess, inflammation of the brain or its tunics, depression of bone, nodes, &c. &.c. or from a transfer of vascular determination to the brain, from an obstruc- tion of some important organ, as a deficiency of biliary secretion, the obstruction of the menses, repelled eruptions, &c. &c. Men- tal derangement sometimes takes place during gestation and after parturition. Hoav these causes produce insanity in some and not in others, has already been attempted to be explained as de- pendent upon predisposition. The cause, Avhich seems to act as powerfully as any, is the habitual use of ardent spirits—especially by those of a sanguine temperament; this acts in tAvo Avays, by diminishing the excitability of the system, and by increasing vas- cular determination to the brain. It causes madness as well as mania a potu, a disease Avhich Ave will hereafter consider. Moral Causes.—Whatever poAverfully excites the emotions or passions, such as love, revenge, hate,-grief, joy, ambition, ava- rice, may be considered as a moral cause of Insanity. It may be said, that all cases of Mental Alienation, from moral causes, are the effects of the over-excitement of the imagination, or indul- gence of the passions at the expense of judgment and sound dis- cretion. Thus the enthusiastic, rash, or impetuous are, more or Mental Alienation. 21 less, predisposed to insanity. Terrible convulsions in a country, aAvakening prodigious excitements, create insanity, as was exem- plified in France; and failures in great speculations, causing a sudden change in the fortunes and expectations of individuals, as is exemplified in large commercial cities. The disappoint- ments of ambition, the loss of fortune, the check or overthrow of inordinate pride, exciting the contumely, rather than the sympa- thy of mankind, the neglects of love, the jarrings and collisions of life have all brought victims to this awful malady. It may be questioned, Avhether the exercise of the reasoning poAvers, Avhere the imagination has little concern, has eArer been the cause of insanity. 'The natural philosopher, the mathemati- cian, the logician have eccentricities and peculiar abstractions of mind, but seldom become insane ; Avhile, on the other hand, such as direct the mind to subjects giving great exercise to the imagi- nation, such as romance Avriters and readers of romance, poets, and enthusiasts of all kinds, are not unfrequently subjects of in- sanity.* Proximate Cause.—Upon this subject I shall not pretend to say much. Dr. Rush gives the folloAving as those Avhich have been offered: viz.—1st. The derangement of the liver. 2d. The disease of the spleen. 3d. The inflammation of the intestines and peritoneal coats. 4th. The disease of the nerves. 5th. The operation of the mind alone. To all of these he objects, and main- tains that u the cause of madness is seated primarily in the blood vessels of the brain, and it depends upon the same kind of mor- bid and irregular actiqns that constitute other arterial diseases." We find, however, sometimes, these vas#cylar derangements when the mind is not materially affected. I shall not, however, stop to reason on this subject, as no possible Avell ascertained result can be obtained; the inquiry, therefore, would be idle. Opin- ions upon the proximate cause of any thing are always discrepant, they being indefinite. In this case, if it be the " morbus ipse," then all may be right; if not, Ave will be only contending with a chimera. Pathology.—Morbid anatomy has not throAvn.much light upon the nature of this disorder. The vessels of the brain and nerves are generally found turgid ; sometimes the ventricles have had se- * The following facts are taken from Dr Rush's work on the diseases of the mind Of 113 patients in the Bicetre Hospital, in France, that were examined by Mr. Pinel, 34 were from domestic misfortunes, 24 from disappointments in love, 30 from the horrors of the French Revolution, 25 from fanaticism Of ufty maniacs in the Philadelphia Asylum, in April, 1812, 7 were from disap- pointments, chiefly love, 7 from grief, 7 from loss of property, 5 from errone- ous opinions in religion, 2 from jealousy, 1 from terror, 1 from an injury to the head, 2 from repellent eruptions, 5 :rom intemperance, 2 from onanism, 2 from pregnancy, and 1 from lever—Making in all, 34 from mental, and IP from corporeal diseases. Observations on rous fluid. The appropriate tunics of the brain and skull have been usually found vascular; and Dr. Haslam has said, that air is frequently found in the pia mater. Hunter, Morgagni, and Bail- lie, have found the brain of maniacs to be hard and tough in con- sistency. Bonetus declared it to be so tough and hard as almost to be rubbed into a poAvder. But it has been very justly remark- ed by a celebrated writer, that these appearances have been ob- served in those who neyer exhibited any evidence of Mental Alienation.* Treatment of insane persons.—Tne character of this essay will not permit my saying much on this subject, and I confess, my in- dividual experience has been too limited to pretend to add any thing to Avhat is already known. I shall, therefore, briefly state the general means. There are two points of vieAv in Avhich the treatment of insane persons is to be considered: 1st. As regards the Moral, and 2d. the Medical. The Moral.—The method of treatment as once adopted towards insane persons, was one of the foulest stigmas on the character of the human race. These unhappy creatures, suffering under the most excruciating tortures of the mind, and deprived of the noblest prerogative of their nature, had these afflicting dispensa- tions of Providence converted into crime—for, to add to their al- ready intolerable sufferings, scourges, abuse, dreary dungeons, nay, every thing that could create terror and degradation were practised. Hence, it was seldom the lot of one of these unhappy creatures to be removed from their dungeons until by death. It was supposed^ and it Av^a cruel and fatal error, that the insane Avere insusceptible of feeling; they feel an injury as quickly as any one, and soon distinguish betAveen kindness and cruelty, as is thus exemplified. The following are the Avords of a maniac Avhile giving an ac- count of the reasons for destroying his keeper : " The man whom I stabbed richly deserved it. He behaved to me Avith great vio- lence and cruelty; he degraded my nature as a human being; he tied me doAvn, hand-cuffed me; and confined my hands much higher than my head, with a leathern thong; he stretched me on a bed of torture. After some days he released me. I gave him warning, for I told his wife I would have justice of him. On her communicating this to him, he came to me in a furious passion, threAV me down, dragged me through the front yard, thumped me on my breast? and confined me in a dark and damp cell. Not ~ Upon this subject the reader will find a body of facts, highly interesting and valuable, in the appendix to the second volume of Dr. Crighton's work on Mental Derangement; it will there be seen, that the hardness and friability of the btain is denied and although the different states of the brain are observa* ble in many cases, they are nearly as frequently wanting. Mental Alienation. . 23 liking this situation, I was induced to play the hypocrite. I pre- tended extreme sorroAV for having threatened him, and by an af- fectation of repentance, prevailed on him to release me. For several days I paid him great attention, and lent him every as- sistance. He seemed much pleased Avifh the flattery, and became very friendly in his behaviour towards me. Going one day into the kitchen, Avhere his wife Avas busied, I saw a knife; this Avas too great a temptation to be resisted; I concealed it and carried it about me. For some time afterwards, the same friendly inter- course Avas maintained between us, but as he Avas one day unlock- ing his garden door, I seized the opportunity, and plunged the knife up to the hilt in his back.1'' This case should act as a Avarning to those keepers Avho are desirous of exercising the authority re- posed in them, with unnecessary severity; and it is an opprobri- um indeed on human nature, that there are individuals who insult the already lacerated feelings of the insane. The change, however, Avhiclvhas taken place Avithin less than half a century in the regulation of the insane, is one of the noblest trophies of medical science and improvement. They are now treated with kindness and humanity, their disposition and the causes -of their insanity inquired into, and every indulgence, con- sistent with their situation and safety, is granted. In well regu- lated Lunatic AsylumsJ the individuals are treated exactly as they Avere accustomed to Avhen sane, that they may be as little as pos- sible sensible of their change of condition. They are allowed various amusements, Avhich are calculated to soothe and divert the mind from the cause of sorrow. Firmness of conduct, and a pro- per authority, is ahvays exercised by the keeper; but violence or unnecessary exercise of authority is condemned. The man Avho has the charge of the insane should have a mild, firm, and equa- ble temper, with a good heart. Such a one Avill soothe the an- guished mind, and recall reason to its appropriate exercise. But the violent and authoritative will be likely to fix the malady more deeply; and, therefore, should at once be dismissed from a duty so important and responsible. To accomplish the cure of persons Avhose insanity arises aa hol- ly from the mind, it will be necessary to find out the cause. If the cause be imaginary or unattainable, Ave must endeavour to di- vert the mind by directing it to other thoughts—that new impres- sions and ideas may be formed, and the old ones be Aveakened, and ultimately made harmless. Whenever the condition and pe- cuniary means of the individual will admit, it Avould always be adviseable to remove him from the scene of his sorrows, (for the smallest object may, by association, reneAV the cause, and repro- duce the malady,) where neAV scenes and objects may attract at- tention, and all that has hitherto transpired be cast into oblivion. 