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Full text of "Mental pathology and therapeutics"

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^^^ 2W7t 



IL^^^^EJ 




MgiyE^^ t 



a MD>NJWiLIRfiai.SSJEaiBE3> 



MEOfCAt CENUR 
STAHmo. CAUF. 94305 




THE NEW SYDENHAM 

SOCIETY. 



INSTITUTBD MDCCCLVIII. 



VOLUME XXXUI. 






lEW/JY 



ENTAL PATHOLOGY 



Aku 



THERAPEUTICS 



W.* GRIESINGER, M.D., 

VRMoa or euncii. iitiiiciitK a>d or aasi4r, loiorK n mt i:*ir»iiTT M 

■■■ua^ aonoun Bmi* or m viDico-nicuoioaicn. uioniTim; 

■>■■■■ MMKIl tlSlUnU »■ Lil KlCiaia UaiCU-Cll CUD Loot ^vt 

u r*au, xtc uc. 



UBRARY. , 

114A •■»>■■¥«■»*>*.«* ia« KlaSA lBV4fW *» HJ^ I' Mlfi**^'^ ■jjl*! 

JAMES RUTHERFORD. M.D.Ems. 



THE NEW SYDENHAM SOCIETY. 
^ LONDON. 



MocccLnii. 

Ki;-] 



lAHEUB. 




.D\i' 




1 I - * 'Jf 



FBINTED BT J. S, ADLfkRD, 



ADVERTISEMENT BY THE AUTHOR. 



Thk first edition of tfaia woA appeared in Gemumj in 1 845 ; 
the sectmd, enlarged, bot not considerablj changed, in 1861. If 
the reader finda in this book thonghts, &ct9> and opinions irhich he 
has met with in recent books, or aitidea in periodicala, the Aathor 
begs him to keep these dates in memoi;. 

G. 

BSKIU; /ww, 1867. 



NOTE BY THE TRANSLATOUS. 



We liBve cDcIuavourcd, in the FolioMnttg tmnalalioii of tlic second 
nlitioii of I'rofcssor Griciiingi;!^! aUndard work on ' Mental Pathntog/ 
ukI Ther«.|ivatlca/ to give the £jiglisli reailcr nn accumt« aud littral 
n'ndenng of the Rcrmnn text. In Ihua ndht-ring to the literal 
inraniiig of the auClmr, wv have foJlowi^d the. exatople of the li'arned 
trtmlulor of the French edition' of this work, with which we have 
tbroughoiit carefuiljf coniparcfl our own readings. If possible, the 
yrcnch translation renders Professor Griesipger's German inedico- 
it)i.-tapk]rsics (not cotsiljr understood crcn in Gerioau) more litersUf 
tban wc have done. It wa« suuu evident to us that ati^ attempts at 
a more liberal reuderiug of thc^- diHicultics woold onl^ fartht^r 
ol»cure — possibly contravene — the nuthor's menaiug. 



pKnFKssoK GEUsianEU is rsseiUially the rrprrsentative nnd thb 
acknowledged leader of the inodrrn German sdinol of Medical 
Pfjcbolog)'. A? !<udi, tii:> work iniut be au objvcl of dueji interest 
to ervxy student in Mental Science. 



CL. E. 

J. a. 



Jmm I. iMr- 



* ' TraiU des Maladittt Meutalra. pitliologie et tb^rapeutjque, pur le DooWur 
W. Oriesinger, &c. &c. Traduit dv I'A^IlrtiiuLud (ae ^itioa) wins Its jroux de 
i"' leur, pu Id Doclcur l>ouituc. Sl^Jcciu dc la Maixcii ccntntle de Poissjr.' 
i«6S. PP- 587- 




»>REFACB TO TIIR SECOND EDITION. 



I AM happf to be able at last to place in iIk- Imada of tbe 
profmsion ibe long-d«IaTrd second edition of this vork. It is not 
ntifel/ « neir vork, man; chapters remain entirrlf unaltered ; 
WMDJ otbcTPi, however, have andrrgonc corrrction and remodelling, 
sod, in ptrticnlar, great additions liave beeii nude, vbich I hope 
may he considered as adding to the value of the work. Fewest 
ckanges hare been necessary in ibe descnptton of the special forma 
of insanitj : melancholia, mania, dementia. Sec, have indeed re- 
naated tbe aame since 1 84^. Most alterations aad additions occur 
in the pvta rrladng la dioln^, pathologica] anatomj, the anntomy 
of the btain, the pn'rliological introduction, the complications of 
itmanity, and treotmcnt. An entirely new section on the general 
(liajpotfis of oientol disease has been added, and also a section on 
idiocy and cretinUm. This subject is entirely omitted in the first 
cAiliiKi. Since the dale of itt publication I have liad occasion and 
opportonity more iminedtalely to employ tnywlf with tbrse state* 
tlnoagh my oonnerlion iritli the idiot naylum of Mariaberg, which 
*afl mider ny direction during the latter period of my residence in 
Wiirtemberg. The nuinber of illustrative casAt has been incrdued 
by tbe addition of several inteTeitioji; examples: in nnny of ibe 
■note important chapters tbe principal literature i» given to UiR 
rader who doira further information ; finally, I tiave, aa often aa 
tfpartnntty oooamd, sought to elocidate the medico-Icgal aspect of 



k 



«lll 



PRBrACK TO TUK 8KCO»D KDITIOK. 



p^diiitne from the itandpoint of the doctrines contuned is this 
vorkjBnd, ss occasion offered, expressed my views sbortly but distiiiictljr 
eoQoeraing much tlmt is related to tli« prc«cat state of medical 
pey cbologT. In tliis I had solely the interests of science and the 
profit of the reader in view, total!/ rcgoMlcm of the censure or 
applause of tliia or of that school. 

Ae, to my great joy, the first edition of this work won many 
friends to the study of our iutcrcstiiig aciciicr, I Iidjk: that the 
Becoud also will contribute to the I'ltension of psychological know- 
ledge, and, in particular, of correct views upon the subject. In the 
Universities our speciality is still far too much ignored, and clinical 
inatruction especially is aa yet nowhere conducted aod acknowledged 
in a degree correjiponding to the importance of tlie subject. 1 have 
done my part. In Tubingen, for upwards of ten year*, I regularly 
delivered lectures upou medical |tsyclio]ogy, in conjunction with my 
principal subject, and, as often as opportunity offered, admitted cases 
of mental disease ioto my cliniqne, making tbcio, like aoy olber 
dieeaae, the subjects of clinical instniction and discuiision. The 
advantage of this is so apparent that I live in the hope that very soon 
the estahli^hmeiit of regular psychological cliniques will become 
general. It is through these that the proper idea, tht- purely medical, 
of mental (Iibmsp, conjoined, lioirever, with n Vnowledgt of tlic morbid 
mciital symptoms, can firal receive that geueral extension, po Tcry 
desirable, whereby mere asylum managers can no longer call thcm- 
gelre* tnedical psychologists, whereby that fantastical bombaat, 
sounding of the spiritual world, which is still aometimes apparent in 
p^cbological literature, will soon give way to temperate, clear, 
medical observation. 

Several of the most recent writers on insanity have been so well 
pleased with the first edition of my book that they have osaumed 
into their writings not only the ideas and doctrines, the arrangement 



PBBFACE TO TBE SECOND EDITION. • IX 

md exampka coatained in it, but have eren taken, without lestnint, 
n tbor own, simple excerpts of whole sections. I quietly permitted 
this to occur, but now it would, of course, be disagreeable to me if 
tnj one were to think that H was I who, in this edition, had 
borrowed from those authors. I would th^efore beg of the reader, 
whererer doctrines, pages, and even chapters, occur similar, or nearly 
abnilar, to what they may shortly before have read in boohs or 
joomals, simply to compare them with the first edition of this work 
which appeared in 1845. 

G. 

ZUBICH; July 13, 1861. 



CONTENTS. 



BOOK FIRST— GENERAL. 

CHAPTER L PAGE 
Oa tlie Seat uf UenUl Diseuea and tbe Method of their Siudj 1 

CHAPTER 11. 

Prelimmmr7 Aoftlomicftl ObeervMioaa ■ I^ 

CHAPTER IlL 
Preliminwy Phjaiu-patholi^icml Obseirationi on Mentnl PhenomCDK . 2:} 

CHAPTER IV. 

Tbe Elemeatarj Disorders ia Meattl Diseus .60 

I. The Elenentarj Intellectukl Disorders .60 

A. Anomtlies of SeDtitneot . .63 

B. Anomalies of Thouffht . .66 

a, Fonnsl Deviatioos . .66 

b. Ferrenioos of Xliougbtr-Delirioui IdeM 70 
e. AnovtUe* of tbe Will . .74 

II. Dm Ekmeatu; Disorders of SeosstioD . .78 

III. Tbe £tuwntw7 Ditordcn of Uovemoat . 104 

CHAPTER V. 

O* Issanitj ia Qcnenl ..... 106 

I. Tbe Aoslogies of lutsnii; .106 

U. The Qeuenl Diagnoais of Mental DiseaM . lU 



BOOK SSCOM>. 

. or emoM* or kestal disuss. 



iw 



ti iHBBftf 



CHUUBIL 




He 



3. IM« oT Actk« of C^nn 

in. Hucii 

IV. PI^MalOMM 






. 13S 

. uo 



IBS 
IH 

i«a 



BOOK THIRD. 

POBMS or HEKTAL DtSXttK. 



CaAPTEK 1. 

SUUsafHeDlal Depnniaft— HdMUcWk 
L u jpoohfiwlnini 

11. llcineteli> in K BOra Loitat SeaM 
in. MefaMbolu vilh Stupor 

IV. UdaacUii viil, Dntrntlfa < 
a. llcbBdioiii iriUi SgietU ' 
B. MchncboliBwiUiDntnclitvMdHudcRiwTnideodn 

V. U«lM(fcoIn wiili Femtttit Exdlnnnil of Ihe Will 



CHAPTER n. 



BWm of M»U| EulUtwD 
1. 



209 

m 

M7 
2S3 
SS3 
961 
271 




^^^r COTtTEKTE. 


J 


CHAITKR nL 


FAflB ^H 


TW Sutca of MeaUl WeakncM 


819 H 


I. Cliraiiie MbdIs (Die VemiekUieil ; Lk Folic Bj>ite»li»fc) • S%i ^| 


11. Dtnenlia 


. 8W ■ 


in. AfMtbctie DtiDCotik. 


. su ■ 


IV. Idbcj and Cretininn 


. ftU ^1 


A. l^cej in gcnonJ 


H7 H 


a. Eftdemie CrDtinitin 


8S1 ■ 


CHAPTER IV. 


I 


On MWCfsl iBportanl Compticalions of Iniunitj 


. sn ^M 


BOOK FOURTH. 


J 


THE PATllOLOaiCUL AXATOMY OV U£NTAL D1SKA8E. ^^^| 


^» CHAPTKK I. 


^ 


B hUi«ki|ti(Kl kaiiomj of Llia Brain snd lU McmbruiM 


■ ^<^ 1 


I A, Tbc Cnaidin 


. 4U 


^^^^^B B. The Ancbwtd 


. 4ia 


^^^^1 c. Th« Fw Ualflr uil Sarfwe of ih« Bnin 


. 490 


^^^^^1 Ik Hie Cerebnl t>ub«taDc« 


. «I4 


^^^^^* 1. Tlu Ventridn ami Inlcraal PmU 


. 498 


^^^ 1. Acute loMnity 


. 439 


^^M U. ChcDaio Luanit; . 


■ «» 1 


^H UL Fmljlie OmudUi 


. a* 


^^ CHAPTKR U. 






. 4» 


^^V BOOK FII-TII. 




t THK PROOKOBIS AXI) TRKATMKNT OF JlEyTAL 


DISEASE. 


^V CHAPTKK 1 




W PngMMi. ... 


. 4*7 



XIV 



C0NTBNT8. 



CHAPTEK II. 


PACfl 


TUeripeutics 


. 459 


I. General FriQcipka .* 


. 469 


11. Fbjsical Treatment 


. 470 


in. Moral Trealment . 


. 483 


IV. Various Modifications of Treatmeat 


. 495 


V, Lunatic Aajlunis 


. 505 


JuBEi: 


. G36 



OS 



MENTAL DISEASES. 



liOOK FIRST- GENERAL, 



CUAl'l-ER I. 

ON THK SEAT Of MKNTAh DISKASKS ASU THK MKTHOW 
OP THEIR STUDY. 

^ 1. The folloiving treatise baa for iU object the ttniy at mental 

ae o> iiuaiiitv, iU diagnosis aiid treuCmeiit. Iiuatiit^ iUsclf, au 

QBuloas conditioD of the fncuitir-!! of knowledge aiid of will, is 

sjniptoin; our cliisaific-uliuu of Ihc gruup of tnenlol discosm 

npon tlie »jin)ttomatological method, Olid bytuch n method 

can Mj chunfication be (.'irn:ti>d. Tbti first step towards a 

*)cdge of the sjrmptoms is their locality — to wUcb organ do the 

ktiotu of the disease belong ? what organ niuat neccasartlj' and 

iraiiabljr be diwased vlierc there is madiieas? Thcansner to these 

tBotioiu » prcliuu&arjr to all advanccuiciit in the etudj of tacalol 

Hiyiiotogknl anil patlraiogical fi«.-ts show us tliat this organ can 
1/ be the braio; ve tbcrefore primnrily, luid in cverj case of 
. fliacBB^ racogaive a morbid action of t]iat o^d. 

i. Phjsiohigj oousi^rs mc-ulal sclivity as a fpctial foiin of 
lie life ; it rcoogoisca in menial energy' the fuiidton of a 
irticuiar organ, and attempts to deduce it from the physical 
oifoi. VelUksovQ cxpciicaents |>roTe that if the me&tal 

1 



3 TUE e£AT or UENTA.L DI8£AE1C9 

ft«ulti(u, in the vide seme of the imn, are zclatcd to tlie whola 
nervous svitem, the &cat of intelligence and of volition in in tlie 
■brain, an^ confined to certain portions of it. Of course, the spinal 
cord, as also the ganglionic system of the sympathetic, possess ttot 
only functions of tnnsmiimon, but al«o a^nlnil runctionB of com- 
muuication, of Bssooiation, and of excitatiun (loiiiciLj, rrdcx action, 
tec), but rvlntiveljr to the higher centrat functions tKein is Dnerclf 
periphfiral. The rtalea of any part of the nervous jyttem, iniismuch 
as they arc transmitted to the brain, al»o furnish mutter of menial 
caeitation and iDlellectuol activity. Impressions can origiiut« 
from every periphfrnl nervous rftmiBcalion which may prompt to 
motives, iiml originatn obscyre or well-iielined concept ions and 
efforts ; hut it is the brnin nlone vhich receives and couccntrot«> 
flicM.' iiiipresaion-<, and which originatva tlie influences exerted by 
them upon series of co-ordinate moveuienti — that i», upoa the 
BCtioiu. 

The deeper actioDs of the understanding and will can no more 
lie deduced from the organisation of the hraiu than those of 
icnealiou. NtrrcrthdcM, the sucocssire acts of the mcutol faculties 
can, in n general maoner, be e^isily referred to the structure of the 
different parti coticvrned. That portion of the central uerrous 
system wtthin the craniom consists of masses of ncrve-fubstancei 
These receive the scnsitirc columns of the spinal marrow, and the 
central expansions of tlie higher nvrves of si'iise ; from this again the 
luotory columns of the innrrow proceed. In aceorduncc with thiSf 
we see that all iinprcsiiioun occurring ccnlripdtilly, tliroujth the »Mise», 
converge in tlic brain, are perceived, assimilated, and excite tlic 
uietitdl facuUiea, and I hen give rise to new centrifugal acts, onj iig to 
the relation in which sense and mind stand to the actinns of ihe 
Miotoiy system. 

We stc that in the! animal snocics tlic psychical [wwers are varied, 
and capblc of higii development, in proportion to the sixc, Ihc 
(juality, and the form of the bratn ; in short, according to t he voloinc 
of the great hcTnispheres. So also, in the human raL-e, we ohrerve 
that great deficiency of cerebral development is attended by weak- 
ness of the mental fucultics, of tlic intellect and will (in niauy 
cases of idiocy) ; and eiperienco teaclies, that iu all men these 
faculties materially alter with the degree of dcvclopmcut, and the 
changes which the hraui presents, at the dilferent stages of life. 
£vcii in these diiinge», these successive steps of gradual |)rogTC£S in 



A^D THEIR METHOD OP STrDT. 



8 



I 



■itiinly nnd decline, ibe mental capncity or Uie hrain runs jinnilkl 
■ilh all the other organic funcuoo?, uid thus proves ileclf liable 
In tin sunc )avs of orj^nic development. 

Ai u nU kDown, it hai bocn ilmij; ■Itcmptcd to refer ccrUin pliuc* of 
BwnUI Mlirilf t« 6tker parti of Uie nerroui tTsUm tliui the biiiiit : for 
iirtanw , fnliag b» bwa Tefemd lo tlie ncrtUB apupatlieticiu. From a 
ndieloKioii point of Ttew, ihii allcmpt ipnug frum Uie tufficicnlly rcruled 
■MMUpUoo of the tMlatcd Aoimetti of the meDlal funiltie*. From the plijiio- 
fit M Bg i nd potniDf tiev, it iluds in oniDaitiOD lo >U wo cnn pooilivelj 
dtdwa RBpeBtinf tli« fnkCtioM of the trmpallictie ntm. Unite m un- 
(naJBrf, Bod cqiuUj iinexpouii<lcd, is (bat (Jootrine wliicb vsuuips an iinme> 
ditte eo-op<ntin>i of kll Uia pvU or the orftuisDi. tlicn-forc of llie bonra, 
^iiil*. Jtc, titit the wenul fnnctioni, lod woiili), •coortliiigl;, dctJuoe uusaity 
iniDciliatcly ffoin dislorhncc of these pcripbcra] otgant. 

la r«Mnt Umt», in eaii»e(|ticnoe of itrj tatcrtetiBg results funiubed bj 
■H wr rm cn t , caKnIiallf p»jGliic«l riuictioDMciiMtion, and even volition, Uve 
ksn uctitind to Ibc tpinil uu-nv (paugn, &ui).«rh]. ScKifl ('rbjtiol. 
dn NVn-ciitptcina,' i, p. an) Lta clcaclj and coiiplusirclj ducidAted tlieto 
Ticwa, M well rtom tbo experiiDontal u rrom the pajcholopcd tUiid-point. 
It auf rtadilf be ailinilled Ihtt the impreaiou* ure produecd in the ipioal 
■mav, gCMraJIj n/tcr tht unB tcitEmc u iu Ibe brtia ; aud il cuoot euilj 
It dirwllf refuted, that ia the ipisal mirmw of tint fng, icnutlon, aad cren 
pui, nUl nmain after dceapitallon ; bat at nfards uill (in iho ordioarj seme 
>f the liofd) ll owMl ba aappOMd lo be here in ({ueflloiit for the Mill inipliea 
•MMtiOB*, wUth have wiered tbe iphereof con*oioiMnMa,alA)]g*it[i (be idea 
of ibe cfttt which producct ir-ovemut, of ipeee* of the limila of body — 
■cu fcr lb« aeeonpLiahmnil of vbieli the oo-operttiou of tUe ccnlril aphere of 
ihe aciiM of tight tt ntnolulel; netetnrj. Vtr? rcccnd;, Pfluger'a ihmrj, 
foaiAd npcm bit cipMimenlal duta. Iiu alao been called in question {G6llz, 
' Kue%»b. Mrd. Jahtbueh,' ii. i8(o, p. 189). 

} 3. l*atholog!jrpTOVM«cl(«rfyaaphT9iologj', that the braiiialouc 
an be lix Mat of noniuil and abnormal mciital nctiou ; that the 
normal atato of the inenlal prooesii dcpeiids upou the iiiti-gritj' of 
Ihu nrgan; nnd that both together aw influenced by tlic slate of 
the other organji in diMOsc. Tlie ioTariuble nnd c^ciiliul syuiptoins 
of RTcbnil (liscnscs may arise from iutcnml cnuKs or cxtemal 
IcnoBfl ; may proceed from anomnlirs of ^niflation and movcmciit, 
ud, in leriotiN diwascf^ e\'en from menial disturbnuct- (exaltstiou or 
dtprotioii of tlic ideality, Ion of sclf-coiuciousucBs, dcliriuin, &c.). 
CaMJ of tcM fret^urat KCcurreocr, nrberr, with nrrloua diaorgnniMttion 
of the bruia and Ion of bfuin-subrtance, 110 disturbsiice of the mind 
Uapparmt, do oot invalidate tlicrvautla of our everyday experience. 

CuIIcctimi of lucb caici ore (0 be found, ai in Ion jet AsbI. el Fhjtiol. 






4 THE lEAT or MENTAX DtBIASES 

d. Bjii. im,* ftrif, iSta. i, ^ «7»)- WiU nfowoe »« ■<>•» of ll<«w "^ 
«tlMr ntkr chm wiih wUnh m «a aniiiteUd, diCmit opoioDt nnj bt 
hdd. In kUM«t all, bUeIl%nee, ra Ue unov aaM«r Uewod.*) ■loM 
conndend: IW oraHMlaMi «r dspntiaa wilwiUKK entirtl; ovtrloolwd ; 
kai CTiB to Um irtiBBHw U iKi^ iMb u« aftriwd lo prove iU iUctcntj. 
—chaitheMtwtfinflfiif limaMltjiMtiow. U aw ot ttaw a k mn tiioM 
Ut Uw iBtenigMM ben MM ta iti fill ntMit. wd b maf. putieolari; ia 
■11 hoapiul cuet, k e o» » pMM Cw «l (^ ombUI w d iti o i ^tcr Um dtMaM ut 
ioM ot Mhsluce witk tbe miUm rtile wu ataMda(a)y tarontUc AH nicer 
diattiwUoM, tlieralix^ ennot (w ^a ww i etw l. Hoiwtthltoadui^ tt niiul be 
adaiued Uiat iken Mj fee dbeaw ud loM of bnl^ tad ytt m appredaUc 
diMurtencc of Ike nintal lib. Tcir niwh depeodi npOB Uie Mat of ttft 
diRuc: all porta gf tbe btaiB do oat ttwd is tbe woe olow ralaiioa lo 
Un mcolal foBCtioBi; aaaaatadandbaonianlatiaiito naseolaraoreBant 
(Poai,Tli>Itn^ Ac). Fmtlwr.witkdiaMku vitkill etWbilaU«ali>rE»ii» 
it a bi^lj pnJiobfe Umi a compciittlioa ii aide by tbo remaiaiag Ixalthj iaX 
{m» } 15). IaUI;, we frequently fiud Itmitcd aiuUoMUil ktiou in Other 
iiBporUat organs vitliont laj itriking fiinotioaal deraageaent (ckramo patrie 
■lesr, plenritie adltesiona, tnbeitie, fc.); nd loM or aubsUoce (thitragb 
gaiigfcuo) has lilewiM bees obooved, ai in the Irogs or in Ike bovela, wliects 
•Act neomj, the procenof mpiration or of digeatiaa preoecdad viihout 
■PIMrest inteiraptioo. Soeh (aola, hovarart voaid not rcadilj be adsuited la 
0|>poaiiioa to lb« tcael, tliat tbe tm^ an tiie ofgiaa of rapiralkni, and 
thit diction taka place in the bowda. 

Fimhvr n.a<l more appositG testimony ia favour of oar afscrttoo, 
that Ihc brain ia the organ alTected in insanitj', is fumiabed b^ 
eiamiuatioii of the bodies of llie insaDe after deftth. In many sucli 
CMiiniEuitiatis, trut: anatomical changes arc found in the brain itadf* 
or in its coverings ; and where anatomical chaiigoji exist tlioseoftlic 
braia are, at least, the only oooftaut. The circumstance that such 
cbangei are not always found »liould uob Trcuken thb argoiuait. In 
titote aOcctiuDH of the ncrrous system vhich an chiefly indicated bjr 
etatea of irritation, as neuralgias, cramps, &c.j we very heqnentJy 
Unci no npprccinbtc nnntomical lesion ; and this is itill more the casu 
in the conditiona of weakness, pandysie, S;c. Very many mental 
(lifcafics belong to the first of these two clasncs. It is with thi^ class 
of mental diseases as with a namberof other nervous alf<vtions, aa 
epilepsy, tetanus, Sk., whose »eat ta iu the biain or spinal murrow ; 
and although in many coses this cannot be ocularly dcmon9trat«d 
by pathological anatomy, ijlJll, 011 physiulogic-al groonds it ia uni- 
VCFBoUy admitted. 

ITio mnjority, however, of ih« meulnlly disesscd, besidea dis- 
turbances of the intellect and will, present remarkable imomolie* of 



AKD TUBIA MblllOD OP STUDY. 6 

tAha faoctioas which doabUesi belong nUo to l1ic hniin f abo¥e 
■11, hall ucinut ions, mnomalica of wruation, wliich in raauy casca tao 
Mt to be pcripIicTfit, but rbosc origin mmt neccssajtly be in tbe 
bnin, ss ia trrefulably demoiislratcd by Esquirol'fi cawa of perma- 
fiCDt baUacinatioiu of sight with cooiplctc blindness Irotii atrophjr 
oT the optic nerve. We *.i-e, too, that the centml cxcitotion of 
ToloBtuy masclet, vhicb b tncoDtestably a cerebral function, 
ii allttcd to the eoeea of duluj' who an: mcnlAUT diseased: soidc- 
ttmes H usumcs the fonn of exalted actirit; and energy, some. 
tfaiuB of cataleptic rigiditj ; at othem it is seen as that fnrm 
of pualyns vliosc rapid progress accompanies the course of a certuin 
bra of inaantlj (dementift). Besides, niniiy oUicr anomnlies of 
foufttioD, m lanenod sensibility to pain and tompcrstnre, 
oonvolsion^ oerchni congestion, frc. Arc obscrrcd 
to the insaoc more a» tuxetaorj symptoms ; which, however, may 
MTd furtba to confinn the existence of disease in the braiQ. 

WUo^ U aD rrnta at tbe tine of Lhc Ural cililion of tbis book, manj phj- 
lieiu«r indod vbolo [Njcbologicsl »clioo!ii, »lill icquirc absolute proof of tbe 
fTr4«'*h[; untoice of \ i, maoj ol the mon emiocul pijcliologi^is ioug ago 
to Uic uoM (orrecl ronolutioa, tbat in etciy mental diacuaa iliu bmiit ia 
I, iDil Ihkl tiiis oertbral nffettbu is the prouniate cause of tlie joujiityi 
SUedcaioUi, ' Pijchologie,' ii, p. 178.) 

{ 4. While we are forced by facts to refer understanding and »t11 
to tbr brain, still, hovcrcr, nothing can be assumed as to theVebtion 
fxiatilig between the»e mental acta and tlie brain, thoTclntion of »<iul 
(o nulenal. From in empirical point of view the unity of coul And 
bod; i$ iudcrd a fuct piiuuriljr to be mniutaincd, and the !i priori 
inreeligation of the possibility of soal apart from body, of abodile 
wdI, must b« entirely distnissed, confining ourselves to abstract con-i j 
ajdefatknu of ita miily and oaeneiis ns distinguished from the cndlen'' 
BoJtficatioaa of matter. Bat these hypotheses tliat have been 
fimmcd to render more conceivable the otherwise inexplicable 
anily of soul nnd botlr, by means of attenuntcd Huid^ which mediate 
between them, "Huida subtle enough to be reckoned spirit," wen 
by the aystem of prc^cslablishcd harmony socoiding to which body 
and Mial Berer net on, but always along vith, one anotfaer, — these 
bypotbcsca are, cRipincally considered, as difficalt to sostain aa toi 
rtftite. ILow a material physical act in the ncrre fibres or cells 
cut be converted into an idea, on act of consciousness, is absolutely 





TBS BftT or nsr&L n 

toMttletlie 

; between 

n vUdi state 

i DBCbnlr tin 

WHila, it B ■osiaficHl^ an>nhk to OMunt tae&cinlaet of um 
nd with Uk body is the mm ntaHte idMioB « tiists between 
faodioa and oi;ga> — to eooMitr ^ «iid(ntandiDg wid tbe wili n 
Utr rtwetioD, tbe •peciJ (WiE7i t)f tbe btais, jait m *r-n«m;» ^mi 
Md itia. aakm an eo m idewd the tftmi hmctiam of the nerves 
ni fpind coed, md to conda tbe Hial fomnfyiMl pre-cBineDil; 
« the mm of all cerAnl ttttat, 

DHUiie infomlioa itgiri u nwtai takes plMstetb* kmIob neittorl* 
Amiidbj n^miJitm, -MA wmU cx}>hiB d! awlal Mfa ^ tW phT^H 
vat fcy tfiriliMliM, whfafc woald npliklfce artwia tj Ihe paydikaL Art 

e*TC U w« did kaow aB thd take9 i>lw* witUfl the Vi&i wbM is ■ctioB— if «B 
couU pcMtntaiatoiUtlwprooeMes, cli(9ucal,e(Mtiin^ Aa,or«hAl bm iailF 
Oidtai MB mi Tfbfilin. afl th«t is elcdricsl nd atriiMiBri, we itiU aot 
■Mtal GoediiloM^ Mb of Iboaftti. Hov thcj wn hs tnaafomed to tlieM 
fa, (■doed, a profaka vticfc ahall rcnaia unohed to the end of lltne ; and I 
bdiere Uiat if to-dajr aa aafd from hetw* eafoe and espUbed oil to n*. mr 
ndtiatamliiij. would not cvni be aUe to oompr*be»d it. 

What ahafl now be aaid of the flat and thalla* mlerialiiin wbidi wtwdd 
orfftMin Ike moat flaaeni aad taoat nloaUe EwU of boaun coueiMUMas 
beeeaae it fiadi no palpdiUi tnea «t tfaeo ia tJie bnia i Enpirical pcrceptioa. 
Id aaenlwHt the pbettoiawa of aeBMlHn, intellect, and will to tlic bnia aa ila 
fiNtion, ksTct not odj tk« aclaal oontcnta of tiic life oT Um hamau to«1 
Mtou«li«J tn all it* ridio, and. in parlienlar, naiaUiGa coergetieally tbe fwt 
of frre >o|f.4le((YTnii»tioii ; it Imtcs tibo, iiatundl^, tbt iMtapbjaicaJ quettJo^ 
vbtl il na; be that cmlcn at Mul-MbiUDoe ia tiiii rdatioii ol Ike aeosatioa^ 
nnderalandng; and will, wliicb takes tko form of psjckJoal exiUenoe, kt, 
Knpiriofim mutt palioDlljr await tie tiac whoa tbo i|ucB(iOBa oooeeniiiig the 
wnnectien of tba eoateala of tlte life of the liaaun aool. with iti fons^ ihall 
likTfl bfoOOM pbjiwlogical iiutead of incUphjaEcal proUews. llcanwbtte, would 
tlitj but dedat fiom the pnrniit of utiaiuwerable qoatUMis, fron alrinBg 
wlWIj in imow, snd from necminft each otiicr of hcna; bj Ibe mixing np of 
quite lirterajtencxtu* quc«tig<nii. ^VoulU ttjc rolloircn and fanatJcsof matcriilisia 
but eoniiiier a point which appwn lo me not lo hare been hitherto toSeieatlf 
brougiit lorwud In lite dicouiaion) of theM qiiMtion), Tho elcmralarf plit- 
Tioinena vliioli orour in the ncrre-mastca miiat be ia all men bIwhjh identico], 
nprvUltjr if the; be emitidercd (u In nowbeliovud b^manj) 4* r«*ciiti&llj olco- 
trioal, neccaatnljr iu tba hixbcsl de|ne aimi'lf;, couiittiuf of ■* nud — , Uov 



» 



AWn THCIH HRTnoO Of BTVST. 

cndlcit virii^lj' at Ihoagkts, f«elin|[B, uid Attittt, not oiil/ of indi- 
*U«J BfB( Uil Qf different »ge4, prooced from llieso «IoDe &nd immcdiatcl; f 

Aqf dbetuaioa OOdcerBJiig the iii*l«rmlitjr or Miimairttalily of l)iu mnilal 
pMcaaei OHnrat, tlienforcv in the |ir«stnt »latc of our knowlttigc, b« decided ; 
tt vBuU (lU in ]Wrt, and iiilreidj in its first prvniisM, tagelher with tlie qim- 
tun cJ Ike inlrrui) o^nfies is the mUtiIj of tie Mtroni tjitcm. Alt roni- 
ft/mon witb the impondcraUM, which ilaad in a relalioa atiilo^nut lo nmtlcri 
■nI KpfMar aliOM toinc«lint immilirnftl, |irun>kc liowcvcr mnlcrjnl cliHn^a 
uA IfcodMewtlOM, at«ol bul Irlife tenricc. The mriitnl nr ncri-onKafCcnl tin* iio 
ml anloguc m Ihe wlxilc of Iho unircrM ; llic ihcotj, u Lnckc lint ulrcaily 
tkovR, u|wrirac«s liic umc diCcullifs, whether thr; tllnw lo lliink \he 
wMniri. Qt vbcUicr iht? will wmfrclieiid the a«lina of an immnlcniil Rgenl 
■paa ■aim-. That Ibe fanetiou of the toiil, mcrMver, muit alwajn lio 
amm]Mtiic(l bjr material acts, no one denies ; this rdaliou i* vcrj well dcvcloiird 
hf SticdmrDlk (i, p. &J, aiid a. a. 0) ; ntily the iJea wliicli jufticipatcK in the 
wsaafe aeeoDipwuHent \» lo Kin a nal, nnd known, and— a *till inoro fruilful 
yrapniUnn !— iadted, tlic more liretj the organic nccumpniiiaicnt, the livelier 
ih» IboaghL Somt pkaara of the mental procrMC* nie, moi-corcr, cviii«ul!y 
mm dowlj aaaocialcd with w-collcd plijaieol cvcnti (wilh oilier act* of Iho 
Mipiiim) than others; for cxinplF, lliaa pure and cnlm llinughl. Aleoiorjr 
aad lot*, ai^ ArialoUc (' On tbc Soul,* i, 4.), do not proceed from tiic uul, but 
tnm Uh Haocbtion of the (onl and the bod;. Indeed, it » is ncmorjr and in 
hm tliat a direct mixture of organic prooMtca it most crident ; the udm niajr 
•Ia» U Mid o( tbo isag;isaUoa. 

f 5. In ncoordanoe with (he forrgoing etatemente, tlic question ito 
fre^ocntl; Aiul ttt htgc\y treated of bjr the mriicr psychologists, 
whethcx in insanity, in the anomulies of tlic uiidcntaiiding and will, 
the iUmbm rcall; affects the pouI, fiads a naij and an afTiniiative 
Bolatioo. Of coiinv « e muat not »pak of diWMes of tlic toa\ iduric 
— R palbology not less iacorrvct speaks of diseases of the vital 
jnocoKf} of tlic fuuctioits — hut of disease of the brain, through 
whioh vmy net of ttto intelliguucn and the will is ilorangcd. 

( 6. Altliangb, hovO'tU', eveiy menUl disease pcocceds from an 
aflcotion of lh« brain, every disease of tlic braiii doea not, on that 
aemunt, belong to the class of mental diaeascfl. What kind of brain 
tflecLioD, then, is it with which wo have to do in ioaanitj? 
Analomicall; c-onaidcred, tlie dticaaes whose ajTnptonu aie called 
inaanity are of nil lite most clivi>rae, ilDiplc irritations without per- 
nr|)tiblio cbtingrs of structure, ioflouinialioD of the cortical subtiUince, 
itlvpIiT, choices of nutrition, angmalies of the drculnlicm witbiu the 
cnniuiu, inlto-nietiingrad apoplexy, simple liypentioia? of tho 
brain, kc. All thnv coiidiliuns, dircrii^ 10 vridd.v fnjui rncli other. 




d 



ftKAT 

oui on'giuale mrmptomH ou accoutiL of whidi we send tlie pttienl to 
an BSflatn, and wliich nre dcsoriLed iu psychological wqtIu hi 
mctitnl <IiM>ii9(>j). All attempfs strictly to JUtuigUMh uuaaitjr from 
tlK acute or clironic tluensei of the brain, as Ibey are dcsoribed from 
the oniiloiiiiail point of view — for example, meningitis^ encephalitb, 
&c. — would bu an undcrtnkii^ most fntile, for even n^rliun cases of 
mmtal disease are reati; mcniugitis, cnccphslitis, kc ' Tlic iiiea of 
mciitsl disroMS being purely symplomatologirol in gn-al mcasarc 
accompanies these anatomical notions, and tlie objects of both do not 
admit of their being compared vith ench otiier. Onlj tliii ranch mr 
in general b« with certainty affirmed, that tlte brain gfloctions wbich 
lir at the root of taentitl diseases arc iafiuilclir more frcqncatly diffuse 
than localised.* 

Cen-bral pfithulogy it, even in tlie prvsent day, to a gr«al eit«nl 
iu tlie same state wliicli the patliology nf llic thoracic organs vnu in 
before (ho ditvii of l^ennec. Instead of proceeding in every cax 
from the changes of struelore of tlip organ, niul being nble to deduce 
in an exact manner tbc pniductioii of the »yiuploiu:» from tlie 
cban^ in tho. tisaue, it hat wry oftva to <Ical with sytoptotas of 
vhieli it can scarcely give au approximation to tho scat, and ofwhoae 
mode of origin it '\a tol«lly ignorant. It must keep to the extenul 
phenom<;fi3, and cstabliwli tlie gTou[u of disensea ecconling to eofoe- 
tliirig common and characttristic in. the symptoms altoKCtbcr inde- 
pendently of their anatomical ba»». As with ejniejtsy, chorea, &c., 
so also with psjchlcnl or mental diseases, under K-hicli <m include all 
thoj« nffcctions ofthe brain iu which uiomaltes, derangemenU of tlie 
nnderstanding and of the will , constilutc the most slriJdng sympltHtu. 

The ordioar/ diseases o( the tirain, drcu inscribed infl&iiiiDalioB, tbftctw, 
lumoun^ tubercular meainitittt, Sec, are not termeil mental diseases, crcn 
alttiOBgh ia these affedians Ike mealal facultita are usually more w (ca 
demngeif, beewise other cerebral sjniptonis, tbosc of disluibnl seasalioa and 
mOTfiiient in Keneml, greatlj predomiiiBle : opf^iorijit dtMominalio. 

ilxcc|il id Dally, lioweivr, tiicli i^lJcnU are &I»o coiutikred as Bieolallj 
dtsrased, and are Kiit into asjluuis, when, for example, tlie case aatunn from 
tlie first tke cUronic fomi, vrlicn maniacal ciciienieDt aels iu rery early, &c. 
On the Other band, In aicatal diseases llic seuaiiivc and ngtorj functions of 
the brain are Tt^ eomnionly alio disturbed; butlhtsdislurbaneeissubontinale, 
— Ibo [isycliiciil appear ae Uw luxiing pIicuoBicca. Mote tninuto dctiuitioM of 



' See " The Diagnosis of Biain Diseases," b paper by the author, 'Arelurder 
Ildlkuiidr.* I>ci)is>g, ittCio, jxtrt i, p. ^t. 



AXD THEia MFTHOD Of 8TPDY. 







I itiirain MUtaol uiil Beed sot begrrea kcre; tlwif genernldi^noiti «^ll 
Is fmai ia the Sod Mdion, clupler ^th oT Ihis book. 

.( 7. As insanity a onlj a complicatioo of sj'iuptoms of rarious 
■iMtiiJ sIsiM of thi^ brain, the qoeittion u^t be ukcd, vheUicr its 
ipoetal Btudj apart from that of Xhe other diseases of the bnin can 
be ju)tifi«(l, or wtietlier mental patliolo^ ebould not rather alvrajs 
BMomjiaojr cerebral patliology ? Bat, althongb at aome more 
i]i«Unt period this tnny perhaps be looked for, an; attempt at sneh 
a combiDBtioD Tould at present be prcmatorc and qaite impracti- 
cablr. If the intimate fuodameBtal union whicli exist« between 
tiBuil; aod the other cerebral disctuea be only coiutnntly kept in 
TJCTt— if in the one, aa in the other gronp, the samucMctaaatomical 
plljvological melltod be as far as possible pursued, — cerebral patlio- 
kigj viU not be irtordcd, but rather adranccd, by the formnl 
specialiting and mooognphtcal claboratioa of tbeac diseases classified 
accQcdit^ to (b«ir symptoms. As psychiatric mast assert the 
pflAtioa so lately obtained for it — as a jiart of cerebral pathology, and 
ft* aereral of its practical pb&KS, asyltuu cccmoiuy, its medico-legal 
boringa, itc, invest it vith an extent and character peculiar to 
itjdr, wliicli nmlcr nil ctrcumatanc«», even wbeii ricwed as a p>rt of 
oerebnd pathology, keep it distinct, any attenijit to obUterate that 
diitiaction would at prracnt be etiU less justifiable. 

1W ■arlkr attcaipl* compleldjr to oombine Hit nH^nUl diwsues. biMd npon 
Iksir cont^wpdi ng laaloia ical cbangra.witU iLe ocrebrd difcu»(Wcr« prortd 
tflkeirvBatofsuctCM to beprenutare ind Impowibl* (Sc. PiaeC 'Palbologie 
l4(At«le,' Parii, 1844). And ju>t w wbca, quite reccnUy, one of oar most 
oniaent |di^oUiu ittemptcd to tlttdy a depirlment of menial diseues from a 
pnvtj wuloinii(«l point of TJew (Calmtii, 'Triiilc da Mtisdjei inftiiiiiiiiatairei 
da Cemma,' Paris, ifisg, a rol.), so tbii pTBtMvonlijr tttcnpl tmits, rrom the 
nsUra of lie (|tt«slioa, oal; ot a pitt of tli«M e«Ddilions. Ttms [tnjahiklrio 
viU hMK mnaia a iptciil bfmncb of iDcdinl scicnoc ; its special (tudj also girca 
to ibi pbjsieian ofiportuait* to acqutiot bimBvlT. in some degree at least, villi 
Ike pbtaOEDCsa of miwl of wliicli, uufoituuntcljr, to lltile kuowUdgo u in 
ftursl attalaed ia tlie onlioary courio of medical aladj. 

{ 8. Insaoity being a disease,' and that disease being an alTection 
tiiB brain, it out therefore only be studied in a proper manner 

' A djauae «Ueb alio ei«Ma dnllt. Wben a reonit writer uyi, lunstiea h 
iBa aa Utile Iran Easaiutf at otli«r iiion fraiu SMtiidnaH of mind, lie Irica a I 
VTtldiad aBlitlmiB. h is evident Itat no ona die* from sound hnJili, mental 
ertalil;. 



I 



T". ~ ■.;i- r-.: — i»;i::." :i' ^i^^ Tin lbu^olt, jihreolc^, and 
-...:. ^- , -;i: it:r— :■:» e;-s;-n. iiii£ lii* T-icue nngc of fpedil 

'■•u'j. iT- 1.:.. Uf~..:>-'i;ti> .":>!srrmf TTiLS^ikrr knovledgc inoit 

r-^':::.:::. ',. •.ii: 2tr^i:ii. :^ ."^i.,i:irsr.. i_ nzOr-TDBaeal, more par- 
I. ^.:i~ ■ ul Tvi--:!.'*^ uii: ijtsi. ritn.-^-TO-iEs c' insuiitj are as 
-^cv-.s -.r 5-11;- .: "-It? 5a;i^-< -L-Ui- SrTf-il jKxtical repre- 
!■:;::.■.;.::.> .- i..ii.::ir*; 1^-: tl.-^Jj;!:;- :i :-srt=. iiiiLH, ind eridwitlj 
.-■.T-; z- ::: : ?"l: ..■ i.:--Lr; :.* ."•t.nihL. K:-g Lfar, and ))tr- 
Ti: „.;.- I'.,i ^'^.LL.i-- :>:." Lf ' :•', y-.K': ijis L-^as eatirelT ended 
.-jLi.; :^.i.-s;* ..: ■;■:*: v-n"'.*.. j;>.iri^ i-^-t :;■ the iutellectiul 
> :>: ri-ii-jiiic ;:-.:r- tj :!■; r;*L.""j ;i: i:iraiz n-arii conflict!, and 
■■-_' ?:■. L_-:* -. ;r.:^ j,rri:-i --.x: Tijiz wrre* iliis end, his 
-"-...■:i.:.f.!L 3 1! j:-:*' .j;i;-i.i:ii;. A £_::1l: rt;rniri a applicable 
:; ::•: -.•..•.-.■-i: .1 t i.-^ ::i: r.-L.:?:* .■•:ii*,ip-:r ii.c fi'r;ect, and still 
•■:-.:^i- ..1 I.-- -:: .c. •-■■ '.■•.^-•tf--~-,x -w-.-i ■w':iiih. some such 
:::■.:. c- ;..■;.-:■.' >'.■::.- j t-liT: li-si. UTiir^ is aiore opjHBed 
:. :■:.-; .■.- : I i<:r' j :. : : ::4^ i-; Liiir.:: :.; :rizsp;*e the nature 
.'^ ::.: z;:i:i_ l^wi*:* ji:: "-ii :i~.:;j7 ;;' =::rsh:T. Facts speak 
l."_i i^,-:^'; :: :* ir-i- ::i ri^::^ :i i tszj irecueat psrchical 
■r.i:'.:rzj ,:' r ;*£ .LsriiM* - i:T .-ii ;: re rtiirTise when moral 
;-r_?.* .'j^ i-.;.rrs-; :i: T:\i-';.::;f;. j^i i:»: ^z-izi, cf the other 
. *.;.y<* ;:' ::,; '.n:.:: i.:.i z^:z:~^ *;j:;n. Y-i present state of 
:':,; •.■.•■..'.;7j:.'.v,v.: J .v.; t:_ 1* i^sr.-Vj^j i:p-:~ifE.t npoQ, and is 
i:..-t\-.; :.- s ir.i: ;\:iz: :_: i:-.-,*?i.-T Tif:!: .:', ihe Jtm of all the 
■.■^.**;-"■-s :',.,"^'.:i ;.•:.:. ■■:*:.;*. ir.:. Li 5 :■.L^;■;-fr^e. li-e isleUectual 
.,''■, L'^<:-..i- .\ ir-.::-. s-. ■.::■,■:" .: : ; ;-.;*-.* ::' ::;ivi::::i". But vhilst 
:i.-j sjl-.irt: i:' •jL:ru..'.;: > :\V•:.^.i■.. ;v,::rt> «::;.::: tiiit of free and 
c.i*i.:i:-s il::--_-:.:. *...; s:.:;.: ^-y ■.::.:* .:' :i:i- :i:;::nalou5 mental 
I :i.ct*sts i.> »;::;!. :l..>f i.-.:/, r..! ^.jiiK* sive rift bilong to quite 
iiiiciher liTr.:cT\-. 1: :« ir,-~ .."isjur; ;'-;rvfrr::>rs cf the inner 
consciousnes*, th,it ia issariTv :r.e s:-;es cf ihi- uiincl, originally 
emotional, proceed ; and where these ha^e given binh to a perver- 
sion of the judgment and iccliiiatioas cf the patient, he is already 
in a state vhere the fir^I condition of alt morality, self-cooscions- 
nes", the power of deliboralion, of choice, are wanting, and his 
acts, he they what they may, can no mope be the object of a moral 

I'mikit] niid rlxl'irical re f resect aliens of insaiiiiv are not oi.k unncccsiarj 
nr.'l fiii.-.r: llicdrtliculiy, bul t-veii praciicaliT ilic; ore posiiiitly diugerous. 
'I iir'nigli lliu.^G ttiu kil; ate filled witli rriireseulalioD) ot mcutal disc.i»ci whicli 



AND THEIE METHOD OF STUDY. 11 

do Ml in the remoteat degree resemble natare : if, flien, the facts do not cor- 
respond with their ideu, thej doubt whether mental diseue be preunt. How 
utanl is the ■itonishnieDt vf msnj persons, when Tisitbg an aRjlum, to find 
the ionates so rei? different from what they expected t Psychological theories, 
vbteb represent mental diseases at the highest pitch of the passions, lead 
BiajF iSto snch errors, 

Anj setiotia controTenj, howerer, r^rdiog the moral view of mental 
^^^^^-^l«^ u now-B-dajs unnecessarj. It would be even superfiuous to oppose 
to this doctrine the numerous cases where inaanitj is prodnced hj causes 
parelj ph jtical — bjinjuij to the bead, by narcotics, &c. ; its bereditariness, the 
fantilj predisposilioD, often showing itself in other reUtifes, as a dispositioo to 
other acTere neuroses, epilepsy, hysteria, Ac. ; its various types, which often 
iftet the course of insanity as that of other nerrona diseases ; Its occasionally 
ofasared interchange with other diseases, the possibility of rapid cure, ita 
analogj with dreams. See. The best refutation however, is the simple examina- 
tioo of the prt^ress of the symptoms of insanity. 




^9' 1" " iia|)cr' pulilislicd in the year 1844, I liave nlrcadj 
called ottcntioii to the uniTcnaUj* demonstmblc patholo^ca] analogj 
which exists between the disewes of the brniii ; iilsn, in ns fmr u 
they present by preference auonauloa? mental symptoms^ and tlie 
fanctional disturbances, and (i«e])i:r orgnnic lesions, of tlie Fpinn] 
marrow. Thia comparison is justified not only by the facta there 
stntril that Iiotli srctions of the central nervous system are liable to 
the same forms of morbid action, vbich only show themselves ?eiy 
difTcrv-ntly acconling to the originally ^vcn diSerencc of tlicir 
rncrgic?, but it has also ibt basis iu the nurmat and pathological 
anatomy^ which teaches us to recognise in the brain and spinal 
coril A single, only artificially dividftd, irhole, find exhibit* to us, in 
both, the same general (li><])osi(ioii^ the same elemeulary 
find also ibc very same patbulogicivl dhtages. 

Presuming that the reader is ncquainted with the 
niintomy, tlif tliviMons of the brain and spinal cord, the stmcturc 
and disposition of their membranes, we shall here premitc only 
n few remarks ujioii the siniclure and conitcction of the centml 
nervouB system, which, further on, will explain certain physio- 
])At.hologicn] TC8ult«, and upon tlic rrvietr of the healthy and morbid 
■tntv of the brttio. ^h 

^ JO. The brain and epiiuil cord form « whole, whotc different 
sections present essentisilly the s&me cIcmcDtary structure, and a 
coinniou, though cciistautjy prcjgrcssing, type of orgauisfttion.' ^1 

' 'Arcliiv r. plij'siolog'. Hcilliuiiilc,' iii, t, f. 69. ^H 

* Comp*re Arnold, '£tm«tkuiigi'ii iibcT dmi Ban dcs OcUiut nnd Ituckcn- 

"arks' ZOricli, 183S. Vuleulio, 'JJim- und Nprrcnleljre," Leipug, 1841. 

'orille, 'Aoatoinis du Sjil^nte nerrcux ctrebro-spinsl,' I'arii, 1844. Longel, 

•Aunt, ct Phy»icJ. d. Sjrt. nert.,' 1841. Husclikr, ' Scl^fidc!, Qtliirn and S«-l(^' 



tisano^ 





PRBUUINARV AKATOUICU. 0BSBRVATI0.N6. 



18 



* 



As the rertebrated atnicture of the bony envelope of the spinal 
cord ncura in a more highly developed form in tbe skull, which U 
co«pos«[ of a aumber of bonet, so »Uo Ute craaiol portion of Uio 
ceotnl oervoas system consists of a complicated mulli|)licitj of 
nerre-nutscs, which at £r«t «if{tit appear not to have itiv «ime 
general structure a§ the spinal cord, bnt ia wfaicb, nevertheless, in 
•pite of many important iliderenoes, an aiulogy with the iipinal 
cord and ita immediate envelopes may be recognised. 

The central canal of the fpinn) cord, nliidi is wen inost distinctly 
in the embryo, but also still perceptibly in the adtUt, and which is 
completely cndoeed hy grey substance, opens at tlic level of the 
fossa of the l-eatricle of Auraatius, doses again at the fourth ven- 
tricle, and form) in the i]iterior of the eerebmm the third and the 
lateral ventricle?, in which it terminates in the iiifundihulum. 

The gmj' subitance o( the »piiuil cord 15 in dirixH coniinuiiication 
not only with the sensitive and motory roots of the nerves which 
paaa in and out of it, and with ita white longitudinal column:, but 
alao with the gray substance of the brain. After it has extended 
into the medulla oldongata, partly ujwn the surface, and partly by 
eutcriug into the corpus fitnhriatum of the olivary bodies, aud mto 
the corpora rerijformia, it cunimunioitn with the corpus rhoiu- 
hoidcum of the cerebellum ; then, iu ita further passage forwards, 
aith the gray substance of t^c anre cerebri, the corpora qiiadn< 
geminn, the optic thalamus, and corpii;* vtriatmn ; and ends, at I11.1t, 
in the infundibulum or in the anterior perforated substance. The 
continuation, tlieivfore, of the gray substance of the apinol cord into 
the interior and upon the base of the braiD, forms a connected 
system of gray lines and masses. Another system of gray substance 
is, however, found in the brain, viz., the cortical subatancc of the 
bemiapheres, which everywhere covers the surface of the convolutions 
MCf^t in ono point — the gyrus foniicntus. Tliis mass of gray 
nibstance oommuuicatcs directly with the hrst system ui only one 
point, at the substantia pi-rfomta, and this ooiuicction is formed 
through the medium of the white fibrous ttaeia ; in the fpinal cord 
itaelT it has nothing analogons. Tt farms the point of common 
termination for the system of th« extended columns of the spinal 
oord, and for Uie system of fibres which arises within the craninm 
aud does not puss out of it. 

Jena, 165^. (fntu>lct(Lcuret), 'ADntomic compM^o du S;it. acrreux,' torn, u, 
Puis, 1857- 



14 



fBBLIMlNA&r ANATOUICAL OBSD&TaTIONS. 



The corticn] gtaj substance of the great bctnisphetu presents t 
Btratified stroctuiv,* nnd consists or from four to six layers of nili- 
sUnoe alteruat«!y oiinijue uiil tnnsparent ; llieir diSercoce dcptniU 
cli!i-fly upon the greater or \«ss quniititj of cell clement* entering 
into tbeii coii)|}asitioi). Tbt> must external lujer is iu direct eon- 
ncclion with the surface of tlic TCDtiiclcs. Ihtte aupcrSdnl layers 
of the cortical substance of the brain present frcqucntl/ change^ 
ud more «^I(lAm (jioorgnni^iition?, in tlie iiisanc. The tninnte 
structure of tliia ^ub^tuiux.- i? nut the same throughout.' It is 
composed, fand&mciit&Ily, of cicr%-c fibres, which prooe^ from tho 
while substance, anil in entering subdivide unlil they become vay 
fine; secundly, of pcculinr granules, whicU arc dirtclly coanect«d 
nith the ultiuiate tennination of tbew fibres; thirdly, of gsiiglioii 
cell*, which arc in part dipMt jtrolongnlions of tiprve fibres or con. 
tiiiuutioiis of the granuli-s; fourthly, of an apparently liomt^ncous 
and structureless molecular mas*, which is coimidered by aome us 
cellular tissue having a purely mechanical function, that of nen-e 
oement, but which, at Irait in the cortical subitunce, prcseuLa an 
extremely fine network in which tho ultimate terminations of the 
white nerve fibres and the continuationa of the granule* are finally 
lost, n canalicuUr tinue communicating on fill lidet, and which 
Be«ini to conduct to every part, and condctjuently to render possible 
the traiumusioo to all parti, of the »tntcs of the brain. 

As tliese elemciita of the gray substance present in difTereiil parts 
of this apparatus « dilTcreut anaugcniLiit, the inference may be 
drawn of iliffcrcnccs in function. Thus, in *omc parts, the grauulcs 
form a spi'cia! nnd iiiiportnut layer in the most inferior part of the 
gray eub^tsncc (in the cortical gray subslwice of the ccrebellunt aud 
ill Aiiiirioii's horn) ; whiUt iu the cortical tubstance of the cerv-bruui 
they do not form a special layer, but are more isolated. Thus, the 
gray fubslancc of the cerebellum contain? cliielly gn-nt cells; that of 
the cerebrum, on the coutrarj-, besides a tiuiiiber of Wge celU, 
contains chiefly small ones (Jncobowilcli, sensitive cells) : beside*, 



' Baillarger, '31^in. Je I'AcnJ. de Ucdccinc,' riii, 1840, f. jya. Itcmfilt, 
'Kuller's AteliiT,' 1841. 

' Compare Gertacli, 'Microjeopisclie Sluilicn,' fie, Erltrng., i8j;8. Hrss, 
'DcCcrelietil GjrDtumStruclun,' D[>rp., 1658. Berlin, 'BciliUge c Slructur- 
lelirc i)ct tiruuliirnwindungFii,' Erlan^., i8i;S. C. Kupflcr, 'Dc Comu Amino- 
nil Slructuni,' Dorp., 1859. SlcplieuT, 'Ikitiagc ■. Ilittologic der Kiiide dca 
gnatcn Gchims,' Dvrp , tB6o> 



?R£LIUI>'ARY AXATOUICIL OBBIBVATIONS. 15 

thoe eellii ue sometimes srparaled, in some plnces moro KaUcrcd, 
ud in others mugrcgalcd in special layen. Hie flnv flbnee nliicli 
fneeeA {rom the u-liile nihstAnce extead in the cerebellum nlmo^ 
fisdoRTvl)' to the inoi>t inferior Injcrs of the gray sutislancc; in the 
cocbnl coovotuticn* thvy penettnlc farther iiilo il, giving off fibroos 
dements to ft1ii>o«t all it« Ujrers, aiict tb«}' lifirc ap[>«nr to run horizoii> 
tiUy. In some pUccs the oxes of the white fibres appear to po^a into 
the pvolongatioos of the ganglion cctls ; in other ptacea their altimate 
termiiwlioo appean to be in the granules (ccreb«lluni). In certain 
putt of the grav subitance, ns in Ammon's bom, a coiindenble 
■T^tcra of fibn» appcnrs (o origiualc in the thick luvers uf ccUs, 
wbicb do(» not proceed farther than to another la^er of the same 
nibfltonee, wliere IIm; fibres ini mediately terminate. I'hus Ihe rela- 
ij liltlo which tro as yet kiiov of tbc intimate !>tn]ctare of the 
tj sabvtoocL- pcrmita tu to *u]i)iotfe, not only very great diff'ereacei' 
in Ibe pbenomoin of tltis extremdy delicate apparatas, but alio that 
Uhm pbcaotDcoa on eeMiitially different in the vuiotu part* of the 
orati* 

f II. The vUte tuliitaDee of the brain ia coinpoeed of the well- 
JcBovB tranaparent primitive flbrca ; in general they nr« here v^iy 
toe ; tboy aabdiride many times withm it, and it appears aftenrards 
peoetnlc into the gmy sabataaee, which oontaiti* their ultiinate 
dimiobt, iheir points of termination or of origin. That a certain 
portion of (he white substance of the brain is formed by direct con- 
IttmatioD* of ihe three columns of tlio spinal eord of each side, 
which, liowner, undergo a complete process of deeuMfltioiij is hevond 
donbt : for example, portions of the posterior and lateral columns 
CKD be easily traced into the ctTcbelliim, portions of the anterior 
eoltunns into tbc corpora (juadrigcmina, the corpu* cal!o«um, &c.; 
and, aeoording to uridia[)Uted rcsenrchcs, it is iiduiitted that con- 
tintutioiu of all three columos of tlic spiaal cord cater into each of 
tbc great gan^ion-liko enlargemeatH whicit constitute the knin. It 
ii erideot, however, that these proloiigatious can constitute but a 
anaU {lortion of Ibe balk of the white substance 'New syftcnia of 
Abrc* enter into its composition : these are not only the central ex- 
fiHimw of the nerves of sense, which on Iheir entrnnce into the 
bnin fubstuice euhdiride, disperse thcmxlvea iu various directions, 
and, uBODgoi otlicr thing?, ap]>cjir to farm larger inembmnoas ex- 
pwfifmf in ita interior, but also the new svstcms of flbrca fumiihed 



IC 



I-SKLIMINARV ANATOMICAL OBSBRVATIONt. 



bytltecoinnii39urcs,aQtlthe80-calIe<l investing membnuje (Bel^un^a- 
eieitfaiiz) . 

It would lie of great importance to know the conditiotiv of 
luixturo and of diaptuitioii of each of tlic^ evsteius of fibres, and 
Ihctr rclntioQ to tlie corresponding prolongation! of tiM three 
columns of thn Kjiiiiat cord, (titlierto tlic edbrts inude to ducidate 
thi» j>oint linvv uol been fullf successful, but rcccDtI;f sQ ndvouce 
lias been nmdi: ui unravelling the differcut njsteius of fibres of the 
-H'bttc Eubstano: of the bratu. According to the preeeut state of vur 
knowWge, thi? fuitovriug principal »jntcmi are found in it. 

(i) The Byslcm of fibres of the corona radiala {Siabham'). 
These enter into all the convolutions of the enteiual surface ot the 
liemisplienrf, r«|)eciul1^ at the posterior jinrto, nnd extend even to the 
HQininit of the convolutions. A prc-iiouilerxting retstioa to lite 
ttiotory fuDCtious maj- bu attributed to this system of fibres. The 
coroiiA radiata is not eimply tbc prolongation of porta of the meduUa 
oblongatu ; this is evident from the retnarlcable niie which it presents 
in man in proportion to that of the medulla oblongata. In most of 
the luu'tT iiniiuiils tlie reverse is tlic case; the corona is relatively 
«ini»llcr than the medulln. 

