OHIO STATE MEDICAL SOCIETY. 
Toledo, Ohio, ./wne 10*17-18, 1874. 
REPORT ON 
MONOMANIA: 
X»- 
I). A. MORSE, M. IX, 
LONDON, OHIO. Report on Monomania, 
—BY— 
I>. A. MORSE, M. I). 
OF LONDON, OHIO. Report on Monomania, 
—BY— 
I). A. MORSE, M. I)., 
OF LONDON, OHIO. 
Is there a Monomania? Is there a mania without delirium? without 
delusion.? ? An Instinctive, Mania ? Is there a Reasoning Mania ; themor- 
al insanity of Prichard? How are instinct and intellect related? Can a 
man be insane as to one idea, or fact, and sane as to all others? Can a 
a man be insane as to instinct and remain sane in intellect? Is delusion a 
test of insanity? Is “ Knowledge of right and, wrong” a just and sufficient 
test of responsibility ? 
(lenilemen of the Oh io State Medical Society: 
Last year I directed your attention to a condition, or disease, 
alleged by many writers to be entitled to rank as a form of in- 
sanity, and which is, viewing it from their standpoint, of suffi- 
cient importance and distinctive characteristics to be designated 
a monomania, by name: Dipsomania. 
The views of any one writer upon the subject are brief, 
scattered, yet I collected them; presented my theory; and 
awaited the verdict of those who had given the subject special 
attention. The reception it met with is sufficient evidence that 
my labor was not fruitless. 
The subject of Dipsomania involved many questions not con- 
sidered in that Report; questions that are of great importance, REPORT ON MONOMANIA. 
and upon which many views there entertained must rest. These- 
questions are the foundation of all theories that attempt to 
maintain the existence of a monomania, or to explain it. 
When we desire to explain the phenomena constituting any 
form of partial insanity, whether intellectual or moral, as the 
so called homicidal mania, instinctive, reasoning mania, i. e. the 
moral insanity of the English writers, or other form, we must 
first determine these questions; for no theory, the foundation 
of which rests upon them, is tenable until it is fully determined 
that it is grounded upon truth. A superstructure reared with- 
out solid foundation may humble and mortify its architect when 
storms of professional and scientific criticism assail it; but when 
well laid in clearly demonstrated truth, the superstructure may 
be reared to any height, and he who would cause it to topple 
and fall will but more firmly settle it upon its base. As we de- 
clared last year, follow the precept of Aristotle—determine 
whether a thing be so before you attempt to explain it—the an 
sit before the cur sit 
While I thus direct your attention to this rule that should 
govern all scientific investigation, it by no means follows as a 
consequence that I will reveal all the hidden mysteries of that 
incomprehensible union of body and mind—leave nothing to be 
considered worthy of attention—or even extend my research 
further than others have done, for l confess that finite vision is 
too limited to penetrate where Infinite vision alone can pene- 
trate, where Infinite mind alone can comprehend and explain. 
In my report upon Dipsomania I called attention to the 
question raised by Pinel, and again excited by Fodere and 
others : “Is there an insanity without delirium?” In other words 
is not delusion the essence of insanity? 
I remarked that this year I would discuss “mania with hom- 
icidal tendencies—instinctive and reasoning mania; the relation OH IO ST A T E M E D IGA L SOCT ET V. 
of instinct to the mental faculties, and the part it plays in the 
instinctive or impulsive forms of insanity.” 
The questions I have presented embrace mainly these points, 
and although I cannot discuss them individually, yet I will en- 
deavor to consider them as fully as if this were done—the close 
relation existing between them forbids all other consideration. 
In my report upon General Paralysis I have remarked 
that, after hearing the family history and that of the patient, 
the first point to which a physician should direct his attention 
should be to the instinctive tendencies of the patient: whether 
instinct be normal, perverted, exaggerated, or as it were abol- 
ished. 
No further explanation is necessary than to ask you to con- 
sider the nature and seat of instinct and its relation to the 
higher intellectual powers. 
WHAT IS INSTINCT? 
Cabanis, Papports du Physique et du Moral def Homme, de- 
fines instinct to be “those ideas produced by internal impres- 
sions, caused by excitation of internal organs; an act execu- 
ted without a knowledge of the end or object, or without a con- 
sideration of the relation of the end to the cause, always em- 
ploying the same means.” 
Thus each species of animals has its peculiar instincts, exer- 
cised only when called into activity by Nature’s demands, as for 
defense, to gratify appetite, to perpetuate the species, and like 
acts purely instinctive, and which under a change of circum- 
stances are unmodified by them to any great extent. Foxes 
avoid their pursuers as foxes ever have from the foundation of 
the world. Reason does not teach them when detected in the 
course they pursue to modify it. REPORT ON MONOMANIA. 
Instinct is inborn—is not the result of education or experi- 
ence further than this: animals may be taught many things— 
the education of one generation frequently becomes the instinct 
of the next. Animals generally perform instinctive acts as well 
at birth as at any subsequent period, with this modification, that 
their performance is more dependent upon the degree of devel- 
opment or maturity of the physical system of the animal than 
its associations or education. 
Reid, Intellectual and Active Powers of Man, defines instinct 
to be “a natural blind impulse to certain actions, without having 
any end in view, without deliberation, and very often without 
any conception of what we do.” 
Laycock, Mind and Brain, vol. i, says: “Philosophers in 
speculating on the mental differences between man and animals, 
have attributed to the man reason, to the animal instinct. Hence, 
animals are irrational, men rational beings. Instinctive actions 
are not founded on knowledge or experience; rational actions 
are. Instinct is the cause inherent in animals of those proceed- 
ings on their part which take place, not only without experi- 
ence as to the past, but without any conscious adaptation to ac- 
cidental circumstances, and without any knowledge of the re- 
sults to follow the course of proceeding. In short, in instinct 
there is what is termed a blind intelligence, i. e., an intelligent 
adaptation of actions to ends, but without knowledge of the 
past, present, or future. * * * * “If we consider the 
meaning of the term Instinct, in its widest application, as man- 
ifesting a blind, unconscious adaptation to ends, the actions ap- 
propriate to nutrition or alimentation, and of respiration or 
aeration of the tissues, are instinctive. The acts by which these 
objects are attained may or may not be associated with states of 
consciousness; and even when there is a concurrent feeling of 
pleasure or pain experienced by the organism, we observe that OHIO 8TATK MKD1CAL SOCIETY. 
7 
there is coincident therewith only an aiding or intensification 
of the actions; the actions themselves are done independently 
of a knowledge of their order, or cause or object. And there 
are other processes of a similar kind, as to object, which are 
even more independent of mental states than these; for they are 
certainly performed without any consciousness whatever. I fence, 
instinct, in this more general sense, is a property of vegetable 
organisms as well as of man. It is therefore the supposed cause 
of all those acts which are performed either without any mode 
of consciousness absolutely—that is unconsciously; without 
any knowledge, on the part of the individual, of the ends to be 
attained by the acts; or without any volition. Thus I)r. Reid: 
‘He (a new born child) is led by nature to do those actions (/. e.f 
sucking, swallowing, &c.,) without knowing for what end, or 
what he is about. This we call instinct.’ There is no word 
more commonly in use by everybody than this word Nature. 
* * * In this case Nature is but another word for instinct. 
Now the ultimate fact expressed in the word is order according 
to a law of design, without consciousness on the part of the 
thing ordered. In this sense Nature is but another term for 
life.” 
When we extend the meaning of the word to so general an 
application, we may embrace nearly, if not quite, all of our 
mental operations. But when we speak of mental operations 
that do not appear in consciousness, with man, by which with- 
out a process of reasoning a conclusion is formed, we term it an 
intuition. This constitutes one of the essential elements of 
genius. It is a short cut that enables man to grasp truths that 
otherwise the most elaborate process of reasoning would often- 
times leave still beyond his grasp. It bears more resemblance 
to the intelligence of animals than that of man, for this reason, 
that it is the result of unconscious mental activity. The mind 8 
UKCOItT ON MONOMANIA. 
is unable to recognize any process by which the conclusion 
arrived at is attained and unable often to afford a reason for the 
conclusion. It is this element i 11 man which the world calls 
“common sense/’ “good judgment/’ <8*., a judgment without 
reason, a conclusion without facts. 
Animals indicate in the skill displayed in their labors the 
highest degree of intelligence—yet when we observe that each 
follows a definite course like his fellows, as that the bee never 
builds his comb like the wasp, or a hornet like a bee, that each 
bird of a species builds its nest as all others of that kind, of 
similar materials and in similar places and manner, that all an- 
imals whether possessed apparently of a high or low degree of 
intellectual power, obey the fixed and imperative laws of their 
being, we conclude, that if in obedience to reason the reasoning 
faculty is limited and that it always obeys a predetermined law. 
That these laws are predetermined and not the result of ex- 
perience, of education, or the exercise of reason or judgment, 
may be shown by the fact that a change of circumstances does 
not modify them. That they result from internal impressions 
may be shown by such facts as that at the period of the breed- 
ing season when the ovaries begin to enlarge the bird begins to 
build its nest, although deprived of a mate, as when caged. 