24 Observations on For this purpose, it Avould be Avell to travel whenever practicable, and this would be serviceable, not only to the moral, but likewise to the physical health. There are cases where persons have become insane from con- tinually pursuing one course of studies or train of thought, to the exclusion of others. Under such circumstances the mind should be as much as possible abstracted from these, by introducing sub- jects of a different nature. We should, however, never attempt to speak slightingly of any subject, hoAvever absurd, which they may regard as important, for nothing is more jarring to minds so acutely and sensitively Avrought up. But Ave should seem to sym- pathize Avith their sorroAvs, and seemingly admit the justness of their complaints, while, at the same time, Ave should make exer- tions to call the mind to other matters disconnected Avith their malady. It has been said that CoAvper, Avhen suffering under his profound melancholy, could not endure his satirical pieces. Light music, Ave knoAv, is jarring to the mind afflicted Avith grief, as solemn dirges to merriment. Any thing Avhich has the sem- blance of contempt for the opinions of those under a morbid delu- sion must be excessively painful. • "I cannot," says the humane and eloquent Rush, "conclude this part of the subject of these inquiries, Avithout lamenting the want of some person of prudence and intelligence in all public re- ceptacles of mad people, Avho should live constantly Avith them, and have the exclusive direction of "their minds. His business should be to divert them from conversing upon all the subjects upon which they had been deranged,- to tell them pleasant stories, to read them select passages from entertaining books, and to oblige them to read to him; .to superintend their labours of body and mind; to preside at the table at Avhich they take their meals; to protect them from rudeness and insults from their keepers; to walk and ride with them; to partake Avith them in their amuse- ments ; to regulate the nature and measure of their punishments. Such a person would do more good to mad people in one month, than the visits, or the accidental company of the patient's friends would do in a year. But further, Ave naturally imitate the manners of persons. Avith whom Ave live, provided they are objects of our respect and affection. This has been observed in husbands and wives who have lived long and happily together, and even in ser- vants who are strongly attached to their masters and mistresses. Similar effects might be expected from the constant presence of a person, such as has been described, Avith mad people, indepen- dently of his performing for them any of the duties that have been mentioned. We render a limb that has been broken or bent, straight, only by keeping it in one place by the pressure of splints and bandages. In like manner, by keeping the eyes and ears of Mental Alienation. 25 mad people under the constant impressions of the countenance, gestures, and Conversation of a man of a sound understanding and correct conduct, Ave should create a pressure nearly as me- chanical upon their minds, that could not fail of having a poAver- ful influence, in conjunction with other remedies, in bringing their shattered and crooked thoughts into their original and natural or- der." Medical Treatment.—The general indication is to lessen vas- cular action or determination, if existing, which is done by gene- ral or topical bleeding, and then to restore' the organs to their appropriate and healthful functions; for this purpose alteratives are prescribed. Calomel is more generally used than any other alterative; in many cases, however, it will make but a slight im- pression ; the combination of Tartar Emetic will occasionally be found useful; the Tartar Emetic given in divided doses I have seen prove salutary, although, I must confess, it must be used with great caution and circumspection. In several cases, and one case in particular, of long standing and severity, where Calo- mel had no influence, I used the Tartar with evident adATantage; a grain Avas given every hour, until tAventy-four grains Avere taken, Avhen the liver began to secrete freely, pouring forth dark inspis- sated bile in the first instance ; she was then given cathartic me- dicine, Avhich carried off a considerable quantity of bile. The Tartar was again resumed at more distant intervals, giving occa- sionally a catharsis, until the cure Avas completed. It becomes me, hoAvever, to state, that in tAvo cases Avhere I gave Tartar it proved injurious ; but, I am firmly persuaded, from the unneces- sary exposure of the insane, and my not being able to see them as often as I wished. These two cases Avere very desperate, and given up as hopeless. Tartar Emetic acts in many Avays : it equalizes vascular action, increases the secretion of the liver, as Avell as other organs, such as the slqn, kidneys, &c. and produ- ces, if I may so express myself, a diverticulum from the brain. The cold bath, both by affusion and immersion, has been recom- mended, and, I have no doubt, in many cases, would prove a valuable adjuvant. The shock upon the system might, proba- bly, be of advantage in arousing the nervous energy. Sudden shocks have been attempted, in some instances, Avith success.* I will now briefly consider some other specie3 of Insanity, which arise from particular and known causes. *When the King of England, George III was insane, Dr Willis tried what sudden fear would do ; he informed his majesty that he was bribed by Napo- leon, the bugbear of the unfortunate monarch, to destroy him, and, says Dr. Willis, here goes, and pushed him into the water, when some persons, ordered to be near, took him out. This plan broke the paroxysm, but the king could never bear Dr. Willis I have somewhere read of the following plan being proposed for the cure of the king : to place his body in warm water, and dash cold water on his head. 4 :26 Observations on Nostalgia.—:This is a species of insanity excited in those who are absent from their home and country, and assumes the character of melancholic despondency. Persons living in Avild, romantic, mountainous countries are liable to it. The SAviss people are remarkable instances : Swiss soldiers have been knoAvn to pine aAvay, without any apparent assignable cause; but as soon as promised to be returned to their native country, have speedily revived. Nympho-mania.—This is a disease peculiar to females, arising from some irritation and excitement of the genital organs. The cause, by some, has been supposed to be an affection of the cli- toris, which has been cut off, and the patient has been said to have recovered; and in some, in the uterus, and hence it has been sometimes called uterinus furor. In this disease the patient loses all control over her passions, and commits the most open and dis- gusting infringements upon decency. The sight of a man moA-es her passions, and she rushes with uncontrollable ardour toAvards him. The moral power is completely overdone by the passions. The excessive and open violation of all decency by Elizabeth* and Catharine of Russia, questionless arose from this disease, for they were otherwise possessed of strong minds and reigned with credit to themselves. They had an opportunity, (from their sta- tions not being restrained by the rules of society,) of indulging their appetites, and they would, no doubt, if restrained, have be- come raving mad. It is well known that their love and sentiment became subservient to their lust, and Elizabeth especially, cohab- ited with her most Arigorous grenadiers. I bring forward these cases as illustrative of a modified state of this disease, as I am per- suaded that they never, in their stations, would have thus tarnish- rd their fame, and suffered the moral to be so far subdued by the physical, if they were not suffering from diseased appetites. I shall not enter further into a consideration of this odious and degrading malady than to remark, that in many cases it is pro- duced from a privation after excessive and inordinate indulgence, in the same manner as fits succeed a cessation of stimulus, to those who have in that manner indulged, and that it is a species of madness as little under the control of the individual as any to which human nature is liable. Mania a Potu.—This malady is the effect of an inordinate use of ardent spirits, and exhibits itself in two forms. In one there is increased vascular action as well as determination to the brain, together with great excitement. The individual is violent, bois- terous and furious, attempting to destroy every thing. The coun- tenance is indicative of rage and fury; the eyes are Avild, staring and projecting, and all the actions and expressions are demonstra- tive of strong phrenzy. Tn the uterus of Elizabeth tufts of hair, &x. were found. Mental Alienation. 27 The other species is where the disease supervenes the abstrac- tion of stimulus, and consequent deficiency of excitability. It is an admitted rule, that in proportion to the artificial stimuli taken Avill be the diminution of the excitability of the system, and in the ratio of the diminution of the excitability will be the quantity of stimuli required to sustain the system. When, therefore, in the case of drunkards, the artificial stimulus is withdrawn, the nervous energy and poAver is lost. The individual has a general trembling over him; all his senses lose their accustomed actions ; mists are constantly before him, and he frequently imagines he sees objects flitting by him, especially insects. Persons thus af- fected are always under dreadful apprehensions of punishment for supposed crimes, thereby evincing in the strongest manner the terrible evils of their imprudence. I knoAv no sight more painful, or more solemn and admonitory, than that of an individual suffer- ing Avith this species of mania a potu. One patient under my care believed that a guard was in Avaiting to carry him to prison, and from thence to execution. Under this hallucination, when his at- tendant left the room, he seized a razor from his draAver, which he brandished around, declaring that he would kill the first person Avho should seize him. While thus engaged his attendant came down, he cut her across the eye, and Avhen she retreated to call for aid, believing he Avould be overpowered, cut his own throat shockingly. On his recovery, I inquired of him if he remember- ed what he had done, and he said he had an imperfect recollec- tion of his being seized to be executed, and his attempt to defend himself, but no more. Another of my patients believed that he had taken an axe and cleaved the head of his mother in tAvain, and that a guard of sol- diers Avere in readiness to shoot him. The state of this man's mind Avas awful. His lamentations and horror at the act Avhich he supposed he committed, Avere most distressing, and while call- ing down vengeance upon his guilty head, he Avould continually dodge from the supposed aim of the soldiers. This class of in- sane labour under a variety of hallucinations, and the disease is denominated by drunkards the "horrors." It would not be proper to enter into minute details of the treat- ment, but a general view, derivable from my personal observation, may not be amiss. There is great discrepancy in the treatment of this disorder, which has originated from not distinguishing be- tween that species of mania a potit Avhich arises from increased, and that which arises from diminished excitement. The use of the lancet has been, under any circumstances, condemned by ma- ny physicians; but where there is great arterial action towards the brain, and general