(2} Tlic cspausiou of the caq)Uf calloBum. TIic corpus callosum 
(like the pons Varolii in the cerebellum} ouglit to be considered as 
the analogue, more higlily developed, of the niiterior commiseare of 
the spinel mnrruir. It appears to be fotoit-d priucipuUy br the 
fibres of (lie coroiin, ivhieh in pausing forward crow bcrc^ and pass 
to the hemisphere of the opposite «dc; therefore the dependence of 
each half of the body upoa the opposite bcmiaplicre. The fibres 
proceeding from the corpus cnilosum radiate to all the conrolutious 
of tlie heiuisphures, cspeLially, however, to their internal ond »ui)c- 
rior jjorts. 

{3) The Hystcm of fibres of the anterior comniinure ; of whicli a 
liajt suddenly tormiuntes in the inferior convolutions of the middle 
lobo of Ibc bruin, auullier pari entcRj into the posterior lobe, from 
which it spreads over the whole extent of the superior border of the 
liemisphen??. The anterior couiniissurc appeiirs, therefore, to bo in 
wati an apparatus of connrction betwoe]i the two hemispheres in 
tllftir totality (in niuiiy animals rather a connection between the 
olfactory lobes), nie high psjehiwl fundion which by some has 
l>«en nttribuled to this syalem appears to me to be in tbc highest 
degree doubtful ; the very considerable size whicli it presents in the 



PBELIUJ.NAUr ANATOMICAL 0B8BBVAT10NH. 17 

KsBgsroo (Gratioilet) aeems nillicr to indicate tliat it has soute oou- 
oectiDQ with Uie movepients of the lower extremitiw. 

(4.) The cx|Mitnoii9 of the mnca of tiense vcithm the hrain, nnd 
in pnrticAiLir of the optic ncri'f. A fan-formed cxpOQsioa can be 
dulii^ished «-itIiin the bcmisphcrc* passing from the optic tract to 
tfatt summit of the posterior lobe; other such radiations puss 
fumrds in nil the auterior oonvolutiona, tlic high development of 
which it clumclcristic of the human brain. TIic opiio nerve oiid its 
raots ere io the humno s\Kaa rciativdjr small, but the expansiou of 
the oerre witbin tlic braio assmncs an estraorthnary ttevclopniL'tt. 
This expansion is not Io he considered throughunt us h aiuplu cuu- 
ttiioatiuD of Ibu Gbre9> of the nerves itself, but rather m the ret^ull of 
■ 8inltipli<:altun (if thne, or of the addition <^f u new svstfin of 
ibm Ui tile optic iicn-r. 11ii« high developincnt of thu cxpnmiun 
of the optic nerve appears to constitute an csscutU diaracteristic of 
the huiDBD bnin, and uho of I Imt of tlic liijjhcr apes, and to rcprt^scut 
M ftp)iar*ttu devoted to some of tho most importiuit mental functions. 
In Dcarl/ all maminiferoutf animals tlic impn:»siuiia of sjglit appear 
(o «<-!(<■, Io m very great mcosurc iu the corpora quadrigrmina to 
wbii-b thcr comparntivd^ Urjjf, iu inaiijr animals perhaps only rootj 
of the optic nerve proceeds, much more simple and more immediafe 
n6c\ actious ; in man, on the contrary, most impresaiuua truiia- 
miUcd by the optic dcttc nppFar to t-xjierieucc in thnt <'xpnii»iun 
within the cwebrum a further (jsychical elaboration (hy conibinatioD 
with &brt« and ganglion mnacs of other Bjatem.*), before acting 
DpDD the moTcmeutfi. Tbric sji^jeai's to exist vrithin the cerebellum, 
■nd Ulievife within the cerebrum, au eipansiou furnished by the 
ndilory norca; it appears to enter, with the eootinuutiun of the 
fibres of the posterior column of the spinal cord, through the optic 
thfthmi into the hemisphere** 

(5.) Special b/sIcdis of Gbreavhlch para from one convolution to 
mAher, and line the isttmal aspect of the cortical substancR. To 
Qmm tytlaaa Uic fibres of (lie gyrua fomicuttis appear to belong, 
winch radtslc in uU Ihc convolutions of the internal aspect of the 
Wniispbem ; the arcifunn librcs also constitute com miss u res lic< 
iwcen tbe different parts of the i^anie hemisphere. ^V!lile in (he 
pay mbvtancc conduction and commuiiicatiou of imprrFsiona t^i all 
is provided for, tlirve fibre systems of lliQ white lubsLance 

2 



18 



PSKLlMlNAftY AXATOUICAL OB3SR7ATIOK8. 



tppear to fumish likewise a most complete means of oomini* 
aicatioti betwecu nil purU of tli« liemupheres. 

Tta« pnloogatiout of Urn pMt«ri«r oolntnu «f tti« ip'iokl oord, or, «t til 
vnitit, the bundles of fibres in direct commanicBtiDD with them, giro off suc- 
Mt(iv« purCiaas to tlie Mrebt?!!*!!!!, (lie corpora (juadrigeaiios, tlie optic tract, 
ted llie licmiaplietes. According to f orilk, whose rcacsrchca moreover require 
coikHnnatiou m lanay pututs, tli«re exitta irLltiiiL llio cerebrum two lafge gnvu|M 
of flbfea, dUttuct in their mode of dispotitiou but int«r]iced wiib one anotbcr, 
one of wbioli is oooiiiMted to the anietior and Latere columu*. th« othsr to the 
potterior oolumni. To tbs Idtor group, wbicli is much tlio mora imporlkst, 
b«Ioog not ool; Iha succctsirc caL&r^mcut4 wbich »c fouid upon tlw ixii ot 
tbo braiu, tho corpora quad rigc mini), Itio optic tbaUmi nod corpocA fttriatk wilk 
tlicir gray kt^ranU, but *Uci nil thn oorpus calloium, the icptum luctdnm, and 
the fomiK witli it» dc[riidcncic», wliicli nil surround, ia a circuhr fnitiuer, the 
oonc of fibru which proftRnJk from the anterior nnd latciral cord*, penetrate) 
tiie grijr muacs of tho Ibnlamua and corpui itriatimit u « Aatteocd Iruak, and 
nmifiu in the intfliior nf the grent homiijilit^rM. Aeeordjnjt to FovLU, t)ie 
DCrrous mcmbrHnc of the aurfnce of the vcntrictes, and (ai llmt ia Ammon'i 
bom ii pTuloDgcilititoihewliitciiiotlexteriM] UnelUof the conical sub* tnnce) 
Ike entire aurfaco of the lirnin is Lotimatcl; tolated to the prolongatioos of the 
posterior cord, so that the prolongations and dcpcndeucJes of the laterd and 
SDteriur cords, from tbeir entrance into Iha thilnniiii onwards, temsiQ tbso* 
latrl/ hidden in tho inlcrior of the parllatis fumUhcd bj the potterior ooHl^ 
and ncTir step out upon the surfiicu ilsrif. A reUliou wuuid hem mist 
aiuiilar la what is scca in the dislrihufioii of the pr-riphcral nerves, where tlie 
cntaneou and mucous surfacea ue likewise supplied chlcllj b; uer*cs of the 
pobierior column, while tho nerre* from llie aiil«riur uuJ lateral culumBS an 
dialribuicd pnni-ipally to the xuhuiijscctil muscular laTcrs. 

According to this view the braio, tis > whole, would have to be considerad 
U a great gsogliouic enlargement, which, like the spinsl ginglia, bdoogs 
primarU; to the prolongations of the posterior cords, but ia which tlic prolonga- 
tiODs of thennlerioroiid lateral cordt not oul; enter most intimatet; into Uie 
composiiion of the ganglia, but ereu originate in tliem (the gnj eortex). 
From thii poiul of view the ccicbrum would reprt^seiit then no enDrmuu 
gnngliou tesultinu from liie blending of the opltc and ulfictor; ncn'tsi the 
cercbclluni woold represent a gimilar uno result luj; Icota the nudilor; Dcf^e aod 
fifth pair. This appellation gauglion mty be allowed to remain; ■ tnore 
uiirinlc definition vculd lead to ilc cuuclusion Ibut both brains form the inner 
expaiisiutii) of a oeuiral, oud puitl/ special, nervous ajatein., in which llio 
immediate prolangaticii of the columns of tho ipinsL cord are eombined most 
intimately with uew masses of grai; substance, with new s^sMms of wliito 
ilbreB, in particular the central expansions of the nerves of sense^a circum. 
stance the ph^Tsiologicnl impartaucc of which is sEiowd b^ the verj great and 
InporUut put which the ceulial fuuctidti of the souus pliijB b nluiOst all our 
psychical ads. 




PBBUMISABy ANATOMICAL OBSEnVATIOXB. 



10 



r 



J 12. The cerebellum therefore, contiiiis proloiigations of the 
three columns of the f\nnaX cord in tite rompfict mus of mcdullarv 
hiTers which fonos tlm kernel of the cen-bcUnm and its imtijcdiule 
envelopes, and this kernel in, ncconlitig to Fovillv, surrounded by a 
membnaoiis oxpnuston of ii»ve substuice nhich line* the intcranl 
saxfux of the coiticti substance, and » formed by prolougation!> 
of the aaditory nerve and of the BAh pnlr. Both atrveit ttcnd, 
besides, prolongationa into ttn! Uyers of fibres of the kernel, rhich 
arc linnd in tbcir iuteriot b>' the gny fringed metabrue of the ohvca 
of the cercbeUun. 

From the lAtenl ealumot ef the (piiul eard la important eontJnirciit gwt 
villi ilie corpui rMtlfunne into thit certbcllum ; lh**e Bbrca go priueiptltf tu 
itt bcmiipliMe*. few if laty of Ifaem go to Uie middle portiou. Tlie Itbm uf 
tbo pooiVdTolii alio f^o to tlis lateral parts. Tlie wliite tubsuneo in the 
interior of Uic arcbelkThein»pljcr», wliioti iiDncdiatel; lurrouiKl Uioolivo, 
eont* pr)nci(»ll; from the piooeuui cerebelli ad oor|^oT• quBdrigemiiia, tlie 
oalj point ol direct comniuiuci^iaii belweea the cerebrum and lli« oerebeUuni. 
lie bet of the cntrence or n root of the auditor; nerre with the corpus ruti- 
KumeialollM keraeloflbe cerebellum iicotillruicdbjGraliolct. Gixillol('L'E);p6- 
riencc, II, t8jlJip.49;)tiiupubliAlicdacuc u( NolcDci-piiikUe ia nkicli tbc audi- 
tof^ nerve U)d iJie Ilitb pair entered into the vciiclM vhidi carrcipondcH to the 
tcrcbcliuoi, the oplic uittl ulfActury iicrrcs into tlie pnilt nlkich roprocalud the 
eetebnm. It i> cerliia, licnrTcr, Hut the pcrcrptiouH of ioudiI do uol lake 
pboe in lh« ecrcbclluin. Ttic little thnt cjin bo taid rcgnrdiug llic fuuctiona of 
this part of Chc bi«iii is reduced tu ilii», ttial it appears to linve more to do 
villi Lho mOTmitnls of Ibe vcrlcbnd columo and ttio tmolc ihajt villi tlioso oi 
the cxli«itiitJet i ptobabij &I10 it preiidei over tbo moTcmouti of ccrtliiii 
portiou of the ritcen (the geuital orguu). Tor all this many relatbns of tlie 
ftadilot; MCTB aad the &ftli pair liave yet to bo ditcovered. Tlic cctebcUuin 
■ippean lt> bave very Ititle to 4I9 irilh IIm ktgticr QGiital fuactions. 

The corpora giiaiiriyetniiia also arc evidently urgiitis of very little 
importance psychically. In uinii nnd ia tlie liigher animals they are 
always smaller in proportion na the heioispherea aie luri^tr. Thej 
liare na evident reUtion, and are indispciuablc, to the sense of 
aigbtj priocipally, however^ they comtitute the apparatus of the 
ledex action exerted h; the aeu5e uf li^'lit upou gnM combiued 
musouhu- inoremesta. 

Id the ctrebrum prolongations of all three columns of the fpinal 
cord arc likewise grouped tugetbcr, so that the anterior aud lateral 
paita radiate toward* Che exterior, are surrouiidi-d by the I'orc- 
BWatfoiwl ring-like euuautes, and at last pemliutv upwards ui the 



20 



Piiu.iui]rAaT a:catouical o»suvjirtoKs. 



ocatce u( the coarolatioasr iata the gnj eortjckt substance (dun 
oniptuAc'r). The vitite bum oT the hau^tbcra are not coo- 
ooeted vUh the naaa of p crip h m l nerre^ or with the colaoiaa of 
the spiiul oard, bnt wiA the eortial gr^ wbeUnet ; the surEtoe of 
whxb, aocordiag to BuQatgcr, has an mm of 1700 sqaan: centi- 
metres,' not ia rdalioo lo ootvsrxl wruisarion aad mascnlar move. 
ineid, but to the inldHgcnce. 

Of tbcM Uiree uceEtoty •traetom (otrrtrftiM, wrpKs ^mdngcmioB, ant 
gnat Icarispharea). iriudi ara copafaidai la tha oardital kernel to the spiml 
muTOv in tfce biaio. it b dwiyt iho Isik wUeh ttaaJa in Uh mMt ininediate 
idatioa to the imad. Cofortantel; thcit hodiou tre of soch « utan thit 
Uiejr (like Umc of tk« eerebellna) t»apt, l« a vei; great extent, bein; 
oxpertincoted epos. Their rcrr cUcvm aMt*)i7fatiot(oa pmidca ntket orw 
Ibc aioveBGattortheestmiitj«>,a)(>eeitVof the*rQi,ortlM loag«,aiiJ Ibe 
ooaetauiMe, tkan i>Ter the auroMentt of iks Inink ; the kessplucn'src tbe 
teatorancoR»cioiaiMof<if°'>t>catiMataiid Inn ibem Mam to pnneed 
all Uiew extreradf eoaapBcatcd acb iatefMadialing betweea tlie senaarld 
iaipreBions snd the abstract piTcliinl pboBomaaa, aad, ■(aia. betveca liicte 
butandtlieaaoremeeta; IIm liiniU to vilieh ^ueul pijeliiul lib mvf citeiwl, 
BUil nt arUch Knmlioa ao<1 atoreiaent ocmc^ are daioit aibittarr. Tbiok of 
tlia eaUleM nultiplieilj of tin novenieats of tlie tongue ta speech, of the 
dttboritc itwiorilM liiubs, npeeiallj of the bamls, aWionaaetablc inteitioiu 
asd impultn of movmeal mtat here take plicc, ia tke eeotnj orgaoa, trilL a 
rapidiij mill lumen; which are aneqatUed. Hum Eaealtiei jJoae rawtt 
Di-ccuitAte a far greater iJeTelopiii«ul of tha bowaplune in man Una ia anj 
olhtT nnimal. We often obtcrre in dlseaaea, ia htcalined isjur; of tlie hemi* 
k|ih<Tcs, llml iho incdin betfre«a lUe word Lliou-kt oad tlip Bioronieiit tif itie 
loiH;ue, bawcen dctcrmiiialiou and the u>c o( incaibcr% are sniipreued ; here 
a i;rrU deal appi-'art Rk t>ar>lj*it vhich is eertainl/ due 10 no dimt aCeclion of 
llio inulorj' np|uratu% but or ptyrOeat function. Tliink, on tlia other h^ryd, of 
iheendtoM miittiplidijr of phenomena vbieli we can iMAh(r uim nor demon* 
ttratc, vliiclt nre produecJ, for niini|ilr, betvccn Hm impreatiooa of Bight and 
tlic nh%tract iilc-ii ; llicsc pliRUomeiia are alsu produced bj cnnsci wbich lie ia 
I hi: aiiimnln of tiju licmi«|>hrrc:k TIiU trnutrunuBliiiu of the porecplioni bwng 
iTiiicU fcUongfr, itiorc varied, «:id mute dcvcJop«l, in man tiian ia aoj otlior 
nuiinal, it mutt tje admiLlcd lltit uiorc coaipliculcd nrrangoDionts are required. 

Tllf two ntrvcd of tlic ccrebnim, l!i« o|jtic and the olfactory, com- 
niiinicate with the surfiicc of the vcntrides, and are connected by 
tlio Liipniisions of their rool^ with uhuoat nil (lie fimilBmculal ])nrts 
of the bntiii. 

Aa the hhiul Ici-iniiiation of th<j v«iitriele«, the iiifundibuiuin, 

> ATeragc of llii'cc l>coti», ' Aiioal. Med. Ptjoliol.,' 183,1, v, p. I. 



VMtUUlN'ART A\'\T0M1CAL OUKBVATIONS. 21 

ui iU iufuritir part a paiticiiUr appetuii^, of mhue fime- 
fioa ve wc igocinml, ttic pUniuij bodr, 90 Lhcn exists sapoiori;, 
Vfotk tbe doUcatc iiltud aqaBstoa of Uw voitnctilBr ontjr vfcadi 
fiffBB Um inferior suiCiee of the cocpais qtuAaganBt, m M riogo m 
ippcodage, the pineal gbod, tlK amkgy b stiB wse AJking 
when the ronflgontioD of tfac nei^twuritur p*it* hi CBati i fcarJ ; in 
the one ease vc have the mammillary bodiet, ia tke ocba tte eofp^ 
qnidrigcmiiu* but «lule ooe of these, the pibutatT hodj, ia oal; is 
coaaectioQ witli tlw gnj sabttono^ tiie atbcr, tW pianl gba^ 
eaauBusicates onJy vith the vbiie pobitanee. Then ttnetmm 
wfptMr to larc no connection vith tbe pvjduial nod frrTf^ 
fimetions. 

( 1%. To tbe exunuutioa of Ibc fanin in tbe bodr of ooevbo 
lima Irca incntiiUjr discaaeJ, tbe sUtc of tbe onebcal corenn^ 
iboold. in the tlrst pbce, be minotvlr isrestigded. In the sfciB, 
tme idtoold not oulj notice thoee dcF^liow </ torn vhicfa aiUt of 
bdn^ ewitj estiinauJ, socb as marked obbqoitT, Itnotlj camlw, 
conrexitics »nd concavities, bat sboold ibo giie tbe mnsan- 
■xats of iU rarious diuucierai tbe thkhawii ud taxan itf tbe 
enunil bono, wul Ibc degree of oawfca ii ga of tbe watmtt ; tbi» m 
joaag fwnoDB bctog "oiDewhal raotbid. It b ixeaMi; la ob«rre 
wbotber tbe dnll [iroeiits on ita mtcrail sm&ce asf Bodo^ sr 
■bup oweoQs projcctioiu, to rxunino tbe Sonmiim vbiefc gne 
punge lo (be gn«t veMcb, ind ilso tbe gie*t rdns uJ utatHj 
tbeanritc*, with rtrrmicc to cooiiictioii, dflalatioo, or 1 
TIic drgm of rqi!rii(Jti of tbo MBBfei, tad tbe eoadi ti o a of II 
blood ibrj eootxhi, ongbt to be iBcntuHud. Ia fttiam l ia g tbe 
■nKnnt of blood nmtaiwd in tbe mnnbimDei ad ia tbe bob itjdf 
It a Dccaauj alnT* to hear in tatad tbe total q uanti ^ of Mood in 
tbe bulr, M A coutilenUe qonntilT of blood vitbtn the ennnai in 
gnnt gmenl jilctbont b of tnoch leaa Qguficune ibra in Offxaile 
■■■ mill cvodilkiu. In ilie Iiohl^ Inin Ibe pin miler sad 
nnebnoid ue thin and truulnn-hl ; there it, tt is troe, a degnr nf 
cii»dtjr akmg the liae of tbo kiBgitadinal nans, and gtial rant 
vfaicb is of no ngntication ia adnhs or old petsons; ia joatb, 
ktv^cr, it is itapcotaat^ as it narks tbe pmions eriMenge of fin- 
bojcnJ btpeneinia. Tbetanic msjbe Mudof ihcParrbianinil 
■ad Ibis U nUu true «itb rcgstd to tbe nawnnt of fcnns vithia tl 



99 



PRKLIMINART AXATOlftCAI. 0B8ERVATI0N9. 



cntiisl cavit/, it bnng alia more coni>i Jerable in old men. Whan 
the brain is health;, and Tnshly talien from the skall, the niefflbnnts 
aze eo«il;r detached trou the surface iritboat briitgbg with tfaem 
poriioof of the cerebral Fubstaaoc, cxc<-pt, pcrliap*, sruU and s<.-p»- 
rate -4ak«i. Tltc contnn- is Iho case when the bniQ it diseased. 
TtiG conroIutioiiB slioidd lie clow to one nnotbcr^ and their euriace 
should be. smooth and uniform: sn unequal rongh pitted surface is 
eliancteni>tio of atrophj of some of the convolntioiu, wltich is like- 
wise of less si^Dtflcance in old nge. In a healthy brain the whole of 
Uie gnj subftAnoe should eontrnsit ittrongly with the irhite vuV 
stunce ; the inner IsTer of tlie eorticnl gra; sobitRnoe onght to be t 
Hltte clearer tb&u the more external lasers. The white eabstoote 
oiiglit to be lirmer lUnii the grny; some pnrt«, as the pons v.-irolit 
and the meduUs oblongatSj are of Grroer connstence than the man 
of Ibc white substance. Morcorcr, the consistence of the brain 
ought to ho uniform over all, and partial indorstioos and softraingB 
arw of grL-nftT sigiiificanee than the degree of couristence, the Imrd- 
ncBS or softness, of the brain as a wholc.^ 

' The wight* of the bnia liatc not (lie gnat vtixta wlucli wu fomerlj 
attaehsd to tbom ; (lis mon iin(iortiint points upon tliLi subject will be ooa- 
tidcred in Ihe Fourth BodIc. 




I 



14. Tbe fnnctioa of tlic spitrnl mftirow is to oondnct impn»- 
suns to, and impulses of laovemcDt from, the brain. Beside*, and this 
i* it* principal fanction, it produces tlie more simple reQex acts, the 
tmnforinAtioD, Ktitl pretty direct, of senratioDs into iDOvcmCDt?. It 
» Uw grajr subftancie nhich is the aeat of the mediator}: fauctiona 
between Ibis doable oeotripetol oiid contrifiigal current ; reflex nction 
coiucitates one of it? specific function). iJut the grity nubalance 
>Iio coDducl« from nntl to the bnin. TuwAnlx tlic bruin it couducts 
otrtain qualities of scnsntioa vhieh could not be conducted b; tlie 
posterior columns, which evidently- ntao origioatc in the gray 
ntbsUuoc itaclf, and constitute a eort of "psychical" modiRcalion 
tad Iracsfonnation of the centnpelnl impressions. Inversely, the 
impulMS of moTement from the brain do not appear us yet to 
pOMew all the qunlitieii necessary to isolated muscular rontmctions. 
It appears to be in the gray tubrtjuice that these impiUses ore first 
eUboralcd tuul utmgtd in a proper uumner. 

All the inpitBsions tnn»mittcd through the spiuid cord, aud 
tkoae pTDcrcdiiig from the itcrveti of special «onAe,»ig;hl,hcaTiug, &c., 
in collected in the brain. Thcic, without being confounded the 
one wttb the olhcr, they meet, arc combined, oafociated, brought 
into the most manifold relations and combination!^, nnd avalcen 
within Ibc brain other new, but purely subjective, intenml images. 
AS the«c images leave behind traces or remains, of which tbe 
mnbtnatioo produceii ngnin certain gpnernl results (AbstTBctiona), 
■ad, quite involuniAry, in the moment even of their prodaction, 
Uiej are already logically elabomled, eoUected, and associated in 
i«dgtnR)ts, cotKliuiotu, &c. All these phenomena are evidently 
iMiiDately icliUcd to the actnity of the aensohol sphere of the biliu. 






Si PItELIHIXART PnTSIO-TATnOLOCICAL OBSERVAnOSa. 

But Ike brain is nUo an immense re5cx aiipnrntu^, in vliich lU ' 
^lc9 of sensorial excitation, of frhidi tliis organ b ali 
oonatantly the sc&i, arc tnnnforweil into impulKe* of morcmenL 
Here also, t^ ft certain degree, simpk' immwlintc rellex acticms Iron 
scDwi}' excitations to muscular coiitmctions take place ; gencnllT, 
bcnrercr, Ihc^ nie of & very comjilcs antuir, ua starta Trom fright, 
lunnonioua iQOTCmcnt*, aiiH the like. Much more chiinu:t«ri3tic of 
the brain, liowncr, are the reflex actiona from those already eUlx^J 
rated results of rcrj' many aensoml acta, modified hy oppona^H 
influences, and which have become more or lea* nbstniet. ^Hiej axe 
foUnwed, on the moturv side, by retltn actioos vbich do not manifo^^ 
thcjnscKcs in immediate tnnscular contractioos but tend ratho^H 
only to the etcitalions and to iKc most general ifieaa or eoiweqnent' 
miLtcubr movements of the greatest complexitT and Tari< 
(actions). 

All these fuTictioDfi ought also, bjr analog}', to b« attrib»t 
principallj' to the gmy substance of the brain, and in jnrticular to 
tUc cortical gray *ubst«tice of the lieniispherea ; the great extent 
of whose surface conntitntes one of thft chief oharacteristica of 
tlio buinaa brain, which is very ofleu found altered in mental 
(IJssami and baa been long declared by many to be the scat of tbs 
"iiit<4iect" and of the "will" The iutellcct is, it is true, a 
revolt of mnny and very complicated acts, to uhich, also, the prooen 
of trsiinni.«9ioa is Indispensable; bat this even, and indeed in tlie 
moat eonipliented manner, ought also to be attributed to the gr^ 
Biibi>tance. Between the perceiitioufl and the" idfas wliicli they origt- 
nate aa belvcen volition and the rcsidtiug acta tliere are many 
iiil<-rmediute conditions; these rill have to be aoughl for priuripnlly 
in the white system of fibres, and here, as has been already retuatked, 
it )) impossible to Ax the liinit where what U specially psychical 
begim. 

LThc wills of tUc rcntriclcs appear. moTeortr. to be of oonslderable import- 
ance iu rcgurd to mcnUl fauotioati Hat appears 1« be sh'OWU bj obwmttoii, 
wlicre lljeic is a Inrgc accumiiliitioa (oj^cciidl; if rapid) of oorGbTO-tpiuI fluid, 
iinrl wliere iU GQiittiliitkin ia ttltoreii vitii lupvrflpial maoentioa of the ventrieu* 
lar walla; in llinsD cn*e« tli«rc » aliraja dt>e|>deineutiii, aetata of stupor, Jte-i 
Kvornl patliolo^ioal anitomicnl obunaiions upon llic inaane aluo tliow this. 
If ve etui, on t!ii» nocoiuit, limit llio menUl ppocei*« jirincijiallj, but no* csdu- 
tiiclj, to ilie ccitbrsl gr»jaulMtB»oc;it a|ipc«aou llic olliei tiAiid rcry pnbahle 
that ail ibe free ivrracu or the brain, Ibc cottical gnj aiibstanw, n* well as Ik 



FltU.IM[S\ILT tSntO-PATBOlJaOKKU DBSBaVAttOJCS. S5 

vilU, MS dpMkUr rcbled lo Ike ■oU |inaa«>; thai their 

hjr Mlwa ilepcwl* apon tbe iaicpiij «{ lUi free Mcboe «f Ua kaia 

ibat it a principallj datiirfaaaon » it vfakb gire ne to ifae ■yfta— sf 

ijr. On tlie otber laad, wlicn iIiiiin,Miiiliiiii eee«r ibtwW iaeyer ia 

I wwtnl labilMOf. dhtorfauoea of ■bimiI aw iddaw «fcw»li ^ tWy 

HeuBpuj tke ■caUl denagCMMA «Wb ^ lom ectai^ tron t^ 

! of Uw TenUide, or l^ —»*'—' ■ahitane^ deeper ato Ike iatcfior of 

: brain, linitcd inJhainilkM fa Iba while HbUaee {vitkaot fntnrt on 

iia) BCTcr gin rue to great dnbtttanoee of ike Ugkr anaal fcgahirt ; 

the; CUM BO dhtariiMCB U all, at if Ike mm onl ecatn kii ao 

U apiNMi to he ebietr a nedioB of Ummimam, kot Inae- 

iBBj laLe phce bjr •ercnl ««J>, inil >o be eaaUod to tmid tic 

part. 

^ 13. Ilicofalnlaervoossjiteii), vbichespanda itself iatlwlieait- 
fpherts, is iloublv and syioitwtrical, like the peripbeal BCfVfMU qrstem. 
Vcdonul.lioiieTcr, think doable with oartwo h cBUBp hB M Miymore 
tbao wc MC double vitb our tvo eyes. In explanation of ibe anitj 
of the ihougiiLs, as tcO u of the itofiresnom of tease, we must look 
lo Ute middle aimple parldof the bnio^ the commiissurcs. It is 
ocilato, bovn'er, lliat injaries and diao^aaisations affecting both 
hilvei of the brain, evea when thej ait> relstirri; miiniporlani, gire 
rise to nDch more serioiu ftod more geaeral symptoms, cspemlly of 
pfyobieal kiod^Uiaa disraMS limited to one side, Tlienlbr^ wheo 
changes are found iu the btaJa in mental disease, thew 
allhoo^ often auimpoitnnt in thcmsrlvta, ahnost alvnjs 
botb «de% and a vide extent of stractore (HTperrnniaa, 

Cksca hara btco R«nrdMl b which, willi vtrj poMidomlile alropbjr of one of 
like great koBisplicKs, tke moUal fmllin bare mnaiud iatsct. One heini- 
[ Vpk««c. tkoatofa, tai; mCm for tke i»«r(6nnuc« of Ik* ntntal foaetioru ; j«t 
Iu liM beta otMcrrcil, th«l in lLc»e c«*^ tke niiiKl i* rtrj etaHj bligwd. It 
Uisl ifl tueh orouiMlMeca tlie attiritj dcrcJoped bjr tke ooe beni^ikors 
I go on onlj [or ■ »liort time villi a oettkia energy, ks if ia bodth a coa- 
laterckancc of functioa bel«ceii bolb, or * dislnbatJon of the mnUal 
r o«iT the two hemifpheret. took pboe. 

I spkiiins of Wigts (' DualK; of Mind,' Loodoo, 1644), who uraoKS ■ 
» daaliij of the mlod tn tlie two cerebral hemikpliera ; the eoiqectura 
('On Ike Brain aa a doable organ, Cliepten on Ueotal PbTaiotagj',' 
j^ Lgndoo, ISSS, p, 179), ibal vaaj aieotal dbonlcn, upedail; Uu 
I of umlal dmnily tni Inlrmal coiUndieliMi, depend upon a difliirnmiy 
lla tke fanetiomof botli bemlapliorc* ; and Inallv, tlie mmt allcmpt of Pollet 
ltd Rftrmcatsl abbrrnuiou lo^didiubanra in llie equibbriiun of theiniiFmi* 
I liM «f tka two hs w tipkcre*," are wanting in anlBcwnt proof. 



26 PRELIMISABY PHYSIO-PATFIOLOOirAL OBSKRVATIOXB. 

In ■ Ringrle ease of quite rrocDt diiMse mobmctioliK, iritb ideas of pcnecu' 
tion, BtUmpts >t auioiJe (ibr«tiier br<ing insKnc). vehftTebMrd tbe pklient, who 
oould ulill gi'e » good ticcouot of lii» »t«lr, »ay th«t he fait ntj well ; thai b< 
vu dcms«>i oniT on Dn« iide, tht? riglit (id; of thg heiKl. AnileBOVs «ue* 
hsM bMn pahlulicd. Friedroich, ' Allgcm. Patholofps itr ptyeUaehea Srnik- 
bnUD.' Erlangtn. 1839. p. dl ; md bcmme, ' Vcber unglciohc Grotse beider 
Qchirnhiilfteii.' Wunburf^ 1S31. p. 79. W* an not disposed to alte^ mncli 
imiKirtancc to tliete fMte. 

§ l6. The pajchical life of man, as of other animjJuj oommcnces 
in the orgtira of acnae, and the constant current as which we perceive 
it, pntsea out again into tlie orgnm of movement. Tlie trans- 
formation of Uie sensitive excitfttion to the motor l* th« foundation 
of the scheme of reflex action, with or without sensitive perception, 
la the lowiT nuimals and in children, !<iiii]}Ie forms of tbu psychical 
taking in and giving out can he obBerved in diffi-Mmt degrees of 
devcitviiieiit. Hure wc tee, little modified rad iufluenced by clear 
ftud cnexgetic pcm-plion», cluDges of tJie seusitivt impressions into 
oiotor; excit«Hon ill tlift impultea to tively movemeiitA, in the 
immediate saving and acting according to the nionicDtarr imprra- 
sions of strnsc. Bctir«ni these two fundamental acta of the 
pi^ehical life something eUc is interposed, excited bv the MtiratioDj 
a third element, which presents, it is true, some analogy to the 
sensation, and i? in the closest coimectiou with it, but is not really 
it. It forms, as it were, an accessory sphere which trends midwny 
between sensation and niotciry imjiulae, and, as it grows, acquires 
richnesfl and extent; it becomes gradually a powerful, kdiI in itself 
a complex centre which rules in mnny relations sensation and move- 
ment, nud within which moves the whole mental lifu uf the man. 
Tlii* .iphere is that of the intUligence. 

All mental ads tnkc ]>lncc ivitbin the iiitelUgonce. Hiis U tlie 
special scat of thought, and all tlie various mental acts which were 
formerly designated Hrparatc facidtics (imagination, wilt, anotionaj 
Stc) arc only different rclalious of the undej^taud liig with smsation 
Bud niovcDitiitj or the result of tlic conflicts of ideas irilb them- 

■What is, properly spraiing, inteDigence, what occurs within the 
brain wht-n ont thinks, nobody knows, but th« forms of it» procedure 
are accessiblo to observatioiij and the locality where it perfonns is 
not unknown. All sccms to indicate tliat it, at «11 eTciitA proper, 
clear, cridcut, thought, is referable to tlie cerebrum. And, more- 




rBftLimXilRt rHTSIO-PiTHOLOGICAt 0BSBBVATI0X9. 27 

orar^ Et my vitli rMAon be said, that tbought h an act mont cttiMlj 
i^nied to, and u enn to he reskoiud amount, the inner iensorial 
faBotuJoa. There appears to occar in perception cstealially, on the 
OM nA»t K aabjectire (genenllj very w«ak, Uiiguid) exoitntion of 
tile »eeaorj ctatm, and on the other side, a e<)mbiTuitioii of saveral, 
■ki many of tbcM excitations into a general image (Abstracts), and 
noreofer, one can pat to Bight each of those impressioiu from vbich 
(he vbote has rcsiUted. 

la Uie «)ikr mbm ct tk lann (in the atmt vhieh, for CKtuple, t!ie mrd ia 
Dai bj Hcrbart) crerj inteUect»il net, Miiva or puiire, nnd nilnr^Uf also 
ifn^'iwflj b a pttccptioa. Sensition n a perception whiRli Imt arl»eii iii Uio 
twiin Ifcimmh iniiiii'linti' lrtiainii»io,i af nti uciUliaa liiiLt hu nctpil npon it 
Bntriprtal fibre. A ^nnl nuinb« of other percepliuna ttre not inineiliiitcij 
fM*«k«i bjr irritation of lUe Muitire aerros, but ut jiroJuiiol inUriulljr bj 
tka fwrrf tT" cl tlie brwo, wliiob an iiiiJ«pend«ul of all •oniorial cKiUti^ai 
my ••• alao totimiUlj Jepoideut upon the traoM vkioh lomer MnMrial 
liiipiliMiiini ban left in ibe brain, and with the iuwani plieaomeiuL of tfat 



Vfm ipoak of the " perttpliou" soaiotimti wlj u of tbrnfri kanirn, tlial i* 
to MJ-, wbidi are utiulijr pruenl«il to tlie inind iriiti a orrtaia de^cc of force 
Bad tlaanMMt aonoUaMB also ve apeak of ibem ni ahwnt (apparciiily conserved 
b 1^ nvmotj, bat, in fae*, eiUltng tatlitr ia tbo lUU of dift)>MitiiJiit). Tbere 
■ in ialdligcooe an aclnt^ Ibotigb to us aa naooDicioua life and movemeut ; «a 
t TT^*'— it,ho«eTer, bjr it* ruulU, which nft^nRiidilcnl; make liteir appeannce 
bam MMua uocxprclcJ KMrce: A coiutant acli*ilj rcigiM orcr Ibii almost, if 
act vboUj, darkened tjiberv, which » mwli greater and nort ebiraeleristio for 
Iba Bditidnalilj tlian llw rcUtivelj' (hhU number of imprcaaiona which iwsa into 
Iba ilata of eoaaeioiUMH. A number of phTiioal irritations, of improatona 
fraa lbs interior of Ibe or|^niitn, strike at Brit, and crtn to to >]it>k ex- 
daiinlji Ibia ipben, and, ([iiite laioonociouBl^ lo ui, not upon it, and niodifj 
Ibi UM.a f W. a eaa ahieb take plnee vithia it. Th« occurrmccs, tho movcmenta 
Tbadi ara prodaoed williia ihU «pIi«Te, ooutribule grcntlj towiu-Ji the rc^-tila- 
liaaflf thadnnetor; the direction of our tastesv tbe piidanoe of our >;nipa* 
tbiM ud antipalbifs. 

Grat mi npid chanitee in Uio ideas are'oocMfonally (Iboagfa rerj nnlj) 
iBonayaaied by pereeptible oocarrenoes in the head, bj a feeling m if tome- 
Ikiny cfmed or abut itself, as I( a tlisbt jerk were reecireil, tike the g*th«rin^ 
mi aoUtnbig oS clouds. Galslabi, 'Ijc^ons Omlc* II,' p. 179, sikI Trelat, 
'Aaaali Iftd. Psjebol.,' IHH, VTTT. p. KS. mention aucb cmc*; Kcd atwei* 
iftw bniwa (o oijielf in akicb I ain c«ilaia that no deception took place. It 
ia Hit, of course, to ba ibougbl tbat in these ease*, ebnntea is tie mrrfcw 
pWM*** era titit; U appean ratlxr to be events whioli take plooe in the 
mimtbaam, changm in tbo amonat of blood the; contain, perliaps in (he dis- 
tribatiaa «f the eerBbtO-spinal fluid, oc tlie'like. 



L 




28 PBKUUINAllY PHV&IO-PATUO L OOICAL ORSEItVATlONS. 

^ 17. "VVe liBve Iwen lei) to coQHiler \he «1)i>)g braia ta tin 
gauglia U))OD tbe ncrrcs of ecnse, in which tlic central cx|>tiii6Kri» of 
ihcsw unite with iiew iien-« substnnoe. In accorda»c<! «lih lliis, we 
QikI, in the analysis of the intelligence, thnt tlie con^tnnt, simultA- 
D«fiU9, and ri-ciprucat action of the nteiital fLctiritj villi tbe ceiiLral 
sensorial activity >» of prim»rv im[>OTliiucc. Not on)}* is the intrlU- 
g»aice constantly a«-akencd, txcitwi, and enlertiiued by the sensorial 
itn|>rr.<>sioiia, not only dot-s the rercrae vei; vtu-u oocnr, the scmorial 
function being loiJ claim to and cxcitccl by the intelligence (Imllucin*- 
tiotis, ilJiisions, (l«luaion$, &c.), bul all our perception, if it b« oblj 
Bomewhat clear, otiglit constantly to he accompanicil by some degree 
of sRiisori&l activity, by feeble and vague tcDsorial images. The 
plainest nnd clearest perception is that which occurs with thv aid of 
the sense of sight, in which visual im^igcs essentially cat«r, whence 
nlfo the ^uppojtition is most probable ihut it belongs to the g&tiglion 
of tlic optic nci7e, to tbe brain ; in the intelligence of aiiinuds, where 
the olfactory iit-nc furms vety utensiTe expansions upon tlic vcntri* 
cuJar vrall!«, tlio j>prc<-j)tionsof smdltnay iuili'cil play a very important 
put. On'the contntiy, llie ideas resulting from pure sensations of 
sound (for exninpte, tlic musical ide>) ate very vague, undecided, and 
very dilVlCult to cxprtvs ; and it is TCPy icmarkfiblc (hnf for tiiti ex[>rcs- 
sion of this idea — « liieh consists fiinply of joint impressions from many 
analogous oljcfls, wherein llie concrete clcmcjtl is eff;iceil, and for 
nhich, therefore, it can iicvcr give a eufficicnt, adequate instilutioii, 
csprcially for the purpose of iutelligible perception — we have no 
other means nt our dispOGal than ngaiu sodoioos imager, namely, 
words. 

Speech is a prdcus murli Loo compliculcJ to ndniil of its being iGrcTTcd to 
anjr particular put uf the brain. Some purls on its luwor porlioii, the Burfcoe 
of tbe f<3urtb ventricle, llie ollvarjr boJiei, wliicit nro in man more fully ilcvHoped 
than iu fltif otiicr uiiinn], may initceil be closRl]t relutcd to ttio cxpc^istou of 
tbr fliouglila iiiid lo nrliculntion ; al all events, liewc»er, lliere arc oiler parU 
of ihe Ijiain, Rnd parlteularlj llic Knlerior portion o( tlio betnispliorec. vbioh 
ore very important in tpcfcli. 

It is priiicipnllj in patliologica! coses, where ilic words foil elllougli tlic cor> 

tesponJing llimiglits arc prcseat, oi wlicre coiitiimalti wordt r|iiitc difterent 

from tliuso nieaiil are primnimeeil, tli»l we sec liow iinteli nnut co-oprjvtc m 

the vfiiiderfiit inec1)»iii»m of speceli. This kind of aficction docii uot occur 

most frrqiicnllj ill mrndJ diacKMr, ll ocoura cliiell; in disestet of tlin cliarncter 

.of Joenlisril iiillnmrtiaticae, in tlic sensorial ccnire, or tnorc particularly in llie 

ueiiiif.pbcres. We liinli sfleiiranls refer to the cliacges wbicli oecnr in tpeeeb 

"n Kieiilal discBSM. 



UHtSAAr rUVSIO-PATHOLOOICAL OBSBRVATIOXS. 39 

The Uwt pajdiulapot utai« of wonb i* wry frequeullj nol properly noag- 
■iMd. Wonb nre oooTcnlioDiil iua^ of souod, slsas for klmdy very 
patnJiaed fonrn ; bj Uieouelm thej giro no MQoreta iieas. bat oaly tlic 
fuiuijoa to ■<*cb, Ui B lumber of wI«m oaly (o a inaH eitent ()ov8lo|>ci3, ouljr 
bfaaUtilj ariatingr into Uh state ot ooiiacioiuDEu. and the deljuls of triiioli 
na^ Is odi iu^ridud. Tium it i* thU diffirrcnt iodiriduAli Allitcli JilFurGiil 
iilMto wvrda; tliisuvtij it t» dificnlt to give Ui« comet ud exact defiaitioa 
if tka tieu wkick ioTolce tjio woriit, and to di^lcrmiiie iIlc tiiictlioti, wbicli i* to 
ho iiiiiliifttnciil bj the wordt, and tltcir pouildo combinattan*. Tlic cicitalion, 
(Am w naoertatQ, of idea* vliicli dit.i{i])i»r again before llitir c<>in|ilc(e dc* 
HiVifiiiiwrf. and are replaced witfa new ideat, al*a incotopletetj deirdoptd, incur* 
Vm diagn of luperGcialil; and abttiaotiiosN of the waat of eeusitiro conorelu 
Umi^i. to one vhn in ae«iiil«<ned la keep siiofAj la irards. WiUianl doubt, 
«U Iba bigV meolal (uaolMiu nre bound in an bt(iiial« manner la s;)cecli ; 
taiflub are male, ijwecb h a propetl; peculiar ta the loul of iiim. Tbcce arc, 
kovcwr, oKMnmla of ovr eiiatenca wbea aur inner life aecnis fur ouce to be 
drtitad abwe the twm of vocda, iriion Ihiu:^ uiitpcdkabic, uiespresaibk, 
■nfcnanl bj hnnan ear, rise n from a snddenty opi^ncil ilr-pth, itiid ii^iait itricr 
lafllMiliiiw. )i«rb*pa tt aecmi to ui »:< if all vhidi we iian-x, nr niny jnt nttniii. 
oaU nncr he a rtalittlian of vhot our iDacrmost Iboiiglita bad coaccircd in a 
li^n toeb monieat. Then oac OMnprchenda for tlic 6r*t time what i* mcmiL 
bj 'daapUnf tlio word/ SticU tdrouButoncc* vrliidi hj their iinlurc aro 
monpuiNl b; verj slronf^ ena OTtr>Bo«ing. feelings, ant probabt/ more 
Irvfocot in tlie raiioiu states of mental diuate than in beollh. 

^ l8. A r]aeer oompanson of tUe mental processes witliin tliv 
lyluni of thi> intclligetior, with those deprnding on tbc emotions, 
ravcab to lu nitiijr important nnalof^es, anil .il#o 8onii: cliiTerciiLTS, 
wlud] atv nortliv of coiuidenLlioti sa rendering mor« Tuuplc tlie 
stadr of iiisooitv. 

I . In tlie first place, it ought to be Peineiubercd that there cxisfs 
■ aimilanljr in the geDcral coiitlitions of imtation and irritability in 
pOQcptUNi tnd in wiiAttoa. In both tliere is perfect n-«t unlv iit 
tbc denpcst ult-cp ; onliiiiiry test, wlieli appears for example in the 
Kfisc of sight as dHrkiicss, in the; tuidenlaiidiii^ aa vacaiicjr, 1.4 still 
faaeiian, there is ooiueioaetuss of tlie dark field of vuion, of the void 
(0 iJie aphcn of prrceplion. Bat the proper nffection of the suhj<Tt, 
Ibat vhich In tlio M-nealion i» colour, sound, »ineU, &c., ia nltraya 
the miUly, thil ii, tlit pcreoplion of ivhidi we nrt- codbcjous. Ab 
\hen an, iu wring, lif'ariiig, &e„ mniiy dcgrcea of sticii^h and 
dontCM, M also, in (his knoirlcdgo of tlie pcrccptign, there an 
vtridiGs of ftlirn^h and clcanit>»s. 

i. J-'m tho dntvlopiDt-at aud nonnitl ptogreu of iLc iwrecption, 



so PBELIML.VABY PUISLO-PATUOLOGICAI, 0»5£KVAT10NS. 

BB well as of the Kiustion, a steady, modcnte, and adequate 
excitation from without Is ittctmtrj. In tlic functions of sense. 
Ibis escitstiou it jiToduceci b^ actual cxtcmsl irritation, and tWt. 
which linppetis in tlie sensitive nervous Bvsteui is, in the K)>called 
ecccDtiic pbeuoiuaui, again referred, tt&asportcd, ptojected, to tlm 
pUoe of the acctistomed peripheral escitatiou. The |)eror]>tion, tm 
tiie other hand, never recdvn the irritations b; means of uhirh 
it is exdted, mid which are iudiapeosablo to its coiiitiiLiit fuuctioji, 
dmetl^ Irom the outer world, but alwars through the mediuu 
of lensation. There is then presented in the perception » similar 
eccentric phenomenon, a projection similar to what takes place 
in M:nsulion, itot towards the penplienl surface or tlie outside 
of the organism — wc are conscious of perception ratlier oi of 
as occurrence within our licad — but witlun the same sphere from 
vhici) tlie irritation ordinarily procccdfi, within that of aensatioa. 
This eccentric projection of pcrcqitiona appears to be that vhich 
Drrcif^itatcs n constant entrance of sensitive imagea into them- 
Through it, there is effected iu the ocutral organ of sense that feeble 
weak hallucination which accompanies all perception, and from it 
thi-iu is procured that sensitive appreciation of colour, (om, b6J 
aouiid, 80 indiapen^bic to its cleamesfl and vivacity, and which 
nature has nictcd out to each of us iu such different proportion*. It 
ia the basis of all the psychical phcuomena which are asaigned to the 
toiaginatioii, and eapcciallv of those in vhich we have no more a 
feeble and vague impression, but one in Hit- highest degree dear, 
cIokIj' resembling the objective i^erceptions of 9cn»e, and, like tlieiu, 
fully awakened by the outward activity bf the organs of »usc — 
namely, the k^ucinntioos ])roper. Here the perceptions act in such 
a manner upon the ct-ritriil sensory apparatus, that in it gomctliing 
takes place which ordinarily is produced only upon their external 
irritation; namely, an act of seuiiatioD. 

3. An excess of irritation hus m both spheres the Munc couae- 
(^ucuced. An intent and «udden imjiression of light, a very loud 
sound or strong smell (as that of aminoma), gives n powerful and 
vioicut sensation, together with n sudden shock of the st'iise. Its 
nnmediate paralysis mar bo the result. This has been freijuently 
observed in the senses of siglit and liearing, in the cutaueoua 
sensibility, and, in a rmre case rehited by Graves, it has also been ob- 
"wved in the aenie of smell. Should, however^ the »eu») not be 



PRELIUINARY PHVSIO-PaTHULOOICAL OBSERVATIONS. SI 



» 



I 



I 



quiu psnlyiHl it rpmains, for a time at leosl, less susceptible to all 
wcftker impressious, aud tlit? iucitcd iiopresaioa contioues for a lotig 
time after the eau!« in removed (oontiiiue<] appenraoco of tlie object 
in Hee eye after odc has hevn blindei) by lacking at the sou, of a 
report of a cannoa in llie ear, &c.). It is the sata« witli the percep- 
tion, lu nam, a prodigious nam of perceptioiu of a ccrtaiukinil are 
soddeoly incited by a vtry strong impreuioii, aud h«re also the 
ehock in ita fint strength mny catue even paralvHs of the orgna 
(casea of sodden death beginning nt the brain from rioluit mental 
influences) ; but if not, the complex mass of peroeptioos which has 
been provoked v\\l, at all event* for a long time, bare the aot« cm- 
tnl of our consciomncas, and the susceptibility will r«i»niii, for a 
coDsidmbli! time, aotubiy iiiipan:d in regard ' j all other perceptiooa. 
In this maoiicr, agitatiog cvcato loay lay waaUi and iiapovoriab tho 
mind. 

$ 19. 4. Perception and sensorial function {and liere again the 
fdatiotis are most evident in the sense of sight) cannot continue for 
an HDlimited time in quite the same state; tbejr appear to be soon 
btigued by a continuation of the same actioHj and tlierefore a 
certain change is alway; nccc«san-. '\Yhere no motive to such a 
change u prcseoted from without, n ww sensation or perception, 
pordj subjective, will be called forth from the original perception. 
The simplert phenomenon of this nntiire, within the sphere of 
lensibih'tT, is that of the so-called compUnaentary colours, and sub- 
jective coutrost coloora (the appearance of blue when vc look at ao 
Qfingeet^oar, of violet when ve look at green, &c.). In perception 
something anatogoaa occurs, in it this process proceeds nccording to 
the same fundamentally obscure relntioiiD of contrast and simiWity. 
Wbea a perception has lasted for & certain time it calls up another. 
aimiUr to, or contiastiiig with, itself, that is to aay, tlicrc may be 
pradaoed a serica of perceptions, cithi-r altogether new, or stucb is 
can be retrwed to the flr«t pcrceptioUj which continua to predomi- 
nate. 



Tliis occvi Tcry rrtciuf-iillj, for example, ia those ouea mliert, fn Llie niidit 
of uJ iilcu cxcilct) br sn cilcrnal mumi, oLbgrs of a oomplotclj op|igiit« 
Bitare, Tciy liumoioiu, suddenly srise. The idcu ctll forlh eacli otiicr, u 
««U aocordin^ to the tenie lliry eontsin, u aeconJing to the snirlogy of llie 
HBiorul iBNjf«t entering into tb«m (iwa^tof miQB,of souai), wortb)) tlialist 




tANE LL.. 



"•I, wiiu^iu 



,a \i* ■ 



3i PKKI.I3IINARY PIlTSIU-PATHOT.Or.rCAL OBSBKVATIO^S. 

U MiMliinci seen to mtalti diicue, eapccMj in nam, ui Uie mart (bULiof 
iMDtirr, when Uu pilictit finds and pnommces wilfa grot nptdily lodf leriei 
or naulatij mvBdiog words, wliicli «e uteODiwclod m ncuiin^ or tt le*4t 
MOMcM imly kj (be nwrt inoobeient scnM. 

I> olW Miuei 1^ tlikt of KJgll, npecuttljr ia coUnetm* muatMB. knd 
inrtieuinl/ to pttbologicxl conditions, vo !«e ttiat « acKMtioB, for esalIl[lA^ t 
ydt ]■ I 6trUin ])axt, may ncile an uulogons Mnuftlim (litiiUitl«n, patn, le.) 
U MiotliR fMrt, sad tliot Uicn iMn slwnje ■ Icadmc; to aooomfiuj ll* 
pruntjr •tauiioo. 

In to fitr as through the so-oalleil association of ideas no mw 
l)eroc]tl)ona arc ortginaterl, but only ^omc arc annkciied aod repra- 
dticed out of tlic store of ]>erce]>tioiis which were formTlj- pr*!*ent, 
(bit proceeais called llie memory. The more intimate procccihnj^ 
of thi* jiroDcsi of ivprodactioa luv ohscure, and quite itKomprthoi* 
«ibl« ; old ideas aoil<I«nlj- arise without %\\y ongiu being discorcrahte 
in the iduaa that Iinve been pn-sciit, even n« those icprodnclioiu oT 
H-nvorinl images, which Hcnle described Diider the title of tit 
mtfmory in tie aetne$, rcajijicar euddvulv, tuid vitbout motive, iii the 
field of vision. 

It it njMD tUt Goitral reprodnctJOD a{ the pcrwi'tion tlist all tlM Riaro 
ddioM* BUtnUJ tMOomMS of combinfiUcni driicnd, nod llicrcfore tlic inUHifcnn 
b Vaij naeh afHIcd bj anjliiing wiiidi. lu au; t-xtent, impiin tlie meininj. 
tn mkDf mtutal dueue*, ptrticuitirlj ii> dementia, iIt impouibilit^ of judginff 
enmUXj, mid of fotming ri^lit coocIusioDa, is cwiiig to Ibe dettmcUon of 
MfRMifj. Idea* arc moro cnttilj reUiincil and reproduced accordiog to llie 
degm of slimtctli. and of foicc with wliidi the? at first entered, sod to Uje 
tieahbiscM and aetiritj ef the brsln. An; dixue of the bnin miy mipKtr «r 
dulnj llio niemorj, conictjuetitly Itie »Ute of Hic mcmofj. In lumj of llio 
iasanr, Indicalcs the sevetitj of thtir nnladir. Even bIj'cUi clangs in Ibe 
ccrtibrfel lUtc*. m, (or exampla, the cITccU of alcohol, con couaidvtabi; idiuin 
or retard Ikt rcpmduolioa of idcn*. braik op assocUltoiit of idcna wbicli 
«rfi! formtrly ftmiliiri and re«nll old and forgotlca eombiuliont. Tliere 
aru f«w pliiuci of menial dclivitj upwi wliich tlie effect* of direct pbfiical 
iiillucnota are no ctidenl u upciu tlie iDCinor;. NfTeilbelesi, one tuusL not 
tak« too makriiil n view of Uii; mntler. Tlie uiuriplcs of qnilc putial tan 
of mcmar^, to fnijucntlj Ibc rctuU of wounds nr diseases of tbe brain, in 
which Olio iDight iufcr tlin lois of Ibe opparktus devoted lo a partJeuhr 
elau of idea*, apprar in rtraliU to bo mure ^encrnl iii Ibeir clfocla than ul^ at 
Bret bo Buppoicd. llfrc there appears to eiial a grncral, though modcnite, 
dim itiii lion of tbc repruluctivc ^wcr wlierclij 'boM wliieh arc Itnst ccnueeltd 
Willi the inditidgslitj are tlie Ideas nioit liftblo to bo forgotlcii. (GiBlioJel.) 

In nil liie functions of tbe cvniral orgasB, cvrn of t)ic spinal cord, there is 
memory, aa well in reflex actions tu in neiuoi inl iniofifB, words, and ideas. To 
kaM, \a tltia reproduction of acts and ideas, wbtcii becomes alwajs more facile 



rXSLmiNARY rnTSIO-FATUOLOOICAl OBSERVATIONS. 33 
nal, iluii!* op^owd intpiralMi, \a nliiek Mriu of new iiieaa an 



{ 30l 5. In the next place, tbc drcQinsUiico is conclasive tliat ia 
Iktorgui of perception, -a io tbat of senMtion, the energy upecial 
It Una Ota bn put in ])laj not oulv bv tiicir normal cstcrnal irri- 
UuU, bat al»o by iutcnial irritatioUj nbicli diScrs from jierception 
•ouatioD itself; in particular it is cxdted hj moi\i\A irritalion. 
laliou of the choroid is followed hj imtalios oE the retina, 
•bkb ta»fao«iil>^ the npparitiou of subjective senulious of lEgbl, 
•r rsrious coloared luminous globes, tla!>hc3 of light, &c. ; likewise 
ill irtitatioQ applied to n sensitive ncn'c or to its ccntn; can call 
forth rabjcctivc Mimtiom of sound, smell, fut?, coM, burning, for- 
BtkntioD, &c. In the same manner itritatiou of the brain, lliroogh 
jnkiDal organic irrilutiou« unuiirt^sts itself in new morbid phoiomcu:! 
iptioiL A» tnflamniBtion of tbv vascular mcmbninc of the «ye 
abournial sensalioiu of Ught, to divase uf Ih« vascular oieiu- 
bnao of tbc brain^ of the pi* mater which »o complclclj* invcsis its 
bee Mtrface and even pciidrntcs iuin it, bvjicneinias and exudation 
flO (hia tnMnbnne, begtrt also anomaties of perception (deUrium), 
xttm flAlts of tlt« niind procetOin^ outnards from within (Agitations, 
motiaiw, flee), which, oalumlly, oi^curs to a HtdL higher degree 
indtKasCB (^thcbtaiu-«ib»lau<«itMlf. lJc»clc8, itis uotonljr ihvsc 
loioiu aud palpable diK-iuKZ which cau» 5uc]i atioutulics of pcrccp- 
Uoa. It \i evident tbat cerebral irritation uiay abo ori^iialc 
tbnmgli the commupicntiou of iicn*e-state from distant interna) 
organs, as the heart, tbc intcEtioca, the gaiital orgaiif. Tbat the 
lUTm uf the Dbalumiiwl viscera ate intimately n-latod to I ho cere- 
brum and cuebellum hns been expcrinic-nlallr proved ; and oi, cveii 
iriihin the phyiiolugiral htDiti of Lvultli, tbc btatv!» u[ the ubdouinal 
VMrn hare an evident lnAunici.- upon the frame of iniud 11.1 » whole, 
nd upon (be ailmnrc of ct-ttaiu Linds of ideas, so morbid irritation 
uf the oerva shiuh ba^t: their source in these organs will rrcciucntly 
iadacc morbid ttales of Ibc mind vliicli eomctiiiKs again disappear 
upon remotal of the pcTT]iheral irrilntion, althnugh, at oth(>r times', 
wbcn otKK onginntvd ihry preserve nti indcpfiident nnd permanent 
niitcoce. 

It ttiMj be lictc mcctiDaeil llial in licallli, na iu diieasr, such titffixoa inita> 
litBft Wa ii<^ iiiuJIjr iicile at llic tt-WLMenccmrnt new ideas eirar shd iltRiiitr, 
hiti ia tbe fir»l {laee, IIkj muk iIimo Tvf;aet inili-tcnnuiiilc nivdillcatiuas ot 
Ibc iBtaltigeBte witich ite desi^Btted eini>lious. hi pailiciitnr, llie Ttif>idi(r in 



34 rRKLIHlNARY PUTSlO-rATnOLOGICAL OBSERVATIONS. 



the Meeeuiofi of ike uhu, lad Uie waaaet in mUA tbey nteninglf, m 
mt&£t4 hj thwa inpreuiaM [ran the ocgaiiiM*, wliicli uUaliiM itadf with 
the diaaga of tbe r«eliD(» ud ihonghti 'Mnethiag like ike lijvWd irlucfa 
proJongi iKe teceired JBOWiicnl. tonxtlmM like aa taett Wileii irfucb U^tf^M 
it or rvoien it Ui^mMe.' Lotu bw rarj oonectl; poialcd o«t thk rriattoa 
«kieb eiuti bawceii tke oifiu ud tike tkou^Ia. ** The idterior ikvdep- 
SMBt of the oijuiaHi," nji be^ " acis upon the moI Boeh ten hj tbe tatwh- 
tion of '*''<|i«it« ideoi \^f Iw «»iiyin f^j riaf^ SigA Mtoiri iocfiialMMik of 
eertaui peeolMntiw of the inomiieiit 61 the theo^te, which, m aaptCMUs 
tni pcopoelUoaa, tma Uw fauit o( the -new ud condnaiou of life. Tbo 
■eiMlieaa (ron the otsm el the body, uidindiijillj fMbSe ud ngat, in thor 
wn hope«M powsfal ud eieeliT«, mC npon tbe soul { and Uui direetiou of 
Iha miad, in iudf tinltH, een, boveTcr, be the caiua vhiA gnidea the ft* 
Muhhig powofs of the ipirit oTor a circle of odeqKate and detersuned iileaa." 
Oot ot Unw tratoee of miad, pttcticahr dctCfOiMle idtM m»j eren bo dc- 
Tifeped vhea aided h; eertata cireQiiHbMea. 