The male seeks its mate in obedienceto the same law, and with 
the cessation of activity in the organs of generation, abandons 
her. 
With the human being love seems to be to a great extent 
dependent upon similar conditions, for with the period of pu- 
berty comes the full matured passion—love. Whatever may be 
the reaction upon the intellectual centers, however pure and 
sincere the affection, however sentimental the individual, then; 
is an unfelt irritation in the organs of generation—which at 
times becomes a conscious state—rendering it impossible for the OHIO STATE MEDIC A Ij SOCIETY. 
mind to be directed into other directions—it subdues to itself 
all the mental powers—and reason, reflection, imagination, Will, 
are only employed as servants of the irresistible impulse which 
impels man to gratify it to appease the desire. Thus the condi- 
tions with male and female by which individuals are forced to 
abandon themselves to their lusts are but modifications of nat- 
ural instincts—conditions we observe in nymphomania, eroto- 
mania, onanism, <fcc; the local irritation of organs having 
been reflected so powerfully upon the brain that it yields and 
recognizes no other controlling power. 
With the bird there is a law directing all its actions, the mi- 
gratory species showing this in the highest degree. When the 
breeding season is over they gather together and as if by com- 
mon consent wing their flights to other climes. This occurs 
before change of season warns of approaching cold weather suf- 
ficient to affect their comfort, and again they return only when 
they are secure from the fatal influence of winter. Instinct is 
to them a certain guide. Again, animals select such food as 
Nature determines. Nature determines so far as we can judge, 
all modes of activity with an animal, and it is no contradiction 
of this to say that the sense of smell or taste determines what 
an animal will eat or drink. 
Thus, in the so often cited instance of Galen’s kid, 
which when taken from its mother’s womb drank milk when 
placed with other substances before it, in preference to them, 
after having examined them, it has been said the senses enabled 
it to decide which it should drink. 
W ho educated this sense of smell or taste so that from birth 
to death an animal will eat or drink only what will sustain its 
existence? Who educated its senses so that whatever may be 
the degree of hunger it suffers, it still will devour only its 
proper food? W hat but instinct governs this: what, when, 10 
REPORT ON MONOMANIA. 
and the quantity it shall eat? The poet has observed all this 
and inquires: 
“ Who taught the nations of the wood 
To shun their poison and to choose their food? 
Prescient, the tides or tempests to withstand; 
Build on the waves or arch beneath the sand ? 
Who made the spider parallels design— 
Sure as Be Moivre, without rule or line? 
Who bid the stork, Columbus-like, explore 
Heavens not ins own and worlds unknown before? 
Who calls the council, states the certain day; 
Who forms the phalanx and who points the way? 
Collineau, Analyse Physiologique de Ventendement Humain 
Paris, 1843, presents an extended consideration of the subject 
of Instinct. It is valuable as furnishing us a starting point 
from which we can extend our inquiries. lie says: “The word 
instinct is applied to all internal movements, sensitive, intellec- 
tual, affective and moral, whether voluntary or involuntary, ex- 
ercised without knowledge of the cause or nature of the action 
by the being which acts, the action being the immediate result 
of its organization and innate disposition. 
In psychology instinct begins everything; it manifests itself 
with the first organic movements; it is a kind of intelligence 
communicated with life, and which develops itself more or less 
according to the degree of organization, the circumstances, and 
habits which facilitate it. With man, instinct is arrested or 
weakened as soon as we have an intimate perception or con' 
sciousness of our intellectual acts; for this consciousness is the 
line of demarcation we place between instinctive acts and those o 
intelligence. We say that we have placed, for this demarcation 
does not exist naturally, it is a mental conception. In reality 
instinct exists wherever there is intelligence, even where reason 
rules, and retires only as reason causes it to disappear. In no 
other way does it yield to reason. 
“The internal movements of the organized body have limits OHIO STATE MEDICAL SOCIETY. 
11 
they rarely can pass; the organs have generally a determined 
relative volume; as the stature of man increases but little be- 
yond a certain height, so it is with his mind. The great 
genius appears only at long intervals, and however well he may 
be guided and sustained by the labors of those who have pre- 
ceded him, he cannot pass the limits placed by the period in 
which lie lives, except in rare cases, only by emitting a few rays 
of light or impulses which resemble more instinct than they do 
intelligence, for we find in their works profound views, beauties, 
of which they are not themselves free from doubt, although the 
conception appears simple and natural. 
“ But that which proves better this last proposition is that 
when it becomes necessary to renew a work of a certain extent, 
which has escaped from the memory, they can never do it in 
the same manner, nor like in all points as it was before.” This 
confirms, if true, what we have said concerning the intuitions 
of genius. Always as civilization extends, the force of individ- 
ual intelligence increases, the material which feeds thought, 
which is digested and assimilated as mental food, becomes 
greater and more abundant, thought becomes more generalized, 
and co-ordination results in organized principles. Hence we 
would then expect intellect to be developed in a corresponding 
ratio beyond instinct, instinct, in abeyance, to be guided by in- 
telligence, or supplanted by it. 
But with man before intelligence is developed there is some- 
thing that gives rise to action, there is something that directs 
and limits it when begun ; it is not reason, it precedes intellect 
and exists with animals deprived of organs competent to con- 
struct or form a thought, animals not sufficiently developed to 
exercise reason; this is instinct. 
Instinct controls to a certain extent our moral as well as 
physical and intellectual life,—we struggle with it continually, 12 
REPORT ON MONOMANIA. 
and it is only when continued mastery of it has placed it in 
complete submission we are able to pass beyond its influences. 
This determines the moral life of an individual: his tastes, pas- 
sions, appetites, habits, desires, propensities, and although from 
its very nature he is unconscious of it, his moral liberty is de- 
pendent upon it. It is that with which St. Paul continually 
warred; his reason teaching him that with fallen man, instincts, 
unless guided by Divine hand, are at enmity with good morals 
and religion. This applies to individuals; nations are but the 
aggregate of individuals—multiply individual history and you 
write that of nations. 
Instinct is placed in man as a conservative power, protecting 
and preserving him. It is inseparable from organic life; it 
commands all movements, determines all actions, and requires 
the utmost freedom in all its manifestations when so controlling 
that which organic life is dependent upon; in the majority of 
instances where it presides directly over organic life there can 
be no restraint from intellect or impediment to obstruct its free 
exercise of power. 
It is inborn ; but not infallible. It is never wanting even 
with monsters; yet it is not wholly the result of organization, 
of sensibility, reason or will, for the condition of its existence 
is that it produces all, organizes all, directs all in the great 
ecomomy of nature. 
Singular as it may seem, while conscious action is so apparent 
in the instinctive movements, yet nevertheless instinct is blind; 
it is an inherent principle of organic beings, developed in all 
organs, yet not the property of any organ ; not a special sense, 
yet rises above the senses; absolutely essential to animal exis- 
tence usurping the empire of reason, it directs the forces which 
intelligence can utilize and systamatize, thus becoming a power 
behind the throne, not only to shape individual character and OHIO STATE MEDICAL SOCIETY. 
13 
the fate of individuals, but through individuals the destiny of 
nations. 
117//, the supreme executive power of the mind, cannot al- 
ways.resist instinct. Pain, the emotion expressive of injury or 
violence, may induce instinctive action—may appeal as a mo- 
tive to the will: the will impelled by the irresistible motive 
yields obedience. \Vre do not always do just what we wish, 
we‘do not always know beforehand what we are going to do, 
we sometimes, prompted by desire or emotion, do what we 
would not. The highest degree of intellectual development, 
the most perfect freeeom of the will gained by long exercise of 
its power, will not secure complete submission on the part of 
instinct. So clear is this that some writers regard instinct as 
the determining power of all thought, emotion, action; of our 
intellectual and moral nature. This we do not believe. We 
accept the assertion that instinct is felt in the domain of all 
our nature—but that conscious intellectual action is never in- 
stinctive action, although instinct may prompt the act. Still 
with our own consciousness of free action—our boasted free 
moral agency—how much of all our conscious life can we say 
is free from the directing power of instinct? We think of 
what we would not, we try to think of what we cannot, and 
learn at last that our best thoughts are spontaneous, surpris- 
ing even ourselves with their force and clearness, unconsciously 
as it were, expressed. The will may require a train of thought 
—or direct the train of thought through the mind, holding it 
upon one subject, yet it is apparent that the thoughts expressed 
are co-ordinated by instinct, and that even as we write we know 
not when we write one word what the next shall be. It is 
then as if by inspiration man’s best thoughts arise and flow 
from his pen, to his own consciousness appearing as if com- 
ing from a source beyond and higher than himself. There 14 
REPORT ON MONOMANIA. 
may be intuitive conceptions of an end to be attained, yet in 
what respect does it differ from any instinctive act. IIow can 
we prove that we determined a thought by our own intellectual 
acts and volition, when we are unconscious before it is con- 
ceived that it will ever be the offspring of our brain? While 
man’s mind thus guided by instinct may run on, lie has power 
to direct his attention to it, turn it into other channels and 
thus thwart instinctive power. 
THIS POWER TO CONTROL THE MINE—WITH CONSCIOUSNESS 
OF THE EXISTENCE OF SUCH POWER, SEPARATES 
MIND FROM INSTINCT. 