excitement evinced by strong and forcible pul- sations of the carotid and temporal arteries, inflamed and Avild staring eyes, accompanied Avith great muscular strength, I have 28 Observations on never hesitated to resort to general bleeding fir^t, ami generally Avith marked effect. After this, I have given nauseating doses of tartar emetic, which equalizes vascular motion, sometimes acts as an emetic, and always as an efficient cathartic. Having con- trolled the violent symptoms, I then resort to the alterative and tonic plan. Emetics have been strongly recommended in this disorder; but I have no hesitation in believing, that in many cases, they have proved fatal when used primarily, by causing a rupture of some of the blood vessels of the brain, these being in drunkards general- ly distended and Aveak. The cold bath has, in some cases, pro - ed highly beneficial, although it should be applied with caution. The nervous disease or horrors, requires a different treatment. Here the stimulating and alterative must at the same time be used, to keep up excitement on the one hand, and restore, on the other, the deranged functions of the different organs of the system. The stools are generally found of the consistency and appearance of pitch or tar, and the calomel or blue pill, Avith small doses of tar- tar emetic, must be used until these evacuations change to that co- lour Avhich evinces a healthy biliary secretion. While applying this Ave must allow the patient sorhe stimulus, or he will inevitably sink. Sinapisms applied to the pracordia and extremities, and other external excitants, would be found useful. Opium, a reme- dy frequently applied to overcome the continued Avatchfulness, one of the most distressing symptoms, although generally used, has been, in my hands, unsatisfactory; nay, I have seen it do in- jury, and therefore, I cannot recommend it; and the cold bath never should be applied unless there be a strong disposition to re- action, as the poAverful shock may othenvise, by its sedative ef- fects, produce extreme prostration or death. I cannot conclude this part of my subject Avithout adverting to the terrible devastations which are made upon the,human intellect by the use of ardent spirits, more fatal in its consequences than the SAvord of the conqueror or the scourge of pestilence. Men of ardent genius, refined sensibilities, cultivated intellects, as well as the labourer, if misfortunes assail them, too often fall under the scythe of this aAvful destroyer. Its melancholy and destructive influence is every where seen in squalid rags, and the degrada- tion and ruin of respectable families. This monster, going forth conquering and to conquer, must be resisted by powerful, ener- getic, uncompromising efforts. The law considers a crime committed during inebriation as an aggravation, because the individual, knowingly and voluntarily, brings himself into that state Avhich impelled him to commit crime; but confirmed drunkards have no more power of resisting the in- toxicating draught than the madman in committing violence Avhen under the influence of his malady. The laAv, therefore, it doe* Mental Alienation. 29 appear to me, ought to extend further, and regard all, who are proved as confirmed drunkards, as disfranchised of those rights which the insane are deprived of.* Idiotism.—On this subject I have not much to say. The idiot is deprived of all reason, and the whole of his sentient principles are Aveak and depraved. The countenance is vacant, oftentimes distorted, accompanied Avith an unmeaning smile or titter. The saliva slobbers from the mouth ; the limbs hang carelessly dang- ling ; in short, the whole physical as well as moral system is in a morbid state. Idiots are usually innocent and inoffensive, and are more sinned against than sinning ; and the law regards them with charity and commiseration. They are alloAved to go at large, although their property is placed in the hands of trustees. A Avill made by them, or a marriage contracted, is considered nail and void ; inasmuch, as they are incapable, of their OAvn free will, of performing either of these contracts. To constitute an idiot in the law, an individual must be incapable of performing or under- standing the simplest duties of life. Idiotism is either congenital or occurs in after life. Those which are congenital arise from malconformation in the parents, bad diet and clothing, and from disease. In those countries where goitre abounds, idiots are numerous. I have no doubt, that frequent intermarriages in families produce this disorder; there can be little question that, eventually, it impairs the physical and intellectual poAvers. All animal and vegetable creation, it is ad- mitted as a law of nature, deteriorate from the Avant of change in the seed of the plant, or breed of the animal, and Avhy not the same in man ? The other species of idiotism has been termed fatuity by some, and by others dementia. This is produced sometimes from long continued nervous fever, or any cause Avhich will destroy the ex- citability or sensorial power (as it has been severally called) of the system. Most frequently it arises from a gradual decay of na- ture, when as Shakspeare expresses it, there is " sans teeth, sans eyes, sans taste, sans every thing." To decide upon the actual state of dementia has, and will always produce much embarrass- ment to a Court. The most frequent cause of litigation is in wills; for old persons generally become extremely capricious, and jealous of attentions, and the artful and designing, by insinuating themselves into their good graces, excite in them prejudices * That there are some laws on this subject, I am fully aware ; but the exe- cution of them is so little attended to, as to make them almost obsolete. The moral sense of the community is not sufficiently strong against this vice, as is too often exemplified in the appointment of intemperate persons, although not absolute drunkards, to offices of trust, and the reluctance which is felt of dis- missing them upon such a plea. The feeling of pity often retains an intem- perate man in office. 30 Observations on against their friends and relatives, and become themselves the ini- quitous heirs of the property by the will of the individual. Cases of this kind more frequently occur in that stage of existence, Avhich Shakspeare has thus most accurately described : " The sixth age shifts Into the lean and slipper'd pantaloon ; With spectacles on nose, and pouch on side ; His youthful hose well saved, a world too wide For his shrunk shank ; and his big manly voice, Turning again towards childish treble, pipes And whistles in his sound." In conclusion, I Avill bring forward some late decisions oA'er- turning the former opinion, that the Deaf and Dumb were to be considered as Lunatics, and not amenable to a country for any violation of its laAvs. A case of this kind came on in the High Court of Edinburgh; the individual was Jean Campbell. This individual was deaf and dumb, and was accused of having throAvn her child over a bridge and drowned it. The judges delivered their opiuions at considerable length. Lord Hermand was of opinion that the prisoner was not a fit object for trial. She was deaf and dumb from her infancy, had had no instructions what- ever, was unable to give information to her counsel, to commu- nicate the names of her exculpating witnesses, if she had any, and was unable to plead to the indictments in any manner, except by certain signs, which he considered, in point of law, no pleading Avhatever. Lords Justices Clerk, Gillies, Pitmilly, and Preston, Avere of a different opinion. From the evidence of Mr. Kinningburg and Mr. Wood, (gentlemen connected Avith the deaf and dumb insti- tutions,) they were of opinion, that the panel Avas " doli capax quoad," the actual crime she was charged with. It was true, this was a new case in Scotland, but in England a case of similar na- ture had occurred. One Jones was arraigned at the Old Bailey, in 1773, for stealing five guineas. He appeared to be deaf and dumb; a jury was impannelled to try whether he Avilfully stood mute, or from the visitation of God. They returned a verdict " from the visitation of God ;" and it having appeared, that the prisoner had been in the use of holding conversation by means of signs with a woman of the name of Fanny Lazarus, she was sworn an interpreter. He was tried, convicted, and transported. In the present case the panel had described to Mr. Kinningburg, most minutely, the manner in which the accident had happened to her child, and from the indignant way she rejected the asser- tion that she had throAvn it over the bridge, it was evident she Avas sensible to murder it was a crime. It was also observed by Lord Reston, that it would be an act of justice towards the panel her- Mental Alienation. 31 self, co bring her to trial; for if the Court found she was a perfect nonentity, and could not be tried for crime, it folloAved as a na- tural consequence, that the unhappy Avoman would be confined for life ; Avhereas, if she Avas brought to trial, and it turned out the accident occurred in the way she described it, she would be immediately set at liberty. The Court found her a fit object of trial.* This is certainly highly interesting in a medico-legal view. Since the humane and successful exertions of the Abbe Sicard-, and others, in supplying this unhappy and afflicted class of our fel- iow beings Avith a communication with external objects and man- kind through the medium of signs, their condition and education has wonderfully progressed. They have, therefore, been made capable of estimating right and Avrong, and in all such cases the the decisions of a Court, I apprehend, Avould be similar to that just mentioned. I have thus given, as concisely and clearly as I could, the vari- ous degrees or characters of Mental Alienation, and will noAV consider, Secondly, The legal opinions on Mental Alienation, and the means of distinguishing between real and feigned, or partial Aliena- tion of mind. Upon this part of my subject, very little more can be expected than a transcript of the various legal decisions. It is truer I have presumed to question some decisions, but it is where I have been sustained by the doubts of high authority. That there are some, nay, many legal decisions in Medical Jurisprudence, at variance wTith medical experience, admits of no doubt; yet, the laAv decisions of men of erudition and profound reflection, after thorough investigation, should ahvays be cautiously interfered Avith, even on medical subjects. " A lunatic or non compos mentis," says Blackstone, " is one who hath had understanding, but by disease, grief, or other acci- dent, hath lost the use of his reason. A lunatic is, indeed, pro- perly one that hath lucid intervals; sometimes enjoying his sen- ses and sometimes not, and that frequently depending upon the change of the moon. Under the general name non compos mentis, which Sir Edward Coke says is the most legal name, are com- prised not only lunatics, but persons under phrenzies, or who lose their intellects by disease ; those who grow deaf and dumb and blind, not being born so, or such, in short, as are judged by the Court of Chancery incapable of conducting their own affairs." This definition is certainly very vague and indeterminate. In the first place it has been, and is doubted, whether the moon has any influence. This opinion, it appears to me, arose from the fact of * For a more particular account see Beck's Elements of Medical Jurispru- dence, from whence this is taken. 