Vi ihall tad tho Mnoe ia iwanity; ws viU Me thai ncvlj' tbe nholt 
IMlKaloej «f lantil (Umu« ooMidt is wmUl p w w f a toae oricinating boa 
Unaal fli|piiie oaaBn; aod thtia pamoaouiM tva, fin riae to i a i aa i 
ifaa oenfbraBhle to Ibo aev ■ratil dbpowtka, mi over vfaieti tbe aoet 
nmai eucniutaaeea exerf aa ialMaet. 

$ ai. 6. Perception, tike MOMtMB, Can be accompatiied hv pain 
orpknuR; in this respect tber proent a tut great anilogjr, wbick 
b ^ the nuR vortbr of mnarlc u tnental pain is a funduneotal 
deocBt ia t&saiiily. 

Ia •eualioo, as well as ia peKeptitm, tbr Batare of poia tnA 
planie k ■ bad of rague obsam opiuon, on tb« one hind con* 
ocnuBg tbe eleratioii, do the otber ootKerniag the limitatioQ and 
digndatioB, of the I. His opinwa cms he cotmeotcd with « single 
<x paccptbn, vhicfa will tlieo bo Mt as psiafol : then are. 
r, also io scDsatioii, aa iu pempboo, tauiy more grocnlf 
' ngoe atades of diseomfort vhcR that otwctur optnion b not 
whhd to Bf am^ sefuatioR or pereqiCioa, but ntber to sfuntioa 
or pereepfian aa a wbaie. To these bekag the itate* of general 
aa ra eiae Mj of bodilf ■*£•»•» wtthoat localisetl pain, and in perocp- 
tioB, the fediiig of opptowni, of lovnta of *^t» vithout adniiute 
CBBS^ which a)orranr» when loi^ fim^JlHW^, drrtlop in tarn 
p a rt i edar , reaflf paitiAil, ideas. 

UcBtal pun mar be oeeaaoMd bjr all that dtsturha tbe nonoal 
eooise aad oonbiuation of the ideas which rrf rrfcot the / ($ 38)* 
and which thcrcfim iiiait ita frecdoa. An excess of meotal eieita< 
tioo, wUeh awakes a di«»d(Kd prenate of aev Meia, as also a 
of raotalioo Ceoaui, )aditIciaioe)> con awokoi disigm> 



rULlHlHABT FaT&IO-PATlIOtX>OICAL OBSBBVATIOXS. 80 

lUe Ccdings ; 90, in the dcttcs of teast, pain caa ordinate as veil 
Iknn^ Tiolciit irtitatioa!) and tumultuoiu imprtstioDs u trom the 
ibAnetion of the customaiy excitant (colt), huuger). 

II bM bent sluMro n s nay ut«NStiiig tnuim IhnMigih the efecls of tha 
JAiktisa of thkwoio f , tWt Uie IraoMoiaaioo of tba Uctils ssniibtlitj cui ^ 
MJiKiatJi wkHc Uw tauation of pais u BuwDed ; tiid Sdiiff (FbjsioloKic t) 
\m netatij thowa tfail ia tlw spiul eord Uw vhite poatcfior eolaniu pouow 
Ike prapcftj of oandiutiag tactile intnonut^ and ttttt pain can te Imumiticd 
mIj bj the gny tnbctaMC. EiideDtl^, IhtreroK pain originflln !□ the gnj 
Nhrtaiioe. Il U bj no mouw improlnble Uiat aUn in tbc organn of the pec- 
taptiom tba phomacaa of UmtDiiwoii an not connected imtncdiutvlj uid 
lettmmrij with tlie phcnomea* wkidi produce mmial piii>. adJ tli&t tbc klt«r 
OB wifiaau diiectlj throagh Uie apvoial irritation of oeitaiu Dautilucut puta 
4 Ifca OBibnl tiaaue. 

It voold depend Tcr^ much upon Ae natore of the iadiridofll, 
ttober tbe daangcinait of the uomul course of the ideas vould be 
ID felt M to ori^atc nratal pain. A deLcate verastOe meaiil 
oginkaliaa can fc-el f^reat umoviuce at 1 circumstance which 
ffosJd not at all (list uib a more sluggtah iniellect ; one, for example, 
which could not comprehend the reaacHU of a fact nor solve a 
proUcm. Very mach, however, will depend apon the state of irri- 
tation in whtcb the organs of percepiion are nt the moment, whether 
«r not tbe idea will be accoropaniei! bj pain. The aame drcumatance 
am pfodnee at different timet very different impressionB ; for example, 
if it happens after one haa partaken of wine, on return from the opera, 
or, if ahartlj before, aoinelhing dingreeahle has talicn place. As a 
fiCTvc which i« in B state of nearalgic irritation does not react upon 
olcnal contact as in the nornul state, nud pain i» avakcned by tho 
lUghtrat tinprrasioa, ao there arc ntntos of tlic biain in wbich overj- 
BCDtal irritation awalces mtnlal pain, and where all thought ia 
painful. But tlic actual state of initatioii of the brain is a product of 
aQ tbe former states of imtation id connection with the irritation 
BOW aeling. Wliere tre<ititnt and profound states of laeDtnl pain 
han been experieuccd, wbcthcr on occouut of an original predisposi- 
tion to aaeb, or rental impression* of an xdvcrse kind, there is 
ptdoall/ Cormod a general pauiful ttatc of the feelings which i» 
aooM tiiu ca pcrrietcnl nod iomrtimca transient ; to tbe onfortonate all 
jeem aurrowful, and ha «bo experiences mnnj- reverses full* easily 
into a state of pennancnt aadneaa and misanthropy. We shall see 
that very frequently insanity begins witb conditions such u oocaaion 



3fi rnRMMiN-Anv piiTSio-rATiiot,ot;icAi. observations. 

titf" patient to receiie from ^vcrjlliuii; iiaiiiful imjiressiuiiF. ami lliat 
tbiif frame of miud ia in many instances tlic result of dtsugreeublc 
events. There is here revealed to u* an important tncntul iwedi!*- 
posin(f cause of insanity iu tiint susecptibilily to impression, tliat 
tendency to easy tmd rapid changes of miud, in which, through every 
mental impression, those obscare opinions conceraing sjiccial meatitl 
nets arc anakenetl, and in which, by dogrees, almost every iJca is 
converted into a menial disposition wherein the objective impressions 
are considerably wenlcenied, and a hypochondriacal snbjectiveness and 
egotism is rasily indnced. 

Then mental, like physical pniu, has tliis peculiarity, tint it 
alnays presses prominently into the fort-grouiid of the consciousnets 
ami pcnnils liltle ehe to ciilcr il ; indet-d, iis the highest degrees of 
pJiVficiJ pain eausc external aiiicsttiesia, ils highest modes are 
accomiiaiiied by complete mental insosccptibility to the normal 
excitnnl*. The pupil of the mental eye contracts, and tlic ttliarp, 
fixed, mental pain is the only object with which it is occttplcd, and 
of which we arc conscious; as in hypcrfc^the^in of the sense of 
sight, the rye mthdrans itself from the excitation of light, at other 
tiraea agreeable, and sfcks the darknes.*, so the patient who -is 
afHtetcd with menial pnin avoids mental intercourse wltli the CKteriml 
world because nil contact is painful to him, and, nbjeetly indifferent 
to all around him, lie becoincjt more nnd more conceiiti'utcrd in him- 
Bclf. Mciitnl pahi haa still other important consequences. On 
aocount even of tliifl concentration, all other |icreqiliou becomes 
dull mul sluggish; inj^-nioiw in Iiif own torment iind constantly 
occupied with hia pain, the patient becomes nnconscioas of the 
thinga that used formerly to iutcrcst him; tiiey are inomeutarily 
forgotten, and when recalled to memory, the impossibility of now 
taking his accustomed part in llieni becomes to him a new source 
of gritf. .\s rrcry mental impression i;i disugreeable, there is 
developed a general dispoaition of iudilTerenee and difgust, and 
l«aj«voleiice and love gi\c place lo the dark impulses of suspicion 
naci hatred. Again, tin: law of causality, which is innate in the 
human soul, urges liini to search for the cause* — wiieh oripnalc 
only from wilhiii — of tlic mental pain ; these are songlit for in the 
external world, heennsc mnn is accustomed to receive tlieuce the 
ineitcnients to his mental states: as these eanses, however, (lo not 
really e.\ist in the external world, therefore the idc.x«, opiiiionii, and 
roncluaion.1 whicli (lie pntient forms are false — (hey ;U'e delirious. 



J 



ritE[.I)IINART PnYSIO-FATiroiAOlCAI. OBKERV ATI OS'S. 87 



wircliing for eiinses of Itip mental pen-crsion, these attemiit* nt 
lion, wc sUull uDcrvanls recognise as tlic principal toarcc. 
tiiD (It-liriuin of insaiiilv, and vc stuiU »cc (bat in ihia eeiircbiiig 
tfttT etuaes there is prcacntcd to tiic mind of \h(: pnli^it uol. only 
ifcu in tlie narrov sciisc of the word, biil also, through the in- 
fineace of tlie itiiacination nod of the central evcitnlion of tli« 
wnortal acti\ity through the perception, tnniiy sarioiiR hnllnci- 
Mtioiu ind illiinons hy nhich he attempts to espbin his »tate. 

Scttsitive pain alnara impairs the tonicity and movetncint of the 
ntueles. Somelinie^ the patient ciir<>fiilly uvoids all movement, 
tni] iiiitiiictively nsts the affected part ; sometimes the movemoTit is 
mlly roidered diflicult, there is partial parnlysis ; or sometimes theie 
ire moibid movements, contraction*, and eonvnlsire tTemhlings. 
The mental life hss alao its molory ssidu (scencKt^), and this ia 
affw^—1 by mental {Kiiti in a similar maimer. Sometimes voUlion 
■ cUcBy imi»urrd and paralysed, the pntient in jiiirimsdeeB and 
trartire, ia the same luanner as sensitive pain is »o rn^tiucntly 
»cooin])aiiinl hy n (tate of profoaud eiifeebleinetit of the (;entrnl 
or^Qii; iomctime?, on the contrary, it nilheres tciiaeioi»ty to n 
•iiilHe object^ — ft condition which may be iiilerrupted by rapid, 
kllbough not imcrgctie, meiitul movement; somcliincit the pnin 
ntitts oatfarraks of violeol slid ninilcss (eoiivulsivu) effort, nich as 
imot proportionate to its duration. As, howcvrr, in the so-rulh-d 
KiMeuW teflsifaility, the central organ is eoiiscioua of tlic condition 
»f Ibp motort nervous ftyrtem, so also we are eomvious of thesn 
ftfttn of tlie lootoiy side of ihc- uientnl life ; this morbid mental 
bngnrir, this abKOce of -n-il], tbiK oni'-«idcil mllRTeiiee, aatl this 
eonnilsive jerking of the efforts are again perceived by the patient 
m t kind of inotory pain, which iitcrcaM-s Htiil further his present 
puofol conilition. 



Tilt *(atn of iiiCDtU |>iiiii, aDiiclr, friglil, loirovr, eimf, ic, vrlictlicr bruugbt 
mbnl l>y internl or eilentui eanwi. luve lliB samct efTccli ujioii the ml of 
tbc OfipaiMB M |>lij'uc*l piu!i. Sleep ilisuppean, iiulrltian is impnircd, 
enadition uul i^uctal cxiiauslioii rt>ull. MFUtn] |mio nllrniMcs »omrlimca 
■I||iu ncoovpunied bj w)-ealltd tfitud irnUtlAii i M oilier tinir> it 
I thex uewraJpa*-, in particuUr, Ui« cxialescc of ttiu( qiif^lric pain 
' |wia) u frHjiient in apinal itriialioii It oricn oliierved. Ai ctljer 
lb la ooMfiliontcJ witb pUjsienl nnteillimia of laiiuul iJcprce^ (,Jii»iiiislieJ 
DiiU'iitT to l«mp«rt>lure antl to lioilily pain, rxciicd ti; na rxiciiul cjiuk). 
Tlic ilalcs a( uenlttl jilramre giie enlirclj oppoMtc rtaults; llm (liouf;1ilfDl 
ma.* be nljund lu jiunue (at liliimK tlgcit BualoKirg willt Hie nalure oaJ 



ft6 PRELIUIXART PIIMIO-PATHOiOOlOAl. OBSEBVATIOSS. 

the rwnltt of the n^Balle phjaietl senuttioRi (lee ilio tli6 cbftpter on 
MoDomtQia in Book IK, and Tuious Brliclca by the Aullior io 'Med. 
Viertcljaliratalirin,' 1843 knd 1844). 

$ 22. As the ipecial function of tiie brain, perception, is most 
iiiliirtfltely related io scmorijil activity, so also there exists between 
the acts of the motory nervous fly»t«BQ, wliich lias its origin iu the 
same organ, aiid the pcrccptiou,* vriy direct connection. This tdn- 
tion i» very analogous to that which exista between perception and 
nenution. 

A.' we Iinve seen that the sensorial pcrccptious leave after them 
foehle nnd fnded Vi>stige», which become a constituent part of our 
ideas (§ i8),iti8the9amc with the impulses of movement ; thcylearc 
behind, in the musculiu' activity, faded designs which mix with oar 
ideas as perceptions of movement. There is an intermeiiiftte sphere 
between the jiure pcrceptjou and the nervous excitfition wliicli gima 
Hsc to immcdln-tc muscular coiitrnclion — a sphtire for which there 
exists no characteristic expression, which, however, contains the im- 
pulse's to the series of single musenlar movements ukeady co-ordinnlt-d 
in great gtx)Ups and formed beforuKand iu our mind. Here tho 
appropriate impulses of movement are transmitted to many mus(>les, 
which, in relation to single muscles, constitute cciinprchrnsive whole 
but which, in relation to our apeclid sctions, only agaiti represent' 
fragmtnts, and are comhinetl |jnrtly areording to a. prc-estahlishcd 
harmony, partly according to the order given by pnidicc and 
custom. Thin very comjilicBted mechniii!«in, whose sc^it, according to' 
physiological experiment and the facts presented by pathological 
anatomy, ia to he sought iu the vurious points of passage of the 
continuittiom of the anterior columns and the pyratnidal columns of 
the spinal coti), through the gray subsUince, first in the poc 
Varolii, then in the ccrcbollnm and in the brain, ia set in niotiou, 
on the one hand, by the mass of sensorial irritation which mcvts it 
at all these pmtia. It jiresidea then over those instinctive move- 
ments and notions which arc quite independent of the i nte]ligi»noe, 
or which depend on it only in ilinV-rent degrees, and ihen-bycome 
under its furthering or restrainiiij* intlucnee. On tlic other hand, 
however, the general forms of tliL-sr great impulses of morement and 
their ideal reproductions so mix themselvw with our mental pio- 
oe0sea that they enter into the single pfreeption as essential ood- 
(titoenfc!. Thereby, however, the idea ibidf .issnnies a motory 
diPMtion tending to muscukr raorcmcnt, and thus becomes elfort. 



* 




rsBLiMiNAHr rnTaro-PATnoLOGicAL obsertationb, 89 



IW tHind nerer euitci our T()luntu7 nuveroents in tbe seaM of invokiog; 
«B^ RiBMlai lo oontnctMa; it U nncoudou* of IliCM muscln, knowing 
SbI; the utUnkl iini|[cs injireMed bj previous »ets ol movemeuUi wkiefa, 
«bca once ticj luvo boooaw Tree impulMs of niorcmenl, Mt liio nuolw in 
MOtian. vilkMt furtiior neBtal effort, in pent nnd raguhrly ca-ordinited 
grOMfa («alLiiig, wrilug, £c.). In llic mora limited localiMiii brain disvuM, 
tfaOM uf Um pau Varolii.lbc ceTtbcllum, tlic optic Uialami, Dio corpora ititnta. 
Ac., «e tee muollj dGrangcmctits of Ihi* mcckanliin, nupciiaioD of lU oon- 
■MtNO villi the pcrccptiuD, vbere comiilicaUd moTementa excited bj llie 
brUaliDB of \he ditcue att Mmclimcs involanlaril; perfonned («>lkiiig 
fccwKwii^ nioriiiii ronnd and round); wnnetimei, oving to mcchuii&U u:[>u«- 
tiM of the bnin lubitnce. Ua iafluenoa of tlio jierceplious c&a tio longer 
nmA Ikit nechiuiiin (for exftnple, punl;*!* of one lulC of tbe bud;, owing to 
txtnmmiao iaio Ibo corpora itnaUi). SDnicttincs,ikI)o, cximpltoAlioaiof tb«M 
tw <Mue« oecar, lad, udnd. willitn quite limiled tpbcr» of mDicmcnL, ej'., 
llat of the oirgaa of *peecb, so tlikt the patient cannot pronounce the word* 
«Ueh h* Qunki, or. on tbe ooctrw^, expreuet words which tft bu not 

5 13. TTie mixing of tW intuiiiotw of movement witt otir pcrcep- 
tioD ii the intcnnediate process Ihrougli wliich t^ery manifertation 
of ODr intfUct-Lual life must pan. But that tliere dwells in the 
prjrduol tile witliin us an overrQling tendency to express itoclf, to 
ntiiliit itielf in motioiu and Mt<, depends upon this gon^rnl funda- 
mrntal fact wliirh meeU us creryirliere iu the norvous svstem — 
namely, that peripheral excitations Iransform themselves in tbe 
enttnl ofgutt into motory impulse. At different stage!) of tbe 
pnchkal life wc otwcrvc that diffcroit consequences result from 
litis lUTaogeinent. Id ttic spinal cord, ccntdpctal impresjions not 
rrt reccrrrf into <»n»eiou9i«8s esdte irreguUr, or only partially 
regular, iDoveinciit« of mosclu, sepamtc or iu (p-oupi (tlic most 
•implc reflex actions). All the organs of sense are accompanied by 
raiiscular apjMuataa, vliidi, when rxeitt^t by tlic stnt« of llic ntxva 
of arnae, bcoomo thn seal of incnliintary biil suitable refh:! fictioni 
wUch sMDuipiny and aiil the sensitire |»rc«ptioi). Alao, tlmt 
Ipcater meduDisiQ which cnntnins within itw^lf the impulses of 
movanenl to entim tpriea of muscular contractions suitably com* 
bbnl, ud to vbicb the inoreracnls of tlic whole body tie ultimately 
ndatcd, i« »<t in action by the scasoria! imitrpssions nccording to the 
rinpic plan of reflex action; sometimes it acts hurrnoniQii.«ly, at 
Allien im^huiy, an vben it is tlic result of a violent aetuoiial 
JnqireMion. MavcmcnL<i of the rormcr kitid are iit part evoked by 
■BfilJTe impreastotis from without, as m&y he oh^cn'cd iu the 



10 pnRumsAnr pnyaio-PATiioLonicAi, obseuvatioss. 



rhj'tlimicai rnovcmoaU of tlie l>o(lj* resulting from miwicnl imprM- 
oioas, or in tUc ni|)icl so-called iiisliQctivc acts consequeal on strong 
■ensorint iidptvanoiix (turning ssiilit, &c.). Sometimo, bonrcvcr, Ibe 
c&tues of the seasorinl impressioos, which o«essioa the Action, exist 
irithiti the body. The impressions from the whole organism, (speciallj, 
however, from the viacera, tlie intestines, the genital organs, &c., 
under the form of sen»uou» requirement*, give the impulse to action 
aometimet moderate, sometimes impetuous; in animals thcjr rale 
nncoiilrolIeJ, they constitute tlie principnl element of their pychical 
existence, they impel them to long journey?, ftiid govern all their 
great seritw of iiioveinents. In man, the iiniiiediatc transition of 
th(«c fcnfiitioiis to movement if ttubject in a higlii.-r i!Iegrec to the 
ioflucncc of the uuJcratuii<ling, fliiil through it duty anJ morality 
inlcnrenc to control and govern the sensuous ileDires. But there 
arc cases where these lose their power. In the insane, in whom the 
influence of the understanding over Ihc iiiKtinctit i.i enfeebled, mid 
moreover the sensuous impulses perhaps strengthened, we often tev, 
for cxuniple, the wppttilc for food or llie «-xu:d instinct ^honing 
itself with the most opcu rcgnrdlcssucss. Mitny sad examples (of 
shipwreck, ic.) have »howa that hunger, Ciirricil to the highest 
ilegcec, defiantly overlcapa the barriers which ethical and fc^lhelical 
exhortation np]>o<ie to it; aiid also, without recurring to tuch 
pxtreme casrs, it is n true maiiim that, ereii amongst men uf 
civUiMil hfe, hunger aiid love are tlic sirougest motives nhicb direct 
tlieir nctious. 

In nnimaN, the immeJiiitc reflex nctianB of (be tpinkl cord in (tic bnin ore 

ntncli blronffcr tlinn in mnn. All tl)t!tr jierceptiuiis liitre the tendency to be 
immcihnti^tj Irunafonneil lo moTemoitsi; pure calm pereeplion anems uBLnown 
tnili«ii; liirir wlicile pujeliicii! life !» coiinccicd wiili fflort lownrJ* c-^lcnial 
nbJBCli. Ill mnn, tlie more thi« impulic lo morcnieiit h guvcrucil ti; titouglit, 
llic DiorR Ilia minj is cnpitblo of pun; rcDcction, tlie Ins (bjt impiitaion trans* 
rorms ilfelf iinmedinlclj iii uiQTcmtriit, tlie stron^r aail more developed seems 
lo lia Ills hitellectunl life. 

The impulse, tile iieppsiily lo iiiusFular tnovrmcnt, to nction, in conscqueiicp 
»f sucli sensitive ii)ij>uUions u procecit from tlie iirf>nni}ni. ti cnllcd (seniuoua) 
iwit'met. Tlie &impl<jt aiiJ llie mt»L eniily undcntooil nrc llic nutrient and 
Iherr&ual iatliucts; llic spKinl instincts wliicU belong to mnny animals are 
quilo obscure, and tlielr orifrift lolall; iiniiivcitigated. Still, nt leott in man, it 
is not nlwiiys tlio »«ruiiliDTis projicr wliicli form llic rounilntinn of ibc inglicicle, 
hut ab-a obscure Rioremeala comxcled wiib tbeni, and cvcii awnkened b; llifin, 
in llio peiCcjilion ; movement* llint nrc licxignated in pnrt ni frcliii^, vljirit, 
liowcTcr, innv fail (o furm dislinct rc|<rG9cntaiiinii of llieii' objecl . 



rSfLIUINART PJIYSIO-PATnOLOOtCAI. OD&r.BVATIONS. 41 

Ail iofttnrti in man Iwloi^ nieBlulIf lo tiM bralo, and uot to the (leriplienl 

I Ijtlctt. fha {Kiiol of or!>;iii of b »iroii sonsaticiil m^tj liu In (lin inoit 

pirt of tho orgunm. but noThtre cIm can it aStict tli» meclmniini bj 

loT wUeh eompliciled mnveinetita Ate r«alti«d, aaTWo elte can tbeso 

I peroeptioat be uaited llina in Iho bmiii. Hj mcaai of tiolli, boirOTCr, 

iWe MiiBtiocu m Inatfonaed into iaitinots. 

Om tptaks alM of IW niculkl inktluoO, mletleetiuJ, koeurouUtiva, Tuiuly 
■Miod, Um fere ot cbiMr«a. Ae. Tlicro a liero alao impbcd tin; iicccsiii; to 
MrUifi aeU, stjiTod ap b; eefUiii f^raupe of idena beoomB ptniitcnt : i'duos, 
Inwem, wbidi do not procrcd from onu anolker m single d«Qaitc perceptions, 
1 BMEMilala ution eonjoial];. villi lbs obscnre abtlraolioii of timpla leaia- 



f 14. In the appetites and iiutitict^t, wliercrer they are not at 
once gnttGed, certain waaaea of idnis relative to tlio cud to be 
><twDcil »tniffj^« ikg.iiiut tlie oiipusing oircuinstauoes, nciJ the reU. 
tiotu of tciuioii belwi»n the i<Ws ftre thereby nuiteriallj alterf-d. 
tn this wair llw instiDCis easily excite emolioDs more or less strong, 
ooottDDOOS, or transient (^ 30} ; aiid in ttiat the ioxttncts, anil tlio 
fiseUiigi swakened by thi^m, mingle with thu perception, thu already 
untUKiM) rlemcnl of movement im[)elIiQg tow-jinb outward objects, 
tati nmve* sowethiii^ wann, tiensuous: by this iiiiion lluru nrr 
ptoiatti quite ncv stMcfl of mind. 

Thr rclilioni of the JDlcrcourM cff the teiH elTitr a nooJ cxniii|)le of lliis. 
"A* aslbrtie plouare in lbs Mccel j of mi itnliriiluol of llie ojipaiitc lex, or llic 
tnsUe conrictiua of tbcir cxrcllcncj. Ih firal awakened I'lTuiigli tlic mingling 
nf texaal bclikjt* and eaotioua wiUi the >lal« of miad wliieli nre in llie wlioU 
UtmbI ton, Mid vliicli vUJi the ealinelion of tli« aexiiol fcetinfts aIm ceatc*. 

Their u tiothi;^ )ncon.'<isteiil in seelclng to di^covt-r iu ci>rt(iia 
pwtB of the brain tlie scat of the seiunal instiiicl$. It must be in 
Unm pofls where certain acrra of lenaation and lUeir cmtr.il 
^tmioas — for euimplf, the vagus, the nerve of the Rfxunl orgniis 

Burt irith the molory nppantiB. But hitherto H h.is not been 
proved, nor is the sup|)o»itioii probable, that these parts arc situated 
■pon the superior sariacc of the broiu. 

la Eaaaaily, not only do iho nutrioiit uid uxcil imtinds tctjt oiWti sliow 
thnsMlfn ill as nBcontroUcil inanncr, bat alw dov iniltnctf uppor, tni frc- 
loeatly o( mdi * uUiue aa did not belong to llie fornier life of tlin iiuJiviiInnl : 
praMonl indbMUoM to nrtsia Dot»— ««, for example, tlio cnnlinual collcetina 
tl an aortA of Irifin (fcatbera, ng\ lupcr, &e.)i wliicb icmrudi tis of the 
iaatiacta of mUeetion, fto., ptoptt lo ecrtaiu animal*, and wboK psjdiieal origia I4 
«^!tta(ly peculiar and abdiicoierad. la general, tlio act* of llio iiiMitc, rfa 



43 PUUSniAKT rSniO-rATBOLOGICiJ. OUEETATIONS. 




bat 
it b fcnttrlftUt 

of ""'"Ifl 



( 35. In tLe J B itBMfc fiben aa no Kiif^ dear, uid definile 
byc ihm iM iantioBi ad fadingi «k^ exdte the im- 
of ■oraDarty Md ■hg tb y Ike Mban of tbs volorj nenrons 
■ptoi M i HiM l eJ tovHdi Ae graapB of moades. Ifj Iwvever, tlu: 
koowB md dfftnte jAm^ hf haag mded lo ibe impabes of nove. 
neat, oerdK u ■■*»*■'* spoo t^ miucalar gaomnents, this ii 
eillcJ V7K 



TUi ■■ M kMt the tfapiol om^ lad Oe graudmrt of (be will. 
Ban Us taipdaca of ma^tma/t fnta&i aa kagcr froa taotititt iniUtioD, 
kitfmiaoltra-, til b lo wg, frw —f in Mbw pwiaal to iha ooMeioia- 
MM, iUa^ » o«t7 • ■Br^ dup^^ <^ •Mm tiil wwMh tlwtrriUtiMi 
(woBolMipMikncr.'GnDidpnUaM dcr EUttk,'p.4i}- EMcatull;^ it it tb 
nao praoM M t&ot e( Ptfcs Mtiaa. 

AlnoJj ia my ftr*t «oA apca foycholo^iwl maUats ('AkUt f. pfctvi^o^ 
HetllEitiide,* H, 1843, pi ;(), I btre rtiraeslal tke aotoc; nde of tlw Bcntiil 
llf« u ■ jrnduil aneeestioD of eretiu U/temiat Ua aMM prinapK tnoi ik 
d ai plait nAet action to the mat kwiwB act of tba mD. and ha«a UMrcwitli 
Int ahon Uui ftiwlwwlal faet of all ftjtiaeti life, imoisit pliikMopticn. 
w« will Sad eaanrtiallj the hum opIaxM in a timker wh> tenaki^ does not 
■MSga to the will a lower piMe (Sebopeabauer, ' Ubcr dm WUlea k der N>Ur,' 
■hi 'OfMidprobleaeit dfr Elkli')- I >»*« beem verr li^ifj also (o Gnd Ifce 
aaae goMml idea in tbn Toy valaabk wock apoit NerrcrbjMoloiET t>j Scbiff 
(l^krliaeli d«r Plifitotogie). I ht*e there abo eaUed atlemion lo Uie f«:l, 
llut h inMBJIf much deptnida apon denogcaicnU la tbe normal pujrdiical 
ntet action, without the cstite higlicr intntal lire recjuiring lo be inTolred ia 
liia dbaaac Gvittaio, {'LeftaiOniea' ii, 1, p. tS^ymgntt with ma upoa 
Ikbponit. 

Tlioae inlaitioM of movement: ftssoriote tbeinnctTes to tbe eridont 
WMilire pcri-rplinn; but also into the ix-tcrption, which foiisist.* 
HtMf in alMlra^-l gtiicml iinprossionfi wbicli arv indtcntrd br wools 
(thf intdfiffibh- pcrci-ption, § 17), iniJigw of moTttiw-nt cnn hIm 
enter. TIipw, bowrevcr, arc then only cqunlly obscure gencrnl ini- 
prwiriona from Jsrge innases of intuiliona of iiioi,Tmciit, which still 
are not gcncnilly (■eparntcH. bat are contained therein bundled to- 
grtlicrj in ordtr to Ibc rcalipiilion of the iulelligible perception, this 
■Mf'S"'''*'' "f iiiluiliuiia must go out in n number of sjiiiflc imium 
of movrnient prcriouely nndetennincd. 

Il l.old> Kood In nror; rn>e of nbglmct dcMrr, na in llic wi»li lo be rirtuou*. 



raxuKiNAaT pnrsio-i>ATftoiX)GicAL OBSEavAHoiis. 43 

to be laeeawfal Ca eumiiiatioiiii, fte., Uiat is, vonid reiJiM hia idea of Tirtoe. 
ef exasUaMMii : wlterercr (bit t» a reftl irUi, uid no neni Ibongbt, Ibera ii 
■ Ml III ill I. Ill with the iiles «u obsoura mass of tlill ontonned inluitimu of nofc- 
■■l^ wbeh itt ibi! rcaltsalJon nuuc resolve tbenteku into n coniplicnlcd 
nagUdtttlrc The tletenniiutMii to tkc object dcTdofiCB itseU in the dclrr- 
mmtiau to the eCecliial boias, end lliis lliiallj rcwlrts fttelf iuU) namberlcM 
liigli rffnrtn 

Tbe kins tran^Tonn themselves into eflbrt and will ander th« 
faapabe of nn iniemal force, in wliicb vre recoguisc, even ia the 
tnamnoft iphcre of ilie life of tlic soul, the fundnmcalat Uv of 
rrAei icUon. We mutt will. In the hcaltlij' niinil tt urges and 
iB|id* llw individual lo expreM his ideas, to realise them in actiomj 
■ad thereby to rid himself of them. If this has taken place, the 
(oal feeli diibordcDcd and &eed ; b; the act it relieved itself of the 
iden. Had tbaa its e<iailibriam is tgaia established. This is a re- 
Batkable fuDilamcntal fact of mental fife which the iau-Ard experience 
of neb man must knov. It shorn itself in the artist nliose mind 
for jmn is mtlenl^ occupied with the burden of hia j-rt uncrcntcd 
bftey, to whom the completed aud successful vork ia still vague 
■■d aakBOwn, even u in those nnfortnnate men who, contem|ilnting 
tfae perpctntioQ of sotoe baiArdoas misdeed, arc subjected to the 
DMt lonnenlir^ inward ftrugglcv, ttliich, however, disoppear after 
the pafonaanoe of the act, and are succeeded b> rest 

Then b aho a Bemorf of the effort and of tbe will (f tg), ■ rcpioduolba of 
tW iatvttioB* of moremeiit, winch, tuiJcr ctrtain co ad it ion*, reunite with the 
iiwt. Anwogst differml men there taists great difference in tlic eiiic and 
tmofs wilk whicb the iiitaitiMS of noTetnent succeed in liieir aini, ftpalh; (q 
niaipkU ■faoeDoe of will. 

All dTutl, tka lullnct and the wiJl, form the eentririigsJ notory aspcGt of 
Ih* ic]i«!tj of Ilia sonl. The ■[>ec!al oomlitiilion of tlu> plinxc of lIid *ouI-)ir« 
noMiitBtci. in a cmt ncasuit. Ibat witicli ii nlled the imliviJua! clmracUrr. 
nca* fact* iiRwtil a clow analoKj la whit take* place in tlie muiculo-motor 
imiiiiM ijMca^ whikt pure pomption liaa far more in common wilU the piie- 
is tk« nerrea of aame. Wo Gad, therefore, ia effort liic same 
. wfaidi, M general expmsioiu, rrjirescnt certain statvt of niuwulnr 
•(■lifue ttd paralysis of movement (weakneaa and paraljrtis of tlic 
, loine eonvultion (moltnncd and dalonniord effort in one direction with 
itj ia all oiben}, oooTnUivti ntoremenl (imltucts let loose hj disease^ 
iMIuuDcaa, moibid rtatieatims, forming of projeeta and deairo of action). 
It ii wwtir/ of mniiderralKM, that frrqiMiillj in moiital ditoatct, lliu moiorj 
wik of till lottlltfe anil the naicnki'nMtorji funotion are both altered in Ujg 
«■■ wffibtd manner. ^ii*,tlifitcoecnraabaanDOof wilt, together wilh ^neral 
nIpanljBia of nicnanrol, a nnririi siaggKalfaiD of lb« will with incteaaod 




H r>KUlli:tAltT rinSIO-PATIIOLOCICAL OBSEBVATIONS. 



mtiHuUr MlEntf (tat examplr, is muuaul eraJilioiu) ; at olber tiika tbt 
dtaNM y«ao> qiritU; f roa the dm ipbcr* to llie otbcr, u in u \Hutk oT 
«I^IM MBVubioM, foUond Innedialdr b; > p^cUal convtiljiv-e tUtr. a 
iMtBl ftl ol oNoii. WttluwM or tlio tpiinl cord b bIm fici]uentl7 leea^ 
nM h; « iiiwM (I irflt deiinBdeoe;, nnil alsace of nntal eaer^, 

$ iti. Bat u tlic H-iisntiuus aud fediugs are tlic inore ruilf 
coavrttcJ iolu iuetiiids In |>ioportioa to thdr etrmgtli, ao ff'iU u 
ikwIiifM-tt out ot tite singl« |>crcC[)lioiis th« note msilv ac«onliiig to 
llw Rlrvtiglh Biiil |Kr9utcur« with wbich Uiej enforce ibemselTea. 
Ou Ibis •rcoaul tin etnuigcst U\cas, at the end of their transition, 
MM foRibl; in uiiotis. It is a fortunate pmvi^ioii, honr-vtr, in 
■kMlil tifr. iti»t rvny perctptioii iloes not atlAio to tiiis degree of 
aliTttglht Thtn, ucvntiag to Uie lairs of llie asuodatioti of ideas, 
itx'tT uiM dw coutnstuig percqitiom (§ ly) ; thcjr draw after them 
Ituilur jNlMptiottl rdatrd to them, uud there arises in con^dotunoi 
ft NuAieL Tbr ffhole man of ideas wbJdi reprcKuln the / ($ 2^ 
«i»«f« into Ki-tKOCt uid gives the filial decision according as it 
tmtwJM or Ctvoum ihut lir»l idea. 'J'his o]ipo«ilioii iu coiiseioosDfss^ 
wtw'h iu iho rmt i^ decided br the /, b Ihc fad of Ibe libcrtr of tltc 

iit-lttidual. 

[%* BMuuiiilion of abmlutc bberty, as well as the reiulls thnt 

tkiw (hUH it, t* rrruDeoti5. 'Hie bbcrtj of an individual is alwnjs 

M^lh ' I lTrn;nl iiw« are free In difTcrent degrees. Origiiially 

^K,. ( I » ill no respects free; lie becomes so, fir*t, hy Iwittg 

-m'hI (if a nt«« of weil^rdcrcd unJ casily-erokcd pcrceptioni, 

I'til I't xbii'lt iWrp is fomwU a etroog kcnid, Ibc /. There are tiro 

n tivtol i-'tiditiMa* iiecesMi^ to the freedom of hamiu aelioiu In 

ini' Ht<l idacr, nil unobrlrudeil a^socialion of ideas viberebjr, arounil 

\\w lllHil UlWMltwI. which arc trautformed into will, other ideas 

itlUlitttUMi IMy ^ (lathtn-d, atid mav be ojipostd to tJie r«ni)rr. 

\\\ |h» WHHiiid iddiv, u nulHcieiilly strong / (§ 18), that can gifc the 

ll^Vt*!)*** '■> <i* *"*"* *'^ iitra.% Btretiglheiiiiig one set of the opposing 

mUfyiitmm, itiid (li>T('l>,v n'talivcljr nciikcniiig the other. ^Vitb those 

«t'4iV 111 |H'ft«'|ill(tit aiul mrJitaltv dull, fmHloni is to a gnnt rsleiit 

lilutilhvil III llic dn'<tmlikf lumiottoiy of cuttoin. 11>c tnut of weak 

KilMit h lv«« (ifi', xiKV the tiring ni>sodatioi) is nWcnt from liis 

I . ,. Olid ii|i(i«>«lii^ idi'as lire not, or only very slowly, atraJtened. 

\ ■ 'It r ai Ills petoiiition is active, »iDce no strong / lias 

>l, thill eoiild M-iid n powerfnl, iSmly coinbined 

Holts Mil till* cMifliet. 



FBRLIBIINABT rilVSIO-FATnoi^OICAL OBSKBVATIONS. 45 

ta ■ aefeo-bgiil aspect, it ut rtty important for Ike pItjMcuni to litirc clnnr 

vimipon the nature Oif liunun liliRrlj, ra mucli obacuKrI hj alntnict modo 

«fti«aii«K t^e nibject. Tlie Mfitcnti flf Ibis puragnpli are mninlr derated to 

Un p iw |w » c. Litrert^, Mtentorv, ctnsikt* ewenlialtj in an tiiHuencing and 

liwifimiiiliiiii of tbe (ocaakuiit) nill; in (ocouiona]) tnastu of idcu 

IfMibg !b1o nUecttan I17 llw aid ol oilier idnt, tad npticiilly by tlie entin 

B^hBof oonfaiaed iikaa bdoii^ug to Ike f; in tlio control vbiciii be /exercises 

^^K UiB tcadeneies ictoallf Hiding; tlierefore in Ihe possibility of ulf> 

^^^bwMd. Ilifl laore coaipact and voiUKl Iha /i> in itself, the ni»re deeiiled fs 

Hb ehincier ; on tkat account the more decided]; does eacli one call into 

) mri—. b/ kit aSnuatioa or ne^tion, tbc ideas wbicli nr« nlrcndj flokliiig in 

lla mind. Sa i> the ujins to be andtritood, that " true liberl; coiuitta in 

SwlalMn,** — Mtndj, hj meiini oftbe T. niicro Ihit limitolion ftils. Hid ideas 

Itat •a>*>oaaJI/ tftiag apy often dcjicnding oiiI^f on tlie MDiitivc cxcilntion* 

inMsAtl Ibemoimiil.or oiil7puKiiigdcsu1ioriIj(ciipricia(iM).prFsi uiihindercd 

lowuda Uie taatnrj sidr, mtd enforce tbeir ncoompluhmcnl. By (lie most 

iviod bodilf iD&DCDCc^ lioircTer, tiiis limiliDg poworof the / mnr be icstrictcd, 

JJwiaitlieJ. or quite abAlinhed. 

"When an iodiridual makes moral inotires the rule of conduct in hii B0tious,_ 
Ikk nn onlj be done iiuinuch as b; frequent reproduction siid pniclioe In 
■silci tfte maMcs of perotptMnt whioli are rvfemble to hisi moral hn with alt| 
kn UbMi *o that Ihty, vitli cicrj slroiix motion of the tliouKhu, accompan] 
tWn inU eoBiewuneif. Tlie; form tbcn an eawntisl eonitituent element 1 
the —an of percrptton of lita /; and if a oouflict aiiie in Ibei oonsoicnmess, 
li«f act onl; immediBiel; stqi rnrwird. bat tliej also over nil the eoiileota 0^ 
Ibt /. npoa Ui« wbale, lure (Ue idraiitage. In the iiDnioral ninn, on tbu ollu 
^^pK*! Uie tcotialiol and malisiiaDt thoughts lave gtaduulljr bo roulcd^ 
^^^Narivta tint Ihej alirajt •» ready to >tep foricnn], and liie lit occit^ixi 
^^^P Ikrt wliOM chief irisM Js, vpon (bo nbolo, to the bad aido. Of coui-se it it 
^^El wpfMoed tbat nc\i an indiTidunl on this accciuat tcts nickcdljr in cvuiy 
&Me ; ta hiin alto the aoftocialion of ideal is an sctiie piiiici|>le, and, intmuiuc 
•a it aagetta to liii nund the oontruta of liii evil tIi'>UKlitj, liAlX-amolhcrottl 
Mtioaik bilf-cnwd tnaiiu, nd thi rcmanbrancc of better dajs, vitb thB 
(oo4 adrice* rc(*iT(d in roatk, step into conieiDusneM, mid n violent confliot^ 
■aj moll. la tbo end, iadccd, the / raroors Hie wicked aide; ncro it tu 
EsKMr tie itmJ, the aian wooM not bo imniotal; still, he is a man wlioei« 
tmttiaif it would be Dnsafe to trust too muebi altkoajjb tn Lliis case he 1 
fenc oraraone kts eril desires. TIib alrenglh of tlie opposing noml niollre' 
OB, fcosrte t r , ntver 1>crorcl»Ml be esiimatcd. There is no man absolulcif b^ % 
bUHiiiaut todiBatMos bist sometimes luvc the predominaucr. in nu litimaa 
keipf >tl t^ IMallj suppr«sied, aixl the history of criminal* ihaira Imw 
Bft«» llsst lillle store of youlliful rMollreliniis, llio reiiicnbnucedf an old 
^piif or Terse nf & anag. forcioj; itself iulo tbe train of IbougUl, calls u^i llio 
a ^ i as ieJ noral perceptions, and thcrrwith tbc impTcttion of tUc Rood Is cod- 
fltmid. If itwrs oiatcd an indiridiial anctt as old Ccnci in i5bcllr,r*s dramtt, 
(Le vitlud eaMhHWa eanld with liir, indeed, ucb timo be predicted as h 
Rsall to vliicli be use (rresislibly impelled : but there is no such indiridaal, 
ial no one wko a mcnlallT licaltliy is cooipellcd to acts of vtlhnj. 




46 PBELIMlNABt PUYSIO-PATHOLOGICAL OUfiUBYATiOKS. 

§ 37. The normal reciprocal action of Uie pereqition, vboefa, 
through the ideas BctiLoUy in the mind, other coutrntting. or 
gencnl limiting, ideu are air&kened, whcreb; all proceeds 
moderate stnogtit mai rapidity, m that, in gcuenilf a conflict 
arise in coasciousnees, so thftt thought and rcftectioD, and thi 
a survey of pust and futiur, :irti possible, ia best designated as 
slate of Rf^tHica. Ouc casiij perceives how this is an 
condition of all hberty. 

Nov there arc man}- states where thti reflection U weake 
dcttrojeJ. lliis iippenrs to a gcenter or leas rxteut, find, in t! 
emotions (f 30), which are still coiiudered physiological states ; then, 
in almost all pathologicsl states of the brain. Alcoholic iotoxica- 
tioii, sjmpnUietic cerebral irritations, moat of the docpei organic 
diseases of the ccrcbTal substance — in »hort, all the diseaaes of , 
tbe braiu with wliicb we have hero to do as mental di9easea--^J 
disturb the frvo excrci«c of the perception, mid thereby liniii^H 
01 completely destroy, the reflecting power. Thojr effect thi 
ID many wajs; soinetiuies certain dttiircs and iustinds> Ihroi^fa 
disease of the brain, ore directly increased to excveeivc intensi^ 
(sexual instinct (i«tructivcnp«i), and tiro transformed irio will and 
actions without any other ideas being able to control them ; some- 
times ull perception proceeds with saeli rapiditj, that, in the coufii- 
sion of ides?, there is no one so powerful or lasting as even to 
originate an Eictual conHicl. in the consciousness. Frequently wc 
see both the.-<e ruiiditiciii^ in the maniacal state*, where, in the latter 
case indicated, the slightest excitation from withont often deddet 
the nature of the actions. Somctimc's the pciception is so aluggtdl, 
d tbe / so wcah, tliiit from this source the conditions of an 
internal conflict arc wanting; fur exnmpte, in dementia. Sometimegy 
in consequence of cerebral nffeclion, certain false connections of 
ideas, erroneous conclaeioDB, become so pcnistcnl, and so intcrwravc 
themselves with (he whole mass of idea* of the /, that their conlraatB 
are completely cffncrd from the soul, and tlitv thcreforn press them- 
selves into all concloaiona ; and tbe /, falsified through these 6xed 
ideas, is now forced nlwavit to deciili? according to thdr sense: tJiii 
is tlic case in inouoiunnia, also in many maniacal ami mclancboUe 
I'tates. The determiiiiition and the deed olten follow iii these cases 
with great placidity^ and with apparently suilicient deliberation and 
ehoicu of meeos; notwithstanding the inward reflection is wanting, 
because the false opinions have acquired the strength of iiresistibts 
motivei, and the patient cannot rid himself entirely of them. 



r&EUMINAUT rUTSIO-rATDOIXIOICAb OBSERTJlTlOSS. 47 



U tlic »hm «« We men-); pna a (e« eumjilo, and not enumenltd all 
iki Mala lb wbicb Uie rcflcclioa i« npprcaseil tii tusanit?. Mudt in Uic 
■edhMliB ot Uie niiul U m jrt nUrIj unknown i in muij Hales of iuMititf, 
of ■ to ri atioa, fto^ cntin grtaA Mtim of pnveptious, Ibc mdib of <lat;Ft 
olhclk fakw, Ac, itipcu to hire distppeBred altogellKr or tempotarilj, 
nU^ otbar mmuaa of idcaa, fcjr vliicli t^ fumier were lianubed, bang 
ifciwui to M to tfil i theiBadTt). 

U ill »c>Uml dht m a tha power of Teflection Mffen int. tud lUenwith Ibc 
Ucrtj. Kilnrslljr, tliU )om of liberty b not Uio oawn li al mraUMalioa of ibo 
i pfooEM, bat onlj ■ rtralt of tke nost varied nuDUi diurden abitnolly 
t in onkr to be tudantood ; at do lime cm it liare the »!gii!£(»uce of 
■ daciaiCk iign. Tbe reflection also laftcn 'm tlie iosauo in verj diUcrcat 
IVMi. Itef are oondltlona wliieb cannot bo dutinf>aulied from iKe cIbm of 
^Btal iim t m i viUoat xn VDnktunl atparalioa of tbin^ Mtalogofu^ for 
OM Mt lM , Uie tailijtoi; stage of maay ttatei ol rnfonnd nMlaHbolli, vlriek 
kqiod^ ia mudi fnloogcd and id wbicb tb<n ttiU exitta in Uie palMot a 
nrtMB Oifialj «r rciecttoa. Mesial discaso uid ooapkte nWiioe of tibertj 
■c tWrifon BOt Dm mum ; a medieal opinioB npoa lucb ttalci onght not to 
: ia a goa«ni naaaer tbe abatraot idea*, whieb ougtit lo be iborougUj 
Iran eaeh oUmt, of oillMr nntal diManorlieilib, ofJiberlf or 
tf. W it mnit tnet pIiTaiolo^icall; tlie eonerele pbenomeaa, (be 
ercnl^ cren to tkeir touroe, lutjae their coanectioo, 5nd celinialc 
RMlta. But in order to do tjiia, special eda«*tioa in tbia anbjeot it 
b dlape niable, wlUcb, uBforiunalcljr, ii potsesMd bj few, 

TUo wovU be the proper place to ooosider tbe qnettioo of imputation ud 
myoaoiUlitj: A full iofci ligation of (liia lubject doca not, liowcver, lie 
•itUa the tpboR of Ifaia work ; tbe leading princi(ilct of its itud; ore Liid dowft 
in the yneediiii paragiapbt. k few rcnurki mifht ncTrtthclrs* be itib<^ 
■JtlwL When Ibe qoealion of reapoosibilil; a Tv>t<i, H b«s alvnjrs liilber 
bn s OMtoaar; oonemion bj tbe vcdical jurut to uuwrr it. From tbs ' 
natnn of tbe ^veatien, liewercr, the pbjMcian ia not obliged to give anj 
•fnalaa i^oa ibcae vboU; juridical aiatten, but oplj to fumiab tbe judjte or 
tin jnrj, wbo dectdn tbeee qucalMU, vith IKe facu, full; dtguled, relatii-e t« 
Tbe pbjaician can aUo, If it be hie iDleresl, rofttae lo aot«er tbe 
ot reifNMMubilil; ; and I mjaclf bare, in a celebrated caac (Prooen-I 
rakraor, BnUwvilor 8clmnrg;ericbl, ]>coci»Ur 1858}, declared tbet if (k»| 
ftmtim vf WHwyWi^ were put to aic, I would not auwer it, u I 
etla MadieaL It wm kCMrdtnglj Mt put. What other qncalion bmj Uica j 
be U^t^mtjj prepoMd lo ihe pbjiioiaxia f EridentI/, in meat caaea,' 
flHtiaM fike tbe foUoriiig: — WbatlMr dtseaicexiils vliiolidlMuibs tlie ineutal 
tKthity ntDerall/, and tpeciall; luspend* Ubertj of will ; or, u degrees mual 
Imw W idMllteJ, whetber to a ffrcater or ho* extent it has limited it, or could 
bate ioM ao. B7 aaiwrrisg Ibit qucition the pbjtieiani ke«p wilbin Ibeir 
awn ifbeic, and it eoalmns all tlio cM«nti«la tlist can be IcMncd (lom tlicm. 
Par tbe tkjvekn «bo ti a compcKnt Judge, it h inpoauUe in Ibe piescDt 
•tiCe of tdtnee to gi*e a de&ule aaewer lo Lhit qnealiea, and thererorc be 
dcdan it. end witbont leapoct to conacqueiHCt. He bm so other 
tftu ibja of tralbi ul Uunb; ihovUl not intiniuddle with matrera 



48 PBK.I.IMIKART PnYSIO-rATnOLOGKAL 0BSEBVATI0S8. 

which do not belou^ to hi* ofllw, und for wkirk lie •• BOt ravponsibk : for 
ruiiipte, wliellier the Ian* sliould puiii»ii UiOM vlio arc enrfnitlf to tame 
cxitnt inuoc, or thui de^-ree of punitlimenl sbould b« ioflicied upoa the 
■tcuMd. Tlie jiiii|:u (or JUT7) ara uot boaud by tbc opiawii «( Ikcnicdinl 
nim, whicit it but one clement anious others to Hid ihem in coning to • 
decision. It would bo rearful if Uio uitdiMl eriiktic, odea 10 bad at»d so 
contnulicLorf. luJ ndeciuve iiiOueiicQ upon tlic iuue af > cciaiiittl proccw. 
It w«Tc well tlial (ilifsicians ocuM see Ifail liertlijr \h» influence of tlieir KMtncc 
islimltcili tlic innrv »tricll; tlii'T keep la tlicir own iplicrc, into wlitcU none 
en follow llicm, Uie greater will ba llicit inlliicuce. Ttie sulbor speaks from 
furen*ic ex[>erieace. 



4 



4 38. Ill the counc of our lives, in couscqucucc of tlic progiesflve 
combination uf llic ]ii!]'(:i>ptiaiis, there are forntml ffnai massts of 
idcoA which conMont Ij Ijccomc more associatecl. Tlirir pcculiaritj in 
in(1ivi<}anl9 doi^ iiul dr[)i'»(l iiitn-lj iijiun llic a])ccial cuDteiitii of iho 
nnglc ])CfceplioR9 cxcitcii by sensitive iiuprcesions aiid ontwurd 
events, but also hy tlidr Iiabitiuil relations Lu llie insiliuct^ and will, 
ati{] hy till! pc-rsit>t(Mit irstricting or cxteiiiling influcocr* wbicti nriwe 
out of the wlioU- ori,'uDi»m : wcu llie cliiltl comes to wccive from 
bis, as ytt coiiipnrntivclj' simple, mats of ideas, a general impRssioii, 
theiij ne PDon aa the mutcriiil !.■< sufHciciitl^ ilcvulopcd luid stiength- 
enild, liB begins lo emiiloy nn tibstrnct impression, the /. 

The / is an nb&tiiictioit iu wliicli trace:! of nil funnt-r arpumlL- 
MitfBti(iii0, lliou^'liti", iiml (Icsirv* arc conlniiivi), B!f it were, bundled 
togetlier, and whicli, in the progress of the mcmnl proecsics, supiiUta 
iUelf willi Di-w inuti'rial; bul this iif^iiniilation of the ncu' ideas wilU 
ihe prc-cxitil ing / docs not linppcn at once — it grows and strcngtbeiis | 
xeif gradually, and ihat nhieli id not jet n^milnted nppenis as lui j 
oppoiittoD to the / as n tiou. Gradunll/ it confines itself no j 
longer to a single coiiipl^xitj' of idias and deoin^A wliicli represents 
tli« /, but tlierc are formed seii'ml micIi nia^es of iileos united, , 
orgniiiscd, ntid fttrcrigthcucdj two (uud not only two) souU thai ' 
dwell witliin the man, sind liiis clioiifrcs or is divided nccurding to ' 
the prcdoniinanci; of tlie one or of Ihe other maM of ideas, both of 
which raav now represent the /. Out of tins, interaol coiitmdiclioa 
and strife in/iy nitwit; and such jirtii:illy ocem> williin every thinking 
mind. Ill happv harmonious iiiitures this cunllict is fpunlaucously 
and rnpicllj brought to an mil, sjuce iu all tht*c various coniplcx 
|)ereeptioaa, there is deve]«i>cd, iu eomuon, several gcmnd, in ail 
lecurriitg, fuiidanienlal iutuilions, still obscure, imd which rannot be 
Cfl«Iy expressed, wln-rchy there is given lo all (he spheres of the 

LftNE MtOlCAL LIBRARY 
SIAMfOSO UNIVERSITY 

MEDICAL CtNTER 
SfANFOSD. CALIF. 94305 




rRKMUINART PUYSIO-PATIIOLOGICAL OBSERVATIONS. 49 



I 



thought aiid iriU s barmontsing fundmncntil dircctioa. Fatth on 
tbe one hand xnd empiricism on the oLiitr m&v tcrve as examples of 
snch \-uioux funcUmeDUil directions. It is tlie highest object of 
M:]F-edaca1io» not oiiljr to ac()uirc such gcnrnil and solid fauduDion- 
tal directions, hut to elevate them gmdunlly m much u pofsihlv hj 
tbought into coniiciousness, n.nd 50, in (lie firm potsvssioa of suchj to 
attain to the elalorated fir*t projioinlions of all thought aiid will 
adeqnafe to the particiilnr individual nature. 

At diffcnot liin«s our / pmcnts dilTcrcnt ciiaiactcrs, accordiiit; to sgc. 
nriotu doticsof llff, omirrcnccs, momeainrir eicitatiorisorHiisDrtliat miusuf 
IdcM, wiiieli nt ihe time rtprctcnt* tlio /, hclng more devdoped tlian ollien 
and ocoopjiflg tlie (oreground " Vi'e are anathtr and stiil tho iatne." M; / 
uph;*ic*aD, mj Im a»cltol«r, my sensuous f, my tnuriil I, ic.,— tlmt i». llio 
KTOspi tt pcrociilion!, imiincta, and direcliona at tlie will wliicb nrc eipitucd 
bj these word*— ean come ioto opposition willieachoUier, Kikdiepdciich oilier, 
at HiiTennt liin«s. liot oalj miMt iucousistciicr kiid iliMinier or tlie under- 
ttauditi;; and will result, txtt also— on account of llie conlintied liiiittiDg 
induetiee of tlic othen — complete irant of energy lu eneli of ihrtc Tuturci oF 
tlie / vnu Id ensue, did not some of tticao niorcobKuieoroppirtatfuadamental 
directions return lo all of llieie ftplicres. 

One «f the mnt eridenl, am) in iclnlion to mental dtieaies tnoet imtruolirSi 
nasiplc* of am entin-Jj phjaicilojiicnl rotiuvul and Iransformtilioii of the / is 
•J^ord^(i by tlic mental crcnla wliic^li oeoir daring llic period of puberty. Witti 
tlic airakcninit of actitily in a hillccto dormaat part, and will) Ihc completo 
orgaaio rerolulion wliioli tbcn takes )>lace in b oomjiaralivitly aliort liini>, great 
naaaea of ncv icntation), inttiucU, oNseoro or more dcQuitc potccplioni and 
inpuhea, eonie into conBciausneBa. These gradually periide tlie n]io1« apliere 
of perecptico, and bcvoine const it went peroianenl parts of tlie /. Tliereby it 
ia Itiorouglily allertd and renewed, and Ibc icntiment of uslt undcrgoci a 
ndicid duuge- But, indeedt until tbis aatimilation it uamiiirlvd, llib pea«tra,> 
tlon ukI traAtilioa of the old / caa acarcely tako place witliout niiic)i pfcuute 
on the eoiuoioustieM and tuuiuhuous agtlatioa; that ia. not witUout ;;rccit 
emotion. Tliis period of life la llierefore especially the time for eniolioss 
BfiaiDg from wiiliin, vltltout bring eicilcd by extcmaJ induenca. 

f 29. It if mil viithoiit a [)arj)03e that we Iinve seleot&t thii 
example which illiuttrntcs iiisnnitj b^ many analoiriiv. In it also 
tli«rc b tuuall; dtn-eloped, irilh the comiucua-iiicnt of tlie cerebral 
disraae, mae^M of new sensations, imiincta, and perceptions, pro- 
ceeding from within outwards, which «-erc hithiTto, at least ia their 
present foroi, unkiiorn to the uidividual ; for csampb, sensations of 
great anxit-tjr with which there ia coinhincd the idea of persecution. 
At first these !itiuid_op])og«I to the old / in the charncler of n foreign 
Uou often exciting ouiazcoieut aud feiir. Trequviitly their forcible 



60 PRKLIMIXABr I'HYSIO-PATIiOLOOICAL OBSRBVATIOKS. 

entranoe into tlie whole s|iberc of the pcrce|)tioD is felt aa if it ncte 
Uw poueMlon of Uic old /by an obscuic and irmietiblo power, and 
ttie (act of auch foroiUk poeseuion is expnased by pbautastic 
images. But thii duplicity, tbii conflict of the old / igniiHt the sew 
iiudeqaatc groups of ideas, u alw&js Mxoupasied hj jninful 
opposing sensations, hj cmotiooal states, and by violent emotions. 
Ucmu, in great mra-suro. lies Uw foundation of the fact taught us 
by experience, that the first stages of the great majority of mental 
diseases coiuiat in predominating aiTectiona of Uic sci)Umcnt«, g«u«- 
rftlly of a (uinful kmd. 

Tf the itnmedJRte cause of the nev and nbnorinid state of the {>«• 
ception — the ccrtbral affection. — be not removed, it becomes fixed 
nnd pi-rsistnit ; and btoau^e cutiDCclious are grniliuitl^ formed 
Ihroagiiout vriih tlic groups of perceptions of the old /, and vmce 
frvquently other maims of perceptions mora cainblc of resistance 
are completely destroyed and elfsced through the cerebral disease, 
the r(«i«tanre of the old /, the struggle in couscionsness, ceasn fay 
dcgreea and the emotions are allayed. But nov, through these con- 
nections, through that iulroduction of abnormal elements of per- 
ception and will, the / itself is falsified, and hns quite changed its 
nolure. Thi-u the patient can again be calm, and his thongbta aome- 
times faiTOollj correct ^ but the»« nbnoniuil erroneous ideas posb 
thcmselvFK into ercry part of it as irresistible premises ; boeaoae tiiey 
hflTc over all formed connections, the patient hns become ia no re- 
)i[>ocl wluit he formerly iras, but quite another man — his 7 has become 
iiew and fulsc. At other timea it appenrs that Mreral new 
groups of idaL<i, having little coherence amongst theraaelv«s, arc 
formed, each of which may represent tho /, and thus the unity of 
the individual may be quito lost (many demented monomaniacs). 
In so far as in these conditions all i^motinn has ceaMd, we may 
rightly designate them simply false thought — diseases of the undcr- 
stAuding. 

In the preceding remarks ve hflve eipreued in few wordi tlio DrdiaaT; 
coane of evenb in inwiiiity froni its eotnmcnccinmt io its tcnniiutfoD in 
iaouilile demeotia. Wli&t hm beva Nu'd iloos not, of ooursi^ *pply to every ease ; 
fDr«iainplr,nol lo thedtmenliaeniuingiminediiileljr kftor wouiidiof ilie behJ; 
nncl kIio, «bcrc tbc nioibiil [<liFiioniciia, on the vbolc, follow this ooDrtc,thet« 
are preteDlcd lumy iBteniiGdialc cntetuvi devialioni. In particukr. Itinusli llie 
deeper ftnd fijtllier progfui of mi orgnnio bnin diaeiuc — for exAinple, llut 
obiOQio iudamm&tion uT tlie corticnl subntancc which cuds in ktroplty — tbe 
oouna is so ctirtuled, tint dontatia cniites »o rapidl^r u not to admit oT IW 



rKBLlUltCABT FHTSIO-FATnOLOOIOAL OBSERVATiONS. 61 

bwttiOB of s new / ,- or rcctnerj or death Lakes place bf fore Uitt oin Imppen. 
Wi ttall Rcur 10 Uiii tubjtct in the third book (on lh« varietiea o( initnitr). 