We pass a great portion of our lives thinking, 'with- 
out a knowledge of what we think, the cause that de- 
termined the train of thought, or the object of it. Our emo- 
tions are unconsciously excited, we see, unconsciously, the re- 
ality of all we think, and awake to consciousness as from a 
dream when attention fixes the mind upon its own operations. 
Metaphysicians say this is reverie; but that is only another term 
to express the fact that the mind has been left to itself-— 
abandoned to its own instinctive forces. What have we 
in acute mania but this condition? The ideational centers 
(cortical substance), active by increased flow of blood, 
over stimulated, show exaggerated functional activity. The 
attention may be directed at times to the mental states, or op- 
erations of the mind, yet there is so profound lesion of the 
will that all is chaos and confusion. The state of internal or- 
gans, irritations within them, are reflected upon the brain— 
the brain already excited is at the mercy of a ceaseless train of 
thought, thoughts seemingly unfinished, crowding one upon the 
other. The very profusion of ideas forbids their being matured. 
Here is a condition analogous to reverie, and dreams, but to 
which the mind is seemingly abandoned. It has not power to OHIO STATE MEDICAL SOCIETY. 
15 
recognize clearly its own operations, to hold them in conscious- 
ness—or arrest, except when some powerful motive induces it, 
acting from without, this abnormal activity—we say there is 
insanity. 
There is unconscious, instinctive action, and there is con- 
scious action determined by the will, subject to reason. If 
it is beyond the power of the indivdnal to arrest, as in the 
iirst, he is irresponsible—in proportion as the last obtains he is 
responsible. 
Instinct bears this relation to reason: instinct is not actua- 
ted by conscious motive, has not consciousness of its own acts, 
of the motive that induce the acts, ortho end, result or object 
of them. It is a blind adaptation of means to an end which 
is always accomplished in the same way. Reason is instinct, 
but much more; the mind is conscious of its own states, mo- 
tives influence its operations, and the same result is seldom at- 
tained bv precisely the same means. Reason modifies the 
means employed to suit the end to be attained. Instinct 
prompts man to gratify a passion or an appetite; reason teaches 
him when hurtfnl to refrain, and will commands obedience to 
reason. If there be a lesion of intellect passion may run riot 
—instinct may rule supreme ; appetite, passion, and desire, may 
have no guiding or opposing force. 
Collineau says: “the cause ought to include all that which is 
the effect.” He says: “the principle of life includes latentsen- 
bility, that is to say the cause, force, power that we suppose 
acts upon the organic elementary parts. Latent sensibility in- 
cludes the principle of preceptive sensibility, in this relation, 
that it is the cause of the formation of the organization, 
by means of which this modification of general sensibility, 
this feeling with perception, is developed, and places us in con- 
nection with the external world as we are with ourselves. REPORT OX MONOMANIA. 
The perceptive sensibility manifests the first appreciable acts 
of instinct, and instinct itself is now a degree more or less ad- 
vanced of intelligence attached to the exercise of all the or- 
ganic functions, as well as sensitive, intellectual, affective and 
moral; but still beyond the influence of conscience and will 
directed by reason. 
In effect, what do we observe in the perfected organization, 
considered as a material and sensible being? Impulses de- 
termined by wants, desires, in a word by internal feelings, 
all instinctive. To what do these impulses tend? To per- 
ception—to distinguish the nature of these relations, to 
connect us with objects that can satisfy these desires or which 
excite them; to remove us from those which have not these 
qualities or which act in a contrary sense. It is the exercise 
of distinctive feeling and affective sensation. 
But if, after these tendencies, these desires and sensations, 
we continue to act without consciousness and without reasona- 
ble volition; in the sense of the impulses which have pro- 
duced them, or if we cease to act, we yet exercise instinctive 
action; we do, whatever it may be, that which pleases us, or 
cease to do that which displeases us. But instinct then be- 
comes intelligence ; for however feeble we suppose them to be 
there are in these determinations judgment, memory, foresight, 
and volition. In effect, if we continue to act it is because we 
find the thing good or proper, it is because we find the senti- 
ment of well being manifested in what we experience, and that 
which we experience causes us to hope, desire, foresee and will 
the continuation of the same state. Thus there is an intelli- 
gence, or manifestation of intelligence, in all living, organized 
beings even when they act solely under the empire of instinct ; 
because the order, because all their impulses, and above all 
those which relate to the preservation and propagation of the 17 
OHIO STATE MKDK'ATj SOCIETY. 
species, arc foreseen, co-ordinated and regulated in advance', 
lint this intelligence is not the property of the animal, they 
have not acquired it, they are not conscious of their acts, and 
if they exercise them with desire, volition, and even sometimes 
with a species of reason, this reason and the determinations 
which result from it, are neither the fruits of experience, de- 
liberation or choice incited by motive; they are not free. 
When even the animal does not act absolutely after his physic- 
al organization, he can neither will any thing nor reason other- 
wise ; his intellectual impulses, determinations, and acts, are 
still instinctive. As soon as movements are practiced with 
consciousness and reasoning volition, that is to say, from the 
moment they are the result of acts felt, perceived, distinguished, 
compared, judged and willed, they cease to be instinctive, they 
definitely fall under the empire of intelligence. 
It is then a fact which takes a new character from the mo- 
ment when another fact is connected with it; thus such acts 
as were instinctive because performed without knowledge of 
their being performed (i. e. without consciousness) without hav- 
ing willed them, or having willed them without consciousness 
of it, become acts of intelligence from the moment we become 
conscious of what we do, from the moment we are conscious 
that we compare, judge, reflect, deliberate and choose. 
Is it then in the first place this consciousness, this intimate 
perception of the instinctive act which gives it its intellectual 
character? Yes, the knowledge changes and modifies all, vet 
bears in itself the life and light of it; this knowledge, this 
intimate perception, is in itself, in its origin, but an instinct- 
ive fact. Intelligence is then born immediately from instinct. 
Hut many as pass of our instinctive acts incessantly to the 
intellectual state, instinct is not lost; it is always the base of 
our first movements, that is to say, of those which fall not vet rUKOKT ON MONOMANIA. 
tinder the action of consciousness, and have not been submitted 
to judgment, or reflection ; instinct remains always and is the 
tie that connects all our intellectual acts to the vital principle 
and universal order.” 
Thus what becomes an intellectual act, or an act recognized 
by the mind, may arise simply as an instinctive impulse, and 
does not become an intellectual act until there is consciousness 
of it. By consciousness we mean that metaphysical term em- 
ployed to signify the knowledge the mind has of its own ac- 
tions. I shall not stop to discuss the multitude of questions 
metaphysicians raise concerning this function of the mind, 
whether it is a faculty of the mind, or the sum of all the facul- 
ties, or whatever it may be, it is sufficient to say that when the 
mind has knowledge of its own operations we say such opera- 
tions are conscious actions. Thus I may read, turn a leaf, and 
at the same time am not conscious of the fact. If I read, 
knowing that l read, or perform any other act, with the mind 
directed upon it so that I know the act is performed, I say there 
is a consciousness of it. 
No act of the mind, or mental state, is retained in memory 
unless the attention has been so fixed upon it that it is held up 
to the mental gaze in consciousness, and the more vivid the pic- 
ture the more firmly is it impressed upon the retentive facul- 
ties—the more tenacious the grasp of memory. This may 
serve, also, as a distinguishing feature of intellect. Our fund 
of intellectual knowledge is acquired, and bv memory preserved. 
Our wisdom is this fund elaborated—our ideas are drawn from 
it. Impressions made on the senses give rise to ideas—all are 
stored in memory and become the food of the mind—wisdom 
is this food digested and assimilated. Knowledge is not wisdom. 
A walking library repeats parrot like what he has learned—it 
Hows out as it went in—crude, undigested, unassimilated mass- OHIO STATE MEDICAL SOCIETY. 
es—without appropriation of it there is no mental growth. 
We cannot resist the temptation here to quote the poet Cowpcr, 
showing the contrast between cultivated, systematic, intellectu- 
al action, in a well developed and well disciplined mind, and the 
chaotic confusion of a mind that has only acquired, but has not 
passed beyond instinctive mental action to a degree of develop- 
ment sufficient to enable it to elaborate mental food—to meta- 
morphose knowledge into wisdom. 
“Knowledgeand wisdom, far from being one, 
Have oflimes no connection, Knowledge dwells 
In heads replete with thoughts of other men; 
Wisdom, in minds attentive to their own. 
Knowledge, a rude unprofitable mass, 
The mere material with which wisdom builds, 
Till smoothed, and squared, and fitted to its place, 
Does but encumber what it seemed to enrich. 
Knowledge is proud that he has learned so much. 
Wisdom is humble that he knows no more. 
Hooks are not seldom, talismans and spells, 
Hy which the magic art of shrewder wits 
Holds an unthinking multitude enthralled. 
Some to the fascination of a name 
Surrender judgment hood-winked. Some the style 
Infatuates, and, through labyrinths and wilds 
Of error, leads them by a tune entranced. 
While sloth seduces more, too weak to bear 
The unsupported fatigue of thought, 
And swallowing, therefore, without pause or choice, 
The total grist, unsifted, husks and Oil.” 