32 Observations on females becoming deranged from suppressed menses, and being excited at the period A\hen nature should be relieved of this onus. Of a lucid interval Ave shall, in another place, see that such a state is questioned. Of the remaining portion of the definition I apprehend any thing but a definite idea Avould be obtained. Lord Coke says, " Non compos mentis are of four sorts : 1st, The idiot, Avho, from his nativity, by a perpetual infirmity is- non com- pos mentis. 2dly, He, who by sickness, grief, or other accident, wholly loses his memory or understanding. 3dly, A lunatic, Avho has sometimes his understanding and sometimes not. AH quando, guadet lucet intervallis; and, therefore, he is called non compos men- tis so long as he hath no understanding." Sir Mathew Hale says, " There is a partial insanity and a to- tal insanitv ; the former is in respect to things quoad hoc vel Mud insanire. Some persons who have a competent use of reason in respect to some subjects, are yet under a particular dementia in respect to some particular discourses, subjects, or applications; or else it is partial in respect of degrees, and this is the condition of very many, especially melancholy persons, Avho, for the most part, discover their defects in excessive fears and griefs, and yet are not wholly destitute of the use of reason, and this partial in- sanity seems not to excuse them in the committing of any offence in its matter capital, for doubtless most persons that are felons of themselves, and others, are under a degree of partial insanity when they commit these offences. It is very difficult to define the invisible line that divides perfect and partial insanity, but it must rest upon circumstances duly to be weighed, and considered both by the judge and jury, lest, on the one side, there be a kind of inhumanity towards the defects of human nature, or, on the other, too great an indulgence given in great crimes." Sir Vicary Gibbes, as attorney general in the trial of Belling- ham for killing Mr. Perceval, remarks : " A man may be deranged in his mind, his intellects may be insufficient for enabling him to conduct the common affairs of life, such as disposing of his property, or judging of the claims Avhich his respective relations have upon him ; and if he be so, the ad- ministration of the country will take his affairs into their manage- ment, and appoint to him trustees; but at the same time such a man is not discharged from his responsibility for criminal acts. I say this upon the authority of the first sages in the country, and upon the authority of the established laAv at all times, which law has never been questioned, that although he be incapable of con- ducting his own affairs he may still be answerable for his crimi- nal acts, if he possess a mind capable of distinguishing right from wrong." In the same trial Lord Mansfield observed : " That there Avere various species of insanity, some human beings were void of all Mental Alienation. 33 power of reasoning from their birth, such could not be guilty of any crime. There Avas another species of madness in which per- sons Avere subject to temporary paroxysms, in which they were guilty of acts of extravagance, this Avas called lunacy. If these persons were to commit the crime when they Avere not affected Avith the malady they Avouldbe, to all intents and purposes, ame- nable to justice. So long as they could distinguish good from evil, so long Avould they be answerable for their conduct. There Avas a third species of insanity in Avhich the patient fancied the exis- tence of injury, and sought an opportunity of gratifying revenge by some hostile act. If such a person Avere capable, in other res- pects, of distinguishing right from wrong, there was no excuse for any act of atrocity which he might commit under this description of derangement." The line which Ave would have to draAv in this case, would be Aery delicate, for many madmen, as has been shewn, reason tol- erably Avell, and yet have no control over their actions. To pu- nish an individual, thus circumstanced, with death, would, indeed, be hard. It Avould be the punishment of misfortune, and not of crime. Sudden fits of passion, or eccentricities, or particular no- tions, founded on particular causes, are not to justify a violation of the laAv. Such for example, as killing a person because he op- posed a prevailing religion, as in the case of Ravaillaic, or the de- struction of any one who may be regarded as an enemy to the li- berties of a country; or under any circumstance where the indi- viduals are acting from a motive. There are many persons, as we have shewn, who, upon all but one point, are perfectly ration- al ; but when aroused upon tue particular point of their insanity, have no possible control over themselves. They are, indeed, suf- fering under the most terrible insanity; yet such persons, accord- ing to Lord Mansfield, would be amenable to justice as if they Avere not mad. It is true, that the decision on this point is ex- tremely delicate, that to use the view of Sir Mathew Hale, great crimes might thus go unpunished, and on the other hand the de- fects of humanity be hardly dealt with. To illustrate, therefore, this very important subject, I will cite several passages from the able speech of Lord Erskine, in the trial of Hadfield, for shooting at the King, a speech which should be read by every physician and laAvyer. " I really think, hoAvever," says his Lordship, " that the Attorney General and myself do not, in substance, very materially differ; because, from the Avhole of his most able speech, taken to- gether, his meaning may, I think, be thus collected : That where the act Avhich is criminal, is done under the dominion of malicious mischief and Avicked intention, although such insanity might exist in a corner of the mind, as might avoid the acts of the deiin- quent, as a lunatic, in a civil case, yet that he ought not to be pro- tected, if malicious mischief and not insanity had impelled him to 34 Observations on the act for which he Avas criminally to ansAver; because, in such a case, the act might be justly ascribed to malignant motives, and not to the dominion of disease. I am not disposed to dispute such a proposition in a case which Avould apply to it, and I can Avell conceive such cases may exist. The question, therefore, which you Avill have to try, is this : Avhether, Avhen this unhappy man discharged the pistol, in a direction which convinced, and ought to convince every person that it Avas pointed at the person of the King, he meditated mischief and violence against his majesty ; or whether he came to the theatre under the dominion of the most malignant insanity that ever degraded and overpowered the facul- ties of man." Again he says : " In every case of treason or murder, which are precisely the same, except that the unconsummated intention in the case of the King, is the same as the actual murder of a private man ; the jury must impute, when they condemn by their verdict, the motive Avhich constitutes the crime ; and your province to-day will, there- fore, be, to decide, whether the prisoner, Avhen he did the act, Avas under the uncontrollable dominion of insanity, and was im- pelled to it by a morbid delusion; or whether it Avas the act of a man, Avho, though occasionally mad, or even at the time not per- fectly collected, was yet not actuated by the disease, but by a wicked and malignant disposition." It will here be seen, that the legal conception of madness is believed to depend upon the mo- tives which may have led to crime ; and to illustrate this more fully and satisfactorily, the following long extract from this ad- mirable speech of Lord Erskiue is given. His Lordship, after bringing together all the evidence to prove Hadfield insane, thus addresses the Jury : " Gentlemen, these are the facts, freed from even the possibility of artifice or disguise ; because the testimony to support them will be beyond all doubt; and in contemplating the laAv of the coun- try and the precedents of its justice, to Avhich they must be applied, I find nothing to challenge or question; I approve of them through- out ; I subscribe to all that is Avritten by Lord Hale; I agree with all the authorities cited, by the Attorney General, from Lord Coke ; but, above all, I do most cordially agree in the instance of convictions in which he illustrated them in his able address. I have noAv lying before me the case of Earl Ferrers ; unquestion- ably there could not be a shadow of doubt, and none appears to have been entertained, of his guilt. I wish, indeed, nothing more than to contrast the tAvo cases ; and so far am I from disputing either the principle of that condemnation, or the evidence that was the foundation of it, that I invite you to examine, Avhether any tAvo instances, in the whole body of the criminal laAv, are more diametrically opposite to each other, than the case of Earl Ferrers and that now before you. Menial Alienation. 