V* *^ bIm here call atlmtMn to tke jtnsl tnllucnn vhicb tlio vtatc of 
Ha braMT (old) / mutt hare n Ibeu condilioos. A vtnk / will lie looiiei 
■MMdbf Ibenevi^oonnilperecptioii thaasBlroagone. A slow impeneptiUd 
pUM taB tio* o( Ibe old gnw|a of Idcu by ibe dct nill crrtainlj cMue muotl 
Im* anotiM t but, Iniamaeli U it oOon to tb« / t«M ottpotition, the bttcr ii I 
tki aon rwdilj nbdoed wd abtorbcd. The duttion of the di}cu« u of rU 
Breaanta»c«* the noM iaporUnl. The new grtraps of perceptions trc 
4M(enMs to the / U jiroporlion ai Ibcif oonteata ore reUlcd to tbo old ) Ibcir 
unicio wiB then be easier, bat the oombination of (he two statcj, cooLraatcd 
«iU tka cariier.viU be pioporttOBatd<r Um (trikiDg. Ail tbe»e statcmeDU arc 
kBj ooninMd bf eniTdaj csporimtc. 

. Iba ilata of haahh. tJio Tvions groupa of itieas whioh oan repreient Ibo / 
aital ttcoMut of unit;, above all, in lli« ooinplexu of ideas of tlM 
Aad if, in the cootM of life, Ihii pbpical seasalion of »elf ia in 
I «^ asbfMl to chaagfl (ditcaje, ago. &c.), w does tlie joint jierccplion 
of Ua naa bod; atire as a poJot of uaion for the icmaidnK pctceptioos, utd 
w««eBln (mn vkicli tbe natetr acta proceed. But there are abnormal oon- 
MltniM, partictilarl; ia loental diaeaae, fa nbloli ihe general bodJj feeling 
and aenaibl; chan^, ta that hereby tlib fuodameulal lenanom 
I of tfca oU / underBOM a total tmufonnaLion. Then fac the Srat liiae 
I Ibi paticat ioae hu fonner pcnoaalit; ; thia lie no marc recoffoiaei u liis 

_ feature— (bail for the irrt litne the palient consider* himself a 

tfbrenl pciMtt Iban be aetiuUj it. It u rery ttMntiol to distinguish this 
baai tboae ebasgat vUdi the / andei^ca throug'h aimple nccnp&tion hj new 
idaaa nd «■>, ptodaMd hj Ibe dbease of the brain, without cHential cbango 
in tbe pbysinl wiMrtioe of adf. 

§ 50. A simple diffetmce in tlie perception, familinr to nil, oon- 
Sito IB thi»— that it ximetimes prooeeds quietly as caJiu iniaginatioii 
or tboo^it, wbil« at others it is occompamcd by great disturbance, 
bj n gtotraX state of mental disqaietudc. In the first cose, the 
miHOa of porcrptioDs whicli n-pruciit the / act towards tlte thought 
wbkb b pnscDl in the coaaciousDeaa as quiet ODlockrrs, ns in bcing^ 
perodvcd they are otdjr feehty and slowly changed by it, and when 
obiciin opinions thereby lemlt rt^laiing to the demands or limita. 
tioirof the /{plouurcor dbpleuurc), these also arc of but alight ia- 
tcinatf . In the second casc^ any striking occurrcucc in the couscioua> 
iWBi^ u a nusa of perceplioot suddenly presented, or a. sudden urgent 
imt9a aten irith riolenoc. By these occurrences, separate groups 
af ptrotpttorni are promptly eroked. which bring others along mib 
tJujD ; whiirt othen arc rapidly, but not without oppontioD^ repelled, 
aad tbe f mtut tMcestarily be affected by lliem pleast^rably or p&iu- 
hUjf acoording aa Ibcy promote or impede il> 



82 PttKLIMtNAnr PII\8IO-PATHOI.D01CAL 0BBEBVAT10N8. 



"nine olMFiirc ojijuiodis, pMcliicnl pleasure or pnin (f u), eonUituU) Um 
foundnlioa of «ur moral tcntimcDU. Thti (cDtiincnti' aic corn pie leljr bound to 
tlio iiJcof, nnd by tiicni exclusively vc nrc mode BVtre ot llio icUtiona of 
tension and moTGinEat in <?? rtaiu pcrpeptiou*, of llio dt^roo of frcu movement, 
and of ]>roiuotiii(; ar irttpcdiii}; t)iltuciici.'B nitliin tlirin, mid of tlie nature of 
llicir ttciproral action. Tlio pcrccptioiia IticmsclTW vlioso reUlioii* of 
moronaenL are llmi mailc koonn to u» niaj be porfectlj clear anit ilrong, but 
titcy ninr also Iw vcr; obacuie mid tlinr contcuta nol cuil; ditUnguHbable. 
Frcquenlly, and ctpcoinlij iti plijsiciil influences on the di3{>oaition, wc arc 
uiiublc ccttuinlT to dbtingiiiah llic cau»e of tie reeling of plcaaurQ or |>iifl, 
ScntiniciiU inch ns liavc iiu definite vt>Jrc( preseated, and authasarcof a 
depressed irrilntcd nntiire, often caU fortli merclj a change iu tlie bodilj atatea. 
Sickncaa U3uall;r changes completely our mode of feeling ; it modiCm not only 
the conlcnla of our ideas, liut al«o llicir rchlicmi of tcniion and movement. 
Coiircr»clj, »lrong feelings, wlicn tiicy procccil rrom the pcrer jitioos, are uaually 
accompanied hj marked clianges in the domiant masses of bodily aetiaaliuu. 
Tliu« ninny povcrful fedings arc lialf corpercal and lialf menial (anxiety, friglil, 
Sc.) 

Emotion mny accompaRjr mlm tliouE;lit : Mienti^ lliought can, for eianiplc, 
kIicii Itio allied iilciis meet in h favorable maimer, he accoirtpanicd by a sense 
of pleaMirp, by llie feeling of success. Bat the enioiiona are much more 
livrily when, through n sudilcii chsngt: cci!urring nilliin the coniciuuaiiess. ibe 
mauca of ideas belonKing to the / fall into violent oacilialioii, and the t 
thereby tufers an abrupt or rcsllcsi change. The(« alTeclioni of llie / an 
called the imoUofu : m the Qrst cue they are joyful, in the tccoodof aaad 
cnture. In all tlieienlitnenU, cmntioiij oecur as oi^cntlal coDslitucnt>,alUiuu]|fa 
every acnliment doci not oceusiDU emotion. Tliero are senlinienta, more 
listitiK ajid alnblc, wbidi huvc no emotion, oa the icntimcnti of self, oountry, 
family.* Tlic acutimcnt o( the / can proceed even to instauUacous aupprca- 
sion J one becoiDCi "out of himiclf." 

As in the enioliouf, only the relations of tension and tnovcment in ecrtaio 
niaMos of perceplimi>, nnd the nmnnct in uLi>chi ilic / it excited by tlieae 
CTtub, cumc into conscioumcu • to tlicy have iio de&nite exi&lvuce IIjU caii be 
expreued in wnrda. but Ihey cidl forth desires, aitd are in turn evoked by 
tliem. 'I*lic scnlimciil*, ainco they consitt of rapid chai'),-cs \a the relations 
of teiisiou and inotement in tlie perceptions, arc naturally always bound to (tie 
oiuoiions. 

Uutie excites ia mnny individuals intense emotion, niid alTords a rery KOod 
eiample of the half bodily, half mental. aUtea of lhi» kind. Here, coelain 
cliangea in the aensotions of nound net immediately, and principally (almost uu- 
conwioujlv lo the individual) upon the iuicrnni impnliea of nwrcmenl fof 
KKat exlFiidcd muicular actions (csdcnce, rhythm, mtrlodj), but so feebly 
thai usually no movcmcul is produced. This constant change iu Ibe intcniM 
tnpulses of movement (ideas of moremeul}, nilh Its tei»ioni and relaaaltoas. 



' 9(itKlcniotl 
• Heibirt. 
1841, p. aog. 



th, ■ Pujcltologie,' ii, p. 3 ff. ; Volkmnnn, ' Pijcholojfie,' p. 301 IT. 
'Lehrbueh.' i8j6, p. 54. Drobiscli, 'Enpiri>chc r*jcbologic,' 



rKBLIUINART PHTfi 10-7 ATHOLO QIC AL OS»GRVATIONB. &3 



aoUung but wnlinicab, aaA lodeHl pf in umlcu kind ; it prfsrnu 
ooproaiblo aail Idglilf Hiperllcia], witlii>ul at all cntidiing the 
viU dear peneptioiia or tdaa. }{ere^lllcI»^ tliis cicitnliou of tli« 
■ ■liMiiiti acttl nftt on this iccaant be tUUcr woKlilcs* or indilTerent la (lie 
it taa tantaia nnioli Ibat i» Sited to wotlie, impel, or excite llic prticnt 
, ud tliDs, iultKetlT, esittnd or contncl the tmil iticir. 



I 



lite Jitpatition to vliicb Uicac crcnte arc attributed as movements 
Jttnolioitt) bears an essential relation to the motorjr Mp. of tlin 
WBj-life, to the iaitincts and the will, ^'ot only arc instincts and 
inpolses of tfae vill atrakeitetl hy oil cuotioual stales in order to 
oppoac the timitalion or ndvaticc titc promotion, but also obvcrva- 
tiam sbMTs tbat the production of the aflttctious proceeds mote 
maij ftom the motor; side of the soul-life Ihmi from simple pure 

Satniocd or cipanil«d eflioti alTccb llic / much more tlmn llic Mine cotidi- 
tian i* pure poccpiioa, aad Ibc moit sudden nnd violent agiiatiom result 
from Uw wddm armt ofeObrU in proi;retii. When, (or einmpl?, our lulm 
•ocBlilc ttowgbt ■* iDipedod b^ an uocipcctci) cileinal hJc^ruiicc, yic nin/ 
iodccd be imtofwi ; but wben our will u oppoied, when tlic Meeulion of jilam 
Aeai^cil ud iMen&iBcd b; tlie I a Itinderci), tliii ncitcH much tnore riolotit 
iiHJiWi — tnser.disappointiDCat.&c. Wcfrtqucnlly observe llntttliwiirUdiilaiia 
tad detfiBlatlMU ef Ibe will — tot euiaple, an occupuion eaforced \i\ii\e all 
Ibt {aelimlQU of the indiTidual ar* direcied tovanI« cngasemciila «f quilo & 
dbmlMture— betoiMlliecM»caoflutin;<niolioiu,aiidarinMiiily tli«Ttb; 
Jarefaptd. We knew lli« cue of a man who became iittano because he was 
lMt«d to ba ■ butcber, wfailo be dcbirtd to become an ccclniaMic. Exnmplci of 
lAn ktad an l4> be tand in ail uylomi, 

$ ^T. The qttestioa, what jiropiTl; speaking llic nfTcctioiis and 
ibe irittijnrnla ar^ and wliat posilion th«f hold in the mental life, in 
of gent iuportance U> the undnritanding of insnuity (which so fre- 
tfoaitiy, aud for bo long a time, consists principaU)' of a ilisorder 
af the aflectioDB}, Our pcTCC|>tion and efTort arc alwajs subject to 
pn^rcteive change ; wn oiily, lianerer, sfeak of a sentiment, when 
the mm of perception.^ which represents the / is subjected to a 
viokot shock aal brought into colUstoii, which ($ 30) nc\cr can 
•oonr without i-iiwition. In th>i difturbanvo rif the trancjaillitv of 
Om Bind, there is no further agitation than tbat of thv wotitcd cnlia 
which oar / maiutains towards the pcnxptions present, than of the 
maaocr in vhich, nbovr nil, the nnillifitrious masses of perci-[ilioii» 
aod efforts which we (eel within us behave towards each olhi^r. 
This usual tnUKiaiUitj is not, however, absolute quiet or inuctiviljr^ 



IW rULIU iN'ARY PHTSlO-PATnOLOOICAI, OBSEBTATIOS*. 

but is ibe iMult of Kgulated inodente actiriiy, wbidi atnnttaBe' 
■>uily ropri'Mnta tlir ic<)iurcd unoant of meaUl pov'ct ud the onli- j 
iinrjr ilirccUon of Uic incnUl Ufo : it nay be called the mftat tMt.^ ^ 

Tlia tonloit; of Ihe ■pind oort. wUcli ti ennotd in tlw ubmIm. in tke odi 
liMii«, kt,, u ft nodonte babitiul degree of contnccicw, and on ikc «dt 
if»Mlii)ii ki k modcnto degree of teiuilt*itj and irritibilttj, b the pndntft 
iMit u( a »iii|[)e HMtJioD or manment, but of tbe sum «f tbe eenaalioMiad 
tniliulMW of niOTcaiciit wkkfa i% leo( ia the unit; sod gcncralil; of * aodenli 
Inllaliilliy. It do|«Mda upon a modenle lunoimt ofeiatatMB. wUdiiitk 
MiHitiiBcil resttll ol Ihe MrpanU oeitlnl nerre-aeU. Tllia modesate itftnii 
•|)|iUDiit iiuiolia not hmieai or dMtrojed n a vholebr ewtj WBBatlimmi 
■iMMiMDt, but it bMomet M \>j all anddm aad (trong scButiona and in«t»> 
nwnt* (nliMation, pain, ftc-). h both iloiimiB* tho tooicit; ii aataiallj mm- 
llawa man uuatlUd and ramUe Una at otbera t indeed, aeeofiEig to the ilale 
■f IIm argani itw ilighiwt irritation etn at tinea mdle fatigne, pMn, or ee** 
TiiUiiin* 1 nun a d; upon the vail oan. be a aonm of aanojraace. It ia not the 
aualiiniary liiw, and il would be loo T^ue, allhougb quite cotrcet, to OMHidn 
laUnni D«tiuliluu\ Itc, u changta in tonicity (one-sided iacraaM, iokmip* 
Ilia, kit) I uudtiubledl; ■ImliauAtn from tlic dUlurbonce preaMil. LikeviM 
III III* pamllcl mpnlnl tlatta (mental jiBiai mental coaruUion) tlie dbturhaixe 
fit Ilia *aiiliin(iRla lalh« tnoU tirikiag ; and it ii, is (^JiRnl. in this srnsc that vc 
■fwali a( tliB dlaordor of tho emoliona aiid or Iboir priority in inMiiitj. 



\Vk Pull llio ninii impntnhl*, whose I is cwtly niOTed, Jind 



I 



Vflumi, nroociliiigljr, agreeable or disagreeable feelings— sympalli 
(Hirii|inMiMn, henrvolonw, nvt-nioo, &c. — are rcadPy excited. Agr«e- 
nliln ft* it thin elumoteriatjc^ yet this danger follows, l-liAt the srnti* 
inriiU willingly nttaohthetDBrl?v8 (o thewob«nirc«:scitn1ioi», mi that 
(licy do dqI succpchI each otlier iii a clear train of thought, and that 
Ihr habit of cWr Ifiiiiking ia lost, and the individual goTemcd by 
liiiTO •I'litiiiicMl, oC villus; iiilluerto; lie camiot divest himself, but 
Ihcrrby ordcra his nctiuiis and frumes his life. Tliis is the iinprewi- 
hlr chAniclorin ll«* Ijitd neiise. IJc is cnllcJ MnmprfftlH^, whoee / 
in not i*fl«ly alTcclpd by )ilciLsur« or pain, cither on account of great 
weakness oiid dulnesa of oU the mental powers (apathetic, rery 
phlCfmstiti mou), or became, upon contact of the /with the percep- 
tion present, thpre is simult&UQOUiJy produced distinct oplaious in 
clear ideas instead of obscure aentimonta (iiitclligunt men). The 
man is ulroi^-miHrlal, in whom ihcrc is developed a firm tone of 
mind, who is not immediately moved by erery mental eioilatioii ; he, 




PRELIMiy'ART PnTSIO-PATHOr.OOICAL OBSEftVATIOKS. 55 



P 

\ 



I 



indeed, fedseTenl^ as Dgreeablc or dmgr«eable, and tbejr nrf acconn- 
pcuiicd by obscure opuiioua reUtiog to the promotion or biiidratice 
of (be f; but the J itMlf, hoir«vcr, is not ra vraiiy shaken ; bo is 
iiot easily subject to gentTal mental diRq^uictude, to aag^ anil ill- 
hmnoar, and in joy and pain moderation is muntained. Tlicre if, 
on the other hand, le/^l-nfM of miuii, ulieie maottons of tliu /, rx- 
lended, but waatiiig iu energy, are easily nmkcd • nearly cvcty per- 
cqiLioii excites a simtiinnit ; joy and enilness succeed each othrr 
with tite atmost ease, and emotions become ncoessary to nuntal life : 
the diminished seoxibility thea frequently demonds new and strong 
irritAtion, as finding ple&soie in shocking and fearful event5, and tlip 
/ '\9 ti. re«t onlj ia times of cxb&ustioii aud sU-cp. 

It ii eu; \a rccofrniss the identity of the lut-oienUoued cub with wb&t, m 
llic «(jiti(ivc motorj »pliere, is called irritnUIe veabnca), uud ia couBiili'red tlie 
nost imporliuit dJapostlion aud fundnmcntal stale in mniij nerrous tiiic»es 
(for oKBinpk, Uie sjiiiikl neiirosts). TliU Btatc is well cnlled wcAkacM, since 
witli llie atnglc uid oDc-sidcti Incrcaao of cxcitabiiilj tlicrc is nccom panic <1 vi\ 
abtoJale diaioutioa of pover in (he functioni. In eoiivtiUioiis, llie Tolunliiry 
nuacnlnr movement !i Tuk ; to conitBot emotion, the tJionglit vaA the will bk 
«aik*Bd laaguid. Tliesc states arenotonl; Tcry rrequvntiy cumltincd villi 
each other, m in llic tcndcnc^r lo cmolinnn and liin incrciurd tciidciicj to cun- 
nbiMiiu nnny hyilcticil pL-noDB, but ibty al^o very often oiiginittc iiniuU 
lueoutly in bolli spbcns from tho Bsmc causes, hare in llieir coun« tiic ume 
oosMijuiuiOii*, and the principle* of llieir treatnienl aie tlirouglioul iuiaIu^us. 

^ \l. V)ion the nature, ntetlind, and fucilitr vilh nhicli the /is 
ttfivctcd ill thu fttrm of emolion.') nnd M>ntimontit, dep^iida certainly a 
DOiisidcrable part of the modes of renction, nnd tliereunth the indi- 
ridual p(«iilturilii» of uien. In so for os the [leculiar modes of the 
individual lie iu the inner world of the di»posittDn, and ttiis is not 
opposed by tlie versalility of the mental states, the peculiar manner 
ill which tliis obimge proceeds ib the cliantcterislic; it is this which 
gires the fandamental eompleiuon and tone to our dispoMlion. Tbo 
dbaposilion is a certain modi! of bchnriour of tbo /, the fixed stead- 
fiisl kernel of our individuality, with which the rcfiults of our whole 
touitn] iiisloiy are associated. This may, indeed, he shaken in the 
emotions, but not impflircd or destroyed; what, ela; e&n be affected 
in tlie emotions than that group of ideas, the // The / can be 
detached, and completely destroyed, in scrions disorganisoUona of 
tho brain (in dementia) ; it may succumb, and n new one arise in its 
place (monomanin) ; but even lliis is only the case (} 29) when the 




pRsm into ^ Jttsaom Ab 
bott. IfcllMili aDil 

tWiifaf^Kt mlfcnlj 
tlw fnwihftw of ih» 




the knoQ and deelniclioo 
•rA><dJ/kmbm< 

Tbt aita* nd Ae anHr k «UA Ae bmi of ideu tqinmiU 
% Un / ti oftcotA bv ^it y^RS vilha the caoadonmeu. or 

•■it yi*"^*r of the 8clf-i«n»> 
tt cWMTWMTiws are, sgiin, 
oftbedHpoaitiaBs; wlun 
, ud an BOComiMiiied hj 
fHwHNitt'", the; constilale 
Th* objerto of cooacioiu* 
■m «w oatv W «f A tovfeU mtmn, phmrablc cr painful ; (lie 
our, wbn the graope of pgrCT y tioiM of the /, the inlcratla of oui 
tuiKT life, »K bvooml mi aitsactd, Ihtaagh the events in .con> 
■oiuBBatBa, u tiwir bee covnib >har ifc^— k (datious, and es* 
|ievMlW U Ihetr Inwsfeioft iets cfcfto; th> other, when hathv (hey 
aie W|M«MxI, whttrtcd. ud luntod. I^om ifae stigbtest chaogn 
in the iBspnateia q» to tha matt Jiaka^ cmotton, onir two kind* 
arc poaaiUo: eitha a state of nuthenace and eatpansion of ibc /, 
^hkh HffofA pteware. thorfoK it is in hannooj with the new 
wcunoHM IB PBUBCJB—M, and seeks to ntkia theoi ; or a state of 
limUatiBB aad i fa peewioe, «ltcse the gTMp of peneptious of the /, 
in Ihvir Bow and tniuitioa into edbit. an ispeded and npresedi 
aoiBctiinca take to fligbttaaoactiamptnnaui^yatntF to enter: ben 
the / ia u a utfittin wlattaD W die nev petcefitwcu. Arcordingl;, 
all the di^wHtioui and emotioiis dirtdf tbeinMlTe« into tvo great 
dsssea — the eipuutve (and at the same time alBtmatiTe), and the 
J tp t ea aiu g (and at the ame tiioe BCgitin, accompanied by 
abhorrcoce). To the one bdoag jojr, ^dacM, pleasaie, frolic, 
l»pe, hitmoiir, QMcnment, &c. ; tu the other, aagvr, maUce, dejec> 
txm, ndiicts, sDirov, shame, fear, honor* &c. 

TUi iriatfaa k the baito or ibe tJuilatfw of thM iUm of iouaU? vliere 
iJt et i BW i e( tke dupeaitioa iiinifciMiMli. Ikenfcn of ikt pamiy fomi of 
awalal £Ma*« (S 39). We laeet vilh tvo priaeipel daw* : ia tbe we. the 
ehirf <GMiitfaaaee coatau ta dcpmsm aegatii* diapauliaai aad canotwu— all 
welaBBhofa osoAlion*; ia Iba «tbcr, tltej emuU ia cipamite ■firmalin 
eawtifiHi iKWMiiiLlii Wc haTcaotyetipoLeBor agtr: it ocnpi« aa ta* 
temediria plate Mveea Uiatwo kind* of «Mlioa,*ie«Ml in nUliontoiU 
tmaam, H Woagi niber to Ihc Bnl, ia ikaC it inpUee ui iaiaiiiOB of tbc I ; but 
iticra foUo«ia rinleat mctioD,alJnl7eipuaioaaodeiplosiaaoftlie perwptioa 
■nil rfforl. bj m]ugb tbii koattle inpreMM n or er ao m e^ aad tie Mjuilibritut 
k|t»n cvinbUibcd. Tbc cQoditioas, bovcTcr, wUch an odmlood by the Itna 



PUXIUIKART rnTSIO-PATHOLOClCAL OBSEKVATIOSS. 57 

■nMin, weOffdiiig to Uwir lujrcbologictl mtatt, inlimttelj rtlatc^ loansevl 
Bid MNkigickll; Lbcir proper pl*ce ii bctvcta melaiidioiia uid aoaoawiM. 

{ 53- An important nrciimrtflncT, which ckarly disttiigoishe 
the aaoiioD* from calm thought, ix this — lliat in llie formn- othor^ 
ttpuao proc4?s«ca b<«ii}cs tlic oerfbrsl arc alw&va inrolvcd. Uta 
bnrt'fl action, the respiratkiii, the digestion — the srcrrtioh!i of tlii* 
i4in, Uk liTtr, and the kidnej-s— arc altered in the emotions. In 
ai^er. thfl fitcial Teii» congest; occtisioiially it Mieim a* if violent 
p f^imitm voold •mlTocjiIe. fright and horror quickl;!' i-xntc vaierfi 
tecrdioos; ia grief, ihc rc^piialion is prutuaged and supcrticialj and 
niBsi, tiiicrcfore, lie ourseiouallj' broken hy deep ^as[» and sighs. It 
u thiu that the emottODs and emoticnni states, origiiinllj by excila- 
tiaa cif the Qerrous system coming from the brain, give rise to 
abaorraal physical states. Amotion, when transiton-, aud occurriug 
ia ft pmiouiily healthy u^uuin, i» spceilily calmed; w1l(?rr, lioir- 
mr, bodilj diwaH' ia already present, anil nbcrc (he caused are Ion 
eotokiaid (for example, prolonged sndnes*), tltcre gradually aria 
KftOf ccoiplicslcd disordets or the o^anic mcehanisni, \ihieh tlio ' 
lunplr tcaaftdon of the cmotioa cuuiot as quickly terminate; and 
these diwixlm can now, by menus of nev secondary irritation of tlie 
fanin, not onljr maintain and inercase the existing emoti«ti, but aUo 
origJOBle new cooditiom of a similar nature. 

FoTi it b s fact taught na by experience, that when the uciilnl 
litartioa of the 1»ain is itifliienccd bjr lUe organii- pmcvucs (reapira* 
ticm, digtstioo, &c.), this does not immediately affect the sphere 
of ckar penxptiou ; it doc^ not thereby follow that ire rccdvo new 
thanglitii, bat rather tltnt there originate, in tHe firi^t place, vrilhin 
Mobscare muihllcitionii of «e]f-oon^r'ioii«iie.'i.t and di^poi<ition, feelings 
of fartbcnutcc and liniitntioti of our ineotul function, and thereby 
an cMBtttial ciancnt of emMioiui states in forced upn us (§ so). 

EsanplM U tUt §n vet with la nunj d^cosu. VTc vrty ofteo »ee tbat in 
ttnaa iJiriaJ witli btail diacaio aatict; sppean, and lliat in diseaK of the 
ktortiaw. ia ebaagct ia tL« Uood rttuttinf; ffom icietrtu, mllca. aiiiioni. 
Uiiiafcle wnvia, ilu|t);t»iiDeu «r lliOBght, gtoeral diabtnuoaj, &c., an ofatcrrcd. 
Tie feeiiag of eorpoteal well-being or of bodil; iUnMi g:en«nill]r cMrciMs • 
(Twl fit4"f»" «|XM lU fnsa of ninJ. wUdher it be gUd uwl cbeerful, or 
deiwoMrf aad sad ; ahoaU catcmal caases capable of eicitia}; aa emotion now 
tt^TTTi** ■*• very inncli depeods uiioa \\i**e txialiag. Imbttual or tnuiiciil, 
anfaral ibfaa wliloh mfxciled by tbebodil; condition, nliciliex the cmoliou 
•a bt sanitant. In in iailiTidiul ilrtadjr irriuted bj bodily diMaie. an 
nuUoa excited bj aaj eatcmml came beeomc* toontr Rscd, aad ia more luting 



58 PRELIMINARY PHYSIO-PATHOLOGICAL OBSERVATIONS. 

ia ite dTecU, tlun wbcn it originates in a man who raijoji the best phjua 
licallli and JoyFuI dinposltiuii. 

Tlicic rcbliutu caiutilutc somo o( t)ie laoat imporUnt ruadsmenUI eloonen;* 
bt the pitliolog; of jounit;. The; are tbe key to a knovledfce of tlie prolis- 
|toiilion lo mriilal diaeate* resulting tioai the niwt diverM bodilj discasoc, anil 
cf the mode of Botioii t>l pcjdiical cauiu. The Uller rerj addoai (wa mil 
book) produce inannily dirccli? ; ibey <!o u muob more frequoiiOj secooduriy 
lliKugli llicinttTposilion oroUicrdiaordera) for example, ia tUa miimar— ihtf 
lliraueb lous-ContiLiucd]>rieF llie nntrilion grcatlj sufTrre, and Ihia prlnunlj 
exerts au uifluencc upon tlic brnin and ihRtch; upon IUr p»Tcliical prooosm. 

( ,14. In the emotions calm delilicration Li impossible. The / itself, 
having Talleii into a vaciUntiojC &nd disturhed conditioD, docs oot 
possess tbc composure nevc^sat^ to consider tlic fact« ptescnt in 
con!tduuFtiess with suffidcDt conccntmlioQ and attention. That 
state is which thla considcrntian is possible, and actually t&ket 
pUcR, is cnllftd iAe reaaon. lit order to thiii ci>ii>i(luntioa, atuj 
thpicforc also to dcliberntion, there is requisite a reciprocal dcfinitr. 
ncss of Ihc prrccptious, Idstire and delay, eomposurc niid nllcction. 
The contraatiug pcrcci>ttoiiB (^ 26} must be cajiablo of becoming 
effective, nnd rcriuisitc ralm xcM»i be afforded to tJic /. Neither of 
these occur in uicutal discnse. Through the cerebral affection, dit- 
posilious aiid iastiucta arc produced which become poiaU of or^pu 
of emotions. If out of thewe, ngiiin, fuI»o opinions uise, thej- cannot 
be rectified, uud the patient ciiiinot »ee his error; at first, because 
Ihr penistciib emotions do not permit the calm necessary to allow 
the contrasting peTccptloiia sufficiiiitly to devclope themselves, and 
the longer it oontinnes the more do its results, the false judgments, 
become fortifirai iiud con^uliOalcd; hiter, bowtver, bfatuse thoK 
false judgments have become Intcgml fundamental part^ of nit tho 
groups of ideas of the /. 

lu evcrj fuIl,T ilcvelopr^d tncnluL diacaae it is llicrcforc tiii]io!nil>lc for ttie 
patient to roeofpniae the folaciiess of the morbid perceptions. This («ct is 
comfoundHd to a rery prt'st o»leut irith loss of relleetiou, Apokeii of in \ jy, 
But by lint even tbc iiiiaiie bnTe also loat tlieir reason, niul on the grotiiiii to 
well Ktnl«d by Herbnrt, tliul " llieir ihouglits do not oilmit of Iwiog ditlurbed 
ia tJidr special cclll^^r by means of cstcmnl or intcrnnl oppa»ition." Alio in 
healtb. all kind* of otprii^M, fnl»e ojiinioas, fooliali tb6Bf;liU, pass llirougb Ute 
brain ) but one can, if be b« not actuallT in ■ itato of emotion, calmly ococpt or 
lojecl thf m. 

5 35. Kcoovcry from insanity ordiuarily takes place only in the 
[trimary period, wliifh, litwcwr, nft«i oontiauns for n series of years, 



niUKIKART PHTSIO-PATHOIOQICAL OBSERVATIONS, &9 



I 



ihmitt which it priocipally depenrls on emotional slates. Innsmnch 
m tiuoDgh mnoval of ilie tliMase of the brain, or of its more n>[iiol« 
iMIpaic cuucBp the lootfaid iliapoGitions and cmoliotta disapprafj ttic 
bW judgneotA wliich vere lused upon it must lilcewiae disappear, 
tad the gnnp of percrptioiis of the, now no longer shaken, / cuter 
i— whittly luto Uieir old direction. Stiould, hovcrer, tlie organic 
nam of the cerebral disease not hnvv been removed until t)ic false 
opnionB hsTS entered into manifold combiuntions with the groups of 
pnocptioiM of ilic /, the patient mar ctrtninlT rrcovcr; but }iis 
RVMrcfj' vill be n longer and luucb more gmdiiid pttvcbological 
ploBem, until, thniogh stmtgthenilig of the former normal direction 
of the ibougbUj the coiuicctions which the false opinions had con- 
tnctml «ith the / gniduall}' loosen, and ercntaallr are entirety 
iTMiiihrd Hasj conT&les<«iits do not rcoorer completely nntil thej 
Rtttm to tbrir homes and to tlieir former relalionit nf life, eniploj'< 
mads, kc. When, however, tlie old / in vitiate, eorrupted, nnd 
bbiSfid 00 all aides by the morbid fabe idev — wben» besides, the 
gronp of prrcrptions of llic former f is so coinplclelj' repressed 
tfaiffHUa), iluit, without any trace of emolioa, ibc patient has ex- 
cKanged bia whole pentotudilr, and luu scarcely any remembrance of 
ity tfaea noovtij is next to impossible, and only occurs in rare cosea 
lln^^ escilatian of Tiolcnt emotions, and thereby Ihrongh a l:tnd 
af ac<haai<Ml training (aa Allem|>led, for example, hj ficurtt'), con- 
liwuMulj to repel tbe i^pearanea of tlio insanity. Katutaliy, tliis 
en only be attrmirfrd where the brain lias not' as yet sustained any 
d(vp organic lesion : wliem Ihi* is prewnt, as in many of tboe iUXea, 
ctpeeiillyr in weoudary dementia, all Itopc of recovery is pnsl. 



* * Da IraitenKDt nwfal de la Folie,' Paris, 1840. 



CHAPTER IV. 



TUB KLXaUKT&RT DISORDERS IN MENTAL DISEAi«E. 

■*- '''"-vioir* to tdt coi»»i»i««tion of those comples groups of ' 
iL'b wuibtute the iipccial fonns of mental disease, there 
l^■«unl RtatMBS wliioti fcquire to be brirfij Dotictd; 
. •)■>' ••■{i«nl* cleoMotirr di»iarbaD«c» vliick arc alvajs 
({(oQpcid to^bor, in tlie varioiu forms of ittsaaitr 
1^ &C.). In ihott cerebral aflectbns vbich come 
'• •-• tuMital dueases, there nn, as in all otlwr*, 
^aliiM'l iproDps — BOBulv, eetiMlive, motoT7,Dn<l 
kwt'il I' -I lUMMulin. lliaf, according lo this tttrMfolil 

> '•' lu c^Mmdrr succcssix'elv cscb of the tlircc Icadiai; 

y itj ilisturbmiccs — iotcUectual inuutit;, emotionAl 

luMiiii4;tt «>'*! lUMiiilj of tnovemcnt. 

tt( • , 111)* iMBtal JiiiH<n«re eertainljlte noit sttikitig, the 

111 It "it UiaMHiKw vlitcli the dit^nositii baaed;' batve mul 

' 11*0 aiiJ malorf morbid proocMCt m oiilj Mcessoric*. 
' < iij p|«]r an iinpotUnt patt in iDunilj ; disordcn of 

I <>■ (( 1 8) Mleiiil ov«r a gmt ptii of ila tplierc i tod 
|| xtisMilt wliM al flrat tiglit Bcctn quite rortiga lo ittuniij, 

I I »iihli M«, Bonie of tlie most veigbt; poiota of analomical 



hwi'lON \,—7%t BhnatUiry TnfeUwiual Ditor^tn? 

\ \t 'I'liii «**ii|iliAl nliarnctcn'stic of insanity, tbat vbidl lEstin- 
||0)iitii<a M II* H iri'trliiil Rtatc, consists cbicflj iu tbe bet that certain 

' iMMntf) 'Ill* miiiiUI MionuliM, il baNtuatjIoallndttOBUCiliiittbB 

li «ill not be acaoi npalcd. For the duadsltou of 

•% wii.ti ttti tUnroTG but cnnoH)/ ■laHaawl. Thii nadcr tahj 

*i— 1'^. <lirnt n mu\ ho<nxtt, wlueh iMfll be ptDf»erJ; 

f * MtH>e til iaeribe tfe cinow tatmm «r imaM^. 

«nr ii'l-* iMMCdJaletf fbtkrriif m* Xtiaer^ * BMUnkt apoB 



THE ELEUCNTAET PISOBDEBS IN UENTAL SISEASK. 61 



ft 



*Um of the braio — certain dispositions, feelings, etnolioo*, opiiuon?, 
iJrtcfnunations— prorwcl from within outwards, owing to disease of 
Ihe or^a of the miud; wbile, in thu healthy state, our f motions, 
opinion*, (lelermiantiau;, originate only upon sufRcieot exterual 
BMtim, nod on that account also flaiid in a certiiiti harnionioiu 
rtlotion to the cxiprnal vorld. Ko one wonders if any one who hnd 
soateincd n great Iom it .«aJ, if anothfr to ivliom an earnest wish 
hfta been fulfilled manifnts exuberant joy ; but we rightly consider 
it as ft tnorhid syniptoin when nil individual without any exteruiil 
motive is dc]ircsEcd with sadness or elated with jov, or even, where 
•omc external caose lias 1>e«n gtven, the individual is iinmodi^ratcly 
or for too lon^ n time oS'ectcd by it, us uhtii a trifling oocnrrcncc 
tsMtef an inilividual to violent mge whit^b he is unable for a lonj; 
lime to reEtntn. 



» 



AcMr^iiig Ia tlie ume fuodAincutal prineiple, we judge of kU Gvcals in the 
Berrow (jstcm. F«ti|;in nflcr t loug itiarcU is DOriDili pcfti^lciit iccRtinCH 
sfttr »IBcieat ml ii noibid. A iliivciing bcnsation cipcrjcnei-d nlieii llie air 
it ehill n nonml, (lie seBulkin of euld wben tbuvxtrrual l<tii[ic»lufe is )iif;li It 
notbiil. NoMtbKM of tbo leu f'^'" prcuunt upon tiio actTO ii cfrlniiil; 
■iigkUj MMtMl, but it it normal vlien cemiiucd vtilli pi^ntiUjil iiumlincss dua 
lo aa htcnwl caaac, as diseaac of tLc ipinal cord. So, too, tlic couditioii it 
notbid sliCB a i4i{lit cauc cscitea (lisi>r[iportiouslcIy viuleat reiolion— if 
walkiag a r«w titpi cauica filigue, ot when a gcntlo brcc-in cicttca ihivRring. 
b lliew retpecta, boweTcr, ihe limils of discaie noA birallli ure bj no meant 
rtratfy JtHnwI. linrn llirrr arc niaiijr «Ul« at tlii) <]Mctiption, especially saoli 
m m tmaicnt, Uiat arc not oniiiMrilj considered ns dbcaacs. A glasa of 
vtai an elevate our <piTits vitliout external emst for j'^j. Here, hy meant of 
tW afcobcbc; n oerebral stale, an ripaiisive dispoitiioii, h iaUuccd ttom wiliiiu 
eatvariai a*nk analojj to insanitj. vbiob, hoveTer, do one lias dctiKoalcda 
^""— , as It ^icklj posMs oB vilbout U)j durable dTuct. 

Yay mudi depends upon the duration and intensity of the phe- 
IWiftfUH. whether nc consider tbo inintal stain as morbid. Every 
one fcoova from personal experience, that occasionally there may 
of^pnatc in lu, without outran] motive, dispositions lively or sad, 
lender or bitter — states of mind n bich arise out of slight changes in 
tbc organic proccsKa, and only rccogniiablc by careful altcntion. 
Hieso divpositions are not morbid when moderate and of short dnra- 
tioa, sod Ihoroogbly subject to Uw control of the nuisi of perceptions 
of tbe /; l)ut tbey are morbid vhcn thoy constantly and in every 
■attcr intrude themselves on the individual, nhcn they can no longer 
be ranoved by outvard mental excitation, and vhcii, instead of 



02 TUK ELBUKNTABIT DISOBOSfU IK MENTAL DISEASE. 

bdog coutrolU'd by the group of perceptions of th« 1, thcv affect 
us tamiLttuou*!/ mid C5cit« n lusting stftte of painful internal 
tlistiuielude. As will) such i]i»positioi].s so also ia it with siDgle 
distinct iicrception. A. etraogc or foolisli tliouglit loajr ptus through 
th*: iniitil of the mo»t rational man ; if only it docs luit lodge thi^ro, 
fcut is by a powerful / soon agnin forced out of coasciousnew, no one 
can call thia morbid, lu insanity hoTrever, such disptwitionB, such 
thought?, ara persistent : th^', oning f« the durntion and ^(rcii^h 
of the cerebral affention, become persistent-ly aad deeply impressed 
upon the mind. 

$ 3H. In order to n cnrrect uiidenUttding of insanity, we must 
uursetvca ciideavour to think ydih the ineanc. From the mental 
elates which arc still within the limits of health, and therefore 
within our own experionWj we may form some conception of wliil 
taltes place within tho diseased mind. The phenomena of dreaming, 
the sUtc of the emotions, mcotal fatigue, &c. — especially, hoyfever, 
the flbove-mentioned moderate changes of disposition whicli in health 
arise (pontaiicously out of slight physical disorders — arc for this 
purpose cBpcrinlly instructive. For, obsen-atiou bIiots that these 
phenomens, 011 the one hand, of anger, of iiicliuaiioii to rage, of 
discontent, rancour, and, on tlic other, of joy, gaiety, frolic, are 
frequently, and with unwonted pcraJBtcDCc and intensity, found to be 
marked elementary phenomena of insanity ; consequently, many of 
tlic conditions of healtliy life are met with in insanity, and arc hy 
the comparison considerably clueldat«d. 

But wc find other psychological anomalies in the insane to 
which there is nolbing nnnlogous in tho state of beaJtlij aud for 
this reason we nn; unable fully to comprehend them. Thux, wc 
cannot form any clear conception of what is meant when we hear 
insane persons cumjibin that their thoughts arc entirely made for 
them by others^ or that they are abstracted &om them, or when we 
see how, with partieukr words and gestnres, they associate tome 
rcry mysterious sense, and attribut« a secret importance to them. 
Tlie deepest mental fatigue cannot even niford any analogy ap- 
proachiiigthe destruction of thought occurring in dementia ; scaTc<.-!y 
CTcn cau the peculiar states of sleep nnd (heaining convey any 
adequate idea of it. Whoever has experienced the delirium of fever 
may, therefore, form some notion of what takes place in nicnlsl 
diaoaae. 



J 



TUK BMlM£NTAKr DISORDERS IN UKNTAL DISEaSK. (13 

la Us folkiving pvagrapli*, in tpckkjajj- o( tho IndiridtiaJ morbid aUlcs of 
^afouUon, tbMi^l. tml cITorl, we will tAvt&js lefet to llic com»ponding 
{ipialotpMl atales. Tlu> ibmrolJ diTiaiau ot nieiitil tiuturbttnou is merely 
Bvnnliooal to reader their sludj more simple; llieii more iutimitc lelitlous 
«S he SBdentaod from j»ngnpli* 15 — 34. 



f 59. Obsmratioa showa that the great niBJority of mental diecoMa 
ate Gnl imnifeBtod, not hy senseless discoutse or extreme aeis, but 
bj nortiid ehan;^ of duipositiot], ntioniiilies of tliesclf-seii^tioTi niid 
tbf Bratimnils, und cousequcnl cmotioual states. Aiid, iudcc^l, Ihu 
cailical wt»gv» of iDsnoitjr gcncmlljr comist id an aiialns fecliug of 
flUiiuaoiir, diKomfort, oppression, and anxictv, owing to the fact 
tlMt the aeir groaps of ideas and instincts resulting from tlic cerebral 
ifiwtwo an usoaily at first exccedinglj obscure. On this a«couiitj 
the daCwfauttt of tlie normal process of thought and will, and the 
Be* natal Bt*t«s obtrading on the /, are first felt simply as vague 
■M^ficitioas of tbe sentiQient and dispORition, The diDiiiiishcd 
power •nd energy of tlie /, tho coutracliott of ita sphere of uleat, 
fndaeet tn indefinite state of n1ent.1l pain, and, from its voguenciM, 
gnal ixritalion of tbe feelings. The new morbid perceptions and 
iaatiiKts {m>dncc divisions of tlic mind, a feeling of division of the pcr- 
Hiailily, ud of imminent annihilation of the /. Tbe mental pnin 
djaoovrn itxlf m some of the familiar forma of sgilation, anxiety, 
minam, md eotaib all the forementioned (§ :■) ronitetjuences of a 
adiaUy chBogcdreaction toward* the external world, and of a dislur- 
baooo in the motoiy function of the miod. l^ervecsions of the natural 
IMinp, aTcnioa and hate towards tlioeo formerly loved, outward 
iMMJliililjr, or a morbid fondness clinging to n ainglo object, hut 
wiliKMt the dcjith and tenderness of the oormat sensation, and sob- 
jrct to rapici and capricious chaises, are here ordinary appearance*. 
Tlta tnenascd seiwbility involres everything, hecaute, indeed, it ia 
pamfeDy affected by erorything, mid, from the mournful com]>lciio» 
tkal perradea nil his views and opiuions, tlic individual puts au €vil 
ialapmtatimi open crerything jtrcsent, and discovers in tho future 
Bathkig b«t evO. Bittnut and lospicion are engendered by tho 
U^atg ot diauDtalied power of reeistance, and are constantly exoilcd 

bodil/ teelinga of anxiety. Everything appean itiange to him« 



G4 TnE ELBMENTAar D1S0RUKK9 IS MENTAL DJSEASF. 

becanw-bc nets rtmngeli' tornrds every meiitn] impression, bwauM 
he himself fetls nitered, and he feds a strong inclioatioD to aiKTibc 
bis comlitioii somdimcf fo iht'. (lin-rl iiiflii^nOT of tbc outpi worlt! — 
to believe timt lie is pursued, iiiflueucfil, charmed, governed bjf 
Nccrrt influcncm— and at othira to refer to fai^ former life for the 
causef, and to accuse himself of a variety of serious ctiraw, depravi- 
ties, and mienleed.', of nliich liii present position is llic nwessary con- 
sequence. 

Here IKr most v.iricd modiGcnll'itii of ttiOM funJauiendi] slatei are to be 
observed: SDUictiuici an ciilirc abtO'rptiou of tlio indiTiJtiBl is aclf, sgtncllmca 
totil (!»pair, rrcqurnll^r mnlcvelpner ; oc^tuionnllr (jrmpntliclic tcndcrnesa. per- 
u'tleut scIf-torturC) ■nmclimrsennlitiuiti diisnlii Faction villi llic csleriial ivortd ; 
Gomelimei veanncn of life nnd edm dclermioatioii to eonimil iuicide ; wme- 
limce ilrcnil of destb, of tlie pnio* af licll, &e. Frcijucnti/ i\u: pnli«iit !■ con- 
acious of tlie commencement of iosaaitj, oceiuiounllj lie seeks bdvicc. and no 
linvc knona (ntieiit^ in lliB prelimiuiry ttiges volunturil; cominj; from gn»l 
dillADCCl to tlic Mjluin, 

The akjvc-tiiimcd Mates are tlie {ouodatioii of tbe various forms of meltn- 
cliolj', altliuui(li tli«y jinsifiit liiemMlTn alto iu oihet fornis (as la cbronic 
mnstA}. Ill the mnjoril? of cues Ibc palii-nls feel jtreit disquiet, eica mUfor- 
tune, whicii majr probabljt linve originated the old ajipellstion monMiatft 
npplied to all irlio ven tacntnllj diseased. The analogacs in health; life cor> 
responding to these slnlct itrr, n.11 drpretscd dispoBitions and Mioiiona, dis- 
coiirnfjnnciit, immodcrulc iitiiiibility — linbiiuallj billcr, ditcoQlcnted, And self- 
veiKtiou) fmntsoF miud— as are ocauioQallj' objeircd ia Itijtlilj' inlcllcclual 
Eiiiuil» (J. J. Roo»C«u) ; grouudli;«» jeatoua^r, anger, feur, iiribbiljlj, ite. 

§ 40. The morbid states of cmotigii with a disposition to gaifty, 
obwrfutness, froli^:, with increased mental and badily nctivitv, are 
closely anAlogous to ihe expansive emotions, nnd tliey ore both fol> 
lowed by essentially the sftine immediate coiiaeijueiiccs. There is, 
even in health, a possibility of being " joy-mad ;" a etatc in whicli, 
not only the feeling of present Iinppiness expands nil the powers of 
the soul, but liie dreams of the future seem to be reiilised, and in 
whicli men nnd tliinjt* come nearer to us — ib which we could allow 
every mnu to slinre our fortune, nnd could, as it were, embrace the 
vorld. Dven in thc^e ^tutcs it can attain lo a certain degree of 
Jiaordcr and incolicrcnee of the ideas, and it alwnys shows that the 
excitntioii is not deep whrn the fortunate one enii quickly regain all 
Ilia faculties. Also iu heallh there is usually coitibiricd with these 
feelings an impulse to cxtfrnal muvcroentj ivstlcMiiess, talkalivencM, 
and busiiioM. These states arc similarly exhibited when tlicy origi- 
nate morbidly, from williin outwanlsj they geuerally form the fun. 



THK KI.K31BNTAKY DISORUKHS IN UBNTAI. DI8EA6K. 6o 



» 



lla] slates of moQomsiiit, and are prcsoat, although in ix iniic]i 
«ctker degree, in chronic mnnja and tletoenlia. lii occord&ncc with 
■bit «e have onradvee obwrred, we mu&l coincide with the view of 
GoialuD, that jojrou* inHinttjr almost iiiTurixhlj maVei its lint apjicar- 
vno BS niooMdiog siaXea of ileprcssiou that Iinve pa.«8ed otT. On 
thaa account it scctiu nbo to dejirtid iipoi] n. mental ili9ciii»« more 
deeply ttaltd than the latler-irwntioned state, U sccins ofttn us if, 
Upon a diange in the state of the hraiii, Uie previ»uij oppression 
vn^iing npoo the aoul were suddeulv ri-moved, and as if, a.s a s^iiip- 
lon of stiU deefwr dottraction, tlie fwling uf grc^t mental freedom, 
t^ faBp(7 hopeful disposition could arise. A remote imidogy taken 
from the Beosilo-motorT nervous system presciils itself in the fact 
(ParkiQJe] that when the extremities are weighed down for some 
time by attached veights, imniedistely after tlieir removal there is 
ciperieiioed aa unnsual seme of lightness of moTcmcnt. 

BcaUa, tWe arc prvwoteda namber of oHicr morbid disposilioRi nid emo- 
UaaiHOcU opncioaiaoHi iadiBtliona, aod ivcrsiona, aeiuuouB uul ideal Jorei 
nqaatiy, ftc, too Bunercmi to be indiTidoilljr tUted. 

Willt tfe appearanra of llicftG i-ariou* anoratlics of icatimcot, oonnnonlj, 
Ike f ri ilJBB of the inditidml lo tlie oater world. Lis wbolc character, his duirca 
Mid laatn, am totallj chuigti]. Tlie oniiniilf mui b«>on)Cs Utiec, ILe panimo, 
uona podiga), Uie moral licentjoua, llie utodeftl {iroud and iruolciil. 'Xlic 
diaaitl (4 Um ebanetcT are gcnertdlj Ibc moat ilriVinff ajrinplunit iu tbe eatl; 
tUfct of JMUiitT ; tod gcnertllj tliQ losaoilj itirelf, in iboss cubcs «f ilow 
gndaal oripn, appcan tmp\j a> an exfcuirc ilwelopinent of the natuml dia- 
pO M t ioa or pccnllaritj of tliie indiridimL Therefore, fiom llie pcaulluities iu 
Iha acBtinala of tbe T*tieati it is only villi t>ie gmlcsl »ulicu tliitt kc 
ateold nature to czpmi ui opinion u to lii* former clininctcr. Eitromo 
rieigawuM aad BaleToleaoe taa, for txample. during Ibe duralionuf Die maluilT, 
cootisu for jean in ncn of at other times lund >nd bmeTuleut iinturu, atid 
■• nvBi uj Uie old dupositlou maj be qaiekijr revived, awl ao trace left of 



) 41. The anomalies of emotion which liavc been liitbeKa de- 
•cribtd iR to be regarded esaentially 0.1 nppearances of ahnomia 
ODotioDal irritability-. There arc also, however^ abuoriiial !<t«les 
at dalnr««, and rvca of total loss of emotion. Here cither the 
oeeukMul perceptions ore no longer connected with the change* i 
(lie lelalion of tcniioii of the quiet uiassei of perceptions of the / 
which occur in the heoltlij state — there i> little or no disturbance of 
the cxDotiotu graerall;— or it may be that these events occur indeed, 
bat thrjr are do longer known to the indtvidunl, und tliereforc liavo 

S 







fte 









•tt 






Aotf 



•- Anu/ DenstumM. 



ftrtMU M t ggMl lW t of Iboaglit depend atkr oa i c p pc Bw ign 
»fW»(| from vWeirt nenUl jwin, which ratirdjr occupies tl« mind 
•nd ifmnlu i«»t)iioK elw lo nijproach it, or on ml walmen, espe- 



TUI KLB3IEKTAKT DIBORDKBS IN UEXTAL DISEASE. 67 

AXtf lorn of memoiy. lu both c»80«. howerei difTcmit they tatty 
beM tn thf'ir intmul rauses, there is observer! pot'ctiv &n<l same- 
Besi of thought, the train of thought 8p|}eaTs to stand still ; single 
wmitt nodes of cxprcwioa, inorcin«iit3, repeated for hours, »hon' 
the eoDtinned presence of the sunc pcrccptious. Tberc ta often ob- 
Mmd a heritetion of the s|icech, great unoertAinty m the connertian 
of the thooghtB, uid timidity in jadgbg> This condition is found 
principally in tadncholia and in dementia. 

TUa fanfidort hURbtBge of the porMptioiu it t tery importutt olcmout 
■ nnjB«olal JiMasci. The pnticat cnn no uiorcllioniuglilT dirctt bimsclf oC 
wUta [WIWp t iBM, bo ii no \ongn fter, lio is eontinually cxpoicd to tlioir tor- 
nntlag indMOOM ud impnU«s ; lie feels liov, f;raJti-i1l,T, in spn'te of bis opjio- 
mlioo, lib /, the raicneu o( his person, is being amitdii'd from bim. Similar 
iUlM taa; he otB«rt«d tvta in drMming ; man; repugnaut idcaa b; tlicir «■■!• 
Miat iw w rc a tt induce a ttatc of dttpoiidcDcy. .Vs vill bo found on uiinvto 
coMidetitioai, tlMpI«ssB«u often uiws Ima the continued iofiuence of a gnup 
of ideaa ; vhcMTcr theae disptnv alocp returns. 

An incTcatcd production nnd aocclernted tiov of tho thoughts 
is •one degree facilitates mental oombinalioiu ; therefore ve some- 
tiam obwm iodividnala who at other times arc even iutollectualiy 
duU becone acute and wittjr, cgpcciolly in the happy expre««ioii of 
(aiUay aguort indi\'idiiAls present, rersification, &c. On tlint 
aoooaat we hear tittle visdotn from the imane. 'H)cn, evca in these 
■Utea whnc abundant material ia olTt-red to the rultirnted imagina- 
tka, generally disorder and incoherence rtry «oon appear. Pnr- 
tkulariy when great numbcnt of perceptions originate in the braiu, 
aod tbor course is accelerated, arc thcv succeeded by long eerks vf 
idtai ; and frequently loag*forgot(eii images and events, wordit, fougf, 
and «o forth, are renewed with the frcslinesa of first impressiuus; 
but, iiiumucl] as the pcrveplions so r»)iidlr succeed each otlier that 
tbrfy cannot enter into the necc»ary curithiiutiouf, nod iaasmuch as 
the tnultiplicity of thoughts is attended by convspondiiig cliangca in 
the ■otiaenti, the only result is cxtieinc agitation and tumult of 
t^kaa. JJl is bntried along in tbe most eoufbaed tuccession, and it 
ia ■ ehanee if here and there in this tunooil tbe elements of a 
qnaiBt idea meet together whicb ia io the least more rational ibou 
■bat sorroonda it. 

Tba Utter state* B])[)car principally ui mania. Hiore is often 
Bppannlly grtat mental vivacity, ct^eeiaUy at tlicii comucacemcntf 



G6 rUT. BI.r.MEXTAItT DISORDBftS IN UBMTAL DISEASE. 

no esistaiM to him. To til that formeriy intwest^d him h« is now 
tfiuallf indiffpTcnt, and hft is no longer capable of being mncli affeclefl 
by anj new wiitinicnt; parlicipalion imd interest, pain fliid plwwiirc, 
lore and h-itc, cense. Apathy onel in^iffwence to everything bfyoiid 
the gatisfartion of hw seiistious requirpment* sQcceed. TnlelligBnct 
can tlicrcby be tolerably maintained, but generally a greater or len 
degree of dementia it npparent. 

FcrTcnion of ttic i^'rcttoni ii a state of conaidaibte iaiportinee in a mcitico- 
Icffal point of view, and one wbioh i» frequonlly dil&cnlt to dirilnguuli. It 
tppcBri u B mubid atalo acquired principally by onaniil* ud dninkarda, and 
it rocosniaed to be a diteaac, espeetall.T where it or^mlea rapidly. It Ftvrmi 
■n eticntinl clement in very nttiny lUtot of chronic mania (aeo Book III\whcro 
eommonly all intctesLi are citiiif^iialied nceptini; suoli as relate to certain 
inaane ideaa and to tbo individunl liunieir; iuJocil, there arc caaea where the 
lierrcraion of the aOcctiuai and lliu apnllij ajipcnr ai llic chief clumciils. In a 
remarlaiMe mniico-lfgnl ca»o wiiifth wa.i dcriticd lij ttm opinion of tlio autlior 
(Soils), the crimc—thi; murder of llirco of bit own children— proceeded direotlj 
from lliii anotiiabui stale of tti« affections. And, icdced, in erinei of tliit 
kind, vhere Uiu patient) are fKiV« ralionat, the pliyiiciaa catmot be tco oartfnl 
to dtscoTer coTidiliont of Uiit nature. 



B. Anmalits qf ThwshU 

§ 41. Within the sphere of distinct perception, of opinion and 
ooiiclu^ion, ve cui rendily diftin^isli tiro varieties of abiiornial 
states. Pirst, there it an abnormal relntioti of jicrception in the 
nbstnu-t ; RTOiidly, abnoriiial views in relation to its (false) object*. 
These states are intimately related, innsintich as eertniii formal madi- 
Jicntions, for example, too rapi<I succession of the ideas, eitrcmt! 
sluwuCM Ui the coime of thouglit, or disonlcr of the fudings wliich 
necessarily accompany them, excite or promote certain morbid idt^aa; 
for example, tin? niodt-rate excitation of i>prci'plion, where the com- 
binations proceed with incrcBaed facility, is fretiuently nccompanicd 
by blae jadgmcnta, which result from the feeling of mental liberty 
and mental vcll-being. 

a. Fhrmal DtviatWM. 

Extrfme elnggishnc^i of thought depcadti either on mpproasion 
ariring from vitdcnt mental pmn, wliicli ciitiroly ooenpiea the mind 
and )Kmiit9 uothiiig else to npproncii it, or on real wraVuess, esiie* 



THE BLKUBNTABT DtSOKDEBS IN MKNTAL DISEASE, 07 



i 



cullx Ion of memoiy. In both cases, bowerer different tliej ouj 
be u to tbeir intenuJ causes, there is observed poverty and same- 
tMisi of tliougbt, tile trniii of Ihongbt appe-nrs to slnnd Rtill ; fiiiigle 
TQcda, modes of expresaioD, moTcmeiita, repested for hours, nhovr 
tfac oouLinncd preMDOe of ihc same pprccptioiu. TLorc is often ob- 
«rrad s hesitation of the specchj great uiicvitniiit}' iti tta* cotiovctioii 
of the ti)oiif;ht«, and timidity iti judging. This conditioa is fount] 
imndioll/ in melftacholia and in dementia. 

TUi nunfluent mteroltuee of the fiOTMpliona is a yerj inportuit elcnmt 
IB wmay inntal dtNisee. 1\k patient ran u« tncra tliorauglilj' Jitctl himidf of 
flvbta pemfitfoni, he b no itmger Tree, h« is Rontmnnlly cxpoted to llirir (o(- 
■oaliog ItAaeuooa tad inpsliM ; lie feds liow, gnuluii)]f, iit sgritc of liix oppo' 
•illaa. h» /, tbc miDntis of his |<cr«>n, is being anatclicd Trom hitn. •^iniilnr 
■Itin tnk<r be obMmd tTMt io (tKNRtin^ ; iDftn; Mpugnint ideas hy iheic ccn- 
ilnl naarmce udnw • sWc of detpondcucj. As will be foaml on minuU 
iiniMiiHliiw. duplwnww often tmn rrom Itie contiiiueU iii9u«ucD0f a gTuu|i 
el idsMi whenever Uicm diipenc sleep Tcturas. 

An inCRtaed production and aocelcratcd flow of the thougtile 
in lecne degree fkdlitttn mentnl comljinnttons ; thercforo vc some- 
lines obMTTe iadividaals irtio at other times are even iuteltectiully 
doll become acute and witter, especial!^ in tbo bnppy ntpTc«fioD of 
niilety ogaintt individtuls present, vcnincatioD, &c. On lltat 
accoirot wc hew little wisdom from the insnuc. Tlicn, cvrii in these 

trn where abuiidiuit mntcrial is oflered to the cnJtivated iitiaginn- 

la, geocmlly diwrder md incoherence very soon appear. Tftr- 
tirularljr wbcn great number? of iierccptiona origiuate in the brain, 
and tbcir course is accclvratcd, are tliey suoceeded b/ long series of 
idew t and frequently long-forgolteu imxgcs and events, words, eong^, 
and to furlli, are renewed with the fceahness of lint impn-ssionH ; 
bat, inamDcb u tbc |Krocptioi» »q mpidly succeed each oilier that 
tliny eaanot enter into the neccMary combiimtiotifij ntid inasmuch as 
the multiplicity of tbougbls is attended by corresponding changes in 
tba aootiiDcntf, tbc only ruult is extreme i^tation and tumult of 
ideas. All is hurried along in tbc most confaaed succession, and it 
i* a ehaaoe if here and there in this turmoil the elements of a 
tpatt idaa meet together which is in the least more rational than 
wfiafc ■ummda ft. 