Winter iralk at noon. 
This ability to elaborate ideas from impressions, to meta- 
morphose these ideas into new forms, is the property only of 
intellect. Instinct acts in response to impressions without the 
higher intellectual operations. 
There is one peculiarity of intellectual action that characteriz- 
es the lower instinctive acts. I mean the instinctive, uncon- 
scious tendency to imitation. AVe think in the same manner, 
reach the same conclusions, entertain the same opinions as oth- 
ers, by virtue of this instinct—imitation. All writers speak of 
it as showing its influence in extending nervous disorders. It REPORT ON MONOMANIA. 
lias been an unconscious power impelling its victims to crime, 
suicide and vice in all ages. We cannot rise above it. It 
is an instinctive principle of our nature. We call it ens- 
ima and habit and everything else but instinct ire imita- 
tion. It forms our opinions although we insist they arc, 
the result of our own intellections. Charron says: “Almost 
every opinion we have we have but by authority; we be- 
lieve, judge, act, live and die on trust, as common custom 
teaches us; and rightly for we arc too weak to choose for our- 
selves. But the wise do not act thus.” It is but another ex- 
pression of the same idea: our imitative, instinctive impulses 
guide us and reason never enters as a constituent of the act. 
Hommel says: “An ounce of custom outweighs a ton of rea- 
son.” 
Man is the unconscious tool of instinct—it is the motive— 
the secret spring of his conscious life. The contagious influence 
of custom in determining the prevailing form of insanity of 
any age has been recognized by all writers. Epidemic delu- 
sions rest upon instinctive imitation. Schiller has observed it 
with the sane mind: 
“ Not that which proudly towers in life and strength 
Is truly dreadful; hut the mean and common, 
'fhe memory of the eternal yesterday, 
Which, ever warning, ever still returns, 
And weighs to-morrow for it weighed to-day. 
Out of the common is man’s nature framed, 
And custom is the nurse to whom he cleaves. 
Woe then to him whose daring hand profanes 
The honored heir-looms of his ancestors! 
There is a consecrating power in time ; 
And what is gray with years is Godlike, 
Be in possession and thou art right ; 
The crowd will lend thee aid to keep it sacred.” 
But tlic.se men of wisdom, these men who do not cleave to 
custom, who are able to reason, who digest and assimilate and 
create, are often the last to act. They point the way of truth OHIO STATK MEDICAL SOCIETY. 
21 
to mankind but pursue an opposite direction themselves. Why? 
This strikes the key-note of reasoning mania. 
The Will, Intellect and Sensibilities, are each dictinct powers. 
Reason or intellectual action, alone, does not furnish a motive 
or impulse to action. Hence men of great reasoning powers 
frequently do not act, or if they do they are as liable to act 
contrary to what they teach as are other men. A man from 
his intellectual resources may draw out a most excellent theory, 
as upon temperance, his reasoning powers may electrify multi- 
tudes and yet he be a confirmed s*>t. The sensibilities are 
dormant—reason alone acts—the Will is uninfluenced. His 
reason has no connecting tie of emotion to incite volition. 
The sensibilities not being excited no motive is afforded to de- 
termine activity. The idea to be effective must not only be 
considered by the intellect but it must react upon the sensibilities. 
Our theologians make a practical illustration of this every 
time they allege that men are convinced in their reason of tin* 
truth, yet refuse to give their hearts to God. In other words 
they recognize the fact that reason may assent to a proposition 
us right and yet the feelings be unmoved. Emotion may be 
excited and not the intellect. 
Man may then reason profoundly upon any moral subject but 
unless his sensibilities are enlisted no action will result. Ho 
not some religious denominations act upon this in time of re- 
vivals? All the appeals are made to the sensibilities—ex- 
citement follows—many from an innate power of instinctive 
imitation or sympathy flock to the altar? Why? The appeal 
has been made to the feelings alone. Under the impulse, reason 
not being influenced, the Will is overpowered. When the feel- 
ing subsides all subsides. This is all there is of it. If through 
calm and deliberate reason the sensibilities had been enlisted the 
work would have been more permanent. REPORT ON MONOMANIA. 
When the sensibilities are enlisted, or appealed to a stronger 
influence even though this be born of the intellect may render 
this motive powerless, as an inordinate desire. The intellectual 
impression in the face of animal passion is unheeded. 
The libertine—the gambler—the drunkard, at times, are all 
under the influence of reason and which too excites emotional 
activity, yet the motive or impulse derived from reason, with 
the return of the desire, is kept in abeyance, and sensation cor- 
related in desire is the controlling power. 
An appetite is but an uneasy sensation or feeling, giving rise 
to emotion—this reacts upon the intellect and there is con- 
sciousness of the state; when the Will is influenced a motive 
to action is afforded, an appeal is made to remove it. When 
the desire is stronger than the Will power it is obeyed from in- 
ability to do otherwise. The desire may appeal directly to the 
Will. Desire is an intermediate state between the sensation or 
impression and the exercise of the Will. Do not confound de- 
sire•, an animal, instinctive impulse, with the Will. But we can 
proceed no further until we pause to consider the seat respectively 
of intellect, of sensori-motor action and of instinct. 
If each has a different center from whence radiates its power 
—the sensorium being a bond of union as it were between or- 
ganic and intellectual life we will be able to consider more fully 
the distinctive features of the two forces: mind, and vital or 
organic force as exhibited in the phenomena that characterize in- 
stinct and distinguish it from intellect. 
The anatomical and physiological relations of the nerve cen- 
ters of intellectual, i. e., conscious life, and inorganic, explain 
t 
many otherwise obscure phenomena. 
Man is possessed of a double life: his vegetable growth and 
intellectual life. How are they related? Is one dependent up- 
on the other? Do they react upon and modify each other? 
Which holds the scepter? OHIO STATE MEDIC'AL SOCI ETY. 
23 
The seat of the intellect is the cerebral hemispheres; instinct 
finds itself seated in every ganglion of the ganglionic system, 
its force and character being dependent upon the stability of the 
ganglion in which it is located, but its special manifestation is 
determined by its natural endowment, by the conditions and cir- 
cumstances under which it acts, each ganglion being a brain 
for the part in which it is located and endowed by nature with 
such special function as that locality requires. Instinct bears 
the same relation to the vital powers that conscious intellectual 
life does to mental power. That is each is the offspring of its 
respective force. 
We are unable to perceive any essential difference between 
the operation of a law of nature that molds and shapes a crys- 
tal from its mother liquid, always after a given form, and that 
which fashions the plant, limits its growth, forms its or- 
gans, as well as those of man, and determines their functions. 
Why albumen should assume the form of muscle in the animal, 
or the form it assumes in the egg, why some portions of mat- 
ter form a tiny animalcule and yet others the huge leviathan 
of the deep—why the same chemical elements combine to con- 
stitute different species of animals, the God of Nature who put 
in operation these laws alone can explain. 
Different parts of the human body are all formed from the same 
circulation—the same blood current. The epithelial cell of one 
part selects what shall be appropriated to nourish that part— 
of another what pertains to its sustenance. Is not this an in- 
stinctive force with which the cell is endowed? The cell struc- 
ture of a gland is likewise endowed with power to select what 
shall, when combined and elaborated, constitute its proper secre- 
tion. Is this power of a lower order than that which directs 
the bird in selecting the proper material for its nest ? Metals 
crystalize always after as definite forms, each as peculiar to and 24 
REPORT ON MONOMANIA. 
characteristic of its kind, as the development of animals and 
plants. The laws governing one govern all—it is not the work 
of chance—all are predetermined, the unseen blind force is di- 
rected by the Divine Architect, who molds and fashions and 
brings into unity and harmony all created things. 
Does it require any more faith—any greater stretch of the 
imagination to see the same law operate in the inanimate that 
operates in the animate being? Cannot he who has endowed 
man with consciousness delegate power to matter? Cannot He 
who has ordained conscious action in the mind of man delegate 
to, or confer upon matter unconscious activity ? But matter has 
no active power conferred upon it, it obeys only the operation 
of the forces that are resident in it. What then is this force? 
We say vital force constructs a heart with valves, a brain with 
convolutions, a liver or stomach with secreting structures; how 
does this differ from the force that is resident in matter—if dif- 
ferent, what organizes a plant and what shapes a crystal? What 
difference is there between the instinct that prompts the animal 
to quench its thirst at the spring and that which causes the 
root of a plant to deviate from its course to drink from the 
same source, or the limb of a plant to bend in its growth that 
its leaves may be exposed to the light of the sun? 
From the lowest order of Nature to man the same law gov- 
erns, and is manifest in its various modifications of energy and 
character as the conditions of organization and function require 
Intellect is superadded, as an extension of this power, yet with 
a power not inherent to instinct, not a property of instinct: 
that which renders man a rational, responsible being: con- 
CIOUSNESS or'1 urs acts, with reason, judgment, memory and 
Will, to enable him to consider, determine, act or refrain from 
acting. 
The ability to door refrain from doing, is as we have remarked, OHIO STATE MEDICAL SOCIETY. 
25 
to a great extent dependent upon the animal nature—freedom 
of AVill is freedom from the tyranny of instinct, of desire and 
passion which instinct represents. 