35 '*• Lord Ferrers was divorced from his Avife by act of parliament, and a person of the name of Johnson, Avho had been his steward, had taken part with the lady in that proceeding, and had conduct- ed the business in carrying the act through the two houses. Lord Ferrers, consequently, Avished to turn him out of a farm which he occupied under him ; but his estate being in trust, Johnson was supported by the trustees in his possession; there were also some differences respecting coal mines; and in consequence of both transactions, Lord Ferrers took up the most violent resentment against him. Let me here observe, gentlemen, that this was not a resentment founded upon any illusion ; not a resentment forced upon a disordered mind by fallacious images, but depending upon actual circumstances and real facts ; and acting like any other man under the influence of malignant passions, he repeatedly declared that he Avould be revenged on Mr. Johnson, particularly for the part he had taken in depriving him of a contract respecting the coal mines. " Noav, suppose Lord Ferrers could have shoAved that no dif- ference had ever existed regarding his wife at all; that Mr. John- sou had never been his steward, and that he had only from delu- sion, believed so, Avhen his situation in life Avas quite different. Suppose further, that an illusive imagination had alone suggested to him that he had been thwarted by Johnson in his contract for these coal mines; in short, that the Avhole basis of his enmity was Avithout any foundation in nature, and had been sIioavu to have been a morbid image, imperiously fastened upon his mind. Such a case as that would have exhibited a character of insanity in Lord Ferrers, extremely different from that in Avhich it Avas presented by the evidence to his peers. Before them he only ap- peared as a man of turbulent passions ; Avhose mind was disturb- ed by no fallacious images of things Avithout existence; Avhose quarrel with Johnson Avas founded upon no illusions upon existing facts, and Avhose resentment proceeded to the fatal consummation Avith all the ordinary indications of mischief and malice.". After giA'ing many other cases illustrative of Avhat should be considered as insanity in a legal point of view, his Lordship cites the following very strong and important case, Avith Avhich I shall terminate my quotations: " There Avas another instance in the case of a most unhappy woman, ay ho Avas tried in Essex, for the murder of Mr. Errington, who had seduced and abandoned her and the children she had born to him. It must be a consolation to those Avho prosecuted her, that she was acquitted, as she is at this time in a most un- doubted and deplorable state of insanity; but I confess, if I had been upon the jury, I should have entertained great doubt and dif- ficulties ; for although the unhappy Avoman had before exhibited strong marks of insanity, arising from grief and disappointment, 36 Observations on yet she acted upon facts and circumstances which hail an existence. and which were calculated, upon the ordinary principles of human action, to produce the most violent resentment. Mr. Errington having just cast her off, and married another woman, or taken her under his protection, her jealousy was excited to such a pitch, as occasionally to overpower her understanding; but, Avhen she Avent to Mr. Errington's house, Avhere she shot him, she went Avith the express and deliberate purpose of shooting him. That fact was unquestionable ; she Avent there with a resentment long rankling in her bosom, bott med on an existing foundation ; she did not act u.der a dehision, that he had deserted her when he had not, hut took revenge upon him for an actual desertion ; but still the jury, in the humane consideration of her sufferings, pronounced the in- sanity to be predominant over resentment, and they acquitted her."* It will thus be seen, that Lord Erskine conceived, (and the Court accorded Avith his Lordship,) that to prove a crime to have been committed under the influence of insanity, the act should have no reference to existing facts or previous actual injuries, but be the effect of imaginary wrongs, having no foundation in truth. The case, however, last mentioned, evinces strongly, that although an actual injury is received, the effect may be such as complete- ly to overcome the mind. The question, in such cases, Avill be, whether in the previous conduct, or in other matters, marks of derangement of intellect Avere exhibited by the individual; and whether the crime Avas committed during a terrible morbid excite- ment and alienation of mind, or under the influence of insatiable revenge. Such cases are particularly embarrassing and difficult of decision, and may, by careless decisions, open too wide a field for the gratification of private Avrongs and injuries. The difficul- ty of decision here, Avould be in cases of mania, accompanied with terrible excitements. In very many such cases the person rea- sons Avith extreme ingenuity, and with an indignant sense of wrong, f Having thus given the opinions of madness as adopted by the standard law Avriters, we will iioav sIioav how difficult it is some- times to detect madness. In ordinary cases, Avhere all the symp- toms are strongly and clearly delineated, the most common obser- ver can at once decide ; but these are not the cases which come before a Court or are questionable. It is in cases where the intel- lectual powers are misdirected, over excited, or but partially im- paired, that the question becomes embarrassing. In such cases the insane, under ordinary circumstances, speak and even act so rationally as to completely deceive us. They reason Avith force and perspicuity upon ordinary topics, and it is only Avhen the dis- * Cooper's Tracts on Medical Jurisprudence. t See a case in page 22 as exemplifying this. Mental Alienation. 37 eordant chord of their feeling is struck, that the malady is shown. Numberless cases of this kind are observable in Lunatic Asylums ; and many have come before civil tribunals Avhich have created embarrassments to the Court, the jury, and the physician called in to illustrate the matter. '• It is agreed by all jurists, and is es- tablished by the law of this and every other country," says the eloquent Lord Erskinc, " that it is the reason of man, which makes him accountable for his actions ; and that the deprivation of rea- son acquits him of crime. This principle is indisputable ; yet so fearfully and wonderfully are we made, so infinitely subtile is the spiritual part of our being, so difficult is it to trace with accuracy the effect ot' diseased intellect upon human action, that I may ap- peal to all Avho hear me, whether there are any causes more dif- ficult, or which, indeed, so often confound the learning of judges themselves, as Avhen insanity, or the effects and consequences of insanity, become the subjects of legal consideration and judg- ment." It is highly important, therefore, for me to consider this part of my inquiry particularly, and I shall make free Avith the cases that have been mentioned by our best Avriters, as the best means of illustrating this subject. It is mentioned by Lord Erskine, that he used every effort in vain, before a Court, to prove an individual insa: e, until Dr. Sims came in and explained the cause of his malady; A\dien his Lordship addressed him on that point, and quickly evinced his malady to the full satisfaction of the Court. \nother case of this kind his Lordship mentioned, as having obtained from Lord Chief Justice Mansfield, which is as follows : " A man of the name of Wood had indicted Dr. Monro for keep- in"- him as a prisoner, Avhen he Avas sane. He underwent the most se\*ere examination by the defendant's counsel, without ex- posing his complaint But Dr. Battle having come upon the bench by me," said Lord Mansfield, " and having desired me to ask him what Avas become of the Princess Avith whom he corres- ponded in cherry juice, he showed in a moment Avhat he Avas. He ansAvered there was nothing at all in that, because having been, as every body knew, imprisoned in a high tower, and being de- barred the use of ink, he had no other means of correspondence but by Avriting his letters in cherry juice, and throwing them into the river Avhich surrounded the tower, Avhen the princess received them in a boat. There existed of course no toAver, no imprison- ment, no writing in cherry juice, no river, no boat; but the Avhole Avas the inveterate phantom of a morbid imagination. I immedi- ately directed Dr. Monro to be acquitted; but this man Wood, be- ing a merchant in Philpot Lane, and having been carried through the city on his Avay to the mad-house, indicted Dr. Monro oyer again for the trespass and imprisonment in London. Knowing that he had lost his cause by speaking of the princess at West- 38 Observations on minster, and such (said Lord Mansfield) is the extraordinary cun- ning and subtility of madmen, that when he was cross-examined iu- the trial, as he had successfully been before, in order to expose his madness, all the ingenuity of the bar, and all the authority of the Court, could not make him say a single syllable upon that topic which had pat an end to the indictment before, although he had slill the in- delible impression upon his mind,, as he had signified to those who were near him, but conscious that the delusion had occasioned his defeat at Westminster he obstinately persisted in holding it back." This case fully illustrates the deceptions Avhich the insane can practise, and how important it is to be Avell acquainted Avith the characteristics and peculiarities of insanity. For a judge or jury, as Avell as the by-standers, may find it difficult to be convinced that an individual, so apparently collected and rational, could be insane. I shall now give a case as taken from Dr. llaslam's Avork on insanity, Avhich Avill act as a guard to our being deceived by their plausibilities and cunning devices. " Au Essex farmer of the middle age, had, on one occasion, so completely masked his disorder, that I Avas induced to suppose him Avell Avhen he was quite otherwise. He had not been at home many hours, Avhen his derangement Avas discernible by all those Avho came to congratulate him on the recoATery of his reason. His impetuosity and mischievous disposition daily increasing, he Avas sent to a private mad-house, there being at that time no va- cancy in the Hospital. Almost from the moment of his confine- ment he became tranquil and orderly, but remonstrated on the injustice of his seclusion. Having once deceived me, he Avished much that my opinion should be taken respecting his intellects, and assured his friends that he Avould submit to my determination. I had taken care to be well prepared for this interview, by ob- taining an accurate account of the manner in Avhich he had con- ducted himself. At this examination he managed himself Avith admirable address. He spoke of the treatment he had received from the persons under Avhose care he was then placed, as most kind and fatherly; he also expressed himself particularly fortu- nate in being under my care, and bestoAved many handsome com- pliments on my skill in treating this disorder, and expatiated on my sagacity in perceiving the slightest tinge of insanity. When I wished him to explain certain parts of his conduct, and particu- larly certain extravagant opinions respecting certain persons and circumstances, he disclaimed all knowledge of such circumstan- ces, and felt himself hurt, that my mind should have been poi- soned so much to his prejudice. He displayed equal subtility on three other occasions when I A'isited him; although by protracting the conversation, he let fall sufficient to satisfy my mind that he was a madman. In a short time he Avas removed to the Hospital, where he expressed great satisfaction in being under my inspec' Mental Alienation. 