Hw Utter slates appear jirindiNdly in mania. There is often 
^(artnUj great incutal vivanlyi efiKcially at their commejicuiucntj 



AS THK eLKMENL'&KV UISQRDKKS IN UB:tTAL DOtf.VSB. 

and we hnTc known esses where it iros the iarariable symptom uf an 
•ijitinnebirh; attacV when the putiNit became nrittr. 

iueobtnnoe of the idcu does not. howctcr, lold? orixiule in lhi> wir. 
■unel^, throng over-rulncM of the oaMcioufaca*. There is iIm taoobcrcnc« 
ot tim^i md spcedi cormpondins to prcqeetiou of the tbougfiti laii of Iho 
enoUons. u aagtr, ud ftlili iiiwlher viiieli prameds from eenplvlc abolition 
and deep dcstruclwn of the meutal procn«cj. The p^ohologiol mcdttnUin 
of (his lut Niidilioa ii *till verf obunre in ill Uetaib ; it t|)peare tbat the iii> 
ooWrance frcqaeatlj depends on the fact llat the perceptions are called furtli, 
not ohI; UGOtdiiig lo thetr {unulor or conlnaling) oontents, bnt «8)i«ewllj 
aeootdu^ to exttnial sunlUi-ttr nf sonnd iii t^ mwdt. rcrlispt dcfldeat te- 
oifrDBaL ictna of the tvo hslrcs of the braim naj bare ionic ioAueuoe in prv- 
dudog neoliennoe. looobrrcooe b frequent at the oominuiceinent of neutal 
dfaBMW, when there is violent dittarfaenoc of tbe cmotioiit, aad here it b no 
DMN an CTilindication Ibmil bin tbc delirium of fcTcr or iu dreamt. Oa the 
other hand, Ike intohetesce which flnt Sppeus after a long ooatioiMncc of me- 
laadioUa aad nauia, or at Uie oomoMOMiiMiut of cluooio ioMiiit/, a siguiftcant 
of a tniuilion to the iDcanble fornn of dementia. 

TvomaTked esaoiplesof leinponif incoherenocfnm traoHcot diilurbaoce nt 
Iho brail) in othrrwiM Ixsalthy persons, with a dear dcicription of tlio progreu 
of the sjmploms. b; Sphlding and (ra'like, ma; be teea lu Jessou, ' VenucU 
cinor wtMCiitohaftbdiea BcKraadung,* He^ 1S55, |). ISO. 

To lite morbid states of thonght described ia this pan;^ph there are found 
MUij psjchological anilogie), pnrllj in the determined ptrsiitenoe nith vriiicli 
disagTMsble ideat often follow tu, in intimldatioo of tlic judgment bj an advcrso 
occurrcnec, nlao >n so-eolled snllciiicss nnd in confiuioQ of the ideas owing la 
friglit. To the second series to lD<]uiiciousi>eu nillioul ideas, ia liie inlerniil 
ooufuvou which Ofigiostcs from sbundant limallaneont reception of idtn* vhicli 
hare no common chaiactfristic or leading direction, or in the incolierence of 
imnges in dreams. 

§ 43. Memory in ])nnioular is vet; Tariouslr affected in inetitftl 
diseese. Sometimes it is ludmpaircd os regards the crenlA of the 
former life aa well as tlie occurreiiceii dtiring the disease. In llic 
preceding pnrtinvph we have spoken of \\» morbid iiicrcftsc. it is 
more frequent, howe^-er, to obsen'c cnftehlcnioiit of the raetnory in 
various iiiod«». IJementia in imrtlcular is eharaetcriwd by feeble- 
ness of such n kind thflt events Iiappenmg at the present lime arc 
(|uickly, even instantaneously, forgotten, while there is diatinct 
rcw>IIection of events thnt took place in former periodsof life, which 
may even be the subject of tolenibly well-orciejed convtwalion. At 
other tiiDL's tlic conteQls of tbc jirevious hfe »n: either (seliloiii) 
eonipk-tely cfTiKcd from the tablets of the meinory, or (more 



r 



Till; KI.EMKNTARV UISOHDBftS IN UBNTAL DISEASE. CD 



I 
I 



beqacntlv) are so fat reiaoved that the^ become so ngae and bo 
stiuige to the individual that Ihcy can scaieety be rccognispd m 
mniB in bis own hiatorjr. line the adual individual exi»teDce is 
Jated tiroBi tlK conuncoccmpiit of the <li»cA9r, uad ihc entire furmcL* 
lift) if dtlier attributed (a a slnuige pcnoiialitjr or »t leiut to n 
farawrtiaitediffiNcntFtHtr, to niiiinnginarylifc. Tiiiscnlrangcmcnt, 
tin* complete fidling awaj of tlip fmmor /, (lejiciiil.t, iini only upon 
rakneafl of mitnoi;, hot ordinnrily it is proilutcd aiul rendered 
piTnit*iTt bj 5i)fcuil Hciisilivc uiioiualii-j ; bul (he di9ap)>earonoc of 
vbole Buuses of forinLT jKrceplJoiis in cspeciallv favorable to tllu 
MDie^uont int«nul production of saob a delirium.' 

An iodiridual «ho bus nrcovcred from iii^iiiit v geiicr»11y reiacin- 
bcra vbat occurred to biiu duriug \m HUva^i:, imd cuu oftcti uurr<ttu 
with rannrkablr truth and prednon tbi; most trilling incidents in 
tin otitff vortd and the minute detnils of his motives and lenti- 
■nU during tbc iiteasc. He can often interpret every gbincc, 
vord, and change of expression of his visitor — circomstaiiccs'vrhicb 
mggait an inddeatal caution to thosi* who have to do with tlio 
Inirr. to bo constantlj on tbrir guard a3 U) liov they cotiduct 
ibemseives, to be just and mitd, if indee<l »tich an enbortatioii be 
required ! lliis kind of iotelligcaicc is ccpfcintly ubscrrnblo in tho<'c 
who hare recovered from uielnncliohn and iiiddi-ratr states of mania, 
IfM fmjiKiilly oAcr nioaonuini.^j of irlticb the patient generally 
Mtaibt very confused idem. The statement of one who hns re- 
rannd thai he ho* do Itnovledge of anything ttml occurred during 
his diseaM is to be received with caution, siiico the pnticnt 
oDcb MDceak vhat be clearly remembers through deceit. 

Vntk tbe nOBUtiea of fona wliicli lisre been descrlliu] tbcie nre frequently 
ttmattUi chaafei ia sfieech sad t!i<! modes of »pre»iaa. iltnj acR dumb 
aviag Ia annalin of perc<plion,or even wlien aumorout ptrcejtlioiu arc 
, bBemwHO rtflex wtioii oocun ia Ibe sp|ianttusof ipcedi. Olliereipoal: 
f, Uwir nsmtivc* we «adU», or, tritliout cnminunicnliiig aujtliiu^ 
to a lutcDor, Ibc oaatinuous reflex nctioa in llic organs of sjieecli iiru< 
n«^ ■■ [aoMsml prsttle (logomuis iwopcr, gooorallj witb iuaolieoreoco). Vtc- 
foesUj It is ratticT tbo foraislioa of sealcnoci aad Ibc mode of eipraadion that 
h thend ; Hej ut SMre flaeat or interrupted, diacannectcd, alfeeled, &c. In 
allwr CMC*, whiek an tlie most ioUrttlinj;, lltcro appekr in llie kuguage of the 
bnat Mirly famed votdi, aad old oau >re empIoTcd villi new sigiiiScBtioris ; 
ia ahotl* tba palinil (onni tor bintHlf anew laoguage. It ffovli appear Ittit 




Eiamplee are found ia f 49 and in " Dementia." 



70 THR RLEURNTARr DTKOHDRM rX MF.NTAI. DttBAMK. 

ex m t nn i lly ardiaarj biginme h not wlaW to OtpfNt Min^«t«lj new kiul 
■tfufs eontoU of Mmlioa nd parwptioBt and lkM«fan wtm vtadi u« 
faraud, or Ihtt ia the libaBnul otrtbral ttaM Uw easfntioMl imngea of 
■ODiiil (>x>r(ii] dirvctlf ttu- op tad «UiuI« to otber perceptMus (»m } r;), or 
thtt rrcqucnll; Um hiilliciutioiii oS haiiag ioLncdiatclj ncceuitate the Tor- 
Bition ftf tiev oonbuiiUoM 6f ijUiblu. whioh are Ibeo retained tod Mi fast 
(ia drtaaing atao tfcere b Uiu tonud ntw wotit). All ik«M chaagn appear 
mart higUj defelopcd in (Aratio Huia mora tnaunllj IB BiaU. 

Tba altered nodea of eiptCMMa, under certain oaadittoai, prcMot to Ilia 
practiied phTaioan direoL ptrfnta tt itigutau ; Iboae vho feipi insanitj initala 
iKmc stiit» TCtj GloBui]/. SeeSaell, 'ZcitscliTin fur P»;ehiatne.' 1851, ii. p. 
1 1 i W. Na*M, fUd, 1853, X, p. 5J5 ; Martini, Ibid., 1856, xtii, p. 605 ; 
Bruiua. ibid., iSj;;, xif, p. 37; Blandct, " Du DAire phonAtique," 'Ottettc 



*. Penertioas ^ T&oi^JU — Dtliriou* Jieat, 

§ 44. Mciitnt (ItwoM! (low not neceesariljr {ni)it; tho esiatenor nf 
(leKrioiM porceptioTu. Mark«I changes in tHe chanAlcr ftn<l in 
tin •aitiuentit, morbid di^ponilionit and irmotioiut, blunting of tite 
ventjinciils, total or partial relaxalion of the mental powcre, win 
exist without trul/ iiwimc idcan, as acute and clmmlo mdrbid 
Rtotes of Ihe niinil. A number of suc)i esses may be oomprehnitlpd 
under the cUm of manl iii»iiiiily (6'(!»«i/inrri4N<tiMit). But ex- 
])cn«ioo tcachoi that, ia tli« grMt mnjont^ of coMf, the mental 
denagetnent does not ccasi! licrc, tliat epecial 'mf«at idens are de- 
veloped, and tlint llirsi; fal-^n opinions which can no loBgrr be rrgil. 
Iat«d an nccompamod by true delirinin, tlie mental affection, which 
at the commenwinpnt wa« only wi insanity of the feelings nnd emo* 
tjons, l)i!Comcs also insanitjf of the mUlttct. The pressure of llie 
morbid nncaaiiicsa tends rnpidly to incorrect perception nnd intcr-t 
jirctalion of objective i«lnlio»s, but at firtt only of aoch as rcloto to 
ths (Wtient himself or to his immediate fiiirroanding*. Th<: false 
oontcnla of Ww tlioughttj i. e. which are not in harmony with the 
estomal world nnd with the cveat* of the farmer life, at first gene- 
rally happen in Rucli a way that the patitnt altetnpU to nccount for 
hii diapositions and morbid cmotiooa by the Uw of causality 
($ 33. 39] • Tlie most vntied <-xternnl cauwa and events, nsd the 
innumerable recollcctiotis of hi« individual existence, alford «buud&nl 
mati-riol for this attempt at rxplonation, and circumstanci's, rducn- 
lloci, and th<- vit-n's of life, tinvc here Ihc mo»t dcci<i<^td itiDuraco. 



THK BLBKBHTARV niSOHnp.RS IS UF.NT.M. DISKASB. 71 

^ir eiunple. llie »amo dbposition whidi excites in tlic supcntitiouA 
macl Uk idea of wilclicnft may in anolticr »uggc«t the idea of being 
punned by freomtfoiu, of invuion ttirougli aectet m^^ctic influrnccs, 
ta. Ail hjdlucinalionB 1i.xtc a special, irifludicc, as veil on clie 
Aviutioa of such inano ideaa as oa their a\Kcial objects j Ihc^ arc 
M iWquiint, pnuwut niatt^riali for explanation so livdjr, obtrusive, 
uid ofton to comUal, tlial in our ciperii'iice we must fLiuI tliPin (o 
be a Domtnon soarcc of tmaiic ideals ; thus, the subject of an halkcl- 
BAtion of »ight who sees flprjr appcawnoca belierts himself in hell, 
mother with ui hsllucinatioti of tmcil thinks he is eunoundcd on oil 
ndts by dcwl bodies, the eUliivia of which he bi'hcvo he stnclls, and 
tlMseost found* fortltet conclusionsj &c. 

A* to their oontenta, two leading differem^es nw pnrticulnrly to he 
ahtfrred in insane coDoeptions — llrst, joyous, sublime, brilliniit iAciw ; 
♦•™">'V- , tombre, mdj nnd painful thoughts. The former nrlur from 
'■ liire emotions and from chocrful joyous hollucinnlions, the 

bUer fronilepnmod itJilcs of llu: disposition, nnd gloomy ilUbodtiig 
luBndnsttona, as languagn of mbuse and mockery which thn putinnt 
it aliniys hcnnng, di>bolicid grininces whicli hu stvs, &e. 

The fabo ideas aud oonclutioo*, which nre altcinpts nt cxplanalton 
■nd TiiulioatioBl of tlie actual disposition in its eflccla, are s)H>ula- 
■Mouly dtnniloped id Uie di»eiLied mind ncoordiiig to Ihu law of 
eaanaHty ; ou the part of the iodindunt the oxpUiiatiuna do iml 
imply rrftedion, *till lcs!« arc such conclusioiia fiirtnfd by the trdious 
fono of syllogism. At first the delirious conceptions arc fleeting; 
tl|B J peiacives Ibem, it may he terrified by them, flckiiotT)»I{;i:; Ihrir 
tlwaidity, and yet fed i)uitt: imoblc to rid itaulf of thc-m, sud strug-^lcs 
•ith Ihem; gmduxlly, by continued rcpotition, they gain more body 
%ni fonD, Kpel opposing idcaa and form ronnedions with similar 
BUUK* of perceptions of the /,- thfn they become conslltucnt paits 
t4 Ut wd ttio laticQt FKunot div«st himaelf of ihesn, or only in some 
iamm bjr axcluinge with simiUr falso piTCcptions. The excited, 
lively, and happy insane ideas arc naturally received by the / niiich 
morecasflr and completely; it yields toth«in after a short resistance, 
aad then it occasionally give* itself over to the insane perceptions, 
halfoainsciouH imaginntion in a vorld of happy drpuni arises. 

All blae Ideas, hoTcrcr, arc not to be considered at (liiu cx- 
plteslitff; many origiiislo villi thn fortuitous a.hrupln>ces of hallu- 
rtnalians, or of those pceuliir tiusint thvtigbl! whiHi ofiea tpouta^ 



72 THE KLP.MF.MTARY DISORDERS IN IIKKTAL DISEASE. 

neoDsly intrude on tbe healUi}* mind during its most earnest cm* 
ployment. They often origiiulc siaplj from p h a i itasma of aaae, 
dreams, owing to external circumstances ; their ]»cri(istenc« de{)ends 
on the present disposition of the pntient, tnd vbether in the present 
perceptions any mnterial for couuection is fouud. Wc will find, on 
rarvful attention, tliat niimy sucb ideas in the inmnc are related to 
hitllucinatioiu, which, however, dn not cWrly show themselves. 

la the culj itsgci of inuoity, vhco the disorder of tbc cmotiou ii alili 
tho prmoipal clfmcDl, intmnierable strange i^erHptlons bcgia t« pw tlirciu([h 
lIic minJ (t( the jixtiMit ; iiitcrwMiTiiig Ihoiaerli^i with iLe oidlnaty circle ri[ 
hit Ihougiils, lio CQD neither free himseir of tliem nor aMitnilale ihem. At firet 
Uteliiif; Huii cliaiiseable, l!ie}' graiiuttlly galu bodjr snil form, but Ktill tlie cmo- 
lion&l eicitctnent ia tlie fouudntioii on wliidi the; etaiul or fkil. The dislurb* 
ance of the emotioiia grKdonllj dimmisbcs, and therexitli do c«rt«ia Itading 
iiisuo peroeptiona become propottbDite!; t»bt rooted j gredmill; tlic entire 
tnentsi life cireica round lliem ftitd uiumei ttielr ohanetcr, tbni is, tlie inco- 
herence becomes tjslematio. Tliia, too, is •till » period of mcntnl ttotiTitj ; the 
Iranifnriniitioii oftltc whole internal lifo aliU prooooil, port!; with the actul con- 
s<int of the /, with the co-cperttion of rouon. Witcti thi« proe4M, whioli u 
alirnjt ilw, is kt last oompleteil. tlica the eUtionir; period follovs, in rrhicii 
tbe insane idriu, uonr become fixed, ciist mcrelj u remiioi ol rormcr uUro 
prooeuo. 

Wc should speak of Sicd idcu only where the f^se opinloai htn beooma 
radiealijr and jicriiiaaeully Gied, u lu chroiijo toMDitj. In tneiftncholio, maniat 
and iiioiiontania, the; frcquetitl^p clnngc. All the fiilac upiQltiosof the insane 
hare the ehnmctflriitic tliat tlie; are related to the luhject itself, or at least 
have been forined out of false ideas relating to biin ; tbey are thercbj distiu- 
guished in a gml degree, if not fully, from the erron of tbe besltby miiid in 
reference tuobjectire rclalioiu. Tliiu, »□ insane tnan maj' believe that all Jews 
on damned, but incrclj because be consiiien himself injured bj them or 
beotiue he has dictated this punithmeat ; he maj believe ia the eiitleaee of « 
bndgo from the earth to the moon, but ddIj that be hitnseir inig;l]t vaik upon 
it, or that its roniCractiQii may afford a proof of liis creitivn power. Nearl; 
all filed idc*s are. when reduced to their fiin<lnniGnta! rlcnientii, expreasioDs of 
A frustration or gratiflcfltion of what specially tclnlea to Ihc cmotionj, tbertforo 
Ibcir sepantle oomi deration, as if tbvj were the chief ]>oint» iu iuiauitT-, nlwajs 
tends to n one-xidcd nod onrrow view, and the knowledge) u well as iho 
meclicnl Ircntmant uf thrm, ran, in imIiTidiiAl case*, rest only upon tbe view of 
(lie iiiGUtal ilntcs Ifiug si tlicir foundnlion. 

Tbe insane ideas of the mentally diaoBtcd arc dinting; uithed from the erro- 
ncotjt view* of the henltbr, not onSir b; the oircumstanoe of tlieir relation to 
the discnicd tubject hinuclf, but alio by numerous other osiioatial cbaruteriitics. 
Tliej are always connected with a disturbance of the wliolc mentnl process, 
(emotions, incohcrtnce, &c.), whether it be lliat ibey arise therefram (gcuenlly 
in the preliminary stagesl or that they involve such disturbance. Often Ihry 




I 



I 



THB ELEUBSTART UISORDERS TN UENTAI. DIRRASK. 73 

u« dinotlj oppoted to tbe former ricwa bcU bj llie indif idunl ; be cuuiol get 
ri4 of Uwtt At will ; Ihty ttihl *' ogAiiiit llie tcitiiooa/ of •bu* ind uiid«r> 
ilMidmt," »djs>tneat, lud comction, Rnd ihercfgrt lUnd in n qttito ditTerent 
fdition to ike «motioiu uid tbe wil : tbi^; dftp(^n>d upon a ditlurbuiee of tbe 
hnin «hle)i fnqnenllj abovi itself in otiier morbid ocrvoui ijmiitomi (diaorder 
af tfai iJeep. bailuciaiilioiiii, |itnt]iticap|tftraiiOM.ftG.). Wennauilyeeefrom 
lU» bow iuu«MOBkbl« ud fundancnU^ljr fnisc it ia to Mnsider tbo emn, 
** Ike ddoakm" of bj-gose age*, u tbe belief ia irilchciBil, cucbiatmcals, ix., 
u it all k&iIog««i to ncotal dtM«ic. 

On the special form of tbo dcliriuui, llicre is still another 
etreuinytADce wbicb exi'fciflt-ji grant inHucnoCj an<] wliicli liiibcrlo luu 
Dot nctit*d nifiicKnT nltcntioa, nnnicly, tbot tbe nature nf the 
ddinniD is oflm ilcUTmiin-*! hj the scriw of prrcrptions wliioh last 
ocCnely engaged tlic patient's nttcntion itnmt^iatel^ befon.- the out- 
ktnk of the uuuoUjr. CotkfnjiieDtly, if thMe ue coiutautly dwtll 
opoD by the patient, it is often envniooslj' supposed that thev have 
bten the nose of th« inMnity, while, oa the conlmy, llicy maj- 
ktw be«i Mmpletelj or to a great extent fortuitotu. 

Ia tbeyvr j849,«beuall Ibe world was esgroneil in polilict,it«aa beLicvnl 
Itmt m maaj aan politics Itiid been ihe eanw of inunit;. Fletnmiiijr (' P*j- 
afcaan,' f. ifiS) bnagbt fonranl tro cKunpIo where the pstieut bad atteoiled 
IAb kiuiL abort)/ before Ihe outbreak of llic iaaaaity, and lUc dtliriout con- 
ctptioai fcr a long tine rcfcrrMl to Ike incidcets of tlic hunt; Knotbci Lsd 
jail b<ea raadiuc an attouut of a joniMj to tbe Uimata^u, and Unit farmed 
tht oealrtJ pout of the detniow. Tho same is observed in acute ddinum. 
Ia • oa>« knovs to mt, wlwira tlic Iiut hcallb; enij-tojnjc'iit of a l7|itiu» palicut 
«H nodiox tbe ueoant in Ibc newspapers of the war tben ngiing in Ibe 
Cktaca, tbe deliriaa ol Uie ferer for *«reral weeks was couSned to tbe aulyeot 
oTtUtcrcat. 

{ 43. Whether the patient is affected by only a few or by very 
BStiy falM opinioDs, whether bis dolirium is partial or general, is to 
be eonndeml in c^tiniating hi* conditioo, and ia at leatt of some 
iliapwiitin value, ae the first case is obscrrcd more generally in 
BHltadioliii and munonumia, the latter in mania. But it is trrong 
to baM a distinction of forms on tho fact of the insanity hvitig 
partial or general. Eitpedally would it be fundamentally fal&c to 
beline in the existence of ttat<?s in which the patient has but one 
Hl0e, limited, fixed iJva, while in all other mpccta hu idcna ate 
i|aita hiialthy. We flItaJl aft«nrards se« that cren where lliia appear- 
ance can rarlieft arise, namely, in the form of chronic insanity, there 
ia always prtacst a deep inwud deetractioQ of tho mental onity. So, 





74 THR r.LRUKKTART DISOnDRRS IS MRNTAt. DISBA«R. 



llifn, tha one-»ii]e<1ne.'<a nF tW ilelunons flrtlmnrily ilependK, nnl *o 
much on the patient'* hivvitig oiJy one fixed idm as on the fiiet Ihil 
the nunc ideiiiiCDiiaUittll^ rcpcatiMl b^liim in preference to an^ other. 
Pionlly, thceo reUtioiiR arc en^ject to froquent cbftngc. The sanio 
pBtJent, in thc> name. Torni of iiisnnily, cnti not only obange liia ideaii 
from one Aay to Auolhcr, but he ran al:*o to-dny renouuee fabc 
npitiious ujiou inanv points, ^vhiic, pcrhups, the day brForc he n'as 
deluded only on one ofL-ustomed fRVoritt- iilwi. 

The cttabtiahmont of a olui, monomanid (in opposition to tnanui), wliiok 
related Icii to tho eiiitetice of a single died idea than to tlio omsaidrd domt- 
niou of D particular impulBo (moiioiuiiiiU of mutder, of iboft. &o.), \sj leltiiig 
uidc Uic meet iniportaiit rektions, namely, ibc fun dun cut oL mcclj^l itatc, liat 
anited wliat i> outirardl; dittLi»?t and separated nliat h inlcniall; united ; it 
t« iiot, tbcreforc, to bo .■ii>j)rovcJ of. 

Originnll; e»tablitli&d by !i!ir|uirnl, und alvrajrt of more importancs foraiut- 
rntljr tlinn pntholngicnlir, tliii dnctrtne, even in the Imi of lis birtli, lia* fallen 
into Attntcof oomplot(> neglect. Itariod ('BludM etiliqiica >iir let Uono* 
mrinieii,' ?m%, iH^a), Moral, Palrcl (' Arcliivpi (icn.,' i8j*,4, Aoi'itl. and in 
finrt ulio Bricrre nnd Drlanimivc, iiavn dcdnrcd Ibcnisclvea generally afraiiist 
it ; more rreeiill;, boweve.r, (lie latter Ims candidlr moilidod his views (' !>(& 
rtcndonioiiomniiioB, on I'olic! pnrtirlios li'itPuBcs,' Puris, iH.-p), Smwcly jinjf 
Fi'cncli psychologist now maintnina it in its complete orisinai tonao. Tlic dia- 
ciisiitn in the .Sficit'lc M''/}ifOji>ycioi'(yiiiH'- mij be oon»Dlt«d on tliia siibjeol ; 
it, liowcTcr, (t(ica not olTtr imich real inforitialion. 

Tlir piirtial dclirJuTn, the government by a tingle delnaion nhieh become* the 
centre of all tbougiit, bpiirB many niialo^iea lo lliu oelusivo doininlaii of eoma 
particular class of iticaa iti hc&llli, or to lli« tenacious attachment to a faTotile 
theory vhieh to the subject of it is an element of hia very axut«noe, or to tho 
domination of certain jiasBiouH, u) lovo, jvalousy, prido, deaira for iileaaurv, 
avnriw, Se. Tlieje, in llieir liiglior grades, when they cupel everythinj ctie 
fioni tbo niiutl, arc ei^unlly destructive lo Llic nicntnl life, and mniiy r.ven in 
their ci|irf6si(iii, aa in external iliitracttoti rcauUin;; fmiii iitlernal cancrnlriiiion. 
AlTectation, plra*nre in niitvard pomp, pretent iiumeroua rcacmblnnret to the 
eorreapoiidiug furins of inannity. 



c. 



Anomatiet nf the Will. 



^ 4fi. Volition also presents in the inmne mjiny seriiius dcvintioM 
from ordinary etatts of hcolllij iia well in thcjse inltmid sphfrcj 
where distinct jwrception is transfornicd inio coiiscioua dlfoit as in 
tlioBe wlierc indistinul, Uiough not on tliat acfount lese forcihio, 
rlfurt (impul^) is excited through sensitive iniprrssiunB uoil obscure 
emotions. 



\ 



'J 



rnS KLKUKKTART DISORDRRS fK MRKTAT. RIBKASIt. 73 



I 



I 

P 



In liie Ant pUoe itaiid oppoM*! m extremes t totjit absence of ?oli<. 
laoBndrithaainomued.evfnimliiQited, power of vill. Wenkncua 
a( win may jirnrccd from inobltil^ to rortn conclufsions, ammg frnni 
■InggislUHM or pcR^pplidu or the mut or an /sufTiciently jiotrurfiil 
to debnninc volttion ^m an undefined perception, or it may dopfnd 
oe the iafluence of deficient reflex action on the perceptions. Thr^c 
lUin mnUhit tbemwlva in « hopotosa npathy, or in extreme 
InsUUoa, tnesolulion, iucapicaty to call up the occustomcd ini< 
pnlaei of tbft will, for example, to ordinary employ mcnta, aa<I arc 
vwrj bcqnaot in tlie first, melancliolio, stipes of insanity. On the 
ntlur hiod, abaeace of volition (in dementia) originntes from tbo 
ab»oaoc ol tiatr perfie^itiona in general ; irith loss of thought, voli< 
Itoa aUooMMS. 

Incnue of will takes tbo form of inordinate desire, a thirst for 
MtkiD, • ptaaioQ for forming plane, attempts to realise all thought in 
ttoH, tnlinjf pecaliariljr, powerful desire towards certain objects 
■niihr to tlio strong directions of the will conieqitcnt on the 
pMsions. Il ibovs itself cither u the frequent re-siilt of n weakened 
«tU, or it is reallv foundMl upon n feeling of iticrcflscd bodily and 
DMiUl power, very great viijmir, am! morbidly inereased feeling of 
self, Tbe last froqiiontlj appears in Itie fonii of Ko-called iiionoiaaiiiu. 

In georral, however, tUo morbid cmotiuns bring along with thum 
llirir oomaponding stales of effort, and llitw) are the inoni clear mid 
iutiaeif tbe morbid volitions are mon: special, in propnrtian to tho 
tKrtlBftiTfnrf with which the insane perceptions liave Tm\-u rarnii<xl 
dM of ■boUmu or lullueinatioiu. 

A> the reflex neti\itT of llie s]unal oord may be inoibidly exdteil 
b* mrsiu of certain ioflucneos (aa stijchnia], or on tlio contrary 
diinitiiihed, it is ih^ same with the brain. An eicnmide nf gcncrnl 
dfaniuntion nf the cerebral reflux activity wTiich ia found in various 
MSta diaeasea (very often in'typhos), and in nearly the same form ia 
amay nebueliolic and deiaenled stales, and in the so-calloil exladet, 
n i—antoil to us in tile ooiiditiou called 's/ii/km'. Of partial diini- 
natiaw tboro an numerous examples, but at ptocnt lliey are 
iHBwH' to deKne and to point out. Tho eleArest cases of inoroasoil 
hSk MtinQ art to bo found in m.iny conditions of excitement. It 
ti poviblc that such increase may depend on a state of tlic brain in 
wlucji tbe diffusion of the iinpn.-»iiuii (to another plac«) is hlnd^rDct 
Iff pm'cntML In tlic spiiud cord we Me that when tlic Irani* 



70 THE ELEKCSTAtT DI.V>KDEU Hf MENTAL DIIRABE. 



tuantax of tlie centnl ippuatai b internipted bjr a 

Mctwii, tbe ndei acta bcooBS atnagsr ia tbe port Uow tb« point 

ofKctton. 

AfawDce oT wilt iJi»S4) » ^KOKud bj LrabnadMr in tlv 
'ZeihcIirHt (or Psrchbtrir,' tr, 1847, p. 562. 

( 47. Of all tbc morhid dcsit^, the fioknl uit|Mil>«> to Bosculiir 
Ktirity, tu bodjijr morrniciit, u pftrticnluljr to be notiocd, as it is 
DeeOi eajMcialljr in sUil<s of mauis, ta b constant ueetaAj to it>ile» 
OMtlioii hither ini] Ihitlier, betting ahoat, )muniii^ kc, a state 
*hicfa fmiufntly involves the iujunr and deatmctioa of what » 
inlbin reach of the ptitnl, -wilbout hu Wrhig tnj iettate parpoa^ 
in iloing to. The patient »ccks and finds relief &ocn his intranl 
prfwore and tlie bonlen of bis fcdi^ hr ihroTiog them outranb 
($ 2j); thofc stale? in which riolent fwlings of aniirtv or ccrtnin 
^odnng- ideaa ur^ the pati«nti} to talce to tlie commi>i>ion of certain 
dcRniCr! misdeeds oome under tbe nme ategatr. ThJa impulw 
towards a definite cad, towards aomc decision of hi* painfal cud- 
dition, mAj bcconu.- so violent as to induce the psitcnt to the jxTpc- 
trntioii of deeds which in other iitates he would reatdatelj »huii, 
owing to the feehiig that thus alone can deUrenUKe and rest be 
found. Therefore, if we closelv es&mincj as we ooj^falj ncoonling to 
Ihcir motim, the several known eases in which (he incooc have 
manifcBtcd their ducnae by dangerous and lawle&i ads (manlrT. 
nuicide, incendtariam, robbny], we will tlicrchy discover the great 
differcnciM that exist between their respective fundamental caosts. 
We immediatcJj feci how onsatisfactor^r it is to arrange sach cases 
Bcn»dittg to the nature of the acta oonmitted, or according to a special 
impnise to moidcr, ineendinrism, suicide, kc, or to consider tbem n 
" pure difwiues of the will " (monomnTiia in the M-nse of lesion of 
one of the faculties of the mind, of the will), and that il is neoesMry 
to judge of thrin individuiillj nccording to the fund-trnvutal morbid 
Btatca of tbe mind from which they proceed. Therefore, the sereral 
impubei of thia kind rccut as motina Pomctimcs mcUuirholic, 
■ometimes mnnincal, sometimes partially demented, and we shall have 
Again to refer to them in tbe special consideration of these forms 
uuaDit^r. 



In locli trndeneiea la devise miocliicf, to tear the e1ot3iin;, to ilcilro; tbe 
furnitar^ to conceal thinct of raloe. to»tesl,fte., la also in manf orhcr ilraugc 



M 



THK KLEUKKTARr DldOBDKHS IN MENTAL DISEASE. 77 



MliMt af * bamtnt Ulure (u &[«>;» niulresaiiig), Ihe patieulaare Mmtliinu 
pnotplad oalj bj ■ j^tMrnl ntocstUj to dcftlnicti«D, in onier to fic« tlicmaclTcs 
■f tMr Ql-biraour, to feat Iheir nge, tataetiiaa by distinct motivcK, aai oul> 
bi l&e no*! nrc »•« UiosM ItiCM ut« be consideretl st purclj Rotonulie. 
Eilbci halladnations eitjoiii tlicn lo such acts or the cITcrt b; a TiotcDl during 
ind ts |n«eara r«)t frain iatenul anstct^r oc dvlirtous conccptiani jiropcr. 
XAr (' Benctkun^^n e<i GutaUio,' p. 490) reomJa a sumbcr of nuch cucsi 
■M Ua molircs girea bj Ihe patieDlt. " One of our patients bent out nil Llic 
■iriuia vilbta ki» rcMli viUi iIm grealut quietaeas ami oompo*nre lo procuiv 
chM for ttm fUlinit op or movse-holet, inolber tliat be mij^ht be able to coin 
Ofm Haiti* to bi* heart'* deiim. Anollii-.r dclibcrutclj tore ill Lit tliirta lo 
fian ia order lo colkvt liat for the militnrjr hoapltali ; atiotlicr look doint 
lb« tl«f€ to lifbt hit pipe, aaA High leiinrely replaced it. Another broke tbc 
eUira into pieces, and, iu aniwtr to mjr tjnution wh; be acted so {ooliMy, he 
MliUrd while quielljr proceeding vilh his voik and wltliont lookiog u|i, ' I'bi- 
Im^Iij Bnat coaqatt ■ttbetica.' " XtrcrUielcu, in ludi cesea no mutt not 
jjkai too inplictt cmUtoce in the pitient't account of his motiTcs ; ilicy are 
lAa tUfoMly ttHtfti n pmg their real moliTes. ftnd nanj such cue* 
nated M of Um aceiM in ShakeipttAre wlmro Fattttff when in a dileiuma 
■IviTs luweied "in itarebed lioen" (m SteiJ1niH») FT 

Wbrlber, aiid to vlint extent, certain directions of the n-ill ami 
iMpoIaei in the insane, [mrlicuUTty ducIi as lend to crimiiiBl nets, 
IM immtiblt, i< a question whicli can scarccl;' ever be aiiaw«rcil 
wilh cerliintj. Few of Ihc acts of Uic insane have the character of 
foned, P^i^y autotDatie oiOTemeats ; io mania nbo, according t<j 
tbe teatiniODV of inilividonb who have recovered, many of llie wilJ 
<ksim eoold often b« restrained ; tlie criminal deed? of tlte insane 
an not goicrally intliiictive. Tte loss of fr« will (or, if wc 
tbeowr. trmponsibililv), therefore, seldom dcpcnda on the fact' of 
itubOitj to liAVe abstained from the act committed, or that the 
ngrmil ooDditions of volitioa hare been completely suspended. 
"Ae MBaM of this lo&a of free wiU chic-fly depend on quite a different 
mmt, Uwjr depend ou violent excitation of the emotions, or on 
incDbcscaoe, od ftiae nttfoniu^ proceeding from delirious coocep- 
liocw, hallucinntioiw, &«., niid oti the circumstances mentioned in 

ta 11m ctiaanal acta of lUv iounc the ciicsmitnncci worth; «f minute laTca- 
tiptioa an wbetber tbe palititt maitifnU-d a vrailnr tcndetie; (■« to ilcnl) 
ena ut bealth, whtcU ia onljr mow ihowiag Sltclf when the power of ibc r«IUc- 
tlta li sa^tDdcd. or whelbcr tbe dcure (int aro>c with the iiitnnilj, and dix 
las reoonrji wbtther it rcallj proceeded from morbid emoltonsand 
ScalittoU 'OnCk-plODiBuia,' iuVacubiand Basic's 'ZeilMibiilt,' 



78 TUB XLEUEXTABY OIS0ROKR8 IN MXXTiX DIVEASl!. 

1837. 1 Heft. p. 179: HoJiMBtt. " Oi CfcplaBM h ," * OiiMbnrg ZeilxJir .,' 1 , 

To the aHufnUtion of tuch dc»r», U> the free discVonre of tutdeneics 
wbicli »n gcncnllj c«nceitl«d. to nrtain BwiUd unjiulMt, maj be reftmd 
naeb of Uie pcenluirilj wbidi diiUngaubu tho mndnct of the iaMinc. Kadi 
bi its snikigj ID lNslUi7)ire,ptnIj ia tlioMit«cii)iaJr kkbitiasd caprices whidi 
an M«uMa*Uy obaarred «a cnriwa ■pymit^M fa>p<*^ "** ettytic inlelletfa 
(vhifih fora Dm BitcriU* of tnaj ■Modola ithlcac (0 IcacMil nan), partlj 
M tfce ilitcetiau or the will and noda* oT aetioa of IIm panioas ud rmotioiui. 
I1»ae ia cklatl afcrd materiab for nanaroiii toai]nriao«a, and we find in Die 
pMtt arbo dwdl much on lite enwtioad italct i M M Mc mu uialogies bj vif of 
•mnple. Tlias, vlien lb« meboctrallo kaa tte Inpdae to lekt« bla bom«, and 
trnn in the open air becante it ippeara too conlocd for him, and because ho 
oipcots allevialkM froa his *Ute of intenul pain b; Owliranl dbquiet and 
ch*n^, BO Ibe aana appean >u cases of rtal monlal poin* when the BuHettr 
Bpewb hb life in Ihc open air, or eren ia dtitaiil Ixtids, in tbe trorld, in order to 
rseover tBtcmal cniDi b^ outwan! dixinietMid reatleaaaeM. EJchcndocff has 
well «x|)rtaicd thia disposition in one of his wclI-koovB loi^ 



Sbctiok II. — Tie EUmeniary Ducrier* <f Sttuaiioiu 

( 46. Previous to tbe conndcntion of anonuUes of lensntioo — so 
important in iusanitj — we >liaU conndfir the various modniii vliidi 
tlw general feetiog of illtUM \* manifnted. lo Uw msjoritjr of cases 
of mentol disease tkit feeling of illness is altog^cr absent ; 
generally, tlicrcforc, tlie paticiita do not fed ill, and oftcu iirntest 
agaioat medicd treatiiwnt. ludced, in not a few casea of atnoua 
mentol disease Uiei^ i», instead of n feeling of illness^ a aonso of 
cxtremo well-being, cf increosi-d budiljr jwnrct nnd vigour. Such 
palicnta (inuniac*) arv oflcu angr/ and irritated vhen anj doubt id 
eipneaBd as to Uwir perfect heallh, ai)d voluntarilj refer to their 
oxoelleut nppcti(c — uiorbidljr increased — to prove it, Tbis abscuce 
of llir fc«litig of illness \* observed 111 n nuiiibcr of braiii sflcctionfi, 
auiiiuiinc* after injuries of the head, nnd rcry commonly in aculc 
iiieiiiugilts aud ttic offcctions of the brain in Ivphus fever. At the 
lutglit of the disease, when intcrrogBtcd, the patient generalljr 
answers that he n quite well, oecasionftUy eren he nssures us that 
we are much deceived bj considering him as ill, vchile, vhen the 
dflDger is past and the sjnoptoins allevisted, there enters a strong 
feeling of illness, of deep depresrion and fatigue. This fwlutg, then, 
u gMMrally present iu couvnlcsccacc from these forms of iosanitjr. 

Tbcie aiY, on the other hand, other states of insanity where tlie 



I 



rnS £LEM£MTABr DIBOBDBRS IN MENTAL DISEASK. 79 

feelbg at iUaen is not only proont, bat aoems, ia retalioa to Ibo 
al4<etivB Bpmptocas, to be immsdiatcly increawd. Tlie patiuil is 
IhMfay deceired aa to the objcdirc facts of his stato of bodily 
fadinp, and iodalgo in faUe idena of aenous apncial di-tejue. Tlicro 
ia Iku fbnntd t diaproportionntcly strong or peniatcnt feeling of III- 
0^ B AnubnKntal etcitiviil. of Uic iiypoclioitdriaciil riutr, uid it is 
Atntitniio of Uiese that tlmr gcncTally arc Qot cDtiHncd to 
pMxaJ itapreanons of bodily discomfort, but, as tlio atteution is 
dinoted to tbo indiiidaal oigaos, di^ngrvrablc frcliiig<i arc nwakcnrd 
{b each f>r thent. Tbe aam« conilltiou itf t!ieiicrvou»i;<auri» is fuuiid 
in an acu(« nuinoer in tlio cnrly etagcfl of most scvorc fcvere, but 
tfav there ia no time for {he attention to bccuiiic fixed, onil thu 
o( illnns ia oooa justified by Hervro objective syaiptoiiu. 



4 49. Tbeio are, beride?, numerous other anotnalics 0^ the geuciut 

nUitj. In the Snt place, those extensive modiBcationn of tho 
MMtlioo of aelf which ordinarily nccompony serious nITection of the 
miod (§ 43]» and which establish tbe idea of troiuformatioii of the 
pmon. Tba paticnta renounce thoir former pcraonalityj and con- 
■ider themailTea aometimn aoinutla (wolves, oxen, fto.), lometimea 
hiftoricnl indiridnals (?fapoleon). Somctimr* the whole body in 
ooosidend dead, or as not really tbcirs, or as coinpnied aitirely 
d( inanimate substancea, aa vood, gluss, irnx, butter, kc. XI othci- 
limca the body is niiTcly fdt to be extraordinarily lie&ry, or to have 
aoqniird a very pt*i circnnifrrencRf &c. 

On the other hand, these anomalies of the general sensation aro 
niDCtinHl looJ, confined to certain parts of the organism. Tlii> 
patient toppoacs that ceitnin of his membi^rs lire wanting, or tlmt 
they arc not connected to his body in the way thry used to be. For 
oaiDpIc, hn thinks that be nu lon^r ha^ a he&i, that one of hia 
■nut or leg* is pettiUcd or made of glor^. Or be feeU ns if a certain 
part »i:re uncommonly large, and tho nose in particalar is, in many 
tatm, tbe olject of this illorion. 

Tbere are, beaidcs, obserred in tbe insane, as more transient statci>, 
aossliona familiar to many healthy persons in dr«amiag, of flying 
Ugfa in tbe air, of baing precipitated from a height, or of general 
giddincM. Sonutimea a veritable aura b fdt before an attack, oa 
^ ia brfore an e|>ileptic soisure. 

The MBt nnd the wore iminodiato cauae of theae anomalies of 



HO TIIK RLEMKNTAUY DlSUllUKllS IS SIENTAI. DISBASB. 

Ihe general sensation arc difficult to uiidcistund. In several cms, 
indcedj they depend — For example, the feeding of abeence of a pott of 
the body — ou evident nDKsthcaia, or more fretiuently an analgena of 
the orgm. At ttlicr times, liowovcr, the periplienl wnsihility of 
Ihe rutancoiu surface, and petbiipa even the KDsibitity to pain, is 
fully lunintnincd, and ohscurv tDodificnttons of the muscular aeaai- 
hilily, wliirh likewise appear to play an important (art in ordinary 
dreaming, may be the original disorder irhicli the cxpUuatory 
reflection luy^ hold of to foru djirioua conceptions, 'llic tratu- 
formation into animals appears to be much more related lo the mind 
in Us origin, and the buia of this false idea may depend on the 
Bjtpcaroncc and influence of ccrtnin instinct« peculiar to certain 
s|}ectes of animals, as tlie cruelty and ferocity of the wolf. But 
here also a marked de^Halion from the normal geni-ral sensation is 
always necessary to the full development of the ideal metamorphosis. 

Lcurct (IVoEin. Tsjclioi. mr la Folit,' Pwi», 18341 p- 101) li" ""■<!« ■» 
iiileTetting colkdioii of sevEral old eKoniples of tlie w)-called TfrantAnj>ia, and 
tcTcml cniei of morii ceceut ilaLe of ins&ae penODS wimdcring in the vuods aod 
csrrjing olT, anil ereii kiltin{[, cliildren, from a fierc« instiaci to marder. Wier 
ntrrtlci en exunple d( n nimi from I*«Ju& wlio^ in the jeir <ri4>* brJirred Iiun- 
■elf tTOuarormcd into a wolf, aiiiJ, «n tiic open plain, attacked and altngblcrcd 
(boH wlicm he met. " I bri rcnlljr n wolf," (sid lie, "and the rtasoa wkj ny 
»kiQ b not Imir; tike tliat t>i a wolf ix llint it is itvcrsed uitl tli* hain aic 
iUBide." To coDTtnco liimseU of tiiii iic made incisious in his body, and cut his 
leg* aud anna, so Ibat he illcd of the woondi. 

EiDinpIca of inasno pcnoni comidciing tlicmiclvea dead, and not recognbtng 
their body u llicir own, arc numerous. Eiquirol ineittioiu llikt, in a voaun 
who beliured tbat (lio devil lind cftnied any tier body, tbc aurface of Ibo skiu 
tras coinjiielHj insensible. Tliisnu also the case in Uie folloning utmpte 
tram FoTille. A solili«t oonsidered tlist b« had brcn dead siueo the battle of 
AtislcrlitE, in nliicli lie iras scrercly nouiidcd, ^Vlicn any odd »kcd hoir be 
VIM be invwt^ed, " You ask how fslher Lambert in, but father Lnmbcrt Is no 
more, be wu curried oH hj n caution loll nl AutlcrliU. Thnt whicb 701) uov 
■oc ii nut liim, bul murely a cluiimy nincliiiiK madu la rc^t-mblu bioi ; pmy aake 
anolher." ^^Thcn hu !|'uk.u of biaibclf bi- never uid /, but slwsjs i/. The ikia 
iH inM'nhihle, uid, ecvnrul liitics, atlucks of vurious kinds of inoiobility and in* 
wnsibilitv \\aic occurred. 

A youiif; tpiiepiii', vbo had sJio iiunicr^us indlucinali'oas of stnellaiid of 
taste, toniclimcs felt bis whole body of titcb an cxlraordinnry wdgbt thnt he 
cotild icsTctly siniid u|>righl, nt other tiines of incb li^litiicts llial il tecnit^d as 
if he rose from ibcfloomnd Hew : besides, liia bod; and his llnibi seemed to him 
to cttomcusly eulaig'ed ihat it vis impossible for bim to pss* Ibiougb a door.' 

L > Bullci, '£>iB]F on IlalluciDalifliis,'IjyoiiH, 1856, pp. 58-Hii. 



TOE XLBUKNTAB.T DISOmiBRS IN UBNTAI. DISEASE. 81 



k 



Ttondl sUtM then tn ilao inalogaei » Kate dueuex. A mcdintl rrimid 
hat fte^umtlj told me iliat he, in ercn »lif[lil fclirilo dTcclions, bu aIwhjs Uiu 
■mmUbo of rcnvkablo tnlaixcmcnt cf the limbs. 

A nnwTllifKtTit frMn fcrcr bdiOTed thiit li« vu raHj two penoit*, one of 
vfaoi bj in bed «bitc the otlicr walked aboul. Allhongli he lioil little or no 
■jflili. ytt ho »tc ■ great deal, becaiue lie hud to nourish two bodies (Lcuretr 
ke eit. p. vi). 

FkUcat* with panijns of senntian or one half of tlie bod; have sometimes 
It* idea Hat another p«fMB, or even a corpse, lica bcnide tlkcra in bed [Boiiil- 
laAi'Tait^dc fEnciCphalit^' Pari*, t8a,'3, p. C4). SacK false opiniom bc- 
iMftA tlH ■O'CaDid illnrioitt, toon to be considered ; fuilbcr oxAmplcs will 

bei*«kl«i. 

Hw •enaiioii of fljing in dreams appears to be doe to acoelcmtion of tlto 
iaiffamlwy fnorenuBta, ud that of being dnwn from a btiglit to their booomiug 
llm* (Onktiolet) ; Doncspoadiag imago* arc aasoclstcd vith these. 

All eansUertblc alttntions of the Mmmon seDBetion are alvays amonfpt the 
■Oil aportaal tlcmrnta of mental discMc IYIiod thiA gcncrAl basis of the 
boddf aauatioBt 11 falsiQcd, oorrcipooding fajsc Jdtaa ore fonncd with citrcmo 
aditj- neM aaosnaltu are always to be sperially uiTCStigated, ts tlicj 
fiinlah iadieajjou for tbcrafeuticol trcstioCDt. 



{ 30. The MuuthetiM of the insane Imrc to be considered more 
in delML Puainiilioii or complete suppressiuu of the j^umbUily of 
ibc altiQ to iiii)imsioiis of tanperaturc oad of paiu ia by no mcima 
frfqiieci, ftin lots 13 it |;eneral in insanity. We find, on the oon- 
trar;, in some instanocs an excess of scnsibilitj to pain (Ksquirol 
relate* aod) 11 caw), anJ it is remarked Ihttt in asylums in winU-r 
tile |iatiatt0, with Tu^ few cxccjitioas, cotiatantly awk the wanulh. 
Ncvothctoii^ cascR of transient aiitl penistent ciilaatuus autcstlicsiu 
(m alrcadj sbuwn in tlic foregoing ^), and of analgesia, are soini:- 
Unm tern, luirtictiUrl;' iu atalos of iiielnncholia and dementia, and, 
^'ff»fll!»w< to morre local limits, it is alio frequent in h};stcriu. A. 
carafnl isnstigatioa of tlie cutaneous seosibilit; in the various parts 
of tlic body slioald oiwaya be made. 

BediiNu (Siitiasof the Aoadinie d« Ui^toinc, aand Dec, 1S40), coni- 
iwafcalwl a ease of aeeidtnl wUeh ocnirrcd ihtough want of sensation in 
tha |ia>ient. A giaticnl In Bic£tce, wliil« no one was in tiie room, laid his head 
01 tie nJ-ltol iron of the slave, and put his irnn into the midit of tlic lira. 
TW ctrcngsnKll &nt drew llie people near ; the I'nticnt wa* quite uneonccmed 
■d Uuvngbowt pre no aiga of paiu, iLoagh tho ann woa burned to Uio 

Is the 'Zdiscbriii fur i'sychistric,' si, iS^, p. ^17, there is an exnmple of 
fOiulafj Hilf-btinung b) a molancliolic pntknt. ilevas quite happy, altliougb 
IffH tU|fc, sad ualaa were bunwd, ao that even the bonca were cbancd. A 

G 



B2 THK BLBHBNTABT DIS01U>£BS IN HBNTAL DI8CA8B. 

fotient in Bedlun, mentioned V MoriiOD, bud llie bick of 1u» bead vi»n tU 
Hie lill llie greater i«tl of lh« (vrebnl «i*cring|« were Iwniai ; fce, liow*»w, 
reoOTcred. Micb&t (' Qai. UebdiMii.,' i8s<>), citn » nunbcr of am ia wbidi 
mdanehofiea toftnd imttlRlioii vithoat pthi (loalgetui), uid it n intemting 
ihat tliu sUte ottva exists tbo {u Dtllrium Icwmtituun (atrrMum), »o lliat 
the p&lientt tear off the buidasei, wd dm moik itfuitaBij the broken limtn 
(Dapu.Tlrtn, Klote). 

Sncil (' 7icitxkn(t far Psjvhiitrif^' x, t8s3i Ji. 313). in ite foUenl*, fouiul 
Ueiliu(]uiteiinmtbrtteiii 18 (f), aodmfithcrcwM&stlgesiii; tbeitu»theua 
In slDt<3 of cxcitnlion ud doprcMioo vu proHat nlmiji in cua prucntiiig 
little hope of recorrrrj. A rery reaufk^il* OM is oonnmiuciUad bj Rnixudia 
(Uocon, ' Pajcbologic Morb.,' p. 31 j\ of a boj who lud kithnio coociiietcd 
bimseff pcrfeetly nil, and oil at «i»e alitbitcd Ibo vont dnirci asd most 
reprebnaiUe bekmour. He na net entirdr insane, bit tlie vkote cutueon* 
Buftoe became eeusationleH. TbU slate va> iDtermitteiil, aud «rlw« it vent 
off tlie patient bBcame a^fn qatts orderij and obediait. SinuItaiiMiiilf itilli 
tbe BUBntbcsia tba worst desires, eren desu« to murder, rctnmcd. Ia genet^ 
panlifiis. too, there is aometimes present an erident diminnlionof the cutiaeoai 
sensibtlitT. IMminDtion of the >«n«e of smcQ nnj l>c assumed in Ibosc psliaats 
wlio would uuso IbcmKlm «llh their cxcmaenti. All tboae uiatlie^ 
must have a oeutral basis. 

Wc soiDttimes htm the insane, rspcdally mdancholiea, compUin 
o( quite a difTcrcnt kind of aiucstlicsiaj irhich is more rclaled to the 
iiitellcctnAl, tnort inward, «et in sensntioii. " I tee, I hear, I feel," 
saj they, " but the subject does not reach inc ; 1 cannot reccdns the 
Btmsstioii ; it seems to mc as if there were a wall tjctwccn mc aod 
the external world," &c. In SQch patit-nts tliere is somelimes a 
(liminutioii of the peripliPTsl cotaneous sensibility, w that the sab* 
jcct« uppeu to tbeni somevlnt indistinct, oa iT rouijb, wooUr ; but 
this, when constantly prc«?nt, does not explain the phenomenon. 
These modification!! in the pereeption of sensatiDOS rather rocall to 
03 the changes vhich, in. general, our mind imdei^oee in regaid to 
the sensitive worltlj parti/ iu the various agc« of life, partly in iJic 
emolioaol nnd impassioned itatos. In the years of childhood we leel 
Uie vorld of vcontiire nppeuttDcea neaicr to us, we live iminediatdy 
with and in it, an intimate bond of a Hring dependence unites ns 
to it. Ah ll)e Kflection becomes nwtnred (his bond becomea 
relaxed, the interest cools, things appeiir otherwise, and we become 
more xtrange to the outer world, Although at the same ttmo we 
know it belter. Joy and the expansive emotions generally draw 
na i^n to tlie rxternal world ; r^erjthiiig creates tiiiew a lively 
unpicancn, and under the rejidy intlueuce of icntuoua imjires' 



TBX ZLEMBXTAftT DIS0RDB&5 IN MSXTAZ. DI8EA.BE. 88 



I 



* jo/ aserdMB m inuuodi^ and reinvi^orBting induciioc. 
"OtB eppoeite ia tba cue viU) ttie painful emotions ; Uie rs(<-nial 
■wU, Mumatc or iuanimatc, appears to hava become saddmly 
nid Md atrange j it seems ako a« if the objeota of cm nfibrtion 
w l(Mg« belooged to ua, and, aa BOthing can nor excite ia us 
a lir^ icnproanon, we Leoomc cvtranged (o «xt4^isl object*^ and 
■Ota and ■ore eonceDtrated in ouiaelrca (tsolation). Ad aiuloey 
may be aeai faEtveoi thac latter atatci and the comptuinld of ilic 
BMtanalio&s, aa tbor ioteiwhjr, their doiation, and their want of 
■ a rta l OMitive, urge the patient openly to complain of such chaogea 
ia Jiia pover <tf reodring impreations. 

Putlier euKipla of IbcM conditMos will be fbitnj is Uic diftptor on taelaii- 
dnly. Ia aaMbcT potat of lisir Ihtj no alsa laatcgooi to the fauLtnou of 
] im pa iitai doriogaletp. 



4 Ji. In Eoata(7, together iritli much diminitbcd, or alniost, or 
OBMphtdy Rtppiemd, eitenul aensatioiifi, there exists a strom; 
iolaaBl Gonotttraliou on ccrtiuo fedings, cicdoi of ideas, imogo, 
kt., aith gicit eleratxin aad teiieioo of the entire mental activity. 
This rtate ti maniTetted by a Terr highly emotioua] expienioa of 
iho ooojitemnce, in vhich there is depicted aatomshmeut, rapture, 
pain, aooocdiog to the nalare of tiie cuotloDs. It is gvnernlly 
aeeoBfiaided hy eonnplete losi of speech, iimnubility of the limb«. 
Bad oftea by a catalrjitic tttAtc of the muscles. The patients appiiic 
to be ({oite absorbed iti Uicir rtaotions, they generally ri^fufc 
aoniiilnDenl, and portienlarly does volition appear to be entirely 
piuilial*. Hkw atalca are not very frequent ; titey wmetimca come 
at praaarily after n vtolent shock, in h^8t«ric«l insanity, ia onaii- 
Ms, alao in epilepticf, and, now nnd theii, io oltcnifttion with 
TklcBt atUdcs of mania. Fasting, caoaes of weaknrsa of any kind, 
nni of aleep, oppwr to favour their origia. In the religious 
Bcrtaciaa of bygone times, of which wc have reliable iuformatioii, 
tboe cattaca appear also to hare played an imptHlaut part. 

Xha M^iiitktA (xUful semihilltj eombiaed vitli Immobility of (ho h6Jr> 
~*'*naa tfV> *ilh aboUlkw of hearii^, catutc tbia ooodUioa doiely to r- 
■kep ; narartbileta, it k tiuly a atate of wtkefuhwM^ with completa 
go eertain pawatwi douoecting aielaa of iileat or leualioDa, 



• "WaraBrioeli ilfacct mn tms (Ui All f 
Se^ekim flUub iciu liera nrKhlowCB I" 



84 TBB BLBHBKTAST DIS0SDEB8 IN lUDiTAL DISEASE. 

$ 52. 13ut the moat genend and roost important senative anoma- 
lies in ststcD of mcotal disease oic tbc haUodnatitnis sai ShsAxM. 
}^y lialtuciiiatiotis wc aDdcrstand subjective sensorial imager, vliieh, 
bovever, axe projected outwanla, and tbereb; become, apparentlv, 
objects and icalities. By as iIlu»oii is meant tlie false iutdprctation 
of an external ol)jeot. It is an liallacinntion when I aee human 
forms while in reality no man is near, or hiear a voice vlucfa has 
not spoken; it b an illusion when I take a hriglit cloud in the 
heavens for n ficrj chariot^ or when 1 believe that I sec an old friend 
vhen a strangfr tralks into the room. In Imllucination tliae is do 
external objects, it is n false sensation ; an iUusion is a &1bc con- 
stractioD, o transformatioQ of a peripheral sensation. 

The motive to ibis sensation doe* not necessarily require to exist 
ill the cxtmiiLl world, it may idso be within the special orgsuisin, 
tlierefore, the false interpretations to which peripheral pains (ncaral- 
gir, rheumatic} are Rubject are considered illusions^ as the idea of 
being t>regiiant, nliich proceeds firom QDoaual abdominal senaaUons, 
or tlint case mentioned br Kuriuirol} iti which a patient had pain in 
the knee, and kept strikiiig it vith the fist, cuUiDg out, " Wait, ;ou 
rascal, jim shall not escape me V 

Tlie dittliuctioti bct-iroeii lialluoinatfODS and illiuintk'i was made by Es(|uirol. 
It uuclit to he mamtuincii.alliiough it onnnut be luiliercd to willi jwrfeot e»ct- 
nets. In the touscs q( tasle and cutauconi tematiou mpcDially llic distinctiou 
is ofUn irapoulble. In tbe other senses, too, tlie view of illttsiooa as false 
jiKlgaivnlH is, in anmy cascB, too liiuileJ. Thej ure, iu lli« nmjority of oaset. 
Actual IraiisrorniBtions <if inijirciijiniu trtitiaailtt«d by tlie orgaiis at Bcase, 
when, for example, a porliait ou tliu w&ll appears to ri>U its Ofcs and walk out 
of tlic frtiinc, or nliicn tbc Yitago o( »a old womsn appears to be joung sad 
beautiful. Here interaal image:! are substituted for real perceplions ; it ia a 
miiLuie of laUuciaatiuii and nal sensorial perMption; tlic latter becomes 
ttiereb; IraDsformcii in tlie sense of ttic domiiuLt ideas and frames or mind. 
We can also ospross tbe rolatioa between tbem to ; llie Lalluciuatioos arc 
citlier qaitc eoniplctc nlion tlioj proriilo tlie entire object, cr tliev art iiiMin* 
plete (illusions) when to h real external object otbor qoalities vbicb it does 
not poascM nre altribatcd (Gratiolct). 