If intellect is seated in the brain and instinct in the ganglia 
of organs, how can this be ? 
The brain, as every other organ of the body, has its life of 
vegetation and that of function. In this respect it is as depend- 
ent upon the vital forces controlled by instinct as all other or- 
gans of the body. The brain is not an independent center, but 
only one great ganglionic center of the myriad that dot the 
body, fill organs and everywhere preside over their respective 
locations, exceeding all in size, and endowed with a special 
function: intellection. 
The brain has its wants, manifest in desire, arising from nu- 
trition, it may be reacted upon or react upon other organs. We 
have tl»en from the lowest to the higher powers, first vital force. 
It is something imparted to all organized beings, for when with- 
drawn they become disorganized. We have above this, instinct, 
which is the mind of vital force—then intellect. 
All are too familiar with the anatomy of the nervous system 
to render it necessary that I should refer to the distribution of 
the different sets of nerves, to show the intimate relation exist- 
ing between every part of the nervous system. 
The ganglionic, or sympathetic system, consists in one or 
more cells, scattered upon or in the tissues of every organ of 
the body, a knot or collection here and there giving it the pe- 
culiar character expressed by the name ganglionic. When the 
collection is large, of both cell and fiber, it is called a Plexus. 
There is a net-work over all the body, the ganglia—signal 
stations—transmit to the brain—or allow to be transmitted only 
messages warning of danger. They'act as centers of power to the 
vegetative function and arrest in a normal state all communication. REPORT ON MONOMANIA. 
The chief ganglia are those of the head, as the opthalmic, 
Meckel’s or the Spheno-palatine, the otic, and submaxillary; the 
neck, the cervical ganglia; extending along the side of the ver- 
tebral column, right and left, in front, as a double chain, we have 
the prevertebral ganglia; upon the posterior roots of the spinal 
nerves there is a similar chain. 
We shall not stop to discuss the question whether these gan- 
glia upon the roots of the spinal nerves have a special function, 
to modify or arrest impressions coining from internal organs; 
whether they come between internal organs to modify impres- 
sions as do ganglia of special sense. This you may determine 
for yourselves. 
Within the abdomen and thorax the principal ganglia are the 
cardiac, solar, and hypogastric plexuses. Added to these arc 
numerous smaller ganglia, situated upon the viscera, and which 
are additional centers of nerve power, reinforcing the. larger 
centers. The nerve trunks of the sympathetic are made up of 
fibers from both the vesicular matter of the cerebro-spinal and 
the ganglia of the sympathetic. Their fibers have their central 
termination in both systems, some arising in the ganglia, others 
passing out through the anterior roots from the spinal cord. 
The fibers from the sympathetic interpenetrate those of the 
cerebro-spinal in the roots of both the anterior and 
posterior nerves. Those fibers derived from the ganglia, which 
enter the anterior and posterior roots of nerves upon the spinal 
cord, having their central end in the ganglia, are of the “gela- 
tinous” form or non-medullated. Those derived from the 
cerebro-spinal system are of the “dark bordered” or tubular 
form. Thus each system has its distinct fibers which are so 
blended that both are distributed together. 
This system of nerves supplies the blood vessels, and pre- 
sides over organic life; some portions of the body receive no OHIO ST A T E ME DIC A E SOCIETY. 
27 
*other supply of nervous power. The muscular coats of the in- 
testinal canal from the stomach downward, with the ducts from 
the glands which open into it, that which forms the walls of the 
bladder, of the uterus, ureters, the fallopian tubes and muscular 
coat which governs the size of blood vessels, receive no nerves 
except from the sympathetic. Independent cells are imbedded in 
the walls of the heart, uterus and intestinal tract, forming cen- 
ters of power independent of and free from cerebro-spinal in- 
fluence. 
The ganglia of the sympathetic system are not endowed with 
a high degree of sensibility, in fact some writers deny that they 
arc possessed of sensibility at all, yet severe suffering arises 
from disease or irritation of them. Irritation is transmitted 
through their cerebro-spinal trunks, and hence the brain mani- 
fests its inhibitory influence. Irritation in an organ may thus 
be reflected upon the brain, another organ, or generally diffused 
through the body. 
Irritation of an organ, as the liver, is transmitted through the 
sympathetic trunks, which also include the cerebro-spinal, to 
the vaso-motor centers; from thence may radiate influences that 
paralyze the vaso-motor nerves of other organs. The vaso- 
motor system has centers wherever there are ganglia, but the 
chief centers are in the cord and brain. Schiff, Salskowsky, 
Ludwig and Thiry, locate the vaso-motor center for the whole 
body in the medulla oblongata. Tseheschichin located it at the 
junction of the pons varolii and medulla. Brown-Sequard ex- 
tends it up to the cerebellum and cerebrum. Kronecker locates 
it in the floor of the fourth ventricle. This seems most reason- 
able, for here in close proximity, are the motor and special sen- 
sory centers, which lie in the medulla oblongata, pons varolii, 
and base of the brain. The intimate relation between the cen- 
ters of the ganglia of special sense and the vaso-motor centers REPORT ON MONOMANIA. 
as thus described would explain the sudden reflex action of 
blushing, or the opposite, extreme paleness, or violent and sud- 
den changes manifest in reflex actions. I)r. Jewell, Chicago 
Journal of Nervous and Mental Disease, in an article upon the 
Pathology of the vaso-motor nervous system sets forth these 
facts very clearly. 
To recapitulate, in formulas, what we have considered, we 
find that we have encountered with man, as it were, three prin- 
ciples, powers, or forces: 
1. The vital force. Natural force as exhibited in all Nature’s 
operations by which all organizations are perfected whether ani- 
mate or inanimate. 
2. Instinct. The same force manifested in a higher degree. 
The general action of organic nature; the phenomena having 
their origin in organic action; the phenomena by which nature 
manifests her wants, and the impulses that cause her creatures 
to seek the preservation and reproduction of their species, co- 
ordinating muscular action to this end. 
3. Mind: Intellect. A power superadded to instinct and be- 
longing only to rational, responsible creatures; that which char- 
acterizes individuality and enables man alone to become con- 
scious of his personality; that which enables him alone to 
comprehend his instinctive tendencies, to know God’s laws, and 
confers upon him ability to perform the duties enjoined therein. 
All of these may exist in one individual or one or more may 
be wanting. Thus man may exist in the simple vegetative state, 
as a parasite, nourished by the maternal circulation with com- 
plete absence of the cerebral system; the ganglionic, or nerves 
administering to vegetative life alone being developed to any 
considerable extent; he may live only as an animal, controlled 
wholly by instinct, devoid of reason, as in idiocy and in some 
forms of insanity; he obeys his instinctive impulses, and is be- OIUO STATE MEDICAL SOCIETY. 
29 
neath the brute when these forces are perverted; or man may 
represent all that nature has conferred upon her most perfect, 
creatures: vegetative, instinctive, and intellectual, or moral life 
Before his fall, in the full enjoyment of all of his faculties, 
these existed in harmony; man enjoyed full and entire liberty in 
his thoughts and actions—-free will. His mental and moral 
life being dependent upon the integrity of his organization, his 
animal life, he enjoys freedom of will only in proportion as his 
organization is perfected, and every part operates in harmony. 
By this we do not mean to say man is in no way, and under no 
conditions responsible, since the fall. He can obey vicious im- 
pulses, yield to his instinctive feelings, excite by mental effort 
vicious sensations, and through them when excited, be reacted 
upon by sensual impulses. 
He can repress, when they arise, voluptuous sensations, in- 
stinctive impulses, appetites, passions, and if he conquers they 
retire and in many instances leave him master of the field. 
His will gains strength at each success—the appetite or passion 
is correspondingly weakened. Instinctive impulses, appetites or 
desires, unheeded, in time rust out, or die from inactivity. 
Leaving out the question of vital force, of which we believe 
instinct is but a modification, we have man ruled by two an- 
tagonistic forces, instinct and reason. We say antagonistic, 
not because they never unite to accomplish the same end, but 
because they less often act in concert, or else one becomes the 
servant of the other. 
Two sets of nerves we have called your attention to, as minis- 
tering to each of these powers, the cerebral and ganglionic. 
Intellectual force depends upon the due development and nu- 
trition of the cerebrum. Instinct is dependent upon the same 
conditions of ganglionic structure; while man can live deprived 
of intellect, he cannot if deprived of instinctive force. This 30 
REPORT ON MONOMANIA. 
being accepted, is it strange that organic life, instinct, instinctive 
appetites subdue intellect and dethrone the vnU? 
Man enters upon life with only instinctive life to control him 
—instinct directs all his actions. As he develops into manhood 
those forces have supremacy that are most cultivated and de- 
veloped. What iu early life is but an instinctive appetite, if 
cultivated becomes a powerful passion. Passion thus developed 
reacts upon the organism, and mind and will power succumb. 
Passion may also react upon the brain so changing its vegeta- 
tive life, that what at first was but an impulse communicated by 
an organ becomes a power to control imagination, reason, and 
the will. There is organic lesion which renders a return- to a 
normal moral state impossible. Is it necessary to enter into 
details to show how man’s stomach or generative functions sub- 
due to themselves every other force of his nature? 