39 tion. The private mad-house, Avhich he had formerly so much commended, now became the subject of severe animadversion ; he said he had there been treated with extreme cruelty, that he had been nearly starved and eaten op by vermin of various de- scriptions. On inquiring of some convalescent patients, I had found, (as I had suspected,) that I was as much the subject of abuse, Avhen absent, as any of his supposed enemies ; although to my face his conduct Avas courteous and respectful. More than a month had elapsed before he pressed me for my opinion, proba- bly confiding in his success, and hoping to deceive me. At length he appealed to my decision, and urged the correctness of his con- duct during his confinement as an argument for his liberation: but Avhen I informed him of the circumstances he supposed meun-. acquainted Avith, and assured him he was a proper subject for the Asylum Avhich he then inhabited, he suddenly poured forth a tor- rent of abuse, talked in the most incoherent manner, insisted on the truth of Avhat he had formerly denied, breathed vengeance against his family and friends, and became so outrageous that it was necessary to order him to be strictly confined. He continued in a state of increasing fury for more than fifteen months." There Avas a case Avhich came under my cognizance, very nearly similar. The individual, a female, Avas always using various de- vices Avith the master and the commissioners of the institution Avhere she Avas placed, to obtain her liberty, and Avhen she found all her efforts unavailing, she burst forth with the vilest torrents of abuse. The cases Avhich I have mentioned, will, I think, clearly and forcibly shoAV the, great difficulty Avhich sometimes exists in deci- ding on the state of mind of an individual, and the necessity of using great precaution in giving our opinions. For the life, the prospects, or the liberty of a fellow being are always in such cases at stake, and the " ipse dixit" of a physician will have great weight before a Court and jury; for, from the physician, in such cases, aid is demanded, and much dependence is placed upon his opinions; his responsibility is, therefore, proportionally great. Nothing can be more aAvful than the punishment of an individual Avith death, for the commission of an act, the guilt of which he is, from his unhappy state of mind, unable to judge. Nor any thing more distressing than the imprisonment of a sane man, driven perhaps by rage and impetuosity of temper, to exhibit those signs which the inexperienced and rash may pronounce as the eviden- ces of madness, thus taking the most effectual method of produ- cing such a result. Strange as it may seem, cases of this kind, arising from ignorance of the physician on the one hand, and of designing men on the other, have occurred. It is astonishing, as Ave have frequently had to shoAv, how natural madmen are on some points, what prodigious intellectual efforts they have dis- 40 Observations on played, and Avhat varieties of aspects they assume.* The cele- brated poet, Lee, whose plays constantly excite the admiration of an enlightened audience, Avrote them in a Lunatic Asylum, and was, at times, seized Avith th.e most violent maniacal fury ; and I have somewhere read of a lunatic who aa rote a poem feelingly des- cribing his melancholy situation. Shakspeare, the perfect master of the human heart and passions, ably delineates in Hamlet and Lear, the different characters of madness arising from grief. In Lear, Ave see the characteristic traits of the arbitrary monarch, defying the fury of the elements. In the beautiful Ophelia, the fondness for flowers and various emblems of sorroAV ; and in Ham- let Ave scarce knoAv Avhether the poet means to delineate, as he forcibly and beautifully does, those hallucinations arising from vi- olent emotions of grief, or feigned madness. The various aspects which this distressing malady assumes, in various individuals, make it necessary to ascertain the temperament and disposition of the individual, and the causes which may be assigned as pro- ducing the insanity. I Avill now attempt to explain the discriminative marks between the real and feigned madman. Much skill is required to feign madness, and the pretenders are very apt to overact their part: Avhen in company, they are bois- terous, Avhen alone quiet, and it is difficult for them, for a length of time, to continue consistent in sustaining their assumed charac- ter. To the experienced there is likewise a peculiar cast of coun- tenance and expression almost impossible to feign, particularly the sudden transition in the expression of the eyes, from a glared vagueness to a flashing quickness, Avhen any particular emotion or passion is excited. When the paroxysm of a real madman is over, he tries to conceal his malady; he feels the unhappy in- firmity of his nature and shrinks from observation. Whereas the feigned madman will endeavour to give convincing proofs of his malady. Some, hoAvever, are so acute as to deceive us on this point. The real madman has all his organs of sense perverted; he Avill bear the most offensive effluvia; the most violent noise ; and is Avholly inattentive to physical wants, and can endure long watchfulness ; Avhile he Avho feigns, will find it a difficult task to submit to these endurances. Still, madmen may sometimes be wanting in some of these ; but, on the other hand, where the madman attempts to deceive you and make you believe him sane, his very efforts to effect this object is the strongest evidence of his being insane. For Avhen reason returns, the individual, so far from being desirous to give convincing reasons of his sanity, shrinks from observation and avoids the most remote allusion to his malady. He feels the humiliating condition Avhich it has * We will always, however, observe, that all these intellectual efforts partake of the imaginative, more than the reasoning character. Menial Alienation. 41 pleased the Almighty to let fall upon him, and instead of being clamorous and determined to obtain his freedom, and seemingly insulted at the means used toAvard;. him, he is silent, submissive, unobtrusive, and rather under deep humiliation. The physical signs Avhich have been offered are the folloAving : The countenance, as has been already stated, has been found ge- nerally sv.arthy, Avith dark eyes and hair. The secretion of the mucus of the nose has been said to be diminished. Mr. Hill says, that maniacs have a peculiar fetid odour emitted from their body, and recommends it as a sign. This is, hoAvever, a miserable sign, for our sense of smelling is not equally acute, and any person neg- lecting cleanliness Avill have an unpleasant odour emitted from his body. Dr. Rush has mentioned the pulse as a good sign. He asserts, that the pulse of maniacs ahvays beats stronger than those in health. "The knoAvledge of this fact," says he, " has once been applied with success in the administration of the crim- inal law in the United States. One of the tAvo men who were condemned to die for treason, committed against the general go- vernment, in the western counties of Pennsylvania, in the year 1794, Avas said to have lost his reason after sentence of death had been pronounced upon him. A physician was consulted up- on his case, who declared his madness to be feigned. General Washington, then President of the United States, directed a con- sultation of physicians urson his case. Dr. Shippen, Dr. Samuel P. Griffitts and myself, Avere appointed for that purpose. The man spoke vehemently upon several subjects, and for a while the state of his mind became doubtful. I suggested the propriety of examining his pulse. It was more frequent, by twenty strokes in a minute, than in the healthy state of body and mind. Dr. Ship- pen ascribed this to fear. I then requested that the pulse of his companion in guilt and in fear might be felt. It was perfectly natural in frequency and force." From this fact the individual was recommended to mercy, and he was pardoned. I have a very high respect for the opinions of Dr. Rush, but I must think his conclusions here were wholly gratuitous. He does not tell us Avhether he kneAv Avhat had been the state of the culprit's pulse before the commission of this act. Noav, it is aa ell knoAvn, that the pulse varies in different individuals, and is influenced according to the healthful or morbid condition of the system, disconnected from insanity, and, therefore, a test, liable to so ma- ny discrepancies, should "never, of itself, have been considered satisfactory. " It is necessary," says Dr. Haslam, "to observe that insanity may be counterfeited by the criminal, in order to defeat the pro- gress of justice ; and with this view may attempt to impose on the medical practitioner. During the course of my experience I have Avitnessed only tAvo attempts of such imposture, and in both m- 42 Observations on stances the deception was so clumsily executed, that it required but little knowledge of the disorder to detect it. To sustain the character of a paroxysm of active insanity, Avould require a con- tinuity of exertion beyond the poAver of a sane person ; they do not keep up the deception when they suppose themselves alone and unAvatched; the assumed malady then disappears, and the imposture then recommences Avhen they are in the society of others. They arc likewise unable to prevent sleep. If they en- deavour to imitate the passive form of this malady, Avhh h is an attempt of a considerably greater difficulty, they are deficient in the presiding principle, the ruling delusions;, the unfounded aver- sions and causeless attachments Avhich characterize insanity ; they are unable to mimic the solemn dignity of systematic madness, or recur to those associations which mark this disorder; and they will Avant the peculiarity of look, Avhich so strongly impresses an experienced observer."* I have thus endeavoured to give the best directions for distinguishing between real and feigned mad- ness; a point, as has been shown, sometimes extremely embar- rassing. None of the plans herein given should alor.e govern u.s ; and in all cases Ave should be cautious and slow in offering an opinion.* Indeed, those Avho have not seen many cases oYinsanity, should never presume to give a positive opinion in Court, as they must, in intricate cases, be Avholly incompetent. In all cases where the slightest doubt exists, it would be more prudent, and consonant with (he ends of justice, to have the individual confined and secretly watched, Avhen, after a certain period of time, he will expose his real state of mind. In all cases of doubt, coming before a civil tribunal, it is the bu- siness of the judge or jury to consider the motives that could ac- tuate an individual in the commission of any act Avhich may give rise to the supposition of insanity. If the act be Avanton, 'and done without any possible assignable motives, and the character of the individual has been previously good, these should strono-ly induce us, in connexion with any of the signs just mentioned,^© believe the individual insane. And, on the other hand, if the character is bad, the motives strong, and the symptoms equivocal Ave cannot err much in believing such a case feigned; always' hoAvever, when the slightest shadow of doubt presents itself, giv- ing time, as already mentioned, to confirm or destroy the opinion. I "will noAv consider, Thirdly, Some practical questions illustrative of points which come before a Court and Jury for decision. For this purpose I have adopted the questions proposed by Dr. Male, viz: r J Q. 1. Whether there is a probable chance of recovery ? :* Haslam's Treatise, in Cooper's Tracts on Medical Jurisprudence. Mental Alienation. 