Tiie literature of sensorinl delirium is verj ricli. Eiquirol, sereral articles 
in ■ DietioDnnirc de« SciencM Mt'dicaleK,' snd "Tmli- de i'Ali^ation.' Safle, 
" Mpo). sur le» llaHaciiuitioii»," " lUrue MiSdic-,* Jaauaiy, 18J5. MuUcr, 
'Uebcr pliantutiacbe GfsiciitiersctieiDUngeD,' Coblenz, 1S36. lilut, "De la 
Tolie Soiuorialc," 'Gascttc Mfd.,' 18.^. Itird, " Thnt^Ulicho BraierkuEftiu 
iibet SianeatiinacliuDgcn," Tnciircich's Magazin,* Tleft 17, 1831. D'ltiz, 
" Ueber die Quelle dcr Sinncalftnaeliungcu" ibid.,Hort in, iS^t. I^eurct, 
■FragDieus pajrobologiquca,' Pari*, 1834. Boltcx, 'Snr lea UaUaciaatiODS,' 




mZ 1LK1IE!«TART M80IID8R9 IS MENTAL PIS£ASE. 85 

I^OB, iSgfi. hUn, * GeUteikrtiikbtitai.* trasilated b; Ideler, {. 1843. Higen, 
'On Wt— M»i iHBl io npTi ,* Lclpxig, 1S37, Bailkrgor, iu 'ArotiiT. Gja£r.,' 
t&^»•3. FUUnoo, ■ Ajuia]. Ufd. rsjcholc^.,' Mui. 1&44. Likawiso Ibe 
whIiBfi of Aniold, Real, BuUn, Hoirbaucr. Neumsnu, Fricdreiclij Jowea, 
AwJMbiall ia Hlii'i ' Xnitc,' p. t8ot Mqi), &c. Suiogowitz, ' Dit (iditcul«r> 
Hg^' BvBb, 1843. Uiefa£a.'Du Di'lirodcflSc&atioiiK.' Puii, iM- Bail- 
hl|v, "Do IbUnciiMJiaMi,'* 'Mi^. del'Ac«d. deUid.,' tome xii, Fub, 
llflli. Briane. ' Qet HiQnoiiutioBi,' ?>ri9. 1847 (><)d edition, 1833). I^ea* 
iMebcr, ' Otbcf die Eutcbimg doc BinttaliiDKlniDgeu,' J^erlio, 1851. 

S 55< IlallucinaUoaB uajr occur in all the senses — in the senses of 
ngfat, ]uanag, smcU, toslc, aad cutaneous scosibililj. Id individunla 
wwfiimw this, sooietiincs thafj frefjueDtljr several, occaiuonnlly all, 
tbepB nmoi setuoml functions are affected at the s&me time ; the 
btOudnatioia are real seontioiw, not mttt faacj. The patient 
naDf, end not mutij thinks that he hcarsj »ecf, and smclU ; and 
duiUd we meet the ecnsorial dehrium with arguments of reason, ve 
gcamD; rccdTo answers as Lcurct did trom one of bis paltenta 
[' FrafpDcnta,' p. 203) : — " I hear voices because I hear tliero— how 
tb(7 OTiffioalc I know not, hut to ntc thpy arc as disliuet nsyour 
ovn toioe ; if 1 admit ilic n.-alitj' of your words, you must ahtu allow 
niB to bcticTc in the reahty of those voices, as to mo botli ure equally 
appreciable." Thus, in tlir opinion of the subject of ths hrdlucina- 
tkin bis subjective sensitive pcrccjilions hHvc commonly the same 
mliiy a« tb« objodive percoptiona ptesentetl by tlie exlenutl worhtj 
and to this very drcumstnDco is in a great measure due the imjiort. 
nee lod danger of the piKiioinraa. We are accustomed to tnint 
gar aQaMB, to comidcr that as most true whifb we ourselves see or 
touch ; he in whom false senBorial pttrM-pHona ar^ <iubstitnt«d for 
tha«« which itc tjuc, mi the material of his idens and their combi- 
natiun thereby fuhnftcol, oaUsn a new sjihcro of appearances and of 
til«j)oo<L He cannot dtstingaiah thetn from the objective reality, 
wecor&ag to which he r^nlntea his thoughla and acts, aad in geacrul 
ft ouutot be fonxxl oa him by tbo opinion of a stiangcr; he if com- 
peUiHl to follow the deception, because to him it lias the force of 
■enaorial ooavietian, and uut only are the most crazy aud stupid 
idcsB awakaicd and maintainod iu him, but very often the mo«t 
dangerous misdeeds result from (he hallucinntions. 

tka aol^eetflr hsUaciaaUoM may, at uijr momeat, be inciud bj voices or 
tUovata taflkt violeaee «i Umclf or uilicnt for«xami>le, lonrntder id <on> 
I of having bad a coniuaDd from God to deed* or veDgeancc lot sbuiiro 





86 TUB ELBMKKTART niSORDRM IK MIKTAL DISK,\SIt. 

lu^oigo vkicli h« hu hetri, to. The nuJQrtL; ilao of Utc ctiaiH coBuiliail 
\>3 tko buM dcpeiul on bkUucinalioos. t eiranmiUMB vbicih. fnm Hit gtmi 
Uvpimcj of lialluoinatioDt, (s not to be vondeted at. Aococding to £M|<urol, 
80 in ever; loo palicoU have linJluciiuttiou ; Falret (* Lep. Clin, da ULU. Utal^' 
P**!*! ■^.'H> PS" 'SO S'"^- °' ooorw, « mneJi lower praporUon— tboui t 
tbird of tbc nnmbcr of the pftticnti. 

{ 54. SultJMtivc sensariid fnnctioa w in itceU uot estmonliaarv j 
BSBflBtion originating throuj;!) internal initntion, without extenuil 
cause, is ratlur an (rvcrjiluy oocurreacr ; our iimcr woild of :<cii8e 
is ever tHiire; indeed, at), even abstract, tliongbt is accoiD[>anie<.l hj 
in inwnrJ hcnring and seeing ns .111 evident cfisentid cIcmcnC or 
uormal mental Itfe. Dut the scnsiitioiis nliicli thus origitrntc arc 
generally VC17 weak, and tim is what (UsLingaislies tlteni from tite 
extcmtil perceptions ; indeed, during sleep, wlien the renwitioiui 
originatiiig intetoatly caonot be compared with i}eripli<Tal impression^ 
tbej ofleo unune for us the strength and the character of external 
ecnsationsj aJ«o during wak iug thejr may hy degrees become stroiigct 
mid mom active, uiid nt hist resemble realitj. TheM con.<^tiiutc tim 
patbologicAl states of irritution of tbc ncr^'ous ajFttm. 

Physioiogjr shows that the Dcrv-c8 of special sense react Icwnrds 
(ill irritjition nccnrding to their own inlicrent encrg)'. Tlie eom- 
pri-sstil ur cuiige^tcil retina gives light, the irritated auditory nerve 
sensations of sound, &c. Shall wc, therefore, consiilcj- liallucinationa 
na the simple results of irritation of the periphcrd cKpiuisiuns of Ibc 
carrc»|)onding ncn'c ? This is impossible, in the Ilrst phioe, und 
principnllf, because hull uciiiai ion:? can t^ist where then.* ia euspra- 
eion of tho pcriplicral sensorial function ;' and, secondly, because, 

* Tlie obiervatinnt of luiqtiirot u|kiii tlib pi^nt deaem to bo Aillf oem' 
nmaleatci). " I once find uudor mj ciiro an old mci'cliiiut, •mlva, nfier a vet; 
■otiTO hfc, wu aciscd wilii Ijlnck cnlarncl in bit (ottj-fourth year. Soma jtan 
AJWroriia he bcrjirnc iiitsnc ; be vm vcr; agitated, ipokc loudl; vitb persons 
vhom ha tliuugUt lie »aw luid heard. He saw llic moat woutlerful Ibinga, aind 
wu often (luitccucli^iid with bit vi'tiant. There wu in Silp£t*iire a Jewot, 
aged thirtj-fisiil. wlio win blind and a mnninc. Norcrthclcjs, tko mw tlie 
straDgc«t \hwgt. Site died indilratjr. I found on ciaminBlion nf the body 
lie Bjdie Mrtu aInphitJ in Hfir mlk/t aurtf. C«rtainlj, io llii» cuo, Ctanii 
uii»icn of imprcMiont wu uajviuiblc. It it the muiio vritli the dutf itIio tbiak 
thej hear i>erson» spcnk. We liare nl prMiiiit in Saljirtni'TO two wtimeu 
abaaliiltl; ileaf, «lio lisre no olhftr fulu idooi [liaii llinso of bearing vBrioiia 
penoii*. with whnin tbej (lia[i<ila night niul Any ; tlicy often boooine area 
rprious." (Ktquinil, ' Mnlndict Mcnttloa,* vol. 1, pn^ 19^-) Uora r«oeiil caiet 



THB KLKUF.NTABV DISORDBSa IN UKXTAL DISEASS. 87 

Mmdng to all koovn tmct, hj direct irritation «f tbesc ucrvcs— for 
flnnyle, Uie retiiu— Uwn can be produced &ta\a» of Ugbt, globi^s of 
nltrarei] iinagee, &c.> but no definite complex forms (ioru, 
trees, kc.) ; in tlic enr u huuiiniag aoisc, higli or low soonds, 
;iK> fonaeil words or lanes. For the Inttcr, floiiK^tlitiig mure is 
tumely, tlic oo-openitiou of llio pcrr«ptioD, from which atono 
lotvu^ retAincd from former impretuoim or produced anew, 
woie. Tliii projcoiiaa of tJie jMsra^tioiij bj vldcli tbo corre* 
' wnsorial images vnltr oar mind, this penetration of the 
•eiuorial fanftion into the pntvption, hy nhich the latter 
llir ajipeRnuico of tltu lu-iisatioii, we have Ictinini (^ i8) to 
ns tho function of tlus imagination; but while, as a nde, 
UxK BcU arc sucli that in tiw. fidd of vision onl; itlcal outlines and 
fumt* ariac, oon«e<|aeDtij' onl^ u'atkoiiod f&dcd images aie conserved, 
•o bcrv, ill pusing tliroii^lt nunioroui tnmsitions of vtrenj^h and 
nticiljr, tiie peroeptioa awakens ttjoag acoaorial function, so tliat 
oolj tfae Uiiogs Imagiitcd arc really dear oiiJ culuuml, urticulate aud 
■f1"4l" "' Tbe seat of all these acts, the scat of Llic iumgioation, is 
DoC ihf) retina nor tbe raniificatiotu of tbe miditorj nerve; it is 
vithiB tbo bmia, aud doubtless it is the ceclrat expansion of the 
nerres of seBM; therefore, in nccordancc with important oliBcrvatiotiP, 
•t mast consider hnlludnntiona as intra-ccrebral phenomena. 

But this dou not rxliniiat thr (|uc3liui) ; then: are miinyotbcr' 
hda — all apecUUj evidnil in balluciiulioni of sight — whicii indicate 
that tbe peripheral espniwions of the nerves of wmsi?, when intort, 
an: ooncvmtd ia scuaorial dcliriuui ; ou the one hand, morbid aclLon 
in t)ir tjf, {nvolvjng tlic ictiiin, ap[war» to onginiit« the pruducli»n 
of halludnatiiiiu (or rather iUuBiona, which in this case, hovcrcr, 
CMUMit bs distiDCil; M-pnntted from tuillurin»tions}. Tliia is cs\k- 
cUl^ieaibcascswberv, with opikcit}' of llto transparent media of the 
^c, ludJiirinAtions of sight exist/ mid vhcrC it would appear tlut the 

■tf liBlliietaatim bf licfat with atrapbi and deseneratioo of the optic nerve 
ban l«cn puhliaheil t^ >ToIiiiioa (' UeJ.-Cbirurg. Beriev,' iVj6); Romberg, 
' XerreakianHieiteti,' .inl eJilion, p. 138); Berpitn (Gatlinger ' N'utiir- 
faiofcai riiiaminlopy,' 1(1541 'I'tjcbiotr. Carreafi.-l>l,'i,No.^B4!!l);Leabu*c1ir, 
I. c;, p. 3J. Cslneil uul h'unila bavp also ohMrreil tuoh cam. Ttis reixnt 
of ike Vienna Asjiam (\Vira, 1858, p. 46) coiiUini two etuo hIi^mt, iif 
WwIbom or OBo eTe lkrou(|h attopllj of Uia glolx. tlie Mulo liBtlucinations 
kIWtad tba diMued t* the beollhf tjc. 
I* 8t« tkt wrU>kixivii c&M! rdnt«l hj Bonnet, (' Kstal Ausljrtio tar I'AmCt' 



8ft THS KLEMENTAttT DISOBDERB IW MENTAL DISEASE. 

iDiagtantton icizea upoa tlioso iodiMinct, diesolviog, douily iaugM, 
wlii<')i liie rvtiiin receive* rs material bijonging to it to tnnefonn 
tbcDi into iinagiuarjr combiuatioiis. On Ibc oUior hand, however, 
those cascp, b; no mcms rare, where ballucinations of siglit can be 
maile t« ditntpjii-ar hy roveriug the ejea, diow that tlie iutaci retina 
can tote a certain part in the ]>rodaction of these phenomena ; some- 
times even vrhcrc tlic asGS of vision are oot poralk-t, tialludiuttioiu 
arc seen double — at all cvcnis, there arc case* wlicrc ballucinnliona 
exist oniy on one sitle. MiehiSo mentions sach caws ; I mjsell' have 
ob-^crred a ca»e vliere halluciDations of hearing coDlinun) doling the 
wliolft duration of tlii: iiisaiiitv, and wcnr only of llic left side In 
tli« cases communicated by Kicscr {' Zcitschrift fiit I'eychiatric,' x, 
1855), of halhici nations of liearicg of many years' standiug, the 
majority were of the right xido ; sometimes opposite phantasms of 
(^ifTcrt-nl senivf, such os hnJIucinntiom of sight of the right side, 
with hallucinatiotts of heariDg of the lefl side, arc seen. 

Cues wlierc tlie ImlluciaJitiuii* of iiglil cciued on covering llie rje* m 
tnnn-it in coii:<idr»l)lR nurnhcr. A J'nuQjt man law mtvnad him all llui per- 
soiingca of II1C court ; lio ilircw liimscir at the feci of thai oiic wliom lin oon- 
udcrcd the kin^ -, I nllnvMl ihn- eyes to be botiiid for two dajrt, and bit ddirium 
ccMCil. niicntLc bnndnE^s were ttikcntnay itccmmciiDedaaDW'. (EKfuiroI.) 
Heil (' Kliapsodies') relates. " A yotiDg lad; who saw apparitions ami moiiitten 
r«ll into doliriuin ivitli CDnvulsioiu. Ucr nmiJ, in order to maintJiin lier in 
the iiprixlit position, laid her hand u|ion llic cje3 of tlie patient, wlio at onoc 
Cftllcd out * I tiiu benlcd V This vm repeated next daj b; Ike [ilij-sician witli 
t!io taoiD reetilL" (£»(|iiirol.) 

"D — , nt. 75, meutally henltlij, cune Lome 0110 day terrified by a llioutaad 
vi«iou» whicii fulloKud liim. ^heremr he looked llui objecls clianj^d thcni- 
Mtvrs fiilo frightful images ; mmetimes muinttroua tjiiden wliieli Kru|>cd at 
him in order to tuck hit blood, sDmctimcs loldien witb ludberds, Ac Tcuesoc- 
tiun vni purfonucd oa the foot ; aliU the hallucinations remained, aiid ho coald 
uot tleep. A bandage wu liiid over the cyot ntid II1C7 at oiicc cciMtd, and re- 
turned Its sooa ns the bandi^ was rcioOTed until tlic palicnt conlinucd it« ilsq 
without interruption for anightsnd part of a day. He now taw Ihcpiuui- 
turns only at long iiit«rT»,l3, and after a few ilayii tlicy tolnll; disappeared. 
Sincothcn llicinou has iciDuned hradUiy." I'BdlcuiidcTticrapcuti^uc.' 1S41.) 
The visiouB ot N icolai also disappeatAd on stiutliug the cyet.' 

chaji. 1,^), of n perron wlio liiid Imlli oyu operated on for chlitract, and rould 
only dislinfiuisli objects vith the rigiit eye. Ho had the mo&t tively lialluciua- 
lions of aijfht without believing in their reditj. In thecsM of a pstiont whom 
I MW iu Titl)iiigen there was cataract of t)olli eyes, and his insanity was cha- 
rBctorisedaJoiost entirely by the nioit masifold liallucinntious of ai'glit. 
' &eo tUso 'Lcnret,' loc. cii., p. 147. 



TBI KUIMKNTARY DI80RDF.RS TN MP.NTAI. DISKASB. »9 



not CHCi, whid are Lhe opposite of bftlludnalion* in th« blind, miy be 
npeU ■• illMJoaat whenbf, bmrcTer, our plijiiologioal Lnawledgv of Ifaam 
■ Hi BBcfc idnnced. Tbtj amj be vieircd a> a ceotnllj prOTolcd uintiUa- 
HMi l»1ltm>Hon of At ntbu sai&e« ftoeording te a »cli«in« givtn 1>7 ths 
■■gintios ; ikit Tie* kw, Indted, It* cUiBDuttiw, but is also tuppartod bj the 
ba Hot ntrnxuidiiig objecis ate often seen througli Uie pbaolums of tight as 

1W tl la potcptiaoi whicb give fonn aad bodj to the Kjuorial fuactiont is 
' akovB 19 tb« dreoiiwluee that eatmn obeerrers can rolimtaril j c*Il 
I MliMiiiiliniii. that is, that dcfiitit* »nd liwi; iAcm, previontl; existing in 
tke (tele of ewMbttineBi. first excited the tcasorial fnnctions. An iadividual 
«bbaJ ***!"■*"** "«™ "f bmriog rem&rlcd ihat Lc eaM liioseir call tarih 
Urn wonla wUeb Uie mtccs subscquextlj spoke, and this aided tiijn la recofc- 
n>ag tli^ M dcceptkini (UdlaudL ' Chapter oa AlcDtol PhjaiolV iml ed., 
p. 5*). The oonuDunioatioiis of Sandran are also rery remukobie (' Ano, Ui!d. 
hijeiu,* Tti, ISSS, p. 542} regarding tpecinl halluGinntiona in a diiease whore 
the tpcoal tboMght*aDid requimneiilB verc beud as voioai. The voice an- 
mred to ncatal qQeslioni of the patienU ns a third pcraoc, bat alwaja rcplicU 
IB Ika MS** of bia mbo. Tstdligent patienla also often tell tis Ibat at flrat 
Har MB a|Mkca lei<kallj,"inait«Uj;" it is not till a later period that tlio 
Hkm tnUj beoooc tudiUa. 

CMalsolMn«ta1iaToqnMt((Hie3tboidDBol tbe inuginalioa being the caatc 
•f hlBMiwlioiis, by calliog attcDlioa to tJie diftcrenoe which eiiata between 
tken nil (lie nmp\e faociea (Lcurct, Ihgen). Tbia objection fails, innfmucli 
la «c (t 8) couider Uie phcnomcaoii of the imagiaatioa aa being odc of the 
(aBebeea of lb« iatenal auuorial appantus, but differing from the others ta 
ataagtb (ace Hiikr, loo. cit-ti. 5). 

DwbtlCTi there ia atiil a great difforeiice belneen bb hallnciiiiitton and tlinl 
toteml toeitatiaa of the imaijitiatioD wbieh, for example, the nrtiJil has in tlic 
cooBiptioti of hia Tork of art ; tbe baQucdnations are coiiudered u extcrmilly 
real— l^j arc ia the cje, in the ear. It maf be aaked, ta this difference tbore- 
tan tfteJit, or b il out; in affair of degrees ? In tbe first place, tbcrc voald 
ba m the hallneiiurtjoa the ecMiptntioa of a tpeolal act, wljicb is wnnting in the 
M.«aUad cxeitAtioB of the iiuguutioii. I eoosidu the assumptuia of simple 
.^jlHrrfT** in deficca u tbe correct one. We aee from the exact doacription 
o( that Mlnoiaatioa*, wfai^ the iuaac give us, that thej ituj range from tha 
mH Med uii Aadovj appcanuoes ercit to the greatest KOtuoas viTacil; 
aad il ie not w mtj aonial fur ailialio exeitatioa of tlu imaginatioii to pro- 
oeed t« •aaioou appcansots, aliboi^h thrjF bo Ugbt and pale;. 

I hn« ■Mit in tateretUng tnufonaition of that obscure, pale, iutemal lial> 
iBlliilTnii, »Ueb aeoosnpaain peieeption ia onlinaiy states into IiallucinatioQs 
•Hh ml objociive diitipelaBW.ia a patient who was exttaordinohlj rich in vitioiis, 
■Bl«Migbt«iliii thtsiL He often spoke of them, sajring that many of liia appear- 
■acdC^atedvalfitottt^une, without coloiir; others aa olNc«ra,elowlj images; 
md Men ai lively eoloured iaiageB, full; comspoudiiig to aotual external objects, 

Ulol abo (lue. etl.) vet; ootrectJf call* hallueiiiatioiw conplclo tmufonns- 
liaM of tli(M|h( tato exlenal tenorul iin|iiewiOD8 ; and the auTec ii toi; 



BO TRI XLXmXTABT IliaOBDBBS IN XIMTAI. DI8I\SX. 



ripifvat mUck • ndiMMia im to Eiqwrol, vk» ipoks to Um rcgu^iog 
lb* Mmmm of kiit»H«eiBaitJeM cCbauuf . " Dnriuc conTetulkn he Hid to 
as > Do ]«M tboJb Mtawtiae»r ' Wiliiout JokU/ nid I. ' Vnjr vdl ; jwi 
Unkqoilt qiuUT.ndl— Itluak^Md.'" 

A»i nt eUigMlprtii»t«4>i 1 htra ygwiow^y leB lw^ed (s niajinl sluiluiO, 
vbohMi Ihininhniit fc-w— — n^r--* tka kAndc datiic ariofent altock o( 
imuity, bid iht impRCSiQM tkit IW Toieci did not eooH ftcm Ua unuedkle 
Mig^boubood i ba hai Mtt— Icri tfatn U a <1ii*«Di» of aerenl uniitM. lie 
llw nade Uie rvsufcahia dwIiTUJoa Ikat In eoold I9 U* bellj auKna voluu< 
larilf aa ia JBe aoc aa tba InBaebMlkoa oT hMiiny . Oa eloaer niTCaUgaUcn it 
wu KM Uul ko Mol tke ctapitaiorj ftiaeliaa oT Uia abdunioal muclai. aad 
tkkl il va* bj lafiM «f IW rMpinlMB Uut be exemted Ub iaflaanea. Oa 
iKiUiac Ihfl bnalk Iha njoai were ottoi chuged-— apfieutd to coom from a 
MiataBanror wm iBrtuL W« fcaow Ihatia npintim Iko etnhro spioal 
ihdd ribta from tha tpinal caail iato Ik* aaiiliat of tie linda aad Mbaiachnw'd 
■paoa (pmias to tbe tUng of tke nuDcna* fcaooa pIbxbmi of the caul of tlie 
qiad aiarnv). aad tUt b afku Mbttdea daiiag iaifiinilMe. 

i 55' 1''"' (liTemtt bebarioar of aa indinduaJ in regard to hia 
hallocinatioiu may depend, in part, on aliglit difftrfnces of a oeiteiB 
kioi), ia tbe atra^ltli and dwnuas of the laUc poccptjoiia, compaitd 
wiUt objcctire couoria] inpieaaioiDs. Far more infloeooe, however, 
ii exerted in this respect bjr tbe >tiite of the ocicbnil functions 
general];, in ao far as Uie; jicnnit a greater or leoa degree of 
reflection, iui<t by llie ilegKe of fduention aiid tbe former views of 
life of the pfltient. 

IlaUurinations arr uot CDtJn-i}' cnntlncd to slatci of tncDtal disme. 
It ia well Inovn that in dimins — to which we shall again refer — 
incbrintion, vertigo, and analogous *t«t«f, pbanlaana of tight are 
pmluoed. But crni exclusive of tlicse states, hallucinatloiia nre 
not uncoinmoii in [lunons nut insane. Tttc wcU-l;aovti caao uf 
PJicoIfti, the fact before quotwl from Bonnet, several of the caac* 
raentioned by pAttenoo, all religioua riuons, &«,, are c]uiui>iui of 
thui. Nothing would b« more erroneous than to coimdor it man 
to \k mentally dtveavMl bfCanae he hod hnlltirinntiDDS. The most 
extended experience shows rather that such phenomena occur m the 
Uvea of very ilittinguiahed and highly intdlcctual men, of the n)09( 
iltfTcrcnt tlisixigitioiiB and varioat oaala of niiud, but eapcdally in 
thoiie of uarin and (lou'errul imagination. Tiuso, who in presence of 
Mnnco carried 011 a long cauvenaiioii with hia protecting spirit — 
Ooctlu-'s wfll-kiiown (blup-groy) virion, and bis idciit flowers with 
tlieir eiirious buda — Sir WiUier Scoll's ap(iarition, in nhich iiia dead 



mi KUUtEMTAKT PISOSnKRS IK UEKTAL DISEASE. 91 



bud Bjrou itooil beforo him in tlic fulil« uf a curlAin — Joaa 
Pudf vIm mw tlto hrAfI of a Utile giil luuliiug ilomi from tbu 
wndow* — ^Bciivcnulo CcUiiii's vision uf the suii — may serve m an 
ouBpio ffOiQ the life of artists. SpiBOU,' PatcAl,^ lud hallucian- 
ij Vail Ilclmoat saw his own soul in the form of a light witli n 
couiileiumee ; Aoilral* tdU that he himself \utd an halluci- 
. o( light, und Lcuret that he has cxpcrieucvd a phantaim uf 
kctring.' Iiidrci), juJging from whnt wo Iiavo heard an<l ohscn'cd 
W thw fubjeot, tuiiluciiuUons doubtJces occur abo in men of very 
■icragc mind), not aa rare, hut as fre^uenlli/ overlwkcd phc* 



Ttit ma who is inenUlljF hratlhy eitlicr views mch Uallucinations 
rU nplpnnwM and co)iiide>ntioii, because he reoogniaei tlicm as 
"ngi"fl'iftg subjectivcilj (Nicohu aud oUicrs), or he U'Uc%'os ia their 
nalitjr, oilhAr bKaoso tia reflection does not ])omc«s tho iiicuiian 
iiy to judge of these plwnoaieiui, hecauiie superstition, 
n of thought, love of tite umrrcltoiu, obaciirc anil restrict 
Ikir oorreot tDtcrprctation; or because certain di«|»oidtioiiK, pofsioiis, 
■ad emolioiu (fear, aiigerj jo;, &&). susiiend refloctioii and cnlin 
nwiiitw^l inn ; or cvoq bccatue the; arc borne out bj halliicinatioiu 
of aa«v«] MnteSf of ugtit, of henriiig, of outaacous Mu*ibilitjr, and 
Ihiu tbo mraoa of rcctifjing one of (Ji« errors is itself tjilsi£cd, 

BaUoWMtioiii •looo, oven vIk-ji considi-m) true, am not 
loSwot to constitute itwanit/. l-'or thi^ there must aUo esiii » 
{cnenl profauml pcrreraioii of mind or fully devdoped insane idcu. 
In ocdcx, liowBfCT, to causiiior lullucinntiuiis as true, it is nccesury 
ibat, llwaks to tbcin, the vholc of the healthy !«!iisuri.il pcrceptiona 
\» ytmtUA I uid UKwforej hnlliuiiDKlWDSj when cotiRidtircd as trtu^, 
nK of fltncw^ ■ Tor; near itep to insanity, antl especiaUy vharc ft 
, pMTtniQD dready ousts. Ia \he still modciftte ooDunanciiig 
of iniantty iha hatluciniitions fix nnd root thcmsclvui so 
flHiljr that very often they are then considered as causes of the 

' Job Wul,*mimp«c» into tte Draa^wofld,' 

* •fisM. KrliUe XXX to Fotw Balliag; 

* X««r aftw a dsaBMatis faU from lbs bridgB of Nmlllj Pates) m« an tbjM 

> • S|«cmJ Fhtltolog;.' 

■ 'rngwiitriyabokc'iK 1,15, 

* Kor furthat «»m|ilM of tialliMmtiou in liNithy psmuiB, wto LkIt, 
'Intsctn,' p. »3. 



02 TUB ELSMEXTAItT DISORDERS IN MENTAL DTSRASE. 

enttre diar^c. According to our opinion, it is only in rare cases 
that we can assign la tbem this poMtioii. Wc belicre, rftther, [that 
halludnationg ranft be connderKt aa srinptonu of alrendy existing, 
although peihapit still moderate, irritatioii of the braia. At all 
CYCut«, however, the fact U conect, that they verf ofwn appear in 
the first period ot insanity, and that withi the appearflnot- of 
hallucinations, with the falsifying of the cxtcnial irorld, the patient 
fircqucutly first begins leaily to become delirious. 

In mciitiLl (lisunsc hallucinations are almost inTuriably considered 
as realities. Slill, in occasional cases, especially at the commeiiw- 
inent, the patient admits tlicir morbid nature. Sometimes, indccdt 
wo bear the patients declare that thej know very well that it is no 
ordinary hearing or seeing, it is a mental hearing' — some one 
''composes to him iii bis bead," &c., or he complains bitterly that 
the malice of strangers, the medicines wlitch he lias taken, Stc, bare 
caused sueh wicked appearances, and he expresses in his own 
prculiar way the idea that he is governed by aowfllung in bia mind 
which is opposed and perfectly foruign to his /. The most rc- 
mnrknljle case?, however, nre those in which the patirait knows and 
can givo the subjective on'gui of bis liatlucinations, and yet considers 
tJiem as rcahtic*. Sometimes th<.-y say that the voices proceed from 
within their bead.* At other times, and very frequently, it aeeias to 
the patient as if tlic voices pri>ci'cd from the rpignstriam, and as if he 
were spykf n to from there — true, not in the ordinary manner, but in 
quite « new way.' In all such statements much depends on the 
prtJent's capabihly of self-observation and of describing his inentnt 
state. 

In mental disease hallucinations arc generally at first circumstances 
of great aflentioii, and very harassing and troublesome to the 
pftticnt. After a time, from habit, they become less cngroMing, but 
they often attain such a degree of indeiH-ndence that they rcmiun 

' Also ShitkiMpBBre tnakoa Hflmlet reply to Uoralio's qucslloa where ho ww 
the glitut, 'Til myniinij'e ejc. Ilomlin.' 

' "C'esl iin IrBvailquisofait dans matfite," Lenret, loc. cil., p. 161. I (00 
Imn seeu such n cue. TLo jiaticut licani sovend men speaking logctlier in liia 
bead ; he sometimes also ttiftugLt tlint b wjiolc labltrfal of persons sat at meat 
someatlierc iu. the udgliboatliDod of liis eudiac regicn. 

' Leurot, loo. cit., p. 177. la aaotliercasc (Lafiugae, 'Quit. Hii^' 1S41, 
p. 713) tite hailucinationi of lieoring came fram the aciglilKiarbood of ihe 
heart. 



ntX KliXUEKTARY D180BDBBS IN HKNTAL DISBASK. 08 



I 



I 



■ibtcd after the disease lias niu ita count, imtl may impede tbo 
tmpkte tetnrn to mental bcaltli; omng to their halluanationj), 
klio, sDch patieuts avcud all iiit«rcoarse with the irortd, and 
tWdbra (all into o slate of mental poveil;.^ 

ffe ifatU bcre mcnlloD a few exuaples of bsllacinBtJoiis oocumog ia 
■Anfaoii Bol i&»nc. 

Mr. B — ODD daj vu rcadin]; Conunuio's 'History of Dnrfpuid;' Looking 
lOTwdt tltft wiiwlov ^ saw a slnill Ijiog on & chair : he Ibougbt cf calling out 
h a^nravbo kud put it Uieie, bat Iw lint nc&t lownrda it k ocder to rinxiiiito 
i. Aa la p«t ont his hand to gmp it it dltappearcd. He wns tcrriQcil 
ilaott to fiuoting. Toortocn Hnvs sfltmnrds be again taw in a lecture- room 
hika College at Edinborgh a Kkull Ijing on t!io desk, and iiaid to tiii neigh* 
bear, " WhU will tht profeiaor do witU a skull to-dny?" Anotlicr time Mr. 
B — VM pw-wat at Ibc poft-QsOTtcm ciami&atiou of a (Hcnd. I'hrcc montlia 
ilbr, when gcing to brd. be foand an inritation to the funeral of the molber of 
Im AviiJ Ifiii^ OB Ibe table. Scarcely hnd be put out the Light «bcn he felt 
Vm0dl aeiud b; itie ann below tfao sliftul>der, and it prcsKd atrongl; against 
bb aide. He aon^t to free himicif, and cried, "Let go rnjr arm ;" lie then 
hdridiMiaoUj aTO>oc^"B« doI afrud." HciiniQCdintdjaiis<irrrcd,"Mowine 
to (liiks K li^bt.'* The ana was theo act free. H— rose, but felt violent tertigo 
n4 graat weakaesi. Wlwa be liad Hglited a Iftinp he saw the countcnaaoe of 
Ui Umd al tbe door, but it waa indislincl, u if a veil w«rc over it. As Ur. 
D — apfnacbed, the llgtirc withdrew ; he folloiTDd it don a the step to the 
oatirdoor. wbcrc he fcU iu aMiting £1. lie waa aftcnrarda scijicd with 
I ill hill |ia>a OTcr tltc e^brovi, fercr, and alccplcatncai. 

A 8mth«ni«r iu the prime oX liTe and in perfect health paid n viait ono daj to 
a Miffclaiin Aa be waa eateriag the dour there passed before him the t^um 
ti % w«MaA dotbed in vliite, and tininediat^'i; a secoad. then a tJiird. llu 
•bitaU Ml Ui hand to tciu the last, and it diaqipeartd. Shortly after, the 
■■• waa valkxnc tbfvagk a park in which be aaw aevenj auca f,iiu;iug ; he 
wiiliiJ to pait one of tkcmea tfae bacJi, and waa mack snrpnacd wbou he fouud 
Ikitbe ooaldfedMlthi^g; ttej itill leisaincd before his ejo, and he several 
Mmfm a nla repeated the aUorapt to touch them. 

Tit Ulowinft caae iffmis a atriking example of Dumcnua balluciaatioits and 
OhaitaB in a hmalie, and sbowa bow falie ideas originate from tbcm (Ber^anu, 
" Bawnks of a Peraoo, who had been tnaaaej on his Morbid Ucntal StatCi" 
Mediidi'a 'Aichit fiir Psjcliolt^' 1S34. i. (>■ 15). 

" Oaee there wis a stono, but tneh a atonn aa [ have aercr seen before nor 
T%a elooii appnued lo aae to be waves uf tho sea elerated kto the air, 
Ifcey foagbl with each ether, while an enemy's !l«et eommenecd a niortal 
wHk the loliabitanta ; this wtt* the decisive incniioiit for the salvatioa oZ 
Udfai^ «Uek ajipeand to ma to be already ccim)ilctdy lost I heard uu lliiui> 
Jii^iKWM UgklniiVtlmt aawthafla^aaef eanooa and heard their load reports 



1^ 

■ itenl 
" ii,.ja_j 



M TAE ELUtnVTABT DI80Bi)EIt8 IN HEIttJlL DISEASE. 

nfUif MMBmS^ mtk Mar, Alkrmwtit, on trnftpBg nj Uboi uul i 
oaietmy fcn, I nw m eitnordiiuij ^ointitf , uid ilao i Ublr-ooTcr «bM 
had bam laA IwhwJ tt C— . A.^ oo vwUcr <U;, nun; tUn^ vtre 
vUcli IMiend Ikad inny budi, Itbo<ugHUM7mtiitkiTcbeai*t(4oit. Oao 
erauaf I hj ii bed. iolteviic witti mj ejm ths aiU Kmst, wfaom I np- 
peacd l« h> • ^nM j lUa tb« talkv of lie oufla bcRau to ran vetj Cut ) 1 
Mv the UDcnr. hovmr, rw, Mt bDm Uk candle^ but fran ■ hok ia the will, 
—A Wetd. in ttk q wa til y M to fw a U cacomtlttt ibwia. Itlmdedtlcd, 
wiU a MnHiw Ibnl 1 «*«M U nflbetted. Iltranpco I fdl into tk: dcluioa 
Uat Uw lir vu iMMaed, ud from tbtt noaeiit I eontUnlljr felt i iwralidi 
dit^iwibh odonr, wkicb I tiated b tU food, uid ConBcd the opinion tbat Uw 
boi( hnn^ to ate «« hviwa Oofc. Tbc bnildingt vbich I oouid kx tnm 
■jr now afipmd lo bo ■ unall rUj pipe, wkicb cridtBllj projected abort ouL 
o( Ibo tkimms, wd ikmlotNgadaad u ne Ibe rrisblfol tdot ibrt Uiitpip* 
«H Ibc ob]| piiM hf «Uob dr esoU ntat neiefore all vlu cnlctad. «tn 
■linml ^ Mt lo b« dooacJ to Hflbortios." 

i 56. Is Um ooBKdcntwa of Uw more tmiDcdiatc circutDs 
vnitrwUdi InSuciHutiaat appear, the following caiuea an 
tD b« Icvpl ta Tiev I 

(1) lioml iliacase of an organ of lense maj become the source of 
•DBMrial delinnn; tlioRforo tt u aliraja neocEsai/ imjiut<^ 
•nMiiM tiu pstiMit in tliis re^tect. 

(a) AU rtalM of dwp fxluostioa, whethei' of mtnd 01 of bod;. 
a|t|i«iir to favour tbr ilrrclopineDt of Imllnanaliotw. Af, in former 
timet, tli« struu^ luoeltoism from ivli^ous inotii*cs was a cansc of 
nuuioroiui haHncinatioiM^ so at the jircsciit time wc very frcqueatly 
aop llkv aenaonn] deliiiuB ooniog aa aAcr inaaitioQ, prajongetl 
ftatiag, or oilier oxhaaaltng tauK, gieal mental fatigue, fte. 'Dm 
i$ lurticulnrlj' fiironml bj* ooe-sided mental conccntrstioa, bjr sup^r* 
ptitious iicM irK'n femutlr malatained (Baireiiuto CtUini, loaaj 
devils aikl ftilij^uus viiiom). 

(3) like morbid efooUooal alatea £rom vliich imanitjr so fie- 
ipHBtly originatM CTok« haUiaeiuitioiis and illusions in tbe aome 
manner lu the analogetu ttaXta m htthh, fear, fright, &c., obscure 
tbe aeosorial ]>erceptioii and avakm new and Mat eensoria! 
iawgei. 

(4) Uutword calm and atillneaa farour ballociuations, and Ifae 
|ivoduc4ion of halliunitions between sleepsg and waking is a 
cinrwDstonce of Bpeeial importance. Their appearance under 
aucb circamitaneea in bcaltb is vdl known, and, in paiticiilar, 
J. Muller's deeorqitioa of tbeae e^-ents from iwrsoual experience 




TKB njWBirCABY DISOftDERS IN HSMAL DISKABB. M 

» 6p(HWlt]y r efe iTc J to hf jihysiokigiste.' Obstrvation sbows 
llttt abo in the mcntnllj' (liMA»<»t they very often originate duriag 
llnm ud especially Ihal ibor finl commeacpfnent aUea dates 
&•■ Um tin« of ilecp.* U tti«y Lave U»l«d for a considerable time 
ailcr (boM dtcuinstaDcea in liie commeDcing period of liifninily, 
(fay aliea become pemiatpnt, appearing also vhen th« patient ks 
M^ivakv, and «3.ciling tkU« ideas. lii oertain rare coses, liowcver, 
■ Bttack €>f tnania lia« been kco, cren on the first day, to succeed 
hiAMSBaliou a^naiing' betn-iTn Hterpinjr aixl vaking. As, hovever, 
<KD Uw ample ekmng of (he eyes oocwionally sufUccji to cull furth 
UlaoiniiioBi in Ihow who are di>{io»ed to tbe» (Goethe aud 
J. llfiUcT wy tjiis of theniselvct^), to it ham been fouiid Ihut abto in 
lln ittBmc (JDipte closin;; of the cycUdi causes hallucin&tionii to 
ippew (BsilWgcrf loc. at.). Those esses spokoo of in § 53, Khero 
Ae ^»i«™ oC flight disappeared on closing tlie eyes, again 
wiiu inaaf the part raricr^ which ezista in the complex phenomena 
of the haUoooatloiu. 

an bgr wt mpina nn •mhm at (he MnntBOcinont of tbe ioaanitj 
f^a^t» nade Kgbt of, or it«i»tc<I, tlie riiiag; and ai jot flcelind; tnaano 
} vfcM Ih^ tanud thoa ever in tfceir mind, ud pcrliapc oflmed 
fattafs nJMlcd iheiB. Some Qiglit, when llic light is pat out, vbca ia Iho 
atill cC n%lit all a atcmally o^iu to tbo eir, tlie fint hallucioatloiiK, the voices, 
Bffttr wkick DOBfinn tlie tBMae ideu, anil llieac tliereby leceivc tlie foicu of 
acaaerial eouTietkuL 

(3) Certain poitiona and nibstauces uaod in mcdirinc can very 
luaUy call forth hoUadnatioiu, c^wciaUy the prcpimtiona of 
bdladonua, 8tiajaoDiuin« &c. 
HlHwnfc Uiese art itutnutiTc, u tbe; iliow (liat plicnomcsu cui tn pArt be 
forlii at wOl and be aiido sulijcct* of experiment, jct they Live no 
Rlatioa to Uie liallacinfttloBi of tlic insane, and it is sufficient unercl; 
to iMTa ■untiowd then. 

^ S7- The forms of the rartoiu Imlluciimtions depend^ as a rule, 
^OQ iJk present dispoaition of nuad and direction of the thought«.' 

> 8n Mailar, *Fluutastuclu>GeHcliUenelicuiiuigHi;' Bhinu^er, ' L'cbor 
Bna^tifni :' ^nm; &oUaf, ia fnadricfa'a 'Moguin,' 1830^ iil. p. 67. 
* Baflkfcv, ' Attkiraa Gtotr..' iS^. p. 354- 
')lllhr,loe.eit.,p. 11-37. 

walci MaEbeth nj, whea U woaM aeiie the danar— 
" TiMn's iM sueh titng ; 
It is Uie bloody bmbwia whkJi iafoau 
TIinst«BUac«;c*." 




98 TBft EUOnSXTUlT DISORDEBS IS XEXTAL DISEASE. 



Tiaa aba, to a gretf estt^ decidn wlKther ibej be gay or sad ; and 
■***'**™ ■ nmlj ittogetbcr iadcfcndcnt in il« iiatiuc. 1%6 
btqiMBlly keais Ingoage of reproscb or menace, Rt 
1 i^idi oU on Ub to fcrfofai aane atradoos act ; io mauia, 
tfce k^HvatioM iiiclioa Ub excited rUlc of mind. In short, the 
^uutiuu ^emr, jaloturf, joj, &c.} dticmuncs ibe foroi of the 
This drctunstuioe is impoctnit in a pfc^Dostic point of 
tiev. ObnmtkB wkun tb* hafincbttiMiB dq>cuilhig in tliis vny 
OB a entaoi naibid -"•r^hnt Mbe, <■■ agun dixuppear oii removal 
ct that ■tale ; while irfy Jw t kaUoanttoii»— aot connected witb 
BMo li g n a l stato — xldcm admit of nal con:, and goieiaUY enter u 
GMBBittil eJcsMiita into thi* itifto of f^iff wi fi TiMintBi 

In ftates of great veaknea*, after lo^ pda, before death, tc., 
jqjDU3 briUtaut haltndnatioss ue often observed. Varioos other 
cyanic conditions — ijntatioo of thit gcnitil orguuj want of food, &c. 
— detcfmtneinothemjstbeoontcotof thesearaialdehrium vluch 
now pteaents adeqnatc images, voicca, &«. 

The remarkable similarity vhich exists betaiefl certain hallodna- 
tions pro(luc«d hj certain !>iniilar eansea is w^ knotni. Thna, 
appeannces of animals, mice, nts, birds, kc, are very conimou in 
ddiritun tremens. Wc m^bt be inclined to consider soch u 
phantsstic tnmsfMQiatiotis of nMcvr wlUa»U», were it not that, 
aecoiding to oor observation, large auiiaab*-«)iiietime3 in great 
becds— are abo &equentlj seen ; boracs, dog», " a miUJoD of cattle," 
&c. He illutiona, too, irluch raoll &om taking stramonium, 
beUadoiuu, and espcctallj indian bemp, are sooMirbat specific. 

HaUndnatioBS of a religious kind ore rerj oommon. The iLiukci 
rooogniscs tbc reUgioos clement of bis being in the images presented 
by bis tnuginatirai ; and tlus, tbo bi^iest sentiment of the human 
Blind, be takes plcssorc in coajirming bj sdf-dr&im images. la the 
mentally dJEcaacd, voices from heaven, sometimes demanding bumon 
aorifioe> sometimes announcing divine messages to the poor mono- 
maniac, are TCiy frcqaent. Ibcit contents rarr according to the 
degree of education; and mucli depends on wbolher the indhidnal 
was formerly moiit engronsnl witli the ApoL:ilyp<ip, with the Unnia 
of Tiedge, with bj/ron'a angels, or with modern nediumt. In 
general, a belief in tbc reality of sueh morbid risions is not a 
ebaracterialic of this age; yet, even in oar day (1816), a mono- 
Buaiac was recognised as iDBpircd, not only by the mosses, 
but vrns even considered by an arcblnsbop, and by a minister 



I 



of polioe, u an amba»sador from God, and as such van comulted l>j 
tUng (Looiii XVIII) ou matters of UntQ. 

5n tbo kbtor/ q( tlie pcucoL Martin, bf iicurtt (Ice. cit.) p. 171}. Wlul« 
Ofmid ii lun^iiMg his field, « lifjurv n|)peaieii Mok liim, sad tumntoiiGd 
Ub to w«ititb«Iibgallhmleocd danger loliit p(;naii,Hiideon>pinc; ngaimt ' 
Blitstc. A.rin tiie alTiir !im1 crcaitti a grt»tt cidtnncnt in I'om, i'inci de- 
dwd Uiii MiittiB wt» tiilli, ling uMcr iolcrtniltr/it iiiaaia with hallueiiinlicDa : 
bwH Ihvefon tukcn Iv CliaicQtoi) ; but there aIbo he (oun<l ducipio, anil 
im moocU I lie |>b5udias! 

In tke folluwiug pmgrapli), fuillier aiamples of balluMualiuuti uiid illusioiM 
ia lit* uiMM ire gireu acconling lo llieir idioijiicruiies.' 

% 5^. IfatiitciMaihtt' 0/ aght. — According to Grattolct,tIicrc may 
be distingnished the rollowing leading varieties in hnlluciuntioiis of 
riglit:— (1) Soch IS appear in darkness bv niglit, on shutting the 
ryw, or ui tlw blind: tlicy are generally bright, wen fiery, but 
Kuiie«1iBl {wle ; the forms arc very frequently thove of birds, hideous 
bcMj ftc, nod they have s tendency to move to aud fro. (3) Thoae 
urn in dim bgbt or in the twilight itrc frcqacutly white figures 
vfakh appear to take a ponilJoii m the room at aii appreciable 
datmo^ mad do not move to and fro. (3) Thoae seen by daylight : 
llwy appear geoexaUy as jwrfect iratitics. This, hoffevcr, I caimot 
noobonte i Inm many dcdcriptioiu ui halluciuutious, I iu»uuic 
tliat tluf are aUo frtc^ucnUy indistinct and aliadoir-likc. 

Very oft«a the patients see masses of fire and of light ; and, nccord- 
mg to ctrconutaQces, according to the direction already givea to tlic 
Ihonghta, these appearances are variously interpreted. One believer 
■ that be ia in heaTeo, and sees the majesty of Ood in all its glory; 
^ ano ther befarei himself cuoompasscd by the flomfta of hell. A young 
^^Hpun, at the period of memtrnation, saw (rnlly) her parental 
^mne oa firo ; immediately ahe became furious, would tlirow herself 
into the fircjknew no person, and belieTed.thatahehcrsdfwiu on lire. 
BtMt^ into hospital, she filled the air with perpeulnl cries of " Fire !" 
She (hoi^ht that she suffered the [win of the £ames, and that her 
piKDti «erc abandoned to them. She was constantly a prey to 
dehnUD and fury, and cried perpetually, "Sec how everything barns! 
all the engfinos in the town cannot put out that fire —it must destroy 
us all \" She died in four weeks, and " Fire 1 fire I" were her bat 
«onl>.' 



I 



* (we also Um «ijttairs of Eaquirvl, Il'irni, Leuret, Siiingowili, 
■ Bimicowila, luc. eit,, p. a^H. 



98 THB KLEMBNTARl UlSOBUliKS 114 3JGKTAL U18KA8K. 

Auoilier bad a great uomber of Yuioua. The Soa of God &e- 
(juentlj- upjican-il (o him: lie tto him borne upon clouds, lor- 
roundcd by augtis, aud holding a cross iu liis hand. He oiUusU 
to liim his conunaods, bot not hj words, bot bj signi^, vhlch appear 
in tbe nir. The patient de]i[ie;ites tlie forms nhich he stea in the 
air; liicy are ttomctimcg geometricnl figures, Minetinie^ those of 
Mtiinolsot of bouEchold toatertaU, flowers or miuical ioitnunents ; 
sometimes they are cnrioiu Bgores to which nothing ia iiimlar, &c. 
(Esqairol.) 

Another writes, " I have seen God the Father several tin>c8. He 
hud thr gracioii^ne^? lo »penk to me; He eutrrt-d iiilo scvenl hell*, 
where lie tltv sc\-cral monstrotu bcast«, and had them buried in holes, 
from which one, I bolicvc, gave false oracles. I sctctbI times sew 
John the BKjili»t in heaven, in a chariot with aevcn horses," &c.* 

A geutleniuii who lind hvpochondriacal melancholia oontinually 
uciil ubuut atrikiiijf the furniture of the room with his cane, and the 
faster be wait the more hu struck. I uftcmards l<:amcd that he 
mistook the ohadons of the furniture on the floor, and liis own 
shallow, for rats. I'herefore, the faster he went, tlie more persuaded 
vaa he that the rats were increasing ia iimubcu-. (Ibid., p. 1 19.) 

'I'lic scot of balliiciuBtioiis of sight must be tlie inlemal ci|uin»lan of Itic 
u|ilic ncrvrs. Aniitoinieal ofascrTatioDfi bate .vtt to be made on lliii pcint i in 
ilUaccliont, llm tlmlain&l itirrsicei, (lie corpora qufulHgemina tind their neigU- 
bourUood, «l>o tbo centrum ovnle, iixaoli tw otrcfulif euuuiiicd, InsrCMc 
nporlcd bj Bright C'Guj's Hospilnl Ksports,' 1837) o( a patient who, after 
two spopleclic atlacVs, lia^ bnlluciiiitioiia or siglit, there was fotiad tua fa* 
flamed spot, iialf an iucii iu sIec, in the corpus Kenicalatnin, penetrating to tlie 
lurfaee of tbe bcain. 

4 59. Halheinafiona (f XmWk^.— HsUucinatioiis of hearing mb 
not quit« so common as those of sight. They ore most general in 
Mirliiiicholia and chronic mania, in which thqr are occasionally tbe 
cause of an attack of inniiin. They nrc geiicrnlly indications of a 
more serious, less curable, affectiou of the brain, and are often ktent 
until certain false ideas hare become fully fixed. Tliey^havo been with 
sfi^ciiil frequency observed in connection with diseases of theahdoiDeu 
and genital organs. The aiintoniii-ai signi ligation of tliis fact would, 
if it were known, perhaps advance our knowledge on this point 

I Ziquirol, loc. cit., p. 100 — 101. Ste ul*o a [laticiit's dcicrjption of his 
vbicns ccmmunlcalcil bj llinch in Noim'i ' Zcicubrif^ fur AatliiDpol.' 
%2. Heft I. 



TflE ZUUnUITAIlT OI80KDEB8 IN UBNTAL DISUSE. 99 



(CMUKCtion with the certbellum). The voioea appear to come 
from 8 <li»taDC«, somctimrs Trom tlic ndglibourbooEl ; 
rlimr* from the eirtb, thi; walls, the fnrnitnre, or «ven from t1ie 
ptfinit'i own body. Sometimea tliey continue so (lersislcntJy that 
Ike patk-tits fall ioto a slate of desperation, lliosc who hare 
hiDuciiuitiona of hearing have also more Qonsensicnl Htm than 
gnermllr nvall fixnn the otiier phsnta^tDK, nnd they often exhitnt tho 
■ost pecttliar and groteiquc detneonour. Xbev xv^ly to ttic voices 
bjr frimdly or threatening ^tures or words. Thcj^ often become 
nddenly quiet and attentive in ordur to Usteo, aiid tli«ii comoiit the 
cddcst and most dangerous acts which the voices have recommeaded. 

iL jwnf •!»■> bad Dot spokn ■ word for ux months alt«r (tn nttock of 
hdHi nnbi aor pccbriDcd anj rotuular; act. One day be scijccl a full 
hUk ml tkrcw it at Um kud o( the waiter. He reuukined immonhlc «iul 
ftnctiUwlanerKrentiitMthalie reoOTcred. I a*ked him whj he tiud (brown ths 
taUe. " Uecaiue I,"iaid he,"lieard a voicewhich uitl to nie' Kill tomvbodjr, 
ni jvm tball bcdeliTero] j' I did not kill Lhf; Rinn ; Ihcrvforc nj tot could not 
toidtcrcd, and I rcnaincd quiei and immDvabte. Moreover, Ibc nme voice 
Hfialnl withoat tOMog, ' Uoto and fouwiti b« dud.' ThU warning; was the 
saa* ef mj tminobilitj." (£iqiuroL) See alao tho irtU-kDOvn caae of tha 
Krttkck fttttO, \>y Ika aaae obMrrer 

Apa^mt (eoinnirattcalioii b; Kt«Mr, ' Zeitiohrlft far I'ajcliiiittie x, i^m, 
|L 4^6} daetiht* Ua kalludoitiona and iUiuiont of Iit'stinj; in the following 
Un*a : — " It U aa aarpriuag as Triglilfal, and to mc drgrading, what ncovatic 
(vactkeand npcrinunla— and witliont rruon — hive been made with mjr ear 
idd my bed* tar n«arU IweutTjears! I hud t lie ahockiog conviciioa Ihat not 
«titj vrilkovt nj will, but trta witliout mj knowledge, lotiDili nad articiilBto 
—■ da of Iha Boat rarious kind* proceeded frotn m; r*n a» tho <li3«tTMcrul 
kMdwtdwd it. And lack lomda and wordi! During >ix mont.ht of tlie jear 
ill j Ihij oouiated aloott eDtirrij of inTMltvc* againat mc itiid thuac beloog- 
jacletta; ods tad tbaatme word oricii reaouadtd for two or thteo hours 
wilkMt talamipUon! The* ihrrc would often be heard a bng-cmiLiaucd dit- 
eaaca* ngttdiag mt, geMrallf eotit«itii«f> abuse: tha vmoM oif persons well 
kuuBB to NH wcr« often Imitated. IWee dlaooarscs rareljr oanblned anftfiing 
tkal «u Ins, moR freqnesll; Itie; oontained tfae blackest lies and ralunmies 
eoseeni^ njael/ and olltMS. KrMgaenlljr it would bn made (o iippcjir that it 
was I vbeiaU all that. Tbeae conltouous prolocged sounds vera often heacd 
<l«iU MartOBM; (nqatalljr, kowciTer.tiitjieenad (obc p^^dl1Md half or even 
■ «lnle ntJe otf. Tie; arc likcvUc thrown and TicWnll; rjccUd from nj- 
hod; I tfca imtest Dosae and datlei is h»rd orotind me, espeoislly if I enlsr a 
bonaa «r go latn a tillage or town llit^rcforo I liaie for SAveraJ jreara Ured 
alaoat like a bcnnit. At Ihc same time, mjr cars almost constaattj mound, 
and eAai so slrongl; Ikat the noise nmy be heard nt a eoDsidtrBble distance. 
Wraj liBgla tree whca I approach become*— ercn in calm westlior — a source 
•faanurs aadsousdircaccabliBs words and speaking: theoutetSk&cuiSs^ 



100 THti ULUMKNTABY UISOKDKBS IX AIEMTAL D18E48E. 

cnwk and souDd in nn cxtnordiimry luuinor, uiil relate Mteedotca ; (be hones' 
LoofBdotbo umo: Tbc gwiocKnint names anil ilories; the doga bkik. abuse 
aud RproaoUes, the ooclis tiud lieu», &ud even the getse aui turkey*, eaeVle 
itamu, words, siii scnlcuoea. Ibe smilli cauaea liis bunmer sod bellows to 
sound words, phrues, nnd often entire uuecdotcs, and tliJnlcf he does Mat wilb 
my content and will, AUwlio come ticaj me tell with theirfcet, witlioul tlicii 
«i3l. Die ludit curiotif. droll, and iiotiscnical lliinKS vrliicti bRppen to me and to 
tlioic nroun'l m^. Tliif is cs]>Rciallj llic esse in going up »tairs. Etch the 
pw vilh wbicli 1 write ptoduccs wtkuUtG tooci, wotdt, uidphiuc*." 

At other tim«s the patients liear celestiiil hnrmony, muwc of the 
spheres, coiiarls ; frequently accusations, loose speech, »nd indecenl 
Ungungc, Of tliis female patients often Hittprly complain. In 
Uluaiona of "heai-mg, sounds present are transformed in the senae of 
the ruling dispositioa or false iilea: for example, & noise upon the 
steps Kill be a«cribed to offlcera of the Inw comiog to imprison tiie 
patient, &c.' 

There is n porticulnr kind of balludnation of hearing to which it 
is dilHcult to give a lume, viz., those intemat voices without souodi 
mere livclj" idcaa, which appear to tlie patient as speaking and 
nuswering. They are described by certain of the insane as tpirituat, 
m "the voice of the sotil," &'c. [meniiil Italtttcination of Bailiarger). 
There are nil poauble vArtciies of Ihcuij even to the loudest cry of 
voices. 

Hie point of origin of tlieso morbid phcDotncn& of tiearing mutt be referreil, 

in part, to the fourth ventricle and its neigbbourbood ; but the jiatholoKical 
aoatoniical grouuds for auch an bjpotliuiis ttre aaaxiiy? In oertoia oitet, pbaa<. 
tk&ma of Ueuijif; could be stopped by sluHii]^ llio c&tenial auditory melius. 
At other times tbey bare been found in i!ie deaf. 

§ 60. Seme of smelt. — Hallucinations of aroell arc not. so common 
of the senses we have just considered : tliey kppeor iil»o to 
elong chieDy to the eorly stogcs of inssnity. Schlagcr* found, 
amongst 600 patients, 17 cosca in which bad smells were complained 
of, which sometimes caused ideas of poisoning, with refusal of 
fijod, owiug to the idea tliat the intestines were putrefj-ing. lu 
(he great mnjority of tlicsc cases, however, the bad smells were 

' In Soliillcr's ■ Erwartuui;,' simple but! ucinat ions of bearing in health am w 
described that ibey may be tnkvji ux i-xampW. 

■ Fovillu auyg tliitt be bu found adlicMons of the surface of the oerebellum to 
the Tneiiibrancs. Bui there appears to be also a proIoQfitioa of tlie auditory 

rn% into the grcnt hemispheres. 
*i^ilidinft ilcrk. k. Qcscllecharttu WIen,' 1S38, ig, ao^ 



A 




I 



THE KLKMENTART PISOKDEBS IN MKNTAI. DI8KASK. 101 

objecdre, excit«<l ^om Tithoul, and not tni« Ixallucbatiom ; only 
tkont five c»£fa coold be considcivd ta aacli. In nliiio«t vvetj case 
CI u diMgreealitt! odoun wlucb the patients perceive: liie sinell of 
■Ipbor^ of carbonic oxide, of carrion> Isc. The idea of )i\ing in s< 
pOMOoaJ atmosphere, surrouncled b^ dead bodies kc., ia a fretjuentl 
im^ortfanefaatluciDatioDg. Leurel OoMcit.^p. 19S) Telat«gthc case 
rf « Tomaa irho ucrilicd tlic bad smcU vhich she felt to the 
(flnro arising frona murdered bodies in the tauUs of Salpjtri^ : 
*iwUi presented extenialtj' were veU distinguished, aiid slie wati 
qoite nonnaUj afleoted bj them. We bare seen a paralM cur in a 
jvang nan. 

Sioogovilz narrates the foUoviiig interesting example of an 
OMOStj which depended to a great extent on iUasions of smell. 

K— ^ hnotrlj tiretj bdi] MciaUe, became g^aduall;, far about a jrtT, medl< 
briiTCi tacilarn. imCAUc, tod voliUr)'; Ii« often used secret rEOiedies, and 
il««f» ib&vcd dalntt of UiMe bj wliom he wm «nrroun<l«d. At lut he 
Ojwnlj dcciaml, " I fwl mjoetf rcij untrell j I bkve williia mc ft putrcfjiag iumI 
wUek 4ailro;s mj inmnli : m; Beigbboun tbereforo treat tna vlth modterf 
nl eeelaatpt, »ai kvoid comiog D(*r ma btcauM I emit t. petlilenliat odour. 
He lei a nlttarj and a aorroirful life : his ddtrtant became aln;* more co]i> 
liBiJ. and ha uooontMl for his dUeua by inrcclion from ([Unclon. Ho re- 
i to a vUwtgB Iowa, ud took a irilk to sec irbctbcr thoM wbora ho met 
I aba ivoU bim on leeoaot of ibe bid cmcll. A*, by ehance, a }>uaer.bj 
p«t bU pocket.kuMliKKbicf to bis noao, And at iho lama titne looked at liiio, 
K — Tiolaatlj allacXed him, called bim a hird-heuted mocker, aa unchu-itabCe 
tepiaer of meu, and garc hin a box on the ear. Ho irna iben ttFOgtiis«d to 
it «0 found tbal he iraa insensible to external odours ; be drcjared 
I fca fril oat} hi* own tmeO, wtiioh reaenablcd that of liorae'a urine, and com- 
I abo of a oorrcspoading tailo ia hia moutb. Tbe patient then gare 
' to eaaaiiD ; ha touD began to eomplun of coititanl dull pain in tiie 
laa^ to (RW lean, asd at least fell into deotcntia. 