Comprehending the distribution of ganglionic nerves as we 
do, is it difficult to understand why an irritation in the intesti- 
nal tract, uterus, or other part supplied only by this system of 
nerves, may give rise to ill-defined sensations, general lassitude, 
depression, melancholy, hypochondriasis? When a normal in- 
stinctive impulse, as an appetite, communicated to the brain is 
recognized, whether arising from the general state of the system, 
as hunger, thirst; or from local sensation as the sexual passion; 
instinct co-ordinates organic action, and muscular action in the 
line of the impulse. This may be fully proved with the lower 
animals, as the frog, which are governed wholly by instinct. 
Consciousness, that function superadded to instinct, enables man 
to determine the source of all natural, instinctive impulses, 
although their existence is not dependent upon intellectual de- 
velopment. His organs of special sense, reason and judgment, 
affirm the existence of instinct to consciousness. Without stop- 
ping to discuss the question whether consciousness in a true wit- OHTO STATE MEDICAL SOCIETY. 
31 
ness, we affirm that consciousness attests all mental operations; 
whether conceptions be true or false, it will not determine the 
grounds of belief. But an irritation arising in an organ, it like- 
wise may be reflected upon the cerebral centers, and give rise to 
ideas. It will not appear in consciousness, except there be pain 
or pleasure; then the source is not made known. It is not an 
instinctive impulse, is not the result of impressions upon the 
organs of special sense. The ideational centers receive it as 
they would impulses of an unnatural or foreign source, as when 
the electric current excites a ganglia of special sense. The 
source of the pain or uneasiness is made known only when it 
becomes so well defined, so localized, as to become subject to the 
organs of special sense, through their exercise reaching the in- 
tellect. But when the irritation is unfelt yet equally positive in 
effects upon the ideational centers, it is otherwise. 
•The appetites arc the true instinctive manifestations, and ap- 
pealing to the will for gratification give rise to desires. Perver- 
sion of these sensations gives rise to the various instinctive manias. 
This is an explanation of our assertion, that Dipsomania is but 
a physical condition, an exaggerated or perverted instinctive im- 
pulse. 
We cannot pause to consider the relation of the organs of 
special sense to the ideational centers, the physiology of the sen- 
sorium, sensori-motor function, the manner in which illusions 
and hallucinations may arise, belief in the reality of which con- 
stitutes delusions. It is sufficient to say impressions made upon 
the sensorium may give rise to sounds, voices, visions, tastes, or 
smells ; these carried to the ideational centers may when reach- 
ing consciousness appear in material forms, or in other words 
will be associated with material objects which the imagination 
furnishes. When these impressions reaching the sensorium, or 
ideational centers arc from without, that is, made by an external KKCORT ON MONOMANrA. 
object, of which there is a false conception of the impression 
made, as for instance, one seeing a post imagines it to be a man, 
we say there is an illusion. The appearance upon a moving 
railroad train that everything is running backwards is an illu- 
sion. When a man perceives an object that has no existence 
except in his imagination, as in delirium tremens when the pa- 
tient sees the floor covered with rats, serpents, &c., this being 
the result of irritation in his organs, we say there is an halluci- 
nation. When the mind is able to correct these false impres- 
sions and recognize its own states, we say it is sane. Belief in. 
the reality of these false impressions constitutes what we term 
delusion. When the mind is unable to recognize its error, be- 
lieves in the reality yf the illusion or hallucination, there is in- 
sanity. The mind having been subjected to this condition, so 
that there is well manifested delusion, it is as fully under its in- 
fluence as when belief is the result of normal action. When 
the mind of the patient is so affected that he is unable to reason 
against his delusion, or being reasoned with by others is inca- 
pable of accepting the evidence of others against the evidence 
of his own senses, there is unquestionable insanity. The true 
lesion of intellect in these cases consists in the want of ability 
to reason against the delusion, or the evidence of the senses. 
In other words reason is not influenced by any impression made 
upon the senses unless in the line of the delusion, i. e. not con- 
trary to it. Let us illustrate this by a few cases in which de- 
lusion was the result of real impressions, but false conceptions, 
giving rise to false ideas. 
Dagonet relates the case of a patient who could not be con- 
vinced that a serpent had not taken up its residence in his belly. 
A post mortem examination revealed the fact that two ulcers 
existed in the stomach, one of which had perforated it and 
caused the patient’s death. The case of a woman is reported OHIOSTATE M EDIC A I, S<)CI ET Y. 
33 
who believed that a regiment of soldiers was concealed in her 
abdomen. A post mortem examination revealed the fact that 
chronic inflammation had glued the intestines together, although 
unsuspected before death. Another ease in which the same 
idea existed there was found a fibrous uterine growth. As we 
have remarked, impressions transmitted to the ideational cen- 
ters give rise to ideas. It is not even necessary that the irrita- 
tion, or impression made upon an organ be felt, to cause ideas 
to arise. Patients in health believe the evidence of their senses, 
but if their senses deceive them, or internal impressions are 
made, which come to the brain with all the force and authority 
of those of special sense, and ideas arise, there will be undoubt- 
edly delusion. 
Any appetite, or instinctive function, may be perverted. Thus 
man may lust after his fellow man, he may thirst for blood, he 
may desire human flesh. Organic changes determine these in- 
stinctive insanities. A good case illustrating this is that of the 
boy Bijou, who was in a menagerie at Paris. He drank on one 
occasion, in 24 hours, thirty livres of blood, stole pieces of [ni- 
trified anatomical specimens and devoured them ; devoured also 
a dead lion. 
A glutton named Tarare, born in 1772, weighed at seventeen 
100 lbs., could eat in 24 hours his weight of beef. He devoured 
living cats and dogs; he ate atone meal a dinner prepared for 
twelve men. After entering the hospital at Soultz, in Alsace, 
he ate the cataplasms, plasters, blood from the leeches, and even 
was caught at the amphitheater eating of the dead bodies. A 
child of fourteen months disappeared under very suspicious cir- 
cumstances. He died in 1798, at Versailles, in a state of complete 
marasmus, under the influence of a purulent, chronic diarrhoea. 
A post mortem examination showed the intestines glued together, 
suppuration, an enormous putrid liver, and a stomach which 
occupied a large portion of the abdomen. 34 
REPORT ON MONOMANIA. 
Cases might be cited illustrating the influence of thirst upon 
the system and its mastery of intellect. Organic changes in- 
duce these perverted instinctive manifestations, as in diabetes, 
chronic diarrhoea, &c., as well as in those of a purely instinct- 
ive character not associated apparently with disease, as dipso- 
mania, &c. 
The books are full of cases we might cite to illustrate our 
views but von can apply them at your leisure. 
Disease of the brain may give rise to alt the manifestations we 
have mentioned due to organic changes at remote parts. 
Will these irritations, either in the brain or in organs re- 
mote, give rise to one idea or will the delirium be general? 
We have already seen that the idea correlating the impression 
may not be complex, but a simple idea, limited to a single fact, 
which, however, controls the mind in respect to all that per- 
tains to the reality of this fact. Every mental faculty is enlis- 
ted in support of it. It is then a monomania. 
But the fact that every mental faculty is enlisted in the sup- 
port of the idea, or train of ideas, is used by those opposed to 
the theory of a monomania to prove the whole mind is insane. 
This will be correct if we believe the mind never thinks upon 
one subject independent of all others, and we also ignore the 
physiology of ideation. The fact that generally the delirium is 
more universal does not prove that an impression may not re- 
sult in a single idea. The cause remaining, the conditions be- 
ing unchanged, the idea is fixed. Where a multitude of varying 
impressions reach the cortical substance there will be corres- 
ponding variableness of delusions resulting therefrom; but 
whether the impression is local, i. e. in the brain, or remote, or 
what its nature, we may not always be able to determine from 
the phenomena consequent upon its action. 
Instinctive appetite may not affect the intellect; it may sub- OHIO STATE MKDH'Al. SOCIETY. 
♦lue it. As we remarked concerning dipsomania, the imagina- 
tion, when the impulse to drink is given by the organs, may sup- 
ply pleasant visions of that which in imagination will appease 
the desire. We can scarcely conceive of an appetite or desire 
that is not personified in the imagination. The intellect then 
becomes servant to the instinctive impulse ami instead of thwart- 
ing begins to devise means of gratifying the desire, when this 
results there is, the instinct being exaggerated or perverted in its 
operation, instinctive mania. 
We have these two facts then established beyond dispute: 
1st. That an impression made in the brain by local irritation, 
in the sensorium, or in remote ganglia, or parts supplied by the 
sympathetic, when such impressions reach the cortical substance, 
may each originate an idea or single train of ideas which will 
control the mind in the line of such ideas; the mind being un- 
able to correct these false ideas, delusion exists—the individual 
is a monomaniac. 
2d. That any instinct may be exaggerated, perverted orabated. 
That the Intellect and Will may be controlled by and yield 
obedience to it, yet preserving unimpaired reasoning power 
even as to this instinct; approving or condemning as the same 
faculty may be exercised upon all other questions; the individ- 
ual being powerless in the grasp of his instinctive impulses. 