43 Q. 2. Whether there has been a lucid interval ? Q. 3. Whether the symptoms are sufficiently mild to suffer the patient, with propriety, to retain his liberty and possession of his property ? Q. 4. Whether, in cases of convalescence, the cure is likely to become permanent-? Q. 1. Whether there is a probable chance of recovery ? This will depend upon the cause or causes which produced the malady, and the constitution and temperament of the individual. The physician should be very cautious in giving a prognostic. Insanity, however, is too frequently regarded as incurable, Avith- out physicians sufficiently inquiring into the actual or previous condition of the individual. The experience and successful ef- forts of many, avIio have had the control of Lunatic Asylums, hap- pily prove to us, that there are many eases of insanity Avhich are produced from temporary causes, Avhich maybe again restored to reason. Whenever madness arises from derangement of the chylopoetic viscera, mcnrtrual obstruction, or any suppression, suddenly, of eruptions or long continued ulcers, from a metastasis of gout, from gestation, or the effects of delivery in Avomeu : in all such cases, producing an undue determination to, and excitement in the sen- :~orium or brain, as soon as the different organs arc restored in their appropriate functions, it is reasonable to suppose the malady Avill be relieved. In cases of organic lesion of the brain qr he- reditary predisposition, the recovery rnay be regarded as more than questionable. Insanity produced from moral causes is generally very difficult to relieve. It has been said that the melancholic patients'seldom- er recover than others. The young more frequently recover than the old, women than men. Of all species of mania, none are more terrific or hopeless than those arising from religious enthusiasm, or any other cause pro- ducing an over excitement of the invagination. The reasoning powers arc here Avhoily overcome, and the Avildest phantoms are constantly taking possession of the unhappy sufferer's mind. Q. 2. Whether there has been any lucid interval ? This is a highly important and interesting question as connect- ed Avith medical jurisprudence. When an individual is tiled for his life, or when a will is made eontrary to the expectations of his friends, one party will endea- vour to'prove the individual insane. This may be granted by the opposite party, but they may contend, that at the time of the com- mission of this act, or making of the will, the individual had a lucid interval. The physician is, therefore, called upon by the Court for his opinion, Avhether there has been, or can be a lucid interval. From what has been already shoAvn, it will be observed. 44 Observations on that it is extremely difficult, in many cases, to satisfy the Court. An individual, for example, may be rational upon all except one point; he may converse so reasonably, calmly and correctly, as to induce those who hear him to believe him sane. He makes a will, Avherein his family or nearest relatives are omitted ; the Avill becomes litigated, and the plea is insanity. The prosecutors give satisfactory evidence to prove the individual having been in- sane. But the evidence, on the other hand, may swear, and con- scientiously too, that they saAv the testator, at the making of the will, and he appeared perfectly sane. In this discrepancy of opin- ion,-it Avould, very naturally, he asked, if he had a lucid internal at that time. It appears to me. to decide upon Avhat may be cajled a lucid interval, is almost impossible. A person may be, apparently, lu- cid ; yet the commission of an act contrary to the general rules and feelings of mankind, together with the fact of his having been subject to insanity, is a prima facie evidence, of the individal hav- ing been insane during the commission of that act, Avhatever may be his apparent sanity. It is important, therefore, to ascertain, Avhether the act coi:!d have been done by a rational creature, in the full possession of his intellectual ami moral powers. Kit be not consistent Avith such a state; if it appear contrary to the dic- tates of nature and the principles of right and Avrong, and the per- son is proved to have previously exhibited evidence of madness, he ought, I should suppose, in common reason and justice, be regarded as insane during the commission of the act, Avhich may be the subject of litigation. For any one, at all acquainted with the insane, must be aware hoAV sudden, like the flash of lightning, their passions and emotions are, and what strong and unfounded animosities they have against their relatives and friends. It w ill be proper to offer the opinions, on this subject, of some of the highest authorities in laAv and medical jurisprudence. " When medical persons," says Dr. Haslam, " are called up- on to attend a commission of lunacy, they are always asked Avheth- er the patient has had a lucid interval ? A term of such latitude as interval, requires to be explained in the most perspicuous and accurate manner. In common language it is made to signify a moment, or a number of years. Consequently it does not com- prise any stated time; the term lucid interval, is, therefore, rela- tive. As the laAv requires a precise development of opinion, I. should define a lucid interval to be a complete recovery of the pa- tient's intellects, ascertained by repeated examinations of his con- versations, and by constant observation of his conduct, for a time, sufficient to enable a superintendent to form a complete judg- ment." In a subsequent essay on insanity, Dr. Haslam makes the fol- loAving remarks : Men'id Alienation. 45 "As a constant observer of this disease for more than .twenty- five years, I cannot affirm that the lunatics,•Avith whom I have daily intercourse, l\:.ve manifested alternations of insanity and rea- son. They may, at intervals, become more tranquil and less dis- posed to obtrude their distempered fancies into notice. For a time, their minds may he less active, and the succession of their thoughts more deliberate; they may endeavour, to effect some desirable purpose, and artfully conceal their rtal opinions, but they have not abandoned or renounced their distempered no- tions."* These are the opinions of a physician, whose experience and observation of insanity, entitle him- to be regarded as the highest authority. Dr. Percival says, " the complete remission of madness is only to be decided by reiterated and attentive observation. Every action and even gesture of the patient, should be sedulously watch- ed ; and he should be drawn into conversations, at different times, that may insensibly lead him to develop the false impressions under Avhich he labours. He should also be employed, occasion- ally, in business or offices connected Avith, or likely to reneAv his Ayrong associations. If these trials produce no recurrence of in- sanity, he may, Avith full assurance, be regarded as " compos men- tis," during such period, even though he should relapse, a short time afterAvards, into his former malady."]" Lord Thurlow says, "by a perfect interval, I do not mean a cooler moment, an abatement of pain or violence, or of a higher state of torture, a mind relieved from excessive pressure ; but an interval, in which the mind, having thrown off the disease, has recovered its general habit. The burthen of proof," he adds, " attaches on the person alleging such lucid intervals, avIio must show sanity and competence, at the period when the act Avas done, and to Avhich the lucid interval refers; and it is certainly of equal importance, that the eA'idencein favour of the allegation of a lucid interval, after derangement at any period has been es- tablished, should be as strong and demonstrative of such fact, as when the object of the proof is to establish derangement. The evidence, in such a case, applying to stated intervals, ought to go to the state and habit of the person, and not to the accidental in- terview of any individual, or to the degree of self-possession in any particular act." Lord Eldon disagreed in opinion Avith Lord Thurlow, and said, " with regard to what might be a lucid interval, it Avas a point of some difficulty. He could never go the length of Lord Thurlow. That noble Lord was of opinion, that if the existence of insanity * Cooper's Tracts, vide page 350. •t Percival's Medical Ethics. 46 Observations on Avas once established, the evidence of a lucid interval ought to be as clear as the evidence in support of lunacy. He put the fol- loAving case to Lord ThurloAV. I have seen you exercising the duties of Lord.Chancellor Avith ample sufficiency of mind and un- derstanding, and Avith the greatest ability. Now, if Providence should afflict you with a fever, Avhich should have the effect of taking aw'ay that sanity of mind, for a considerable time, (for it does not signify* Avhether it is the disease insanity or fever that makes you insane,) would any one say it required such very strong evidence to shoAv that your mind Avas restored to the poAV- er of performing such an act as making a Avill; an act, to the per- formance of Avhich, a person of ordinary intelligence is compe- tent ?" In elucidating his opinion, Lord Eldon has drawn a very fal- lacious parallel, and offered, it does appear to me, very sophisti- cated reasoning. The delirium of fever and ordinary insanity, are obviously distinct: that from fever being merely one of a group of symptoms, Avhich disappears with the disease ; Avhereas, insanity is the disease itself, by no means dependent upon any fever, and is perpetually liable to a recurrence. If the delirium of feArer and insanity are, as by Lord Eldon, to be identified in a medico-legal view, inequitable decisions must be the consequence. " Delirium, in the ordinary acceptation of the word, is the tempo- rary derangement of intellect, consequent on acute disease; it may be distinguished from lunacy or madness, by the invariable presence of fever, and it ceases as its exciting causes subside; this, therefore, operates no permanent incapacity ; for though the patient cannot be permitted to do any act, or execute any instru- ment to bind his property or estate, and would not be held res- ponsible for any crime committed during such temporary aliena- tion of intellect, yet he becomes competent to act, and responsi- ble for his actions as soon as the paroxysm and its consequences are clearly over."