Ia a pialimt who bad ttroog haUuclLationi of imell, a fnnK^s of the dm 
aaAOTaalar;^aaabaMl*nat waifotuadinlhe cribrifonn proccaa.aad lurrounded 
b; Ihaalfaototy Btrrei (* Vieaaa Aajlom Bcport,' 1S58, p. 266). 

Ia aaotbtr |)4tieBt, who had been eonatantlj followed for nore than aii 
fwatki by a iiBcU of dead bodies, there was foaad an abaceis of the ooqnia 
oOaann (Ca^ia, ipoted by Morel, * Traiu! du Maladiei menule*,' p. 331}. 
n* iaUad of ReQ mi^t, aocoiding to ocrtain fact* in the minute anntomj of 
Iba bnin. be ooniidered aa olfKlorjr oenlre. 

ffaiiudnatuma of UuU. — In thia aenae real hallacinntions cannot 
b« diitingui»hed from iUasions, false interpretation of real objective 
nopnaiocis (from farted tongoc, slate of the aalixa, &c.). Here, too, 
there are eomtnoDl/ diaagreeable leoaatioiu of taste s^tluch. the 



102 tni KLKHENTART DI80BDEB8 IN UEKTAL DIftEAtB. 

ptlitDta oomplain : tlie^ taj (bat cvvnthiog ha* t> bad tasU-, 
bmUUic, *b&r[>, rotten, sandy, earthr, &e. ; and found on this tbc 
iit» of potsoning, hate towards their neighboum, and frujaeiitljr 
lefiual of food — alwn^re iKi import&al on account of iXa speedy ami 
tnjunouB mila^nce on ttic organism. TIte eiiMa in which tbc inmoc 
Ii9v<> agreeable sensatioiut of tasl« — suppose that Ibejr eat deticxdex 
—are WfT rare. 



£sqoit»l nations neh eaiea ; (lie siiigl« cu« bnxiglit forvard faj I<curet 
if. 19;) can MtTMil; ht cottaiilend aa eiaviple of this. 

$ 61. la the ekin, and in tbc Ti»cer», boUucinatioiu and illunooa 
cannot be dietingmtbc^l from each other; or rather the phenomena 
which coDstitntc them, bo ht as thfv do not depend on autesthesii 
(§ 4g), are in every case to be considered as illusions, bccaaae tbc 
fip«riltc anomnlj consista in i)i« false intcqireUtiou of certain 
Msusatioiis obseri-eil in bcsltb or in vaHous states of disnise. lite 
conuDciicnncut of these ithisiong consist in ocrtain painful MDsalioos 
being merely ]}baQt3$tically compared by the patient to analogous 
phenomena. Therefore, hypochondrincs, at first, say ouly thai it 
teema to fian as if serpents crawled in Uieir skin, as if there were 
frog^i in their bellvj ns if a bird chirped vithin tbrir chest, or, as we 
once heard a patient say, a young do^ lapped water in tlieir h«ad. 
But, by prolotigntion of tlw sensntions, the inflaen«' of unfavorable 
extcrniil rircuu)rtiuic«»j and incmtatng internal disharmony, oviog to 
which t!ic )>ftticat soon begins to consider the matter more cmrncstlrj 
the comparison, nt Girt imaginary, hrcomes n folly developd delirium : 
then, from abnormal cutaneous scnsotionaor moibid musculnr actioQ, 
there or)([iiiati: fixed ideas, in which those seuKitions are seriowly 
attributed eilher to interuat pbantastic caas«s (spiders, crickets, arid 
otbcr animab in tbc body, dcinoniacal poHCSsioa of certain organs], 
or to outward iutluciices of a prejudicinl kind (magnetism, pbyaical 
experiment). TIiub, the idpn of being stabbed or flogged, of thp 
anns being bound or made fast, is seen to originate from certain 
pains in the skin; ami from abnormal abdominal sensations, the idea 
that the dcril, llie hut judgment, the cniciJision,' is takitig jiUce 

' A pntitat of Esquiral's liail lliis detution. " 1 cnn smtmIj bo» il," hi> 

■lutl ocftuionally ; " wlien will Ibers be laitiaft peace in tlicCtiurcU" t \ pUicnl 

til WjDueulM cried coiiliiiiiouslir, formonllis. " Dmiu, and let mo go I" He 

loinolimcs bclJetcJ llut Ito wmi Uitinont«d \ij somctlilngwitbiu lu> boilj, *on»e. 

^nci llikt he iras sirtiok villi tlic liorai or imaj^inarr oxen. 



I 



SUE KLEMKNTARV UISOBDEUS IH BIBNI'AL OISSASE. 108 

tidda the bdly of the patient. Any pnil of the body maj bccomi; 
ikr psiot ol origia of such insane ideas. A yoong mau told mc he 
\ml felt the devil, roaglt ukI bristlj, seize him bjr tlic neck (globus 
brriericm ?) : anotL^r, mentioned by Sinogoiritx, elvSeA \m nmR 
It n^t because venomoiiD womu nrawlcd into it. A todioDj 
ifekea of by Bergmann, sav in ber breast a circulnr fiety body 
uning MHistantly round. 

The wmsi iUtuioitB merit spccinl coiisidcfation, aa, from Dormal 
md abnomul sexaal sensations, there is (m^aenllv developed in men 
tk i3et that they are urged by others to onanism ; in vroiotn, the 
iln of pcegnaat^, of tbeir accoticbement alvays being imtnia«iit — of 
imul intercourse vith some imagitisri,- lover, with tbc devil, JEc. ; and 
MtkoM actuations eoDstitute a freijuent source of sexual irunoity vhiolt 
wy thow Hadf in tlw form of !«Dti mentality, or of nympbomania. 

llaUmeinativus and Uiimtm* of aevtral wnaea comiinii are very 
oomnian, and titc litcrat^irc of (bis subject (tlagcn, Ksquirol, Lcuret, 
BoUes) >* rich in examples in vliich •iiiiiultnneous false perceptions 
of all the Bcosea fonncd tlie most iinjiorUiiit and most striking 
pboMiDeaa of the iimnnity. Tn n practiciil point of view, it 
eaoBiit bs loo much insi-ote^l oti tlint these false perceptions of the 
KBses be nfficientlj iaTertigated, that tliey are often results of 
otggnic proccavti' which may be iillnycd,miil that atteiilian be paid to 
Ibeie in c<»uidering the plan of treatment. In relation to this, ve 
nil^t recommend — a point hitherto quite overlooked in hallucination.<i 
of the three superior scasca — attention (o the state of their accessory 
Dcrvt*, the fifUi pair i in aereral cases, ballueinntions of hearing nnd 
of ngfal apptatrd to as to bara been nwaVeued by iieurnlgic affections 
of thew nerves. 

I tant, Bftir muf ;m» ago, a reMirkable caie wLiolibe^n with luilueintlinni 
of (cnsW MBSaai A ntan was rrlafaicg tiXit i(iOOiili(,'iit iiiglit from a pcdvt- 
trttB caeanina by which be wai somewliat faligued All at once i[ lofiiiej lo 
Ilia a* if Ke mm a giot Uitnial liLo ■ dragon rolling tt«(If in a liilcli llltrd nilli 
■liar by the roadside. Hcbevanic rxceetiini;!T nfniti.anrint tlic .inme time felt 
t^HrU painfully |tn*1>eJ on tkc iiRlit fllioulJrTbjtlte miininh n^erllirtri*. h1^ 
ead4. >■ \m said, fne liiiiiMlf \rf niunin];. InmedialctT nftcr, be fell Inia n 
diMM* wliieli *M Moa diMorrred lo be a pleunl exodation of lliR riglil side, 
UBk ib« wliole of ikBt >>d« tA tiie cUnt. He died in a few monUii, and t va* 
at dwexaaiaatjoa of the bod;. 



lot TJIK Kr.F.Mr.STAKY D1SOK9KB4 IK HBNTAl. DBK^SK. 



SecnoM HI. — The EUmcniarif Jjftordfra of Movement. 

§ 62, We oii«erro, ill most of tbc insane, slight )ncoiui(ler«bl<^ 
(Iborden oi mutcubr moTemcnt; duui^ in Uie tone of voice; 
ilonncM or cxcvssivu rapiditjr of the ooiitrndioii ijt \\k iouwW, tee. 
It is not rate to stc abo a certain l^<^g^ce of general lightness and 
rigidity, or of relaxation of the muscles ; the latlpr princip-iUv in 
»tatcs of weakaes?. DifftctiltT of awreaKnt oi Itie irbok bodj, 
iucluding tlic or^iu of i<[>e4-ch, prrhaps erea statac-likc calalejttic 
rigidity, ie proper, in particnlar, to the so>aitL-il oestAtic stat^fi 
(set ^ 51), i» whicli the cxtnual sauoTial activity is .-tl the same 
time more or less suspended (generalljr n^itli coexisting liailaa* 
nations], and the pntient is plunged cither in ine^cpTcssible iny$tiail 
joy, in ecstasies, or in a state of violent painful emotion. Sudi 
muxcnlnr ngiditr, moderate anJ of i>hi)rt dumtionj may Ik pnvcnt in 
the slightest, moat curable, forini of insanity, and does not render 
the prognosis le^a hopeful ; yet, in cx:rtBin caaw, the paticnta have 
become demecited (Ouislun]. Of far (greater ugnificance are, on the 
one hand, the local ccntrttctions ioterrnpted at times by paralysis, and, 
on the other, t)ic partial or general convulairc stales. The i>cT!ti5tfnt 
automatic grmocing, etrabismos originating during the discaso— ici- 
moderalecontrnetion, dilatation, and irregularity of the pupiU — pain- 
ful conviil«on8 of tlie miuclcfi of the neck — those coiifuwd convulsive 
moveuieiils of the rxtrcmitics wUich cause the patient often to iralk 
irregularly, or to i)rogrcss in short Icapa — are all phenomena of 
;(>rinn)i slgnificntioii, mid their continuance usually indieatce n 
tmnntion to the state of incarability, A constant tfembliog, 
grinding of the teeth, chorca-likv Minptoms in adult iuoatica, 
aiitomnlie rirculnr movements, walking backwards, are libewiM, at 
least in the majority of cases, symptoms of the dcvfloptnent t»f 
*erioii3 organic disen:«e of the brain : sltliougii, in accordnnec with 
certflin observations of subsequent recovery in eimilar cases, wo must 
admit the possibility of the production of the phenomena from simple 
nervouB irritntion, or from temporarj- palpable disease. The gnreat, 
Mid, alas! but too freqwcnt, anomidiM of movement in the insane, 
are, however, the epileptic bihI general paralytic states, to which we 
xhall, (living to their grcnt importnnef, dr^vote n sprdBl chapter (aee 
the Complications of Insanity). 

rates of oWmitte taciturnity, which samclimct contJanca for serenl — 




TUE KLKMF.NTARY UIBOBDEBS IN MENTAL DISEASE. 105 



mtaaWMsfot tcnjecr*, and cren loamr — wo mn*t, Aral of itll,iJisco>CT vhethcr 
Ik iKlinl wiii iK>t >peak (Bimple moittii peculiarity) or eaimol tpnJc (chroiuo 
iH Jiptin ilitw, rrnfrnml mcUnoliolia, stupor. deroeoliB]. TJie Etrengtli ud 
l«> it the voic* comtfwnd io gcnftrol to tlio ruling disposition of mind. 

la Ite imaot Iben '» acawtiina obwr? ed a eoDvubiTe rolling of the eyeball 
(Sptafmrn). Tim pbeMWiuon •ppean U> belong to tlie pcriud or tmiiiilon 
IniUMacnte into tki chronic slates, and is tliercforc or uiifaToreble pro- 
pMM. Uodiflcalioru im (lie iiobililj of the itii nre more common. In«quulitj of 
U*|Hlplk iaMen moat TinjueDtl^ in pandjtiodcmentitL, mote seldom in limple 
OMi of RftBia at nducholta ; «ud Iiere lulw it in ini»l common in olronie, 
■lowly prognanag, uid bopdeu cum. In orrtAm nine* the incqutility appcarB 
lirllicfint lime during contftlcacencc. Grr^t coutractiDn of the pnpili in 
IBM I*, M«ofding to experience, of uufaTorablo progooui, and renders proba- 
Ue U« cinamcntemcut of pandititr dementia. lu ioasnitv, as in many other 
ifcdiBtti of tiic bnia and nerrw, it eannot in every case he uMrfftined «he> 
thcrlbe BlMOniiBl state of llie pupils depends on convuiMon or |iitralyiis; biit 
thi biter, (rom tlie aympUMnt, a])penni gencrull; to he the more probable. 
Sm Hfrier. ' (hrttlc. de> Ilopitaux,' 1851, iq Ao4t ; Seifert, ' ZvitseLrifl 
Mrhychiitric.' x. 16^ p. 544 ; Riclmn, ibid, it, 1956, p. 3). 




§ 63. What iniiy be snid on inmiUy in general, il,* coiine, its 
mode of UTmimliua S:c., can only be drawn from the rtucly of its 
single formSj oring to tliecxlraordinttrj divewities which tliejr present. 
Still, our general knowledge of mental iliscascs is considerably 
increasi-d by con*iderin(f tlieir nimlogy I*) certain kindn>d stales, 
especially to dreams and to the ddirium of fcvrr.' 

The Rimplc Icstiuioijy, ?" frwiuoutly given by llinste nlio Imve 
Ttcovtrrcd, that the wliolc period of their discjue now appears to tlictu 
ss a dream — somrtimes n hfli)py, but more frcqiirntly a paioful and 
fi^luDtnv one; und further, titut during iii.innity, ui certain casett, the 
inijkri-j^ion left by their funiicr hcnllhy life was id^o like a by^^onc 
diTam — might lead us to the griat ^ilmlarity of insanity to states of 
drcnming. 

It is truethut in theiasane the pnncijinl .sigiis ofjtli-ep ar«iib*eiit — 
tjie clo»iiif^ of the external sense^i, the eiippression of coiisciousnraa of 
the outer world, and of the iuflueuce of the will upou the muscles — 
all of which wc n-gard ns essential to dn-smiag. But, on the one 
hand, it i» known thnt ive dream the mon: rt-iidity the less (irofound 
our sleep i.", and that there nrc titatc? of flcep iilicrc nn influence, 
aiinilar, indeed nlmasl nkiii, to a. wiikiiig ."t.'ite i^ exerted on llie 
mnsfles (speaking duriup sleep, sieepiujf of llie postilion wliile riding, 
»omiiainbulii?m}. On the other linnd, tlic whole circle of such 
sensorial nd? as do not originate through external excitation of the 
sensed, iind which iicvertliele:ss may exert such power (which aets 
csert such influence in mental diseases), can be considered as rrlalcd 
to dreaming in the wider ¥cd«. Piiudly, tlnTc arc in the insane 

* Tlie HiialOigT of iusaaity to llie emotional sUtcs ofliealtli )iiu&trcii^5 tweu 
Kpokcn of; Itir niiiiiliiritv pf miuy stule* of incntnl diitease In iiitoxication will 
■ft«rw»ta» tntniioncit (under Uauia and Oentral ParBlj«i»). 



OK 1H8A>'[TT tN tiENERAl.. 



107 



4 vouatioa and o( ntotjon, — duluess of aensortol itnprcstions, 
■Wi u kaq^er affect (^ 50) the iiidivicliuil oa thvy formcrlj Aid — 
temlcning of lite influeuce of the will upon the luuscles wtiich 
tuaiattcd in great elowucss of muvciucut, and even, at limes, iii 
Mit|de pprsistenco of poeilions enforced {§ 62], — nlilcli, in 
iMKtkm with the. coexistent obscurity of consciousness, viviAly 
j^Ak us of what takes place wfaeii sleep come» ou. 

UM, tW MwV»gj of UMDltjr to dretmlng, cipecUIIj to dmnu oocumng 
iitttkU'Wikiag state, raut be ■daillcd. In cliiMreu, we occuionatly we, 
iftddf vWa nttiee sUftlit dueue. tkkt the;, while sleeping, >till iprkk : for 
■^Ic, Ih^ uadcTsltind ilw: motlicr, tlicj amwcr bur. llicjr o[i(ru ibvircyea 
■IneeCUM her. bat tietCTil>el«st Ihpjdtcam on, sad in[)iirliciitartlic,T ciiDiiat 
^Unw ttCHUclTcs fruoi uneuj drum)- ideu. Even Ihc intcrmcdialc coit- 
AttM of sleeft and wikiog, which tscccnl cacli olLcr in rodleii frndxlionM, 
*nt^j bvoar iLe niifieiuaiKe of IHuiion* niid linlluciunUnnt ( \ jfi), nnd nbicti 
n dklBiKiiubed bj ui irrrgulwwtitiLy oTlhciiiiiiginnUcia and by inoobortnoe 
if Ik int^EiTeriM. I'liry are preceded hj % alatc of slecpineu, tlic indiriduhl 
Uvf 4all, torpid, andl»ctl«ni; tlie wntc* become bliiiit, lh« imprcwioDsorl 
M^fiil, MKuids •|)pcu dislan^ his oontdoiisuesi b dull, answers an> delHjeil, 
W l»pt» kiMMlf and tpcaks iacobereutl/. Tlie»e are oftea obscivtd iu tlic 
mau aiaEt i auA of imtDity. In the Gnl placCfSeiialtin: aud tiiotor; renctiiiii 
t— M i U tlia eilcrn*) vodd lirocaiu feclilr ; and tccan(i!,T, a norld of pliintostn* 
■d BoafaMd idou sppctJt, in vhicii tbe palicni lo*c* himsclC. Tliis gnulual 
Utng ot Ute nodenUadiag and <ri!l, vliicli eonsliliitci facallli; bleep, is litakA 
th( i«MaaiBaA,o*itig to lli« penUlctit (paicifsl) emotions; and ircoltmobicrTc 
ifaa, in Uh eonmeiiDing period of tlie riiicase, in ipite of tlie appaieot tleepj 
t ir a i a M *, actW tl(*pIctMcu. 

Sichat aaja, " Lb aonindl E^jral cat rcnseralilD dea Eoniineiis parltculim ;" 
■ikad,caeh msm iDd «ach pJuuo of menial ilfu mij leal Ilie nme llmciwalcc 
■ dtfaaal difma, Ibo one more Ibaa lie other. In svmnaiuljulibts •^■.-itiin 
fa ■Till I we ftij aMire, and dreaais tet in aclioni mnr, if at «!iurl dunitiaii, be 
i^nalarad ■■ aoiamwbulaai ; if of longer conlinuAnce, as moutal di>oider. 

$ 64. Tlie dmm, like iii»;inity, receives its es^eiitisl colour, its 
funiluDental tone, from the goveniiug disposilioii ; wliicli 
ilrtcrmiDcd «■ well \t\ lliu inculul occutrciiccs of wnking life, 
aafij duugrs of tlic organic atates during deep; in which, cxjicciftltytl 
aB ooagntiTC >Utn, and all morbid iinpmjsions frui]] the digestive'' 
iMpw. and ahdoinitia] organs in general, Iinvc a very (,'txiit inlluencr. 
Ilie mliog (ciitiini'tita of pleasure and piiiii cntl for their corrnpoiid- 
iog imiiget, iii vhicli objccta vitliout form in llii^mMi-lveti, iKvoint! 
miwniii clotbol forme, the mdily of the nci.usl imprc^iou is 
iJrlBKve, atul wUnl rnlrr* from without, tbrongb ihr sciisea, nurts in 
tkr dnaner, m in the iiuane man, a centre, preoccupied umt filled 



IW 



AN IKftANITT IN OKXKKAl^ 



will) Uu fpttu diftpuitioii, and beconei pertcrted Md eoHtncd b 
lh« »rnM nt the raliog scDtimesls and ideis. On tbe otber kn^ 
hfifffvrr, tlir Mior ivololdnon of Uu paaaa^titj aad th* mam 
rliiolidU* ru*ur wlieii groiipa of idew and aentiBieBla td maw - 
lomuit liMtilA iDlcnt sUnd opposed (o the /, ud tbe drtam, liki 
iNUit;, ia buay to tnnaffr lo the ntcrnal wotld aad to drtBiatue 
■nllJMtivB intiif^ (haUaoinattolu) of nil the sctim*. 

U tliMBiiiK, lli» ocrun putieakrljr with itoiHj >nwitioiw,ia Uw eUbofatka 
at witbli UiH* ii (tMl tuffwrOion aad tittj liate * povcrfal dect vfoa At 
(imgtMtlna. A eootDod poalUon w bod, prtaiart oa thv ann or tbc braut, 
bNXwiM MUM of waulioaa oC Miik |iut in cli&ias. of dujer, of pKcipKO, of 
lUrMlFoMl excralwn, Ac { k dnughl of aurmniuif on us ncil«a iilcM of bang 
al Kt, Kitd Ilia olhir oireumtanew oonnectcd wilh it ; nrmtb of tbt feet 
WW— IN lu ilreiim of lUifuiag ■wolin, or of dimfaing ■ Ironiiig moniitita i 
■ itigllt prick vnkt* Hum of drava (words ; bodiJj focKasi of aanetj fraa 
Ofipi«M«l rMpintwu tmy «<«t« tlitt Mot of * »ontl«f KlU&g oo n*. m in- 
mtk\a n|itM'ut«li><n» of ftoU cnoie* bnng eoenmitlod, agkintl til of wbwk. 
llo>Dvcr, uiir iikOiriJ /, lo «hi(>ti no luch thoQghU Mong. itroaBlT pntMU. 
All ll»*o cltiiclj rcaeublo lb« valkiog dmnit of Iko BcUacHiatie, tad Lo bdb 
raudllkiiu tlMi ludiridMl cannot r«cqfniM these IU» rcpreacDtaltara as lodi 
fbr wrnnt wl nfloelJoii. ovisf to nfnuion nf the / or even partial orertbrev of 
il, aid bManu rwUicatMn thnafh tkt aensct is impouible, in the ooe caM 
Ikioiith Ibtif diilacM, tad iatba atlMr through tlioir falic imngcs (lullucinalioBi), 
Bnmaa atmt«a (liat wImb Mleop, hkriiig colic ptbi, he dicomcd Uti.t hit 
Ml; vai optard uul Uiat a pRparmlion vu mad« of hii aTrnpoUietia ntm. 
Wo ha*a W(ni(kt forward exanplea (| 61) of umitar intcrTirtiationg of abnor- 
m1 HoattiiMi h; the intaaa vbea anke. 

TU dreiaiw, lik« the iaianet aMcpts all, erea the moat kdrataioas aai fooUih, 
rcpreaeatatioiu u possibilitiM wiUoul (nrticuUr tAtoaialiiBent, and the TcrlMt 
•faaorditj bccoium the moit mKittestiotuUe truth, it tbe autam of pereeptioiu 
vUck oan rpctifjr it rcniaiu doimAat. An indiridual maj' dream of hafing 
toNrda actcntiBcprotdan, u>d bfiUcd with jo; it hit fortuaau aacceai ; he 
awikca aad dncDven that it is aa orliaar; blae tbouglit. Thua, there ar« ioMne 
penoaa who laddenl? difcorsr popctul Motuin, « a meduaical i<l«a which 
miisl chaniit the whole suKtoe of tlw airiK lad vmilar thingi r the; are tilled 
wilh tcsUtj at aaeb dtaoomiaa } what tliej dcmoiutmlr, howerer, ia to ns 
hUj, aad the;, after nemaj, aumot nnckntand wlij tbcj couJd not at onet 
■ee Ihtou^ ineb great errors. 

§ 65. Agreeable, rarishing, heavenly dreams arc very rare ia 
hciUlt : they are most frequent in states of deep bodily or laenUl 
exhaustion, and we oft«o obfeire at loeh timet that the idtta 
fDppresaed during waking come forth strongly in draams. To the 
mdiridoal vho is distiened by bodily aad mental troablcs, the 
dream realiaes what rcali^ has tefiiMcl— fcappioeia and fortune. The 



ON INSANITY IN UBNJSRAL. 



109 



I 



I 



starriDg Treuck, doriug \us impruoamcui, ofleu dreamed of liob 
repasts; the beggar dream* that ho is wealthy, the person who hw 
lost by death sonic dear friend fniidlr dreams of the most intimate 
and Ustiug reunion. So also in mental disease, from the dark back- 
gronnd of morbid painful emotion, hy siiilcing into a 3131 deeper 
state of drcanuDg, the repressed coikteDding ideas and ^eDLtineDls— 
bright idma uf fortune, grcatDc»«, cmiiiciice, riches, kc, ; stand out— 
and, *a soon as this happens, through a change in tlic state of tlie 
brain, but without recovery, the pressure of the painful sfinsalions ia 
removed, the former mtulal misery cliangea voluntarily lu the niirth 
of Uie maiUBC. Thus we b«c cLrarl^ how supposed pOMcasion and 
imaginary realisation of good thin^ and n'iahee, the denial or 
destruction of which furnished a moral cause of the disc:isc, constitute 
commonly the chief subjects of the dcliiiaui of insanity: for example, 
»he who has lo«t a darling child raves of a mother's joy, he who 
has suffered loss of fortune imagines himself rich, the disappointed 
maiden is happy in tlte thought tlut she is tenderly loved by > 
faithful tover. 

A nuaib«ff of other phenom«» of dreaming prtscot an evident autlogj to 
iasuit;. That, tometinies in ioianity, hs in dictms, all idea of Ume is vsntiug ; 
miiiatea Ken tiovre. as in a dream we life years in a quarlec of an Itour, aud 
erenta which would take monlLi to occur in rcaiitj, appear to tlic iiistaue uiui 
to paasiD the sboHest tpacc of time. In tiotli ttate*, mixculnr acaiatioDi — in- 
topreted as RjinKi being prccipitoteil, &c, — uid iliuiioni {ilaji a moit im- 
portant ptrt, and the latter tcrre, in pnrtieuliir. to oijireM ecrtuu tituations 
erolcd bj a gtiverniiii; fundamcnLal di>position Mjd eoircapnndiiig to it.whiU 
(he Rias)« of pcrccptioas of the /, whicli could brio^ order into tliii diaoa, ara 
partljr obliterated or deatfOTed, pari); lio iu paiufut opposltioa to tbe neir coa- 
tcolsortbe mental hfc, or are violently carried by ttii* in ccrlain defiDite di- 
rectioQi. 

Tboae rarer caKs ate very ml«restiug where iutcrmiliiag iQianily takes the 
place o( nomial sleep, and tliereb; seems to staud niiilwa; between drc&iaing 
and aonnambaluin. Guubin ('Die Phntiogialhiouo,' Iraiislated by Wuuder- 
licli, p. So) rcliic! lucti a cAac, aad cuusidcri f;euerallj that there exisia a 
ecrtaia analog; belwccn menial discaM and itntea of druniiiig. Tliote oasek 
abo ar« of llio aatno nature in wliicli a itnto of waking dream auddenl; tntcr- 
nipts the ordioar; ttal« of waking, which after its ccsulion again usurncs its 
ordioar; course. A lad; was tubjrct to aucU paioxyama: auddenljr in l!ie 
nutit of a conTcrsation »lie would stap and oooimcncc to tpeak of touietliiug 
die; afttr a certain time, she would again resume tlic conversatiou at the 
aealenee and word at vrliich she had broken aS, and be quit« uaconscioua of 
the tnterrtiption. A lad; froin New York suddciil; becauie delirious while 
woriciug some mtricalc embraider;r i >lie rcinaiiicd ill for sevrn ;eurs, niid a* 
todden!; recovered, bhc immediately teaunicd lici work wilh the aame cont- 



110 



OK IJCSAMTT IX CnUUL. 



ponuc M if ike hiJ OB] J been u kai ikn* Iras it [rnc*«d. 'AmmL 
Mflaiai|»;eM^' i 1843. ^ 33^!. 

• WlicalIww(diofaictilaldiK«wanMb^pnHt,igfti£i«dnanM7 
liMUnita <Mlb(t»k; tamitiitua tbe sri^ecittr IW Umm iaOnmmh AaOi 
oUUtvd in Ikn. KcMilU «f tte esntiac omhni tBilalie«, Uwj Mt 
totnuAifdjr en thi B»o4J aM \, awl thitr iHa rf ato ceMiMB dmitaat dnwf 
ibc Tklung (UU. 



t 66. HiDj ttoiM oF inasailjr ^«t^ iVMsUe tbe so-ctOcd 
"fg™*"^ ileqi which if obMrred in dirado ncmu Stetatt, foa- 
ticnWIr in atatee of Kiioug coiwtitiitXHul diatailaDoe. Tie csln- 
Ofdinciy feetin; of Trilbeiog in il« liigbcr gndet, tluae indetcritnUe 
tamttiom wliidi weiato liekniglo mother 9pIiae,iR bete nliil»tetl 
m tbo gnat tatidaOioa soil DootcntiiKat mco in nxuiv nuniical 
aUtet, tod itt tkoM fiedtng) of nqninle happinMa eipMicneed bjr 
nuuy of Uu inane wbieb really cannot bs described, aod for Thicb 
lliejr tbeaiKlm cboosc Ibc image of tbe dirioe. Ibe sew cxpre*- 
sioos whicb certain ^oimuimbulirta Mippoae to be tbe oommon 
bdigttage of tbe tvgioii of spirits— tbat UstAaiey to basj tbonadni 
DijBticalljr with tbe oonstniction of the anivcTK, and, »bore ill« 
witb Ibe bigbut problema of bamau tbooght, and that affectation 
of flue UngoagB in tbose without edaotioii, n» all to be fuonil, 
ulike combined, iii nanj' clironic maniacs; and in certain cases the 
gnxiter freedom of the orgam of movement in the latter state con- 
slitulej tbe chief distJnctioB. 

1 1 mpfon tbo Ibat inagtictic eiallalioo, liLe auuiiacal agiutioo. » fm|ur4ili; 
ilrfdoJMd (rOM uilnior »t«lo o( pun. sod IW lliere tbm iwult* inlatioaulio 
dontiDioa, oa liic ono liaad, of the bodilj aod mnlil alTtcLJon dunag vakisg, 
Mill og tlie «()ier, leeoriliiis to «Dr ofasemtjon, of obseare itales of dmmuig 
annnipuied hj nigbtmare, wliicb conititute Uie £ral period of tbe m^uctic 
■latc^ TIic fuftlier eonfimatioo of the latter comlitioni would be tci; in* 
porlant for llw analog; in ibe coune of botli serie« of luortiid atatea. In tbe 
■onuiMiata, alM, tkelr ImavM^— acrorJiog to all Hperienoe m iwtj 
vortblcu — ia gencnllj c«iiiniunicaled throiigli llm mcdiuoi of ballaeinitioos 
(of tigbt sod hearing). Most oF tlie anologici nicntiotied in ibe pi«eed>ag 
parajraplii wit!) tbo oUier sUtesot dr«ining tervo bIso for tlie magiietM alates; 
Bud, pnrticularlf, rrauDiKenoct of magnetic drcaiiK arc sot «o rare u b 
geD«rallT lujipoKd. 

AIUioukIi Ibe diifercnt itales of inwnit; do not in the umo degree pocMta 
tbe clianctcr of drcama — allbough thia attache* most to ccrtAio primaty foim*, 
CBtiecinll; lo melaacUola willi jtiipor. ia whidi, indeed, inlorcouree willi tbe 
external world ia eitremdj llmitcJ, and tniprcnloca are pliaiitMticallj Irans- 
^rmcd, and alio to certain riat« of miuiLa; allhougL, on the conlrary. other. 
tieuUrly wcondarj, fomoi, lueti u purtial deniButia, present all Die aii^nt of 



ON INSANirr IN GBNKRAL. 



Ill 



JM^kto vaUng, la wtuch it liacs Uie pkLieut rcnoODoes liis whole rormtr lire 
jirlH fiile fortmtlen il — wliere he Htm, extemJly in tlie f«lM world of lib 
ImMiMM, an.l intrrnallj in Lbe reveriM «l bis Talte iileu ;— nticlliCT >iceli 
^iquBd<*>l. i^ not niote ualojpMii to oerUin tna^eliotaletnliioU paiiklly 
mmI ottf dajr-Uf**, llitn to tfat waking vkiob v« know bj ci[KHrac<) to tn 
IhMlk; tlatr. 
TU iu)o(^ of nMBtal dttnsc Is dtcftm* hu in mwnt limes bceu treated bf 
t) vtfial a«tbor», espcdallj bj Moraui, 'Antul. itid. Ptjch.,' 1853, |i. 11, 
i; ML, p. sfif. itttun, ibid., 1853, y, p. 404 1 Hollud, 'Chtpiere 011 
VablPhjnolof;.' amd edilion. 

\ 67. Aj» bovevrr, itiMiiity jiitseoia a ^^ilarity sometimes saper- 
fcad, •DaKtiines prtifouud, lotnctimes qunliiativc to tbe t'ariouit 
Ota o( dreflming; eo (He psychical process b^ ineftns of vliJcIi tbi; 
isAnltuJ, when lh« eerebrnt A\i^ase » removed, r«tunii< to licallbj' 
tf^pcscota nrioDs modifiontioDS. Sometime^ rrcovery rrstmbln 
imfk waiting; when llie iiKliridua] astoiiishvd Kcck», as it ncre, to 
bow hifflself, Um maasCB of ideas belonging to tfac disease sooti 
fiappMT. uid Ihc old rretarns ani^jtirrtl and unimpaired to iu 
farmer pUcc. At otlier limc», the already uiiited couu«ctioii» Iooeu 
tixnavlYra villi gn-at^r difHctilly, anii as ihc old / is but &lowly 
itKDgUwoed, reooveiy consists again of a painful struggle, in whlcli 
Ike individool iwakaied fre(|ueotIr tequiren llic instructiou mid 
aihrior of soother will to rtrragtbcn liie. Not uiifrcqacnllT, eveu 
Ibm all luces of ihe morbid state do not disappear, nnd the pntient 
for a long time rttaiiis, as vestiges of tbe past, certain ties, oddities, 
abemtioiu, and pcrvciyioii^. From tliii; point it may frequently be 
ofaaencd that tho patient nodergocs a decided change of cliaraclur. 

It it iasdwiwibUi to refer Iboe |iroc«sic« to ibe moriLl s)>bcre, to «hicl> 
\iuj m Bttls belong u tbo process wtiicli ehuuteitsss the connnenoeineiit 
at ihm &mmo i bat it » etxtain tLat, for ■ eanvnlcaoeiit trlio !iai b««n forinerl/ 
mautij. ftofa moral Intinins is neecuai?, mA tbat rcnr ortcn llio pbjtidsn 
■■f praduM a new HtMi 00 iJie pttieot hj luch inilructioa as i» grjiefullf 
gins to lbs ;«BBg. 

lliOM cases a» very intensting wfaere^ shortly before death, the 
BKstal beallh coinplrlcly tetnni; or becoims deuidedly improved, 
tin ooenn moit frequently in mania,' vcldoiu in mckiichoUa, iiud 
■Iflwtt nfvrr in tlie Kcondnry forms — ebrotnc manin and dciiicntio. 

■ la Ifae tluakcr Asjlum at lotk, tn 33 casts of dntli front manift tbb 
Mtwnd 8 lints, uul iu m froni nieliuieiMUB B times (Jolius, ' ConlrJbutieni 
ts Bhtiill Usalal Utdkuie,' p. >35). Tlic tlirte exaniples brougbl forn-ftrd 
if rililini|is wire slw C4Mi of manis. 



lu 



ON 1H6AMTT IN GK.VKBal.. 



la thoM cues where lerioiu onatomicsl chinges b&TC tiittAy t&ken 
plftcc in the braiu, and the morbid perceptunu hare compleUljr per* 
viulcd und destrojrcil the /, the rundatnenlal rcqaitiUg of letuni to 
nArmni thought Mem to he wBQtiiig. Ilie length of tua« teqoired 
for this canoot be estimated. 

Bricm de Boi»moiit' meuLioiu t!i« case of a ^uileiiet vbo. in lu» t*«alf 
Moond jnr, aUci r&crlriug k violent frigltt rrooi a penoD dnued like a bevt 
At tt mMked likll, became inune, and fw fiftj-two jean did nut speak ■ wOtd, 
but appeared, witli grovla and aiorinK to-uiii-tro of Ifae bodj, to uwlale that 
(pMiea oT uniiiial. Some wnlcs before hh doaili, when diairliiBa and ttdoui 
liad act in, liu began to gpcjili ; liis intelligence abovcd Uadf tobc^ iodeed, inj 
llfoiled, but the coiiBrclion of bis tliougltis vas ooncct and orderlj. 

In CMC* wliere tite cvTcbrnl tjmptoius originato scooadaril;, aad are maia- 
lained by diacuc in otlicr organs, and itill depend on aimpte Dcmmi irriuUom 
or oa tliglit lifpcnemia, luch nieatnl itnproTCiueDt before dulh ma; evea be 
wptoted; tbii 11 catil; cxplaiocd, and it in inaa; wayi aualogoua to tba 
imntion of certain paiai before deatli. Cerlaio eioeedingiy rare c«Mt hm 
alaobeco teeu wLc/e ona dcmeuU (poiiljiic) noaie time b efc w dtath ttcp»et«l 
kK'c^tpvt'^' Ibcii lott rccuUcclioiii, and cililbitod a oertaia corrcctaesa of 
judgment. 8ach, it ii itat, ii ilill far from beiug a itate of rtaioiL Hoff- 
msniioorrccll; rtuiorliR, tbililiis "nlioualitj" wiiidi ictppears abortlj bcTorc 
dcaili IB ici uioit catc* mere]; a re-Mtablitlimg of au equlihriam bcAveea 
d I mini* lied powvrii, tlio jiatt, tbo future, and tlic ntoet in^ntant reblionaef 
Ufe ktill rcRiainiug in ubtcuiil;. 

Uudi mental impravcmcut before death is not alwajs ooincadent irilli marked 
agpaialioaof ibo bodilj ijoiptomB; caioi kaie occurred vbcrc Ibo palicota 
were eoiuidar»d cured, and Iben mpidlj oanied off bj gndden deatb. It is 
Tfrj rare lo tee intanily lUBuitie a ujore terioiu form aWlly before death - 
itlll. in mnnia, an uocesi of fui? tometimei conica ou wLldi doei not ceue till 
dahlb ooouii. 



( 68. The acute delinuui of fever, from which ioaamt; is ia no 
way •pecillcull;^ distinct, likewise coiiaJsts of active dreama duriug 
waking or hulf-waking. Although genejally tlie deUriiun of (eter 
ia laore u statu of aimplc iucdhi-n-ncr than, of mcntui ubcrrotiun, still 
wo obaorvo frcquciitlj' that in these dreams the various balluci- 
lutioiu and falto idi>a!i lire oiily expressions of a goveniiug funda- 
inentul diapuaition, sometimes fixed, eonieLimes chaaging, aud ftre 
tKiu connected throii|{1i the unity of the ruLiug sctitimeut«; and also 
that the special subject of each of the imaginary images and false 
idcM is gciiurttlly decided by accidental circumstancea {physical 
waute, iho paper oa the wall, old rvcoUectioui) . lu the delirium of 

< ■ GiLielt« de> liopiiaux,' 184^, Mo. j^. 



OS INSANITY IN GBNERAI.. 



na 



iba, we can often arrive nt the same fandamentij psvchical 
according to whicb the division of inental diseases into 
M^ pnacip«l forms ts Ifawd. Thus there is a mdaiiclioiia, » 
nai^ pulial dementia (reatricU>d to single insane ideas nithouL 
■uh anotion), and demeotu in febrile deliriam. Tliore are also 
mUm yn^ifponag couslilutiunol caiucs of slight delirium as of 
■ntal dbeue, «ach u prcviouB weakness, heredil«ry iiillui'iici-.H, kc. 
Alllioagl], in general, acute delirium dilTers esieutiiillv from iii- 
anlr ill its slioricr dontion, the absence uf preniunitorv D)'ii)|)tmii#, 
ui its suildvD outbreak, it.i »jiii|>tomntic clinrocttr, tiw iircwnci- uf 
lUgli dfgree of fever — sltbougli, iu acute delirium, owing to its 
Aert duiatioQ, that psrchologicallj organised tranaformatioii of tho 
imcBalitj' obseiTcd in so naii^ niantitl disi'sses is never present, 
>3I, both ktikb of disorders, v regards their nature — nervous irri- 
tHiaOf bjpenemia or Inflauiinatiou of tlie braiu, probably of its sur- 
hiM ■mil ■mil II — svmpalhclic irritAtion of other orgati», eoiotions, 
■■DBO ititcit, abuse of alcoliol, &c. — arc identical; there are 
BBVi which art transitory and of short duration, tlicrc is a kind 
(f ananity whic^ is accompanied hy fever, and, not unfK(|UVutly, 
the Odthnl affection luif, even in oieutol dieetuc, a symplomntic 
■piiScntiuD. So we uay corrcctiy rlciignnt^ Iht psychical disturb* 
nee in iiuanitr as a gonenlly chronic deliriani, and wv have no 
gKHUMla for arreting with Ueorget and Burrows in tbeir vicnrs as 
la the pacific diflcreiue between the delirium of fever and mental 



Set Goorgri, * Uefeer di« Verrrieltheil,' iranskted bf Qcioratti, Leliaig, 
■Sat, p. 197 ; BurTO««, * CoaiBicataries oti Inaanit^,' Loutlon, 1S18; Jncnbi, 
'Bm>a(<ilaB|iii itber die ait Incscln urbundetitn Ktaiiklicikn ,' K.llifrrelil, 
iltjp; UoKM, 'AnaaL Hid. I^cliol.,' vii, 185.'^, ]>, jo, mid Ilousciual'a 
imrwaf Staim's work. Uii. p. 448) >'^i 'Bull dc i'A»il. Xidi>. do MiU.,' 



SscnCN H. — TAf Gtaerat MiayuotU tf Menial J}!t«atf. 

^ 69. The qoeation wbrtltcr an individual be insane may he pat 
■ two £ffesent MOftes. It may be aaked whether in him the general 
meotal dtJtarbaDce u the result of ^eate ? or it may be dcmandi'^ — 
in eridcntlr present nwl ntahliiihed morbid paychicnl disturbance— 
•hdber thu belongs to one of those cerebral allections wliich are 
BBully called " mcuUd diseuHs," or whether the disorder docj not 



114 



on TNSAN11T IN OBNBHAL. 



[lerbapa dcpcud on soiiu: other discjuc, aa meningitis, tjrpliU!>, in* 
toxiettioo, &c. P The latter c|ucstioii is purely medical, tlie former 
is more rrctiaently medico-legal. 

yShea the mental Caculties in a man are in n state of morbid dis* 
tnrbanw, this majr in Eomo cases 1>e casit^r and hj any layman 
distingoisbed; in man; other cases the decision on this point ii 
vcrj* difBcuIt, and rcquim prolonged obscnration and Jntelligoit 
acquaintance witli tlie science of mental diaesM. I ItaTc IumI sub- 
mitted to mc opinions of special medico] ptjcholo^sts, vbo, after 
aix montbei' obscrv'ation of a patient in their ssjrliun, cotdd not come 
to a decision whether thev should declare him insane or not; and 
oldor and rei^ent citses have heen published (Heiner Stockhaosen) 
on which the opinious based upon long observatioD, institated aJ 
ioc, of eioinetit psvcho)o^9it!t hiwe been quite oontradtctory : the 
rending of thcec is tctjt instructive. Wc see, likewise, how vcij in. 
admissible, in many cases, is the denund frequcuUy made on the 
medical jurist (b^ the jurj) that be, after one or two short cxaml- 
nations of the [irisoner, should give his opinion, when, sometimes, 
tlie time allowed 'm iosuffJcieut to enable him to acquire a foil know- 
ledge of the subject of inveitig«tioti. 

The dilKcuitj of this qucation depends on the fact that pervereitica 
of feeling and effort, fsdte ideas and opinions, and even dcQusions of 
tha Kww — all; as wc have seen, essential elements of mental dis- 
MMi— «K sl«0 piciduceit in otljer than morbid states, and con rxist 
together with wholly imdiaturbed mental health ; further, that when 
uich psychical anomiilics do not at all exist, their prominent s)'mp* 
toms may be designedly imitated j or, when thi^ do exist, these 
may be eonoeoJcd j finally, on the fact that there are miny cases 
where the dtieaao is parttalty developed, and with but iocomplddy 
BiariEed riglU) irhich couf^titule the chief criteria trom which au 
individual is to be procouuoed insane. 

§ 70. (1) Ttie chief point is invuinbly this — that, in the 
gmt nti^orlty of cases, there appears with the mental diseitse a 
obugo in the uentJil disposition of tlie patient in bis sentuueuts, 
deBn»i habiis, conduct, ind opinioos. Be is no more the samej 
his fonnpr / becomes cfaAUgetl, he becomes estranged to himsell 
(■lienatftl) (»w ^ 5). In order to prove that this diiuige has taken 
|ikcc ill the i»lKiit, it is BOoeoaKry tbU his foimei habits and 
Dltnraclcr should be made knuWB to the jfbjncim, ctoi though solely 



I 



I 



ON INSANITY IN GEN£BAL. 

tnm Uw eammazucstion of olhen. Tlie contrast is tfaea often 
Tn7 aLniing — the temperate maa giTes himseU to dninkcnncsa, 
tbt bnolooB pores over tltc Bible, the bMliful becomes impudent, 
lb BKnl obsom^ &c. This change in tli'e mode of thought, in 
tbe iffnrtioQs ud actions, is more evident ihc more rapidlv it 
•Draci^ MDil more difficult to |>rovc when it comes on gradually- in 
the eonne of yevs. Cases of the latter kind nrp, if the inKiinit}' 
he liaiilcd to % slight degree, often tcit ditfictilt to distinguitib 
hxn t-crcnln<ritv, immonilitT, oapriciou»iif*.«j or falae views of life. 
In oevuun casn, which however arc not commou, uo marked 
can be dstingniahcd, but rather a stronger devdopmcut md 
of pramiDcDt peculiarities of character } and when, in such 
I, the metitAl disturbance comes on olowlv and gndaaHy, it is 
£Acn]t satisfactorily to prove insanity : thi^i is seen in many ca:!C9 
vt gradtiaU; taoeasiiig morbid detirc for law-suits, in slowly iii- 
aeuing Moraility uid UKtcmpcr. This chaoge is alio wanting 
in caigenital cases, and such as have existed from early youth ; alio 
in tndividoaU who have been sll aloug eccentric, peculiar, or lucu- 
t^y weak ; and in these ctta&t, when moderate iu degree, it is 
oAco nlicmely difficult to diagnose the presence of diicuse, (this 
diflcnlt; is also felt when called on to distiuguish betwcmi o 
£f^t degree of mental weakness or dementia and stapidity,) while 
pecnlinitMi acquired, and changes of the normal individuality 
ilin going on, iie generally more eaav to determine. Trom all this 
we liBiii lliat compuiKHi with the former ways of the individual 
■Mft mlwayi be a principal element in the consideration of these 



We BMit l&ereCm rmke oonalm scquainted urilb Um anteoedenl*. tlie bis* 
lM7, «r tke bdiriduL Caferliuiately, vd are not always astlsted Id lliii l>7 
tte fncBiii aad relatlTCi ot tlie patient, Int rrequeDtIf left ijniorant, tbroogh 
tbrir tiiemee, of tbe most euesUal circumftltuioes ; vb oflcn luarn more iu- 
^ttdfy. LikcvUv, in the iliaat-hred tmository iiuaaity, a* frcqurull; pre* 
i^ilidn cpikflioi, to dranLard*, ud Miootime*, williout ipccuil cnu»c, in 
tan f ied to poeedi (ko total tbangc of tlic pcncoalilT duriog Hic attack h an 
bifoftnt poill ; ba^ iadetd, Ibe lih of aa iaiiTldual maj bo audi ezUraally 
tkas tW gnilaal eontra»t to hit acta U wcd during tbe "atUck," wiiilo a 
^niiilsi%s cf Ua tantT life B%bt show tbe cause of (he emotion, ia tbe dit- 
naiwaS/ itr«ngc*l| tbovgb pcdiaps mora or lua «xtcniallf concealed, 
vUek these acta emanated. Vi'c niut, tbercfore, be TC17 c&ulious with 
to traaailerj iaauitj. vtud u quite familiar to many medical jurisb 
(■a DBfosici *0a Bait U Baisoiif 0!) coininCKo U Fotief' "Uiinioire] de 
rijy.daMM-,"nl. uiii. 18^9), and generally can be reeosnised even wbere 



lis 



ON INSANITY IN OENFRAL. 



lliD sll*ck pietenti a dramlikc chnnicter, and vbere. ordimnir, Ike damge of 
iKe penOD&lit? u moil complete. We sUould in oil auob eun nol« well tlic 
preuucc ot abacnoc of wijr jiRnnonitor; sjnploiM ; oonpltU fttnciicc of auch 
it suqiicioua, 

$ 71. {2) Should the consequent diangv in the habits of tlic 
patinit or the *ii>iie<;leil exaggeration of ccrtsin phases of lii» 
iiidividuiiUly have occurrci) iindir cirnimst-ances irhkh, accord, 
ing to experience, inajf be viewed as causes of insanity, or if 
the iadiridiial hns burn so Hitunli'tl as to be exposet! (o im- 
portaiit exciting caii'L-s, we e;in, with still frrealer confidence, pro- 
nounce Ilia stati! to be ouc of mcntiil disease, llcrediarr jifL-dis. 
portion, nervouB constitution, icjurics to the hcail, dissipation^ 
bjrtteriii, epilepsy, may be nietitioncd as examples of the most im- 
portant predL'posing caupcs; while rlisappointnicnt, fright, acutt; 
disease, the puerperal rtnlc, arc amongst the tiiost fn'(]uent fxciting 
causes : the eautM irill be more closely considered in tiic followinji 
book. But, here ii]j(), thiT(! is greut ilifliculty in pmying and 
judging of the facts. The judgment is particularly difficult in t]iune 
ea»eif where there nre circumstances vhich an, indeed, importaot 
csiues of insnnity, which hi tlinnsclvc^ might he considered as 
symptoms of mental dcmiigctni-nt, but which arc also very oftcD 
presented as app«arnnce3 of imiuuml desires, and have, vitbout any- 
thing morbid, n deinornlistng and degrading influence ou the cha- 
racter, fentiaiculs, and intellijr^ence. Thus, a diiwolutc life, and 
juirticularly the abuse of nlcuholics. Whether tic perrerdtT, the 
blunling of ihe fenlings, and the hahitunl ill-humour cf the dnuiliArd 
iu their moderate degrees should be considered as morbid menial 
states, is ocoesionuUy a cjueation which can scarcely be ?nti$factori]y 
solvctl. In tbe liiglu-r degrees insnnity may alnnys be ndmilted. 
Id the ihiuic way, judgment may otr:astoiialir be difficult in cases 
where very powerful meiitAl cauve», motives to violent cmotious, 
have existed, and uliert- menlnl cxcitaliou or depression, with aJI 
iheir coTisetjutiice^, have i-uBucd as natural rrsalta of that motive : 
for cxauipio, very great depression emotional after the Iofb of a 
fortuno or Ihe death of n fneud, prolonged excitement after di<;ensc. 
"nie csscQlial diffinncc between a melancholic from mental causes 
and ■ perwn Hffected with viadness in a healthy way by the same 
cause is, that, in the latter ease rcnctiou takes place on mnovnl of 
these causes or on the entranec of opposite conditions, while the 
melancholic cannot rid himself of his morbid grief, and his statt 



OS IXSANITr IN GBNKBAL. 



117 



timus, ftt least for a time, even after rcniaval of Ibe «x<cmnl 
■ : this distiiictioR, hovercr, cut scarcelj^ be employed as » 
pncUcal diagnoitic basia. The judgment is, as n rule, mure easWy 
Hiifcd at when no gucIi txtt-mid occasional c^iuses of the saspcctcd i 
lUte, at the coi»«jU(!iit diangi; m t!it: hubiU of the patifiit, can be 
tbiootercd — vbcD, therefore, this chuigc caauot be considered aa 
lM>lLhj reaciioD from external events, and vlien, on the coiilrarj', 
tbere exist pieptred or prtdiaposing csusea, »iich ns lieretiilarv pre- 
dsfoaitioD. Une «e discurej one of tbe most essenlial deinculs of 
tBNintjr, viz., abnoraul reoctioa from itiUnuU causes, from au nb> 
■ofinal mental state. If an individual has, on a former oct^asiuii, 
■oSered from what vas iinqtirMicinably aa attack of insanity, this ia 
of Urn grealot imjwrtancc, for we know that n didposltion to sub- 
•eqacnt attjusks iii Uierebj founded. 

If it vere possible, tokiug into coiuidentioa tlie cLiulogiud and 
□rtic cinnunatancce spoken of iu tbc si-cond book, to demon- 
llic (IcvcIo|HDeot of menial di»ciuc pnrely objcclively, and 
apui from will, a very esKOtial part of the problem would be 



( 73. (3) The 'ymjiUms of moatal diseases couaiist ouly to a 
extent of definite, isolated, and unmliitakabic morbid ajiptur- 
■ad nerer ia any case of directly palpable and physical ^igiis. 
The; drpenJ csKiitially on the interpretation of the mental act^ liy 
aa obwiTer acquainted with disordcn of tbe incntiU fuiicliuns mid 
that taoia of cspm»toii. Two individuals tony say and do the 
Muir thing; for uafiiplc, they may express their belief in vilcli- 
enft, or the fear of being eternally lost ; the iiilcUigcnl, observer 
would ilcclare llie une to be healiiiy and the other to be insnuc. 
llus judgment ia cone to by a consideration of all the accompany- 
ing drcumatAnocs, and from a knowlMlgc gained by experience of 
tbn nrioBa fornu of iosaaity and their accompanyuig phenomena : 
iho idea of being cleniidiy lo&l ia a notion culertaiued so fretjucnlljr 
bf nebmebolica. llutt it mmt nt once avaken tbe suspicion of melan- 
dMUa. aad we nay at once proceed to ioTestigate whether the 
bandalion of lliia idea ia rcoUy that whicli is >ccu in inelaocholia 
■ad the ddirioua conceptions wldch nvcompany it. 

fflioald the condition of the patient and llic coUcctire cwcntia]' 
iadiridtial syniptonu corrcapond to the image of one of tlii; [iriiieipid 
fenm of ioMidt; (to whicli alt classilicQtiiHis muat in the end leOutx, 



lis 



on IS8ANITT IJI OTSEBAL. 



■3 they »re really founded on Mtow), nuuiin, ucljuiehoUa, chrotuo 
mutut or dementia, with the tertnin diagnosis of ttia form, of course 
itaamiiif ie also establubed. But, oa tiw other li&iiO, we cannot, u 
has been alreadr s«n, because the case ilora not complctily coincide 
with ouc or other of these ptiadpal form*, come to the conclusion 
tlui DO mentil disorder ii prtsent. Titese principal forms liavu 
been established bj carefully wlecting the most charaetcristic stat« 
and conneetinff them into tvpical classes. There an^ however, manjr 
intermoliate oonditiotu, mixed form«, imperfectly nuu-ked states, 
which do not exactly correspond to these classes, (ienemlly it is 
not difficult to find out, at least, the general eharacter, vhctbcr the 
itate be one of exaltation, depression, or weakoen : ucrerthdcss, in 
ccrtaia oaMs» soch as morbid dubias of sentiment, monln for law* 
saib, ftc, this general ehnracicr c%-en is not definitelj marked. 

The presence of a deluHon is not at all ncccssaiy lo con* 
stitutc an individual iiisnnc, even in the narrowest ecasc of the 
term (in contradistinction lo dmple disturbnnce cJ the aiTective 
sentiments). In mnny cases no special delusion is present, or, at 
leaat, there is imne cxhibitol, but the scntimeDl«, dispositions, 
and conduct are altered in n morbid manner j and owing to » 
morbid state of the bmin, tbo iDdiTidnal is influenced so that the 
healthy faculty uf judgment ia obacared, the iutdligeiicc forconlljr 
involved, and the spirit held in bond. Such an indiriduat can bo 
" rational," that i», can ^alt without ma):ing great mistakes on 
onlinary objective subjects ; he can distinguiah right from wiong-^ 
direct his aclion^ with a propi-r ni^e of means, with apparent rcflco* 
tion ; proTos by his conduct that he knows a criminal act, and seeka 
to avoid the pniiishninit thereof, St. ; he ran, at Icas-t for a time, 
CO conduct himself tlint notluog t^lrikin^ id ubicrvable, and yi-t his 
disponlion may be so entirely altered, his whole affective scatiments 
so distiirbwl, Hint an osseiitially different relation of the |K-rsonality 
to hinispir (bis former /) and to the world is formed, lUid Ihu irri- 
tnlion of sentiment can, at any moment, appear in im|»ssioued ]ier- 
verted nets and desires. Tliis is purtipulnrly ohMTwd in the pri- 
mnry atajtea of mejital clisra^c, in many moderate Rises of mclan- 
eholin, in the slightest degrees of inaiiiti {/olie raiwnnanU — soc further 
on), and, very frequently, in the cnrly stage of parah'tir. dementia. 

In criminal eaacs, tlie net committed can of itself nflen give 

csstnlial aid iu ansfl'oriiig the question wlvetlier the individual is 

ijoeiitaUy diseased, as, even in the act, there often lies a k-ading 



ON ISSASITT IS GEIBBAL. 



119 



fpBftata of tbe inHUiitjr — indeed, tbe only frroiind for Lbe asscr- 
tia t^ insAtuty cxisU. (l mty li«re note the many instanccR of 
■irier of their own childrai.) lo llie great majority of cam*, 
Wrtct, thb U inndmissible and i]uite jmpo»iblc; vo tnu^t rather, 
ii otder ui prove innnity, snd that tlic on'gin of ttie deol pro- 
nijad from ni<*aUd disease, endeavour to establish before, raclusivcly 
qcilc tndcpcadcQtljr of the docd itaclf, tlio marks of insanity 
to origin, srmptoma, and course. The opposite coarse^ 
o( nalLtug the deetl ittelf the dislinctivc mark of an abnormn] 
■talc, has ted to the doctrine of insttnctirc tnsjinity (homicidal 
ckptonutnio, &t.), alike dangcroua to scimoc and to prnctice, 
bw only ecrvvd to bring tbe medical opinion, vay properly, to 
Mfon tbe jadgn. 
Bat, flti>U_v, are tlu>Te not cue* in which, in criminnl deeds, a 
— hid mentjit st»te exist* find has inflococe, and yet prceents no 
eslcrml nanifctlatiuii? I bclJcrc it possible. Who would dnrc 
to tnut himaclf to scpatute his mental racchaiiism as one vould lay 
a|KB tbe korct of a IhmI: ? Who vmgld <hre to deny the possj- 
Ij of active organic inBoences of n morbid natare, itol vxtunially 
whta dtstuibvd and disordered at thv moment of action, 
_ tbe *cale toward* crime? In Uiis sense I was compelled 
to CKprest myuU it the bar in the case of a murderer who EuiTen'd 
tnm wcU-ooDstituted Tcrtigo cpilcptiai. I was constrained to say 
Amif aotthrr Iteforr, nor at, nor nftcr the deed, did vc find certain 
ri(pii of ncntul dietnrlumcc, jct, nDtwitlistandtng, it was possible 
that thb diMatr ollowi^ influcnoes to act on the phenomena of 
volition, which obscured idWclion and wwJcenCiLl tlw freedum of 
wtU, without, how«vcr, manifesting themselves by any external: 
•ymptomi. 

i 73- (4) Symptoms of bodily diseeso nsocttainod by the stole 
of the paUe, th« digotion, the secretions, &c., cannot naturally, in 
iBT cue, be token as proofs rvf menial diM-^Lw ; the diagnosis dvpoads 
eMeatinlly and cxdtisirely uti the mentd symptoms. I'fGvert.h(>!c£s 
tbotmymptoRu of dtsenscs in other p%ns may be of great value. 
PtDio them wc arc cuahtc<l Ui amwcr the qnestion, U the individual 
ia » (tatc of general ilMiealth? If, from these symjitoms, thi« can 
b* Mid with certainty— if, on the one hand, n striking mental 
dnsB b obgcrredf or very eospicious W-linviour, nnd, on the other, 
nKabkl stntc of tjiu nrgaaisni be present — it becomes highly 



ISO 



OH IKSANITT 1» OKtfEa.ll.. 



probable tlist both scries of plieiiomecut iir« rebl«d to cad other, 
i. e. that the menial cliange is tU&lf morbid. As, kowei'Cr, insftiut; 
(b'pciida i-Mcfilially on nn afToction of tlie brain, there are noae of 
itll the psychical ayinptoms, not in the Dtrtow M:n!c, of gteitter 
kignideaiice than ocrtain phenomena of disturbed (irritated, depresBcd, 
&C.) ccrcbml function. Tberefore, anomahes of the coatial seii- 
sorial fuDclioiij hu]lucii)Hioiis, &u., an- of such extraordinary valiK^ 
and violent bcadachcs, elcopteunou, fainting, aniestbaia, oUanges 
in tlic pupils, :i1l coitcomilAtit ronvuUioti? mid paralyse* are abo of 
such great iuiportancc, io the (liagaosis of insaiiit j. If these synp- 
loms can be traced to an ntTectioii of the brain, and if ve can, by 
lliL-ye, prove that at aJI events a cerebral affection i» present, it ia 
clrar I but iu few cases wc cna doubt tliat the »u»i>i:*.-(fd psychical 
e}-tiipttinis depend also upon the cerebral affection; at IcAst thp 
opposite cnn strldom or never lie shown. On the other hand, the 
uuii-iippturiuice of Mich further sviuploias, and the absence of all 
plijsicnl disorder (of tlic pulse, digestion, &c.)> eau never be taken 
118 proof of the absence of a mental disease (». /. a cerebral affection 
of which the actual symptoms aio csclosivelv psychical) j wc fre- 
(jucntljF meet with cases of undoubted mental disease, especially 
Tronic cases, in which the bodilj fnnctioDS rcmaia unimpaired. 