Thus in gluttony, and in disease, the instinctive desire, hun- 
ger, may cause excessive quantities of food to be taken; the 
same instinct, perverted, may cause the most loathsome and 
disgusting substances to be devoured; if abated no food will be 
taken, as in fever, melancholia, &e. Refusal to bike food may 
also be in the line of the delusion, as where the patient con- 
wives the idea that he is too wicked to live and desires to 
starve himself to death. The same cause that abates the instinct 
gives rise to the idea. The idea rules in intellectual monoma- RKPORT ON MONOMANIA. 
nia, the instinct in instinctive insanity. The idea may be born 
of the instinctive condition. The perversion may be only that 
of instinct, lienee there may or may not be delusion, the fact 
depending wholly upon another fact, whether the intellectual 
centers are involved ; whether an impression sufficient to create 
a delusion has been made. 
In all eases instinct co-ordinates muscular action in the line 
of any instinct. All special senses that may be necessary to 
serve any special instinct, as sight, smell and taste, are equally 
under the control of instinct. 
Man is so constituted that tin; greater portion of his life is 
simply to follow the dictates of his instincts. The more he de- 
velops his intellect the more instinct is dethroned. 
Has the animal intellect? From what we have said of the 
relation of instinct to intellect you may infer that we believe it 
has not. This is not correct. All animals possessed of a cere- 
brum have a certain degree or kind of intellect. As we have 
declared, however, it is so closely related to instinct we are un- 
able to separate them. An animal performs many acts that in- 
dicate a reasoning faculty that are purely instinctive—man does 
the same. There is one fact that convinces me beyond all oth- 
ers that animals possess a low degree of intellect : removal of 
the cerebrum produces the same effect that it does with man. 
It reduces the animal to the condition of a man in a profound 
sleep. There may be sensori-motor actions excited, yet if we 
subsequently awaken the man he is not conscious of the act that 
was excited. The brain of the animal seems to be but the ser- 
vant of its instincts, and if possessed of a higher endowment 
than this its action is so co-ordinated by instinct that we can 
recognize no trace of mind but by phenomena that are Appa- 
rently mental, we cannot prove them to be such. 
Can man be reduced to this level? Can intellect be so in OHIO STATE MEDICAL SOCIETY. 
abeyance to instinct that we recognize only instinctive action? 
When delusion exists is it a test of insanity? Must delusion 
exist to constitute insanity ? To what extent is it a test of in- 
sanity ? 
DELUSION IS THE LEGAL TEST OK INSANITY. 
“ Knowledge of right and wrong” has been the test, as held by 
Hale, and still held in some States of our Union. It is a test of re- 
sponsibility but not of insanity. A man who has not knowledge 
of right and wrong is irresponsible, but three-fourths of all who 
are insane arc*able to distinguish right from wrong. 
Wharton* lays down the principle as follows: 
“1. Any species of insane delusion exempts from punishment 
the perpetrator of an act committed under its influence. 
“2. The belief, unfounded in fact, that a party is in immedi- 
ate danger of his life from another, may be such a delusion. 
“Or the belief that taking the life of another is the. appro- 
priate remedy for a minor though imagined evil, may be'also an 
insane delusion. 
“3. Therefore homicide, under such a delusion, is not liable 
to punishment.” This echoes the English cases of like nature. 
Wharton, (in W. & S. 52 Sect.) says: “The delusion how- 
ever, must go to the root of the crime; or, in other words, the 
crime must have been the result of the delusion.” 
In vol. vii, 1863 Abbot’s N. Y. Digest, it is said: “The true 
test of insanity is mental delusion. If a person persistently be- 
lieves supposed facts which have no real existence except in hi* 
fevered imagination and against all evidence and probability, 
and conducts himself, however logically upon the assumption of 
•Held in recent English decisions. RRPORT ON MONOMANIA. 
their existence, he is, so far as they are concerned, under a mor- 
bid delusion; and delusion in that sense is insanity.” 
Greanleaf, Ev. i, p. 464, says: “ What constitutes insanity 
of mind is a question which lias been very much discussed, es- 
pecially of late years; and the opinions of learned judges seem 
at first view to be conflicting; but much of the apparent dis- 
crepancy may be reconciled by adverting to the nature of the 
cases respectively in judgment. The degree of unsoundness or 
imbecility of mind, sufficient to invalidate the acts of the party 
in some cases may not suffice in others. But in regard to in- 
sanity, where there is no frenzy or raving madness, the leyal and 
true character of the disease is delusion; or as physicians express 
it, illusions or hallucinations; and the insane delusion consists 
in a belief of facts, which no rational person would believe.” 
This applies to monomania as well as general mania. In 
monomania the idea is fixed, in general mania the delusion is 
variable. 
It is, by the above, but another term for insanity to use the 
word delusion ; but as we believe there may be insanity of 
action as well as of thought we do not think it proper to limit 
insanity simply to mental phenomena. We believe there may 
be insanity of muscular action, as in chorea, subsultus tendinum, 
&c; there may be insanity of any part of man’s nature. 
Bucknill defines insanity : “Insanity therefore may be de- 
fined as, a condition of the mind in which a false action of 
conception or judgment, a defective power of the will, or an 
uncontrollable violence of the emotions and instincts, have sep- 
arately or conjointly been produced by disease.” 
The test of delusion was first laid down by Lord Erskine, in 
his defense of Hadfield for shooting at King George TTI, in 
Drury Lane Theater, in the year 1800. 
Previous to that Lord Hale’s doctrine; -“Knowledge of right ohio state Medical society. 
and wrong ” had prevailed. This was held in the celebrated 
McNaughton case, partial delusion, (i. e. partial insanity) was held 
to be no defense. 
In the Blackburn ease,* 23 O. S. K., the Supreme Court 
held: the defendent must be able to distinguish right from 
wrong—must be a free moral agent. Here two distinct tests are 
submitted; yet where both arc given it would seem that either 
would exculpate. Knowledge of right and wrong is one thing, 
but the ability to do right is another, dependent upon power, not 
knowledge, hence the man who from lesion of the Will has not 
ability, bears the same relation to the law as he who has not 
know ledge. • This is the test of responsibility and cannot justly 
l>e considered the test of all forms of insanity. 
Delusion has been considered a test—yet it is not a true test 
further than as we consider the intellect. An error may arise 
in sensation, giving rise to a delusion, yet it is only in the re- 
lation such sensation may sustain to reason and judgment that 
we can consider it as bearing any relation to insanity. 
The condition termed formication mav induce me to believe 
* 
something moves over the surface of my body, my senses ena- 
ble me to correct this impression. The man with delirium 
tremens suffers similar sensations—sees hideous objects, reason 
and judgment are. insufficient to correct the error. The sensa- 
tion then gives rise to delusion. Delusion may arise as well 
from an unrecognized as from a recognized irritation. If it 
works the same change in the intellectual centers the result wilt 
l>c the same. 
Actions are the offspring of belief. As we believe so we act. 
The delusion of the insane is to him a reality. In the abstract 
he may reason well—even against his delusion if brought be- 
fore him in an abstract form, yet when the delusion becomes a 
•Wee Blackburn Case at end of my report on UenenU Paralysis*. 40 
UKPORT ON MONOMANIA. 
motive for action he no longer reasons against it. His abstract 
reasoning—the intellectual act—seems to bear no relation to the 
act springing from his sensibilities. We may not be able to 
connect any given act with delusion so as to show it to be un- 
questionably the offspring of delusion. The reasoning power 
of a maniac is oftentimes so perverted that what seems to flowy 
to him, as a logical consequence, to, another bears no relation 
whatever to the alleged motive. He views it from his stand- 
point and the process of reasoning by which he reaches a con- 
clusion cannot be determined—in fact many times conclusion# 
arise without premises—without reason—the delusion is i deeply 
rooted in the mind—is a motive to action and the party is whol- 
ly unable to explain it. Hence where one insane commits an 
act that seems to indicate responsibility we should be extremely 
cautious, and err, if we err, upon the side of mercy. 
Bueknill says: “The existence of delusion is the proof of in- 
sanity ; and an acknowledged lunatic cannot justly be held to 
be wholly responsible for his actions, whether we are able to 
trace the motives for them to delusive opinion or not.” 
Iiv true homicidal insanity1 no sufficient motive can be assigned 
for the act committed. A sudden, irresistible impulse ••seizes 
and overpowers the Will. The intellect if employed is but a 
servant to the instinctive thirst for blood. It is a terrible pow- 
er converting intelligent man into the ferocious beast—exagger- 
ating tile element of destructiveness-until at times he would slay* 
all within his reaeh.- 
This emotional state maybe induced by irritation of organ# 
remote from the brain, or by disease of the brain itself. ; It will 
most generally be found to be the result of physical dorange- 
ment not located in the brain. Many cases reported seem to 
be the result of menstrual irregularity, or follow parturition, or 
are determined by some local eccentric irritation that induces a OHIO ST AT K MKD1CAL SOCIETY. 
londition of tire sensorium more closely allied to that observed 
in many oases of petit mal than anything else.* 
Instinct plays an important part in all these cases. Intellect 
and Will are in abeyance. All acts are sensori-motor. There 
is a sudden impulse, but the revulsion of feeling when the im- 
pulse is obeyed is as sudden. The act may be a conscious one 
or not. If the mind recognizes the act it is unable to compre- 
hend fully its nature. There is a condition with many like that 
which induces suicide. I would need to waste no words to con- 
vince you that there is a condition that irresistibly compels a 
man to destroy his own life. What difference is there when in- 
stead of being turned upon himself he is forced to kill another*/ 
Hundreds of cases may be cited to prove that men not to any 
great extent intellectually deranged take their own lives. Sen- 
sibility reigns—the Will is dethroned. I acknowledge that the 
mind may be deranged and yet be apparently sound, yet no one 
who has a thorough understanding of the relation of the emo- 
tions to the intellect ami to the Will will doubt this assertion. 