* But in the very case of insanity accompanied Avith delirium, or that species produced by over excitement, Ave are particularly liable to be deceived, if not Avell aAvare of the malady; how then can his Lordship say, that the decision, espe- cially in that of making of a Avill, is easy. Is it nothing, that the rightful heirs are neglected, or those Avho have the strongest pos- sible claim ; and under such and similar cases, ought not in equity the " onus probandi" to fall on those, (if the person had been known to be previously insane,) Avho declare him sane during the making of the will litigated. But even his Lordship has, in the subsequent decision, conflicted somewhat with the doctrine above quoted. "When the party has ever been subject to a commis- sion, or to any restraint permitted by laAv, even a domestic re- straint, clearly and plainly upon him in consequence of undi.sp.u- * Paris and Fonblanquc. Menial Alienation. 47 ted insanity, the proof, sheAATing sanity, is thrown upon him. On the other hand, where insanity has not been imputed by relations or friends, or even by common law, the proof of insanity, (Avhich does not appear ever to have existed,) is throAvn upon the other side ; which is not to be made out by rambling through the whole life of the party; but must be applied to the particular date of the transaction. A deviation from that rule will produce great un- certainty."* Without presuming to enter further into the discre- pant opinions of these celebrated Chancellors, I shall conclude with remarking, t'.iat the opinion of Lord Thurlow is more'con- sonant with medical experience and observation. Q. 3. Whether the symptoms are sufficiently mild' to permit the patient, with propriety, to retain the possession of his proper- ty ? , , This will depend altogether upon circumstances. The phy- sician, before he attempts to give an opinion, should have fre- quent conversations, upon a variety of topics, with the person seeking enlargement and civil rights. We have seen hoAv inge- nious some madmen are, and how far, at times, they are able to cloak their malady. I know a gentleman, Avhom a stranger in conversing with, would believe perfectly sane, unless he had fre- quent conversations Avith him, at different periods of time, and had been acquainted with his previous disposition. There are, as Ave have had occasion to explain, a species of insane, [monomaniacs) whose ideas and opinions are wrong*m one point only. Under. such circumstances so long as the delusion" affects not the interest or welfare of any other person, and the individual is rational on other points, hd ought not, I should suppose, to be disfranchised. Opinions on this subject must depend upon the development of circumstances, calmly, circumspectly, and thoroughly to be examined. Q. 4. Whether, in cases of convalescence, the recovery is like- ly to become permanent ? I can, in no better manner, ansAver this question, than in the language of the judicious and experienced Dr. Haslam. " It has sometimes occurred, that persons evidently under mental derange- ment, have continued to transact their affairs Avith prudence, and have conducted themselves quietly in society. Notwithstanding the disordered state of their ideas, they have not obeyed the im- pulse, nor. followed the direction of their insane opinions, and have forborn to act to their own detriment, or to the annoyance of others. Several of such instances have fallen under my own ob- servation ; but the greater part have eventually destroyed them- selves, or become so furious, that seclusion was absolutely neces- sary. It is, therefore, impossible, under a state of existing insani- ty, to predict the future conduct of an individual thus affected, or ■* Paris and Fonblanque. 4S Observations on to become responsible for his harmless disposition." We are thus taught, Iioav cautious avo should be in hazarding medical opin- ion. That there are cases Avhere persons have been insane, and for a long course of subsequent years, have been quite sane, so far as avo can judge frbm their conduct and deportment, admits of no question: But the prognostic of a recovery being likely to become permanent, under almost anycircumstances, would be ex- tremely et;uiA-ocal, for the predisposition, under such cases, always exists, and the malady is brought into play, or obstructed, accord- ing to the presence or absence of the other causes. In concluding, I will presume to offer some remarks upon the making of wills. It is admitted, as a principle of law, that no will is valid which is not made by a sane person. Now, it is AA'orthy of consideration, Avhether persons labouring under those severe acute diseases, Avhich confine them to their beds, are sufficiently sane as to make as fair and equitable a "will as they Avould do in health ? I am of opinion, that no w ill made on the bed of sickness should be regarded as valid, although this opinion be in opposition to an acknoAvledged doctrine of law; and that the la\v should always be " mens sana in corpore sano," a condition of mind or body in Avhich few are avIio make Aviiis. Wills are generally put off as one of the last acts of a man's life ; but it is evident, that no man, during the pressure of pain, or having the fear of death steadily in vieAV, can make a will so'dispassionately as he Avould do during health. The mind during sickness is fretful and petulant, and constantly vacillating with every little circumstance. Indignation at those, AA'hom in health they most esteem, for fancied neglects, is of fre- quent occurrence; and extraordinary attachments, and strange ideas of gratitude, for designing attentions, likewise take place. It is this oscillatory feeling of the, sick man, if I may so express mvself, which opens the way for the vilest abuse, and most abom- inable injustice. It is thus that many men are left large estates a.idjegacies without any possible claims, and those, Avho from their relationship, and uniform conduct, Avere previously held in the highest estimation, have been neglected.* *The following cases selected from Paris and Fonblanque will illustrate the above: "Mr. Greenwood was bred to the bar, and acted as Chairman at the Quarter S?ssions, but,becoming diseased, and receiving, in a fever, a draught from the ham! of his brother, the delirium taking its ground then, connected itself with, that idea; and he condsidered his brother as having given him a. potion, with a view to destroy him. He recovered in all other respects, but that morbid image never departed-; and that idea appeared connected with the will? by which he disinherited his brother. Nevertheless, it was considered so necessary to have some precise rule, that, though a verdict had been obtained in the Common Pleas against the will, the judge strongly advised the jury to find the other way, and they.did accordingly find in favour of the will. Far- ther proceedings took place afterwards, and concluded in a compromise." Mental Alienation. 49 Law and justice were always intended to go hand in hand, and it must appear to common sense and common reason, disconnect- ed from professional technicalities and distinctions, that any will, thus singularly made on a bed of death, should be regarded as not valid, on the ground that the individual, when making that icill, Avas not in that sound state of mind which would enable him to execute so sacred an instrument. On the bed of death, the mind is, or ought to be, always revolving upon the aAvful change whic h is rapidly approaching, and other considerations must be of minor moment. But at that solemn hour, when the individual is on the threshhold of eternity, he is often harrassed by the sacrilegious chicaneries of avaricious men. It has been recommended by Blackstone and Dr. Rush, that medical men should be so far acquainted with law, "as to ena- ble tbem to draAV out Avills during the illness of their patients. It would, probably, be better for physicians to recommend the abolition of the law which allows an individual to make a Avill when confined by sickness to bed ; because, as it has been already urged, the mind is not in a condition to make an equitable will; and if this laAv was rescinded, this important instrument Avould be .made in the calm hours of reflection ; Avhen the mind is above those little petulancies and unfounded prejudices, so common in sickness, and our public records would be less stained with marks of human ingratitude and villany. FeAV ill consequences would result from requiring persons' wills to be made Avhen they were so far Avell as to perform the ordinary duties of life, and much evil, perhaps, obviated ; for the rightful heirs are provided for by law, and the bed of death is not the place to evince our gratitude in a testamentary manner. It may be urged, that if the individual could be proved to have been in that state of mind which was not sound, the will could be upset, but the uncertainties, delays, expenses, and the great difficulty of coming to a precise understanding of Avhat would, in such ca- ses, constitute incapacity to make a wiH, compel most persons (in the language of the poet) " rather to bear the ills they suffer, than fly to others that they know not of." One thing is evident, that no person, suffering under an acute disease, has a full recol- lection of every thing which transpired during his illness, and Again, " Mr. Scawen had left Miss Butterfield a considerable legacy ; but being impiessed, by his surgeon, with the idea that she had poisoned hira with corrosive sublimate, he turned her out of .his house and altered his will. Mr. S died, and so evidently by mercurial poison, that Miss B was tried for the murder, but was acquitted, theie being no evidence that she w;is the person by whom the poison had been administered, and a considerable probability that it had been contained in some quack medicines which Mr S had taken Under such circumstances a restorauon of her legacy might have been expected, either fr-in the liberality of the next of kin, or, from the interposition of a Court of Equity." 50 Observations, fyc. many have no recollection at all; and yet, they Avould not have been considered as labouring under delirium, and they Avould have been regarded as legally qualified to execute a will. I must apologise for thus unceremoniously offering my crude remarks on an established principle of law. There is, however, a prece- dent in the laws of Scotland. It is necessary in that country, that a person, making a will should, subsequently, be seen at the market, or some public place. I have thus brought my subject to a close ; I have endeavoured to convey, in a condensed and clear manner, the various topics of interest connected with the subject; and if I have not added anything, I trust, I have not altogether failed in exhibiting its interest and importance.