I am fully convinced that there is a homicidal mania—that 
there is an instinctive mania—that the lesion of mind is the en- 
thrallment of the Will—that where the intellect suffers it is 
only through this powerless state of the Will. 
It is a question much discussed whether these conditions—in- 
stinctive and homocidal manias—can exist without lesion of the 
intellect. 
If I thrust a pin into a man he immediately strikes me and 
considers the act only after it has been performed. He then 
may regret it. The Intellect and Will are not involved—it is a 
sensori-motor act. Cannot local irritation in an organ deter- 
mine a-similar act, and if sufficiently strong induce it even in 
*1 omit here several pages in consequence of the great length of these 
papers. llKPORT ON MONOMANIA. 
the face of full consciousness? Can these conditions of sensori- 
motor function exist without lesion of the intellect? Must 
there be lesion of the intellect in homicidal mania? 
Tt can; the will alone yielding to the emotional impulse. 
Is there a reasoning or moral mania ? 
We think these questions have been fully determined.* The 
appetites, passions, desires are but determined forms of in- 
stinctive action—instinctive impulses arising from different 
states of the ganglionic system of nerves. As wo have before 
remarked reason alone does not afford a motive to action. In- 
stinctive impulses do; reason may comprehend the situation; 
man may feel the disgrace his condition causes, his interests may 
appeal to him, his friends may appeal to him, his senses may ap- 
peal to him, his moral sense, knowledge of right and wrong 
may enter a protest, yet all this but lessens his self-esteem, he 
feels his degradation more and plunges headlong into the gulf 
beneath his feet that he may drown conscience. He is the slave 
s>f his instincts. * * * * 
We omit eight pages of our consideration of moral insanity. 
These patients manifest strange perversion of the affections, 
sensibilities, and often unusual brilliancy of intellect when di- 
rected in certain courses: thus they may be great musical per- 
formers, but not original composers; they are active in every 
thing, superficial in everything, continue long in nothing. They 
are impulsive, conceited, proud. They love change and arc 
constant in nothing except that they are constantly inconstant. 
They lie with a readiness that is startling, exaggerate everything 
they relate; the slightest emotion animates and exalts them. 
They are easily angered, pass readily from one extreme to 
another; approve to-day what they condemn to-morrow; noth- 
•/See Traitc dela Manie, Paris, ISflfi by l)r. Itnmpagne, <&c,( <fce. OHIO STATE MEDICAL. SOCIETY. 
ing influences them so much as flattery. Their word of honor 
is of qo value; they fail to keep the most sacred promises, and 
excuse all their actions on the ground that “it is of so little 
consequence,” feeling no sense of responsibility whatever in all 
they do or say. They steal a book or other article if it takes 
their fancy, soon tire of it and require some other object. Often 
they are brutal, unfeeling—inflict pain on others without remorse. 
Their reason teaches them they must respect the rights of others 
to avoid punishment; their observance of law whether human 
or Divine is based on no other principle than self-interest. Du- 
ty is a term unknown. Naturally jealous they envy every one 
happiness or prosperity and seem happy only when causing un- 
happiness. Although they boast, they are cowards; bold in 
speech, cowards in action. They arc always planning but never 
execute; their fickle natures, their love of change render steady 
occupation impossible. They are lawyers, physicians, chemists, 
musicians, painters, all in a breath, “everything by spells, but 
nothing long.” They smatter at all, learn thoroughly nothing. 
In a word they are devoid of a moral nature, possess only im- 
j>erfect reasoning faculties, are unsound mentally and morally, 
yet are perfectly able to distinguish right from wrong, and can- 
not be considered intellectual maniacs. 
We regret that we are unable to consider fully the condition; 
its relation to intellect and to instinct. We conclude our paper, 
with these omissions, as follows: 
1. That there is, in the sense we use the term a monomania. 
2. That there is an instinctive, and a reasoning or moral 
mania. 
3. That there is an insanity without delusions. 
4. That delusion is a tent of insanity to this extent: where 
delusion, as we have defined it, exists, there is insanity, this is 
accepted by all authority; that no responsibility attaches when IUKPOKT ON MONOMANIA. 
an act is the offspring of delusion, and is in the line of such 
delusion. 
5. That an individual whose delusions defy the evidence of 
his own senses; whose reason and judgment are incapable of 
correcting false perceptions or ideas resulting therefrom; whose 
impulses, having overpowered the will, are purely instinctive, 
although in all these cases there may be knowledge of right 
and wrong, is insane and to this extent irresponsible. 
0. That knowledge of right and wrong is with this class of 
cases no test of responsibility. 
To these conclusions we append the following views and 
opinions showing they accord with accepted authority. 
“ Tn monomania proper, and in melancholy we have a partial 
ideational insanity, with fixed delusion or delusions upon one 
subject or a few subjects, apart from which the patient reasons 
tolerably correctly. Psychologically speaking, the existence of 
delusion indicates fundamental disorder of mental action-—rad- 
ioed insanity ; secondly the delusion reacts injuriously upon other 
mental phenomena, interfering with correct ratiocination, or 
due co-ordination of functions, and predisposing to convulsive 
mental phenomena; and thirdly, while it cannot be subordinated 
to reflection, the individual may at any moment he subordina- 
ted to it, and act under its instigation.” 
Edmonds, Seleef Canes, Vol. i, 3o, defines a mine man to be 
one: '.... 
1. Whose senses bear truthful evidence. 
2. Whose understanding is capable of receiving that evidence. 
3. Whose reason can draw proper conclusions from thetruth- 
ful evidence thus received. 
4. Whose will can guide the thought thus obtained. 
5. Whose moral sense can tell the right and wrong growing 
out of that thought. OHIO STATE MEIHOAI, SOCIETY. 
6. And whose act can, at his own pleasure, be in conformity 
with the action of all these qualities—all these unite to consti- 
tute sanity; the absence of any one of them makes insanity. 
In the case of Kline, city of New York, 184o, Judge Ed- 
monds charged the Jury that, “it must be borne in mind that 
the moral as well as the intellectual faculties may be so disor- 
dered by disease as to deprive the mind of its controlling pow- 
er.” Also, “if some controlling disease was in truth the acting 
power within him which he could not resist, or if he had not a 
sufficient use of his reason to control the passions which promp- 
ted the act complained of, he is not responsible ; but we must 
be sure not to be misled by a mere impulse of passion, an idle, 
frantic humor, or unaccountable mode of action, but inquire 
whether it is an absolute dispossession of the free and natural 
agency of the human mind. 
In the Hadfield case, Lord Erskine Submitted the following 
propositions to which the Court assented: 
1. That it is the reason of a man, which makes him account- 
able for his acts, and, that without the use of his reason he can- 
not be held guilty of crime. 
2. That it is unnecessary that reason should be entirely sub- 
verted. 
3. That a total loss of memory and reason is not required to 
constitute insanity. 
4. Where hallucinations exist, the deed for which the accused 
is arraigned must be the immediate offspring either of the hal- 
lucination or of the disease of which the hallucination is a 
symptom.” 
We will close with the opinion given by Chief Justice Shaw, 
of Mass., in the Rogers ease, (tried for murder of his keeper 
in prison). 
“The conduct may be in many respects regular, the mind 46 
REPORT ON MONOMANIA. 
acute, and the conduct apparently governed by rules of propri- 
ety, and at the same time, there may be insane delusion, by 
which the mind is perverted. The most common of these cases 
is monomania, when the mind broods over one idea and cannot 
be reasoned out of it. This may operate as the excuse for a 
criminal act in one or two modes; either the delusion is such 
that the person under its influence has a real and firm belief of 
some fact, not true in itself, but which if it were true, would 
excuse his act; as where the belief is, that the party killed had 
an immediate design upon his life, and under that belief, the 
insane man killed him in supposed self-defence. 
Or secondly, where some violent outburst occurs, which taken 
in connection with former acts indicates that the will was over- 
borne. The questions for them to decide were whether such a 
delusion existed in the mind of the accused; whether he did 
not act under an insane but firm belief that the diseased was 
going to shut him up with some dangerous design, or not for a 
slight punishment; whether the facts indicate that the deed was 
done at a moment when the delusion was uncontrollable.” 
A complete set of these Reports published by the Ohio State Medical 
Society, can be obtained by addressing the Author D. A. Moiwk, M, 1)., 
London, O., 
Dipsomania, ... (50 Pages. 
Generan Paralysis, 120 “ 
Monomania, 4(5 “