$ 74. (.;) From the physiognomy, gcstnrea, words, and actions 
of an individual, wo U-arn the pwenlial symptoms, those of the 
mental ftlale. But there are ea.4(-3 Mliere the i;xteriia1 aigns inislcadj 
n« ll]e iiLsiinity i£ sometimes simulaleit, or — but not so frequently — 
I'eigaed. When dissimulation is suspected, the following cir- 
cumstances should cepedally be cousidercd. The Euoitdator, if 
be doe* nut posseiss special psychiatrical kiiowledj^e, very seldom 
succeeds in correctly feigning the symptoms of any one form of 
mental diaeaac. lie (feneially mixes the upi>eaTances of fevcial 
forms with eitch other, su thnl au unnatural ifpresenlatioii of disease 
is offered. Moreover, he usually overdoes the pheuomeiia of menial 
disturbonoe. Ue believes that all must ho reversed ; instead of 
giving expression to dclirioua conceptions, he talks absurdly, and 
conducts himself ns if, in insjinity, the grmler part of the intelligence 
and of the memory must be dist arbed ; acts aa if he could no longer 
cuiint, reail, wrile, or tell hi» iiaine, &e. The simulator is carefnlj 
and very often shows great uncertainty in regard to how he can 
best play the fool ; he expresses and withholds what would bo of 



OJt IKSAMITI IS (lENKILAIv. 



ii\ 



» 



I 



I 



idfoatsge or di^udvaiitu^ to liiiii. He presents fev or no gCDcrnl 
(bodilj) morbid symptoms ; he ni(|iiirc8 far more rest and sleep tlian 
Banj patieats, and is iiicupable of coiiliimous muscular exertion 
(«8 aioiaoil cxcit<:mcnt coiiLiuuiu}^' for wociis without interruption) . 
Tliaefuce, the quiet forma of iDKmitv arc more easily simuliitcd llmii 
th« very agitated ; the ensicst mode of deception is to feign iui. 
beeiiiST'. U uiay be difficult also to j^ve au opiiiiou iu coses where 
vague ddirium with the character of wcvkiitiiv is simulated. Frc- 
qaoitly, olserratioQ where it is tuiretnarkod by tlic patient, and 
cttn sarprisiiig him Ntndinicej leads to our abject; but this wc do 
Dot require to notice further. It is not necessary in tliia work tliiit 
wc tluHild enter into the subject niintitety. It is, honev^r, important 
to obserre UmL even the esisteucc of aiuiulutiua is by no meuua a 
cotwo cridcncc of mental health ; tlie insani; thLTn»<'lvi;» frtc|ucntiy 
flmoUte : indeed, there is a kind of morbid iilcasurc connected with 
thB unalnltng whicli ma; be compnitd Iq tlic nnolagous di:>po9itioii 
notknl in hysteria, but must uot bo ideiililied with it. Wc may 
alia be bronght to the opinion that the individual simulates morbid 
■eatal Bjmptoms, but that he ia neverlheless mcDtaliy deranged, 
oaljr in a vaj difTcrcut fruui wliat lie siuiulatee : iu such a cass, 
mlnrally, otiier signs of insAtiity must be present. 

Should we snspect that insanity nhich really exists is feigned 
hj tbe patknt, who is conscious Qf the disorder, which may be 
aftictcd {MrticuUrly in the preliminary stagejt, or even occasionally 
with fixed meUucholic delirious coiiccption^j when the ij'Cueral dis* 
harmony of tcuiiiucut has again subsided (II. Holliiianu), a con* 
iinnous careful ubsenation of him when he thinks he is unnoticed is 
B moot important means of asceitaiJiIng the truth : it sliuuld be 
|ArticuIarly observed how ho posses the iiight j opportunities sliould 
be given Uim to express himself upon various theme?, when ho may 
oeeuioiudly betray hiin^f If ; his writings, iu whicli insanity often 
appeal! mott strikingly tbao la coavcrpation, are s[iecially to be 
lookcasf. 

Tl*t U Bot dUaimulAtiou wlitn att UtMiK msa dnu'c* lliitl lio is ill— «iicr|(pli- 
caUj prDle»tlS)[UiibtUiC ■wpicion of lii> bring ioHiic. .\ Tcrjuimit (iiuulutar 
moLl also iniltlelliisilciual: ordiiiatiljr ibis would appvar to litm too linsinlout; 
ba WMild tliow Ml oppotito deiotwiour, lio would readily dcolare tiinuclf ill, 
waimfttMlj mcnull; ill. 



4 75- i'^) But, simuUtiun eicluded.and all tliut we have hitherto 



182 



OK INBANITT IK GEIIIIRAL. 



Niid carefully coaaAenA, st3I, in mtmf caste, the qn»tion whi'lher 
Bii uKJiridual be insatke taanot with ctirtaiiU.y be solved. The 
(jarstion, ^^'bvther in<:Dtal]f dueued or not? !• by do means a 
eocKCt ooe. Tbcre are no well-nuiied boundaries brtwctn health 
and discftsc in genrral ; thrn: is^ in mrntal as in o(licr patUnlogy, sn 
■ntcrmedtnte teailory of dJKirder which is not rei fally developed 
duMiw, ftiid vherc tlic individual ^till exhibit* many of the chnrac- 
teristics of health. U Dot this the rase with the siaiplest bodily 
troubles? Where Is the exact point at whicli we pronounoe a mun 
blind ? Only vliere there is ibsohilely no appcannct of t^ht ? Or, 
irbo is dumb ? Who if droj«cal ? The indiridnal who has the 
uligbtest trace of cctteiiui P If not, vlicre doea the limit of dropsy 
eonnwnee? When there are extreme*, nil nre agreed. When the 
(lef[rcC8 ire slight, ve may even argue whether these signs may be 
taken into consideration iu the esse. 

In mental medicine, hofl-erM-, many inedieo-le^ Casca fall within 
this cali'i[orr; for example, of deeds done in passion by iiirsons 
habitually moody, and tJiOfe of weak intellect — of halitonl mode- 
mtf rscifcmcnt, or of pcrt-ersenaa* with temporary distraction, of 
dninkeniiess, hysteria, &c. ; canes of which it inust ordinarily he 
•did that the individuals are not in a healthy mei'ital stale, but the 
marka of dc£nite mental disraic ciinnot be clearly di.<tcovcnNl ; thejr- 
fore, it is more probable than rertain thnt Ihcir nctions arc regulated, 
or nt Icnsl greatly influenced, by morbid oi^nic causes. In the 
mode in which llic«e actions arc expressed there is, indeed, no miirked 
Ihie of dtflinctioii between eceentricity, pasiion, perversity of desire, 
di Jni-M of srnliaimt, and meDtal disease ; there is no constant sign 
from irhich me can (ell whether those states re^iuU entirely from 
organic disease (morbid), or only partially from such, or wlietlier 
they exist without organic influence, as original traita of chnractor, 
or a« the hcTctliliiry result* of th.- pncliieal intlividttalily. All 
rxisiiitg plii-iiomcua of ccivbrnt disorder, hnlhiciiialions, paralwia, 
ic., iind III! physical morbid appeaniices, are hew of special 
vahie. 

Wt must l>cflr in mind IbnL in Ttry mnnf eaits tlicnj arc few Jiklinct, denr, 
nnd petfcoily licnioMl ruble Mgitt of incnlal discnjc or Ileal lli—tliat Iho Reneral 
anil colleclitfi iinprcuioii of the p«ticnt and kis not* mucli more dclormiuM the 
opiiiioii. Oh >ucIi n collcolive imprcwion, bowcTflf, oa!j (lio mau wlio tJio- 
nngUij iitniorei.ind* ilie question, m iutdligent iilijwcinn. ongiit to proceed. 
•0 vi«wof a case b; one man, who ot the maineat canaot dear); show 




ON IN6&NJTT IN aEVEHAL. 



12S 



an wlat iadhridul gronniit ha foraii liii oancluRion, timj be highly vnluaMe — 
hf inatliBr mm ^ita worUileM. Wo nuit not llierefotc Ldicva tliat fn-jy 
^ipkma lo u afiylain b c^ioble o( so jadguig. 

^ 7(f. Tt is cow evident tbnt tlic question wlictlier nil inilividuul 
be menlillj diaciMMl can only bf decided by a cart-ful pcisonal 
emninatioD ; ncvcrtbtlcw, very recently, and in joiac cases prrliaps 
rtill, tfac pby^ician is expected to stnl« bi.-> opinion merely from a 
dncription of the unions. After becomuig acquainted with the 
dnef Cacti of the case, ire al oncu proceed to n piTsonsl cxamiuulioii 
of the pslient. Not unDrequrat!/, (Ke tctv state of what immcdi- 
■letj Batruvods him shova, to the exjierienced ey<>, in liie motit 
BDJiustftknble manner how mutters stnnd : the upnTttticnt is faotaa- 
tiiallj decorated, tlie rJotliing ii- odd, disonU-rly, tonij there are 
ntrki of neglect, of dirtr babits, freakirihiiess, nil of vhich verc 
before fordgu lo Ibe indiridunl. In the next pUice — without sboir* 
tng the paticDl that any particuUr attention is directed to him — liia 
pt^noguoinr, htji bearing, liis eondiict, are to be observed, especially 
in to far u ibcy are expressions of ccrt&iu dispositions : the counte- 
nanre in tlie ividlv iiiFimc itt frequently slriLiiigly altered, or irregu* 
Urljr dUtcirlcdj dearly i-iprcn^ing ecrtjiii) pattsioiiR and oniutinns; 
tbv roke mty , psrticolarly in melaiicholia>, be often t^ken as a true 
exprenioa of the ruling diapoeitiun. Cvuveisatiuu vith the patient 
nast, as &r as possible, be carried on nntnraliy nnd cjilmly; ejm- 
paUij should be sbovn, ve should seek lo ronse his attention and 
pin bis coofldence. lii geocralj it is best lo commence vith (lucations 
rcnrdtng tbn bodily scniatiunK, certain rcquireoieiils or wi^lieM, &c. ; 
Ukb tn proceed lo the former life of the individuni, Ibo history of 
wkicb we allow biin to relate in an unconstrained inainier; hereby 
•e foek to onderstand bis storj', views of life, interests, hopes, and 
plan*, in order to receive From thnc, in connerlion ivith tlist cutn. 
muiicat«d by otliArs, a collective picture of his former individuality. 
Wfi ioquirc into bis present disposition, his iutcltlgcncc, liis conduct 
(eipceully according to the {loint of view given in the pre. 
ec^og chaptrr and third book). In liow f»r these have bccumo 
altered in his present Htatc, what has oocnsioned these changes — 
wbetluT Ibej- are to be considered aa really morbid, whether any 
criminal deed might mult from the morbid disposition or uienlol 
cooditiaa— become now objects of our judgment ; we may couelnde 
' bv a miniite invcatignlioii of tbc general physical state, and nn 
ImiuDation of the several orgin«, the loogs, the licart> ttic arteries 




■bom 4, m 

*»lrM jn ude to fntfrrira rioti 



It of the popUSf 

irf paralytic 

atJiKg f t' w m i f L', of 

of tke nfaDcettul 

Sipl icti, MpediUjr 

■itil k Weoaa ciidoitto 
■etoh Hd tet tsT ftutber 

psjriucai 
in the 

fa iefiitmlr solred, 
■afiflKat u Bicntal 
and Boat be svoided; and 
■ *'ip"". in Eome 
Tke no^ fre^utt mis. 
^|;ka9 fenr, and is •cute 



Ti<aiVit i wi it geaaaUj rtry oai^ iTiiliimiiAnl br tbe smeU 
of llic brcBtli after the aboM of aleofcolfa, &oai tlw imperfect uttcr- 
HiM vUch Be«» «fpnB at the eatet of ftal diatase, aiid froin 
tbe npid); oMing dnnr m c M nd dene to dttf. It faju, bow- 
ercr, been occa>iooaIl]r obsGmd tlut a fit of drookeiUKas hta 
OMuioned the atnOt eotiaataetaaeat of maualj (bal in tvaj ca«e 
pnditpDKd from odur caiun]i and, fimlicr, that ibm are certain 
tpcdail/ prrditpoi<d indiTidnUa wbo, cren aAcr a mtxlcralc indul- 
gence in the oae of tpiiitx, fnll into s state of nccitcment vhidi I: 
inonr tbe character of mania than vi dmokniuess. 

typliiu ferer, in its fir»t periods, occasiouaUjr sppeara under tjjc 
form <A A maniacal attAck vitb grvat excitement, attemptiaj^ to get 
out nt the riniiow, kc, and cerebraj congestion, or even uuder the 
frinn of ineUncholta with i^uport or as a uKire vogue dcliriun), iu 
which tlid patient mAj walk aboat for ftc«rUin lime. In all mratsil 
(liiordera coming on unexpected!; in >oung i>ersons, ire should keep 
in y'kw the probabilitv of typhus fever, more especially when it is 
epidetnic. Fimt of nil, «c note the feverishncss (esjieciallj' the 
incnuHl tcsiperatarc na thowa by the tbermoaieter), the nightly 



% 




ox IX8ANITV IK OENBEEAL. 133 

tn c wWio ns — the full, w&A: puUc—lUc splenic enlargement, the 
TMvob, the meteorismns, the ydlov flocculeot stools. 

NottoBf 1^, A joiing nun wm brouglit to me at tlic lirwpilnl m mcnUlly 
lmaa»i ; lui iiad for Mitral dij» ilioirD if mptonit) of borildciuciitt and vn 
Ua pnrions night b»d left lus room by tlie window xiul procoeijcit to liii uOicc 
■t m firtance. "nte great nnoerUintj of gut, complnlc iocohpn-noe, hetitalion 
» tfwt h , nwkcd incqutlil; of Ibc pupils, permitted, in the alistrnce or other 
tiilniy. tbe aMniBplion ol ^uicVIjr dcT^lopin; montBl ilj^caso wiili pnraljtU; 
the hot diT ikb, Md frcqncDl, ful!, compreisibic pubc, avftkcued iu me, al tho 
Mat tkMj, the tu&picien of fever. As sooa as ihe pAtient was laid io bed, tlis 
fcgaOiw eould wilb ecrUint; br c»tiibli>1icd : t!ic oounu of Uie diaeaao wm 
Kiioas, but eaded in reeorerv. it is a trtll-koon-n foot that, at one time, a 
(••msB pafdioJogitt who was ill of (jpbui fcTcr wm sent to au najliiin as 
iaauM bjr ODC »f bis cclleagvcii. 

Aeale meafng^tic with strong inflammation at the convexity ia 
nmiifeBted by Tiolnit Itcadnclie, vomiting, unliiianr delirious cicite- 
Mcnt, ooqtuImvc appcamacM, changes in tlic pnpils; it ia always 
MCompMied b; high fever — the patient is compelled fo keep in bed. 
Tfau disc&x 19, 00 the whole, rare, and its course is rapid ; in the 
stsjoritT of COM* there i.1 rapid MiiVing of tlie vittil powers, dc- 
cnttHDg poise, coma, and dntructiou of all the mental facntties. 
Biailtr meniDgitiB and the tubercular alTcctions of the meuibraties 
pmeat caentialljr tlw naie ijinptooiB, but a somctvliut utgrc pr<i- 
Irsctcd aud irregular cour»c. As n rule, luberculosi? of the luiiga 
mav br ducoTcrcd ; where this doe^ not exist, the diagnosis froni 
tlie first form is, in adults, unccitiiin. From wliat has been »ud, 
it is eertfliiilT but seldom tliat these forms can be confounded with 
mental diaeate; «till, thpre are cases of somewhat protracted modc- 
nlc tubercular basilur ineuingitis which majr again improve, and 
which prrsi-nt the appearances of mania (but with couvuUi'oni', con- 
traction of the ocnieal muscles, &c.). nud, now and tlien, recuDl 
and tapidl; fatal cas» arc actaoltj' brought to opiums as caAis of 
■oania. From this diagnostic question, that disease which accord- 
ing to the older Ettltiolog}- was designiUed meningitis i» to be 
i|tihe ciclnded ; for the so-called chronic mcuiugilis there aiu no 
oomplelcljr ntisfactorjr diagiioatic aigiis. 

Whca, howetrr, lliese great mistakes are cxcindcd, when it ia 
cbaH; estoblixhed that the patient is menlallif dUtoMed, then com- 
n cn c CT n riew n;Hr« of diagnostic questioiui; namely, which state 
of the brain ma^, in this coocrete cafe, lie at Ibe foundation of Ihe 
ncDtil diaordcr (( 6). In tilts, tlic same fuudnmcntal principles of 



t 




12C 



ON IKSA.t4ITr IN GENERAL. 



dil^osis hold good as in all othci alTcctioiu of tbo bnia. .\n 
evident []i«enK! wiUiia tlie cmniuin i», if imy jutnlvtic apppanutces 
are munircHt^J, probubty uuilatcrnl ; etatr-^ of coogestion tre nrrivcd 
at hj their wclUliiown signs (beat, reOiicss, &c.). la the iinmeitse 
majority of cases no definite anatomical diagnosis can be established, 
bnt the genenl (and very important) sTinptomatic physiological 
diagnosis whether the aymptoms represent more a state of actite 
irriuilion, or of tor])or, nr of cxtinu»tion of the oerebral ftmctioas; 
this is tu be determined, not by the psychical symptoms alone, bat 
by all the appearances collectively. Tfowwe tromc to the cooduding 
scrica of questions — viz., whctticr the csisting cerebral diEtarbancc 
is primsry and idioi>ithic, ot secondary and sympathetic (from dis- 
ease of other organs, from changes in the blood, &c.) ; to a vord, 
the qtuxtioQ of palhoffeuesis, the solution of wliieh i^ to be sought 
from the prcscat symptoms in connection uiih the etiology and 
liiitory of origin of the disease (kcg the following book). 



BOOK SECON 

THE CAUSE AND MODE OF ORIGIN OF MENTAL DISEASE. 



CHAPTER I. 

THE CAUSES OF INSANITY. 

^ 78. UnstatJie Lcadof OMtMsainineiital asiu gcutral jiatbology 
ate understood Bill tbe diHerent cluses of cimimst^nces to wbich 
tBMj be ucribcJ aa ioilncnco on ttie development of tLc diiease, 
altboBgli tlieir mode of coiincctioti maj be ronously exhibited. 
'Ihe causes comptvliendj on tlie one imnd, the external circuiu- 
dtooes (nationality, climBtc^ season of the jau) under tbe lufltLcnce 
vt which inMnitf a generaUj", with more or less frequL-ncv, oh- 
•ervcd ; on the other hitud, they signify certain external injuries 
(mnstroke, wounds of the head) of which insanity ia frL-qucntly a 
consequeoR j fiwdty, they comprehend oettnin intcmaJ states dcpcii- 
deot on the OT^ganisin itself (hereditary disposition, previous disease, 
or otlier general disturbance of the organic mechoninn, such as 
JSaemt of the longs, the genital organs, &c.) wliich wc know by 
otperienec hafe bb influence in the derelopment of insanity. In 
ray muy of tbeae drcumstances the intiumte connection between 
tboB Mid the influenca aacnbed to them, tlie mode in which from 
them the mental dtaetse b derdopcd, is scarcely ever or not at all 
nidoit. Tbe condanon p&it ice er$oj>rvpUr hoc depends, therefort', 
OD » rimply empirical (statistical) knowledge of the fact tliat tbeac 
putscular ctrcuoittances (for exfliaple, hereditary disposition} verj 
hfqaently coincide with, or precede^ the commencement of the 
inwu^* In other of thc»o to-called cauaca, their mode of action, 
Ub DAnuer in which^ in ooniiequence of them, the disease is esta- 
blialud, can be coraprehcndeih But the proriace of elieloyjf in the 
Damw sooM ia only to enumerate euipiricatty tbe known circiiin> 



13S 



TUB CAUSES OP INSAKITT. 



slaiiccs of cau<<aUon ; it belongs to paiko^ny to explain tlie pliT^o- 
logtcal connectiou bctircen cause Aitd effect, to sliow Ibe jMirUcubr 
tncdmuoal act by iDcnn:> uf wbich inmiity i» indiucd tliiougti a 
giTOi dreunutflucc (for exunplc, excessive depresriDg emotion, 
licstt-disease, &€.), a task towarils which wc luivc liitlierto done 
little more than prepare the wajr. 

4 79. Etiology, and especinlljr palhogctij, arc of the uluvMt 
tinpcrtancc ia tlic ])raclicc of incntul medicine. If, tlicii, the old 
siyiiig tuhlata eanta loUitttr efftiltu is no lougor »fincttoucd \a Ihix, 
HK in general nivdiciuc, ia full)' develu|>cU uiid confinned discme, 
aud ifj likevise, the removal of vatin^ remote cs&ecs \s. beyond the 
power of the phj^ieian, stitt wc frequently aec, eapectitlljr in com- 
mcncii^ iitsanilT, that by icmtiVBl of certain of the niauy ordinaiy 
co-opcrntiiig cau*M, the disease may be successfully combated, uud 
especially uU the various periods of transition in the <lisc35e, all 
those orgamii: disorders wliich pathogeny points out us intermediate 
between the external cauae« and the dt-vcloped cerebral disease which 
ia tlicir final n«ull, present rich opportunities for medical treal- 
inciil. Further, even the Uiefiry of insanity ciniiot be onderstood 
vithout u full knowledge of \\& causes and of its mode of jirogma 
in individual cases: therefore, the etiological questions are the 
iiui$t important in the whole range of mental therapeutics. 

In concrete cn^es, we deduce the etiological circumstances from 
the history of the case j and this is always to be coUcetcd with the 
gccntcst care and strict attention tu minute dctaUs. It is here 
neocssary, in tlie Ant (ilace, to guard nguinat the great inistnlccs of 
assuming, without satisfactory evidence, the conjectures of those 
who have hitherto surrounded llie patient regarding the origin of 
the disease, or, in hapiicus so often, of considering as real causes 
cvrn decided Hytnptoins of the conimenciug insanity, or only the 
last aceidentiil nrcumstance which caused ita evident outbreak. 
U'e ougbt not, lioiicvcr, lis u rule, to be satisfied inerelj with tlic 
striking bodily or mental cireuiii^tances which itnmcdiatcly ure- 
cedcd the insanity, bnt must assume » position from which the 
prrsi:iit morbid state can a}}pat as the ultimate irsnlt of all tbe 
preceding circumstaiires of life. Tlic inquiry into the hi^toiy of 
the case ought to embrace the whole of the bodily and mental 
antecedents of the indivi<Iu3l. It iniiJt commence ab opo, indeed 
from former genemtiont — family predisiiosilioii— and minutely trace 



TUC CAVSK6 or INSAMTV. 



199 



\ 



t 



thr bodil/ derdopment, tlie habittuJ ttate of h«ol(h, tite tiatan of 
ibe tfiMuea to vliicb ttie patioit is subject, and of those which be 
bM tinady h«d. Likevise, u rcfsrda tJit; tnctttal sphere, wc roiut 
biUtfiallj uul intdligcnUjr comprehciid the rdation of the piedi»- 
pwitiom uid coQgeniUl peculiarities of disposition, the degree of 
cdncmtion, and the ^orrnungincUiiatiiomof the indifidutil — hia mode 
of Ufc and Ticws of the world, his outward position and (he nature 
of his tboogbts ; thus endearourtng to gsta a full picture of the 
hittory of Uic individaalitj. Oolj in this irajr 19 an insight into 
the true histoijr of the»c diocose* pouible ; ooljr thus ciin we succeed 
■> paaping at their bcgiunings tboec fine threads which have ulti- 
tatidy ciktwioed themselves into delirious conccptiuus; only thus 
an «r, ia m^aj cases vhero insauitv appears suddenly and appa- 
natij witlioat motive, recognise the fnr.baclc cAmmencemetit of the 
ptvpuntiou for the dtMn»c, and the almost iDAthematicftl nccc«ity 
of its occumnce. All this is of tlie highest importance tn a sjatcm 
of treatment which gathers from the historjr of the case indica- 
timis, souctin3cs for Ibc nmclioi^tioii of inveterate cbionic morbid 
ptocessrs, st olhcn fot the rcmoviil of certain pryctiloU cnu]>iee(, and 
•hkb teqoira a profound knowledge of the character of the indi- 
vidual to enable us to employ all bis inherent resources in support 
of our active tnatuietit. 

Iba epBMiia ot tliMc about ttic patient rcpirdbg tli« etiologr of the diceaia 
He nore rnqvcntl; cmmcoui tkan ooneet, and almost nlwaji nrc at lout 
am uJed. bj tajmcn, and evm hf pAtjiiciao*, tijmiilonu uf canim«Qciiif( 
Md otcaaknaUjr of shnd; cooOnncd iuMailjr sit rnquenllj regsriJed oa 
f at Ib Ike eoMiMBoemenl of th« ounlal iuaar, » slroug desire f»r olco* 
littHci, er alraig mxmI imulioa loading to ciecun or to otusisiD, can, 
lor e m ipls , appear ai sjmt^laDi ; the alrraiij dialing emolional excitcmeat 
naj ONMwa aadbcrect cotiaeclion*. rath six^ulntioiis, relie:ieiu veutions ud 
daMmioai^ aad tho cirvr it oftta commillctl of Mscribing tlie <li«caw to 
ill ■■> Will Mi. naforlmBle love, on aulnckj vtiituce, rclieioD, Ac. Sc. So^ 
■boi it v<f7 often hajipeu t^ inaaniljr u coiuidered bjr tlie friends of tba 
palisM or bf an expcricnoed pbjriiciaa u of reccat orisio, irbicl), on closer 
istMlifalioB, tbovi iuclf to be of mtitj }c«n' atanding and alruuij dccpl; 
rooted. Fisd UokU rcktci tbc cue of a patwnl «bo wa> said to bare been 
rial ••■Ite iana^ vUe b fKl llie (Ummc bad ctisled for fUteen jttaa. 

n» Ocnnaa pajokeloglsta claim the merit of Uaving atwajs imJenUiod the 
ctialou aai palhaKnj sfioMudly more tliorou«hlj wd oorrtetl^ and of baving 
nora ■neewifolly didant«t It, than tbe Freeeh sefcool. While tbe Istlcr, 
liutlj «Tca in nenl liasa (Uortau de Joaakt, Briem, Patel»pjw), >till ad- 
Iwfc ta aMraet lahks of pfajiieal lad morsl cauies, in vhich diunkenaui. 

if 




uo 



THE CAC8E5 Of ISSAXITT. 



•ptlcfMj, Mabition, pratUtslion, ^oUties, loa» ot IbctiiM^ Ac., an nngcd u 
htitg of equal inporUooB, Ibe Octbu p^yc b dc g fat* (Hebfotk nd Idricr fm 
tia pqrducal Mdo— Be^muit, Flanwii(, Jaeohi, J ma, Kmmv Zdler, Ac^ 
jwrtJj wllli gmtcr irgud to bodDj csmn) ban (be loog inirted «■ tonali* 
plHig tlie cvuea in cMfa imiiridoal ctw i and ilhH bees non Ike |>kQ villi u 
naat eareTuIlj to oooiider all th« ciicamalMiea^ in their Taiioai coaaccUowt 
vUoh can infliUBCe Ub donJofunebt o[ ihs mocbidilate. 

4 80. A closer investigation of tbe etiology of inaanitjfoon sbon 
tbat, ill the great majoritv of cafct, it was not a single ^edfic cooao 
under th« infloence of which the diaeaae vas fiiull/ cstablaked, biii 
a complication of scvertl, sometimes nnmenHU, causes both pre- 
(lispoeiDg sod cxcfliog. Very often tJie genus of the disease arc 
laid ia tli09c carlj- |)crio(1s of life from whicb the commcuoanenl 
of Ute formation of clutractcr dales. It grovs by education 
and dtenul influences, or in spite of llictt, and it is but seldom 
that tbo abnormal psjcUical inftabihty attains either gradoally or 
througtt Bcaroety noticeable intermediate stages to an evident dis- 
onliT uf mental function. More frequently tbcrc are a greater 
number of paydiical iii)])rcs»on< and bwlily ili»orders, by tbe aoc- 
cunive inflnenoca or unfavomble eonbinntions of wbieh tJic disease 
is developed. It is then not to be ascribtd (o any one of thew 
ctTCumstAnccs, but to them as a nhole. Thus, for example, we see 
in the concrete caacfl, loug-coutinued driuikenncM and mlent 
emotion, hcrcdilary disposilion, doueatic uu(iuiet> and heart dii- 
easo— cbildbirtb tutd violvml ohj^i or shock-— diaippointed lore 
and commencing tuberculosis; in eliort, ve generally sec wvend 
injurious influences acting on the organism, or stales of disease 
already present — and ofteu more numerous and more compLicalcd 
tliiiu these examples — appear lui causes of ta»iiiuty. 

The iliiScuIljr liea in tlie proper nppredaibn of the Influonoe wlucU ndi <nw 
ur ttiuc ciicumiiUuiucs ho* uu llic prudiiclitia of the diseua. We mut hen 
cndeivourb; cvtrj mc&ns to ketp the mind unbilled by thii or tbat lbeo«7, 
and froniouo-ii(lc(i|>irfcicuce of one or uf cerlHia scrie* ofniucs) for examples 
Ihc loniiticor thomentnl. riiejaigmeiit ouslil onlj to be giiided h; a minute 
iuTcstiK^tioD of ttii: fuels of tlic cose ; where empirical dit& ua to the eauM we 
it) uiiT caM iFuntini;, tlic? ou);lit iiiit lo be nipplied by coujeclurcs, and tbe im- 
(loiliincc or Ibe hiiiglc circumstauco prcMot ia to caabb ni to conform to the 
principba uf n raUunal piitliotogy. 

An iiillurnce o( citiintinii cnii nnturaJIy bo allrit)ut«<l with most cwtaint; to 
Ihotccirciuiniluiccs wlioio modo of (utioii cau be clcorlj traced, and vnoae 
cffcoU tbcroforc iddj ho wuidcrcd ns phjtiijlo^icikl ueeMiiitiiH ; or. where lliii 



I 



I 



I 



^ 



TDK CAUSES OP IKSANITT, 

b BcA Ike cue, to Iboce «Ik>m inlHoee is otabtlshcd bj- reliable alatuUu. 
A. ttffid gattfio affection, bafliorrlioiijs, or a Inintieitt cuUneous eruption, 
— ff*. for eiaB|>le, be oonaidtred u uuies, bocaunc o-o ftlotistic* vsmuit (be 
tyinioa, no tiaible cannedioa exuts lietwaii tlicx (tfTeolions nod inMoUj 
Aher u te tkeir sravit; or nitDre. On ilie cantnry, ^isuuA of tlie licart or 
of llw vteries tn muufcsltj imgiortant clioloigicgLl circumstance*, lu tbcy can 
ifcct Die drenletian villus Uie ainium. Dcprewinf; emolii^iii would iiii|«:ar 
to be sock, Uum^ Iktle it knom rt^arding tbcir mode of nction, beciHiie 
ihej — u lUUttlci ineontCAbtblf tliinr — rcij (rcqncDtlj precede the coming on 
«r iaabiiitf , TIm pouibtlttf of sieaUl dis«ic origiiiAling from the irritation 
ptodoottt bj intaiiul vorms (Uenia) can Msrccl; be cntircl? n^cctcd, lu we 
OMMtoM&j M« oUier wikhu orrebr^i] diseues (ojiilepij) originate from Uictn. 
W» elMaU tlwtft bear ia niiad that anvlliiog, to be n cauao, mutt nsillj pre- 
mie tfce pnauoed effect: we tbould nol, for ciamgile, wLeii Mrioua disorder 
of lbs difcatiTe ornans ofipean sJmuIUnFousI; vritU tlic cuiumunccuiunt of in- 
■untj, eOKlwle Ui>l chrooic diicue o( Ibc abdomen ii ihe oauM of the intwiitj. 
la womt CiMi all eliolegieol data titterlj fAll, and the inaaiutj orignutea gra< 
dollj, Bke D*Dj alber chtonic diieasi^s, from influences wliul!^ unknown. 
NalUflg b nare tnoccoiu Ibin here to mppose aa iinnginarf bodil; cauic, 
tad to aUow tudb a loppoaition to influence our mode of trenlmcnl, as, erm 
ia tiM |inMiil di^, it ao ofteo done, capcciallj b; the Tutiuin of tbc lo-cftUod 
ifiHe kbool. 

( 81. Aiter cxtcDsiTD obscrvatioB and comparuoD, wv find that 
Lfac etiologjr of tusanilj* ta in general none other titan tliat of saiy olfaer 
ccRbnl or nerrotis disease. In particular, tlie etiology of epilRpsy 
ud of the alatca of dironic initalioii of the spinal cord olTer in- 
•tmctiTe aialopca as well in n-^rd to prcdisjiositiou ns to tfav mure 
inmedtatecauwD. L\cIudiiigthepredi«po»mgcirfuui!>taiiccs (period 
of life, brTtdilary prcdijpcisition, ocrtun errors in oducatiun), wc diid 
tltat ill all (h«9c diaea«C8 two dtstuid mod'CS of origin may be rccog' 
■Md: in tbe first place, an origin (iditipaLbic) from ioQuences 
woriung directij on tlie brain — shock, injorjr, oxccstiirc fatigue and 
cxtumsttDa of tlie brain and entire nervous system, alcoholic^ 
■ucotia, exMMhre mental irritation throiigli emotion, and the like; 
ia tlie KOond |dloe, aa origin (s^uiptuuiatii-) ttsuUiug from otlior 
fmtiier morbid cliauga in the organism llirougK which the fimctiou 
of ttifl brain becomes aiTected. Thrsu diffitrcnt morbid slati's now 
tfftan to id apra tbe brain pniicipullj in three difTcrctit ways : in 
tbe 4n( ptaoCf bjr generatiug or favouring anomalies in tho circnla* 
tion (hTperBBiia, aoBinia) witlun Uw vraiiiiiiu (diseases of tbo heart 
nd nteriet); in tbe second place, by nervuus irritation of the brain, 
wbidi wc can (oareelj otherwise account fgr than by coioinumcatton 



189 



TR> CAC8CS or IMSAHITT. 



tail mmmamaa of pcnphml bniatioo of eertiia Bcnm to tbe 
CMtiilocgiii,ocaixniig to a ootain extent in a idles manner (iojoi; 
ti • yrip fc cfa l aanv, "*"*«** trf the texaal ovpna, tec.) -, tn the 
lUld plac^ br Jf df iftit HBt f ittflii ud exotaliaa cf tfcs bnin in coa- 
! of ilnoasia (general aianniB, fee). 



Ob tlia MPnwI. tha AalMctM ketvcta 

i^M ia if il if u. iawkMi it laa Wi 
l^nJ bj tk fadifak. Mt tW one kni 

M«ia««ck vkcfcaet ia£Ceml«i}a; 

Mb hrii \lmm. Wi ak 



; tfct Wm eilWr iiJMiiilj. ori»M^ily 

NUB MBCtMa V OIlHr Of ^Uft SttSpnCEH 

ta br. htt ww, ■* it can be 
nlaik^ U ^len ■ fart «iU tka 

^ ^ , ^11 r ■ rf Ik k.^ • 



■■ irfanpMfcW Md ajB^loiBalie 
ke M^ CMiied oat. It is hem 
JIuflai, Tbi* ■• ex- 
■Mij lajuiiaaa biStieiicca 
^ tk atb« ^■i.tbal certaiii 
i|JDai,aot 
ia Ika MBe iadindaali^Bviy 



k fwnawlq 



>«( thti 



Ok 



q< tba coMtiUiliBtt. 
pwiwJ. tlka dprtJactioaJB 
hctvaea MataldiwBW 
wrilj, ud tbue exiatiag 
■ ■■liwii lallie latter 
flo aottid ooaditiuBB of 
{Jm aiHfle, Ife kjxterical ia- 
>) : ia Iha fiErt gnMft igBiB, 
; tar OBBpl^ patalTtie 



ihatM 



I «■ the fMMB daiMa flf ttiokgiGal cir- 
letMn «fll W ain*^ eaBai a t J . In 
I bAbc ia tke OBittMBaiT dirisioD into 
aal BfccHl «MMei {not ab«ge(btx oor- 
»1l vkadib aotwitLBtaBding ocatats 
to bt maitkmBi (far riBTfc*, daoiden of mea- 
»), can act agBrtMa aa predi^KiMag, 
In tkia aannj inw Bt. vUcb nt 
^ Afnttnic frasi acMOtific cxad- 
fo b« a cartM anal^ of individual 




§ 82. If we comider the extreme frequency of all the injurious 
inflarnccs vKJch hnvc b«.-n coamcraU-d as causes of mental JiscwCj 
uid the comparative variety of their direct origin from theae causes, 
we KK of tKocasitjr led ta tlic auomption that certain prcparntorjr 
ciii»iiut«noe9 lire requisite in order that, in indiridoal cases, discasn 
gmermlly, utd in particular (his diseiflc, may arisf-— tluit a certain 
nnorptibilit}' and pT«di«porition to «ach diseases miwt advance to 
BHCt the aometiuiet Kligbt exciting causes. Indeed, in the present 
•tale of science, we are necCMitatrd to admit thia assumption in 
tDOst diansta of Itie nervous system. The cases of injury arc initu- 
Dcnblej aitd it is only seldom that tetauus succeeds them. Numbers 
of ciuldren suffer from worms, and few only fnll into coavulKJons ; 
nuiny indiridoala live under condition!' whirh nre acknowledged to 
cxnt B powerful influence on the develop ineut of mcntBl diseases, nnd 
onlf * few of ihcm really bwomc insane. Should wc attoinpt to 
esptain thew neuroses, which caunot be more deHnitely accounted 
for by the nvaDiplton of a spcciai disposition of the nervous system, 
it may appear, indeed, that we arc but using empty words conceming 
in nnkaoTO sabject ; but sometimes n more minute invcstigution 
pTOi*< OS here to penetrate into the more intimate relations of this 
di^omtion. We know, for example, that in warm connlricjt tetanus 
man frequently succeeds injury than in our climate, that this rom- 
plication ia favonrcd by a cold caught at tlic time of the accident, or 
by RHntal irritation and the like. I'he same may be said of inaanity. 
We kDOv by ezpeiieDoe that there arc series of circumotnnoes which 
hive ■ preparing and *&ro(iring influence on its origin. The study 
of the prediapostDg caiiHS of mental disessea embraces^ on the on« 
hand, the eoitsideration of lAote mart ditlant relilio»» wAicA infittenct 
wMote tommuHUkt, and can only bo shown by statistics, their mode 
of action on tndividuaU being quite uninvestigable, — vit., natiouality. 



lU 



TBB CArSCS OP 1S8AKITT. 



dimatc, Muoo or the yfsur, mx, age, differenoe of sotiil podtioD, mi 
the catimatioD of tbt:ir iutluence on the oogis of thoc dieeucs : ou 
tli« otlier haiMlt togcthcx with tboe geoeral telatioas, wo have aUo 
to uia]f BO tbe indicidnal piedispoiitjoii eongenital and acqniied, 
ntcb as bcroditofy disposition, ednealioa, oonstitatioii, pecaliarities 
of ohanicter^ bad habits, Sec. Bonblkss, the prMlixposing drouin* 
tUaaa «« moic important, stronger, nod act mote feqaentlf in tbe 
pTodaetioii of insanity than the oocasioiul caosra. He who haa a 
ationg iadivi<taa] prcilispwition, espedallf if of a ccrtaia definite 
kind, b endangered by the slight^t ooanoual causes ; while the 
man in whom ihia is entirel}- absent can be exposed to tbc looit 
seriooa conflicts with perfect safety to his mental liealth. 



SRtmON I. — GMeral Pftdiipatinff CauHt. 

^83. I , NatioHalily. — The idea of ttationalitj tnclodM a 
number of the mo^ varied rdationa — the climate, tb« fertilify of the 
•oD, the principal cni|)!oymcnl8 of the iiihabitaiii9, the liuiuinant 
religioua creed, the degree of civilJMtiou, the public morality, the 
previooB lot of the people, the form of ^vemmenl, ftc. These ail 
oo-operate to form certain ttalional peculiarities wliich are propagsttvl 
M pcreiricnt types from father to «>n ; but as all these circamstanccs 
act only when combined and a^ociati-d, it ia iippaviblc to arcord to 
each i>f thrm individually its iiiHucnce on the origin of inwrniy — it 
a only statistically that the reports coaccrmi^ the frequency or 
mrity of iiisaiiity in tb« vnHous countries can he compared, and eren 
this leads to little sntisfiictury results. Of Bcarcely any country in 
the world do wc posscas quite trustworthy statistics. 'Where more 
exact reporta arc preacntod, they nrc often rendered comparatiTtlr 
■udeiH, owing to ttii-ir not being collected according to the some 
method, and especially— a great source of diiTi-rmcc of numbers- 
owing to the iniKing of two »U\ics which ought naturally to he 
separated — insanity proper, and idiocy nnd cretinism. Of many 
dtelricls our knowledge is limited to an aTcrage calculation of the 
nxnier of Ihe tHfitie la atriums, so various in dilTuient countries. 
The uwsulisfacto tineas of this is self-ei-ident. There is still another 
pONiblc jourcc of conaiderahle mistake which cannot be com- 

U-ly elucidated^ namoly, lh(^ probably different dorutioii of lips 
igit the insane in dillercnt counlriea (where life is more pro- 



THE CAC8B8 OP INSAXITT. 



135 



. tlkft number sppcan graaler). It vill be vdl, Ibcrcfore, to 
. the following slAtancnt with great icservatioo.* 

$ 84. For the eoontries of Gcnuany llicro are many statigtics 
pitod kt diffident times, ami diflcring macli in value. We shall 
\j Bicntion a fiew of tlus moat ioteretling. 

tbo Aheimh pronnots of PrassJa, iho number of the ioMQe ia 

to tJtat of the comiDumty vts, in tlie year 1828, i in 1027 ; 

MIR recently Jacobi estimated it st t in 666, In Westphalia, is 

H36, I in 1590; or, inclusive of idiotj, t in 846. In Silesin, in 

1R32, 1 in 1 160: in r852 there were in this province 2147 insuie, 

)f whon 91(9 were idiots, either congeaital or from early infancy. 

the pTovincc of Saxony, in 183$, 1 ia 9S8. Ia Old Pomcmnia. 

1847.110931. 

For AoMria w« bav« very meager statistio. In 1 ^149 there wer^ 

\t twehe kingdoms comprising the empire, with 23,643,000 

U, •5354 iusinc in asylums (in eight of these kingdoms 

«cie at that time no arrluuu). In MoiaTia and Austrian 

then were, in 1^57, 1740 insane, of vhicb, howerer, 1275 

igenitMl mental diwrders; ao that (pxdudiog these] there wcra 

ily 7*8 ioMDe to erery 10,000 inhabitants. 

More tnutworthy rcaialtc we mfFonlcd by tlie rcocnt calcutatioiu 

lide in sercnl of the amalicr German States. In Wtirleinbvfg, 

io i8j: (here was 1 case of menial disease (eiclasivcof idiots) 

1500 toludiitaots, in i8_j3 thera were 1917 intone and 3740 

idioU ; of the Gnt there wa« i to 943 inhabitanb. In 

aoonr t cadculatiun mode in 1 836 |^ve as a result 3084 insane (i 

590 inhabitanU). In Baden ihcrc were, in 1850, on the whole, 

3000 insane, including cretins, or i to 454 inliabitants. In 

inatc of Bavaria (according to Dick), in 1856, there wric 

(1 in 1374 inliabitAntii) and ^6^id\ois (i in io2oiDlmbit- 

1). In the llATarinn district of Upper Franconia (afeording to 

dl). there were, in 1850—53, about 450 iiisana (1 ia 1046 

Jubituite]. In CHdeuborg there was, in 1 845, 1 iosuic (including 

iot>} ia A36 inhabitants. In Braiuwick (inclading idiots], 1 in 

J39 inhabitants, la the Duchies of Anhalt, in 1849, nearly 1 ia 

. ' 111* faUowing are pUiered from l&e bmt MvrCM up to iH^q. Frei]iientJjr, 
t, I luf beei oblisct to linH mjttlt cotireljr to oldcc ilaliiliea, owlag 
rib wmU of rdUUe ref>erti of more T<c«tit date. Quotftliom baro onlj been 
I vav of to ociua fpcciil cun* 



186 



TES CA.08B8 OF MBAKirr. 



450 tnhibiUnU. In Nauiu, in 1840, i in 607 — m iSj6, 1 la 378 
inlMtiiUota. Tli« chief diO'crcncc* in thcae figorts So aot ecrUin]; 
depeod oa difference* of the actoal namber of the ioraoe, but ntber 
on the varying freqnencj? of Jdiocr and cretittum, moA »ptcuIlT on 
tlie (ict tbst the adculatioos wen based dd difldcDt priaciplct lud 
nude in VMioas waja. At all erenta, thcM reeenl calcolatioiu ^t« 
the general Kanlt thnt the nrersgc number tormetiy uttinKd as ««II 
for Oermany aa for the other countrie* of Central Europe, of aboat 
t iiMsne in 1000 inhabiUnts, is much too low; that it sboald (in- 
cluding ictJota) nther be taken at 1 in 500 inhabilant!. The 
lunatic u/lumi of all German; contained, in i8j2, 11,621 palicoti 
(Uhr). 

In Fraooe the old statiotics calcuUte 1 insnae in 1900, or, 
ftocording to the probably more correct raloation of Pi£r(ivm and 
firiencj i in 1000 : n more reoent cnlcnlntioo (1851) giies i in 
800 (795) inhabitnntg. In Belgium the proportion ftood, io 1835, 
at 1*23 to 1000. Guijikin considered Ihia number far too soull; 
bntas he rcpcatrdthrniiii tbc ' Lcf ons orolcs,' tS^t, it voald appear 
tliat Dp to tlint date no ncv cidculation bad biM>n made. Moreorer, 
the number of the insane varies rcrj much in different provinces. 
In Eastern Flanders the proportion ia 1*73; in liVestera Flandefv, 
1*33- 1° Luxembourg, nnly 0*51 to 1000 inhabitantt*. In Ghent 
there is 1 iiiAanc in 303; in the prorince, i in 1473 inhalntants 
(Gaialain, [852): in I'tjs Oie totnl nxunber of the iotane 
araonntcd to nbout 5500. In UoUand th^rc vero found, in 1 8 jo, 
30,56 mentallv dixeascd (i to looo inhabitants). SchhSder ran An 
Kolk considers this estimate too small, and that i in 800 would be 
more correct. 

In Englancl, Scotland, and Ireland, there were, in 1847, 41,810 
patifDls in a^vlum;. Tht proportion of the insane Io (he population 
has bwti c«timnt.ed bj Pit-rquin at i in 783; bv Hitch, for Wales 
alone, at t in 500: bjr Take, 1858, for England and Walea 
(including idiot«), i iu 300. In Scotlimd, in 1855 (including 
idiots), the proportion was r in 390. In Ireland, i in 569. 

For Denmark (exclusive of the Duchiea and the Coloni**) it was 
calculated that in 1847 there were 1761 insane, and 1995 idiots and 
crelinH. In the Faroe T»Uihl.i there was i insane in 114 inliabit- 
Bnt« : almost one third of these, however, were cretins. In Noma/, 
in 1835, thej* was t insane in .i;t4 iuhabitant* ; in 1845, 1 iu 309 
— in iHjj, 1 in 339 inha-bitants. Amongst the insane, numbering 




THE CAUSF.8 OF INSANITY. 



187 



6140, tlirre were, IinwtTer, 49 1 1 cascf of maital weakness, of irhith 
■laovl two tbirdii were congenital. 

Begardiog luly and SfHiin no compri^hpDinvc or nliftblc etfttistics 
■R known to me. 

Aa to the coiLotri«a of tbf Easi, do correct valuation can as jet be 
lBiid«. ThfW an", however, a few exceptions ; for example. Malts, 
wbera in 1836 there was 1 case in 7 — 800 iQhnbitnnt.s anil the 
Grtdc popaUtion of Smyma, wliere Hick wm 1 in 1000 (Moieau). 
Tkis is not williout intfKst, u it shows that in spite of the grest 
difimcc of cJimatc, wc find in these plucts, where European civiJisa- 
liOQ pied nmi nates, the fame proportion of insane as is found at tfac 
period in Eoropean countries. It is generally rapposei that 
nomber of Ibofc afHicIrd with mental disease is ttmaller in the 
East ihan in cinlised Europe : 1 will not deny thif, bat I have 
ooanDccd myself that in tbe towns n great many insane persons 
appear as beggars, fanatics, fee ; Cairo abounds in $uch semi- or 
often whollr-denentcd indinduals, and be who would form his 
opinion from the small number of insane in the asylum at Boulak, 
near Cairo, would very much dccei\*«- bimwlf. In general, the 
mnvks of travellera ia half- or uuciviliscd couatricB concerning the 
fraqoency of iiuanity arc entirely wortlilc^a.' 

Tor tbe Utiited States of America the Dumbei of the insane in tlic 
State of Xew York, in 1825, amounted to 1 in 7 — 800; in 
MaMrhnatrln. in 1S54 (inelitding idiots), to 1 in 50a. In 1849 
it vaa calonlated that in tJte Uaion tbero was i insane in 500 
inhabttaats : more recent reports, however, give a much higher pro- 
pottion. According to Brigham, of Pottton, the |>rnpi>rti(iti of the 
imBOe is in North America almost three time? ns great as in 
Baglaod — a coDseqiumco of the imnienK commercial, political, and 
(cUgioua exolemeRt.' In tbe States of La Ptnta, menial disease is 
mjr freqacDt (Saurel]. In tbo East Indies it is not rare, but not ' 
so frequent aa in Europe (Wisr, physician to a lunatic asvlnm in 
Boigat). 

^ 8 j. From tlie discrciMncy and iiisufficioncy of these statistics, 

' It tn^ lie left to tlie naditr lo juiftc of ths islue of tli« Htatemeut of Dr. 
Batlvi wbo spcat Iwenlj-lire ^enrs among tbe Cbcrokce Indians, that during 
tW pMiod be bad aeter tetn ■ well-mtrked etae of iuaaait^.— BuokniU and 
X«k«i * l^ijcfcologieil Mcdkiae,' London, rSQ^, p. 46. 

■ EaBami, ' Chapttn on Mantal PlijtioIoK;,' p. 77. 



188 



TUB CAVSB& OF rNSANITT. 



it U evident that wc aro deficient in tha very fini «lf menU necttaarj 
lo the polutioii of the much-diBflUSBL-d and ambignous qiifstion, 
whether lAe process of cieiliialioH has incrrascd the number of thwe 
diacases. Wc jiussi'h ho trustwcirthjr statistics from uncivilised 
ftountricB to compiire with those of civilised, nor hnvc ire from hy- 
goDP ocnturirs unr iiifurmation to cnnblc us lo make a comparison 
with present conditiona; and even if wc hnd sucli stBtistica, they 
vould not onnble uii to penetrate iMitiruly lliis complex queetioQ. 
The *|uestioii of tlic influence of modem civilisation ought rathrr to 
Kcolve it.-wlf into a series of isolated prnhlcinii, such as the infliiciicc 
of the increasing growth of tlic populjition in lat^ tovns, the 
infliinico of Wie inanufurturing industries jxicruliar lo innny countrr 
places, the intlueiicc of the diffusion of education, the press, kc 
Hitherto it may be considered pos<tible that the constantly increasing 
uiunber of the insane which is almost uiiivcrBally remarked is only^ 
apparent, and tliut it if owing to the iiicreft^ie of the {)Oi>u1alion, the 
great attention now paid to mental difleases, the more exact mcthodi 
employed to ascertain their existence, and to the circumstance that 
all improvements in nsyhim innttera Itmgtlien the perioil of Kfaj 
amongst the inmates, thereby enuring the ndmissions greatly to 
exceed the number of diaitb8,aad the patients consequently accumubile. 
Tt w, I say, powililu that it may b« ao, but vciy improhnbic ; and I 
would rather coincide with the opinion of mosl medical paychologista, 
that the increase of insanity in recent times ia real, and qnite in ac- 
cordance u-iththe relatione of modern society^inirliich certain causes,, 
aecording to cxpcrieiice, t-xcrttng a great iuflurnce, wliich cannot 
however be quite expressed in figures, have become stTonger and 
more extended. The progress of indaatry, art, and science ncccsai- 
latcs a general increiuc of the cerebral functions ; the constantly 
increasing departure from simple modes of life, and extension of the 
uiore rcftncd mental and physical enjoyments, bring n-itU them 
desires and emntiona formerly tiaknoiirn. The general possession of 
a liberal cilucalion awakens ia the minds of maiiy a feeling of 
ambition wliicb few otdy can gratify, and which brings to the 
Iriajority but bitter deception. Tiidnstrini, pohtieul, and social 
agitations witrk di-structivety on individuals, as they do on the 
masx'fl ; [Jl live faster — a feveriah pursuit of gain and pleasure. 
And great discuiuiuiis upon poUttcal and social (juestions, keep the 
irorld in constant commotion. We may say, with Guislnin, that 
♦be present state of society in Europe and America keeps up a 




niK CADSBS OF IS8AKITT. 



139 



general hnlf-intoxicating slate of cerebral irritation whicb ia for 
removed from a natural snil bcaltbj conclitioB, and must prcdis* 
pose to mental disorder: thus man^ keaomtf insane. The Ae~ 
monilisiog influence of large Iowds— in Paris it is estimated that 
there are 65,000 iiulividuaU who maistaia tliviiiMlrcs by dislioncel 
meana and at the cost of aocicly, in London there arc thousanda of 
children already de^'oted to crime and prostitution— the greater 
frequcncjr of celibacy, the altered rchi(ions of religion, may ho con- 
sid^red as co-ojwntting trircumstaiiccs : but, on the other liaiid, we 
should not forget that the greater diffuaion of kiitiwli^dgc and of 
comfort, aiid belter bygiroic conditions, o)]po3o these injurious 
iiifl unices ; tbnt drankcniiej^ probably evet^vhere, but certaltily in 
those ooontricSj such m Kngland, where it used to beconsiderecl one 
of the most powerful cause!, is supposed to be steadily decreasing; 
that the community' in civilised coutitrii's has opciii-d up to it 
in Dsjltims meuiB and ways of recuvcry which were unknotiti to 
foimcr gaienlions andto uncivilisc^d counirit-a. Thcac draumstanoes 
ought to compensate, at least to a certain eitentj for any^ injuTioua 
inflaecce of the spread of civilisation. 

It bu been nid that the nnmber of the ioionc in J^nglud lutve incroDscd 
niocrold witlUD tbc isit twenty jcars.' KBturnUj, neither ibc populalioD nor 
tlw aniiMlion bas increueil in iliu> propurltoii. VVu can apeak uf timtmiCOT 
«r much smaUec inortue : for eumi'le, ia Wurtembcrf;, iu twcnly-oiic junrs, lUo 
number of tli« iosuie hare iD«rtiiBcd from 1 in 1500 la 1 in 1143. It is, bonr- 
ever, in general, quite imidiniuiblG alwajs to at oiiee ascribe tbsl vbicb dintin- 
gubhes tlie present generation from Hie former to the" progicuotdvilitalion." 
Aeconltiig lo tbiJi ibcoi;, one should oIdo attribuio tbc mcrcaaiug improve' 
nienta iu the munlcrous treapoiiii used in warfan! to our bigbcr state of civilita- 
tioD ! Tlie Abovc-m4:>ilioDed dlminulioo of dranlieaneis h a mark of real cin- 
lisation whicb iudced dcMrrcs Ibe naniu : tbis doM not ciigciidcr disease, but 
proIoRKt life', and constrrei the power and tbe bealth of geEcrations. 

Large towas Tcrjr cvJdcctljr furnith muro iuaane than couutrjp diatrtcls; but 
wlielker mannfaoturiag or ajirictiUunl punuits buvc a marked iuflucoco an tbe 
frcqsencj of losanitjr — wliclbcr cominerciid nutiotia, as sucb, ia tbis icapect 
acquire an uneuviable nutorictj' — whclLer Cittbolicisai or Protcstsuisiu favours 
iittuutf, nad many liir.ihr qiiMlionit, niuiit for the preaeut rcmaiu unfliisweted 
for want of matciini, and owing to tbc utuvoidubir contpleut/ oftlic iutluciicing 
oifeunutaacei. It vould be usclets to ttitii forward wilb arKuiucut& iu favour 
I of or agaiuat tbc statistics, and to ntlcmpt to lolvu incxpiicablu qucBlioua, 

It b a rrmarkablc fact, that great poiilioal agiUtions spp«sr to buv« less iU' 
&uene«oiitfae frequency of meotai disMsex tbau might at first b<isuppoKd. 




' Bucknill aud Tuke, ' PijcUol. Med.,' p. 3a. 



140 



THE CAD8K8 OF INBA»ITT. 



E»quirol nm»rkei ttiit at tlie time of Ibe lint Fr«ncb rerulutioii. icoorduig 
to tiianj Trenoli ftnil Gcnuui phjiiotaas (eioepliiij Bricrrc), the reTolDliaui; 
moTemeal cf 1830, tnd espeuoliy o[ 1848, gave Hie u> litile at do incr««w in 
Ifae Dumber ot Omcs of irisaoitj. To the \titj tht> follaeiice of llio revolntiou 
appMred very conBtdonlile, benose in tliete timet [xtlitics fonned Iho tabject 
of tbs delirium in miuij pitleuls : ihh, u ire liaie teen, it k pwdf acciJeatAl 
ind tuperficial relatiou. 

§ 86. a. Sex. — The qaretlon wlieUicr the one ecx be more 
disposed to insanity thiiii the othnr cannot be definitely snsweredj 
oving to the wnnt or Kufficient statutics. On Uiia subject there is 
nn nbundent HtrratuR- contBimn^ inany stati5tic9, but we have no 
guarantee for their correctness ; in jiarticnUr, all statUticit frsnted 
from Mj/lum reports ikre hiRufRcient and apt to miileiul. From the 
very nature of tliiugs, especially before the recent improtements Jn 
asylum matters, fi'mnle putientt conititutvd the minority amongst 
the inmates of the iwylams; their families have more hesilation in 
parting with tlinn, sni3, btsidts, they ore more rjisily attended and 
restrained at home than men : indeed, the older statisties of Fuchs,* 
prei)ared according to the numbers in a great many ayvlum*, »ho« a 
reUtion of 100 men to 75 women. France and the Netherlands 
formed, however, an exception; the number of females in these 
countries being greater than that of males. In mote recent times 
the German asylums also njipesr to contain [rmsiderably more males 
than feisalcs : for example, the asylum of Siegbuig^ baa ijt t8 yeun 
receivMl 900 moles and ^fyd ft^males/and that of WinQeiithal,* in 10 
years, 396 males and 351 females; while the French establiahinent 
Su Ton admitted in the K years from 1835 to 1S43 eiacLly the 
some number of men as of womcra.* 

From nil these statistics, liovever, it docs not follow that insanity 
is really more frequent in tlic one than in the other wx. Tiie 
statistics of Ev^iiirol, whicli included 70,000 patients of all countries, 
bnt not on that account founded on a more secure basis, showed t 
alight majority in favour of the female sex. For England, Norway, 
Denmark, Ruuis, and North America — also for the Prussian 
provinces of Westplialia and Saxony, and for the sonthem depart- 

* Prepared in llic yetr 1R13 ; !«, cit., p. 9(1, 

■ Jneobi, ' Die (Isiiiilforinpn der 8rpIon»t6rungcn,' i, 1844, p. 57^, 
> Zeller, ' Itcport on tlic ElOcary cif tlio Huipital for tli« Inuae at W^innen- 
thal;' "Joiirna! fur Pijcliinlric tob Damerow nml Roller," 1844, i, 1. p. 73. 

• Parchappfl, ' Aand. Med, Tijoh.,' 1843, ii, p. 367. 



TBE CAtTSES OF IN8ANITT. 



141 



of Fnuice — the statistics hive as yet jhown more meii than 

BD ; wkHc, on the oLber htnd, iit the uorthi:rn (iroviDcCH of 

t, and in the Xetherlands, the sambcr or females is llie gitAlci. 

the older ind the new glatwtics (183: ant) 1853) for 

rftrtanlMrg, for tlie Pilntiuatc of Bavarin, and for lloUand, show 
etceca of females. All th«*c reports secto to require conGrma- 
oa; thcf do not adiiiit of a general coiicliiiiion, but show that iu 
Texcnt localities different rclatiooa exist in tliis respect. 

1 bis equillj loidiciMtble to •tlompl to ilraw a priori condusions from 

\9atej wd >%uiflcv>cc a( icrcnl cavetn spcvitil lu llu female am. TLo 

ofnMtttnittion.preGTiuicj.ctilltlbirlb.are uiidouUitdlj rirctinistaneu 

lUck (requentl; became oaut«t of iuMnit; 1 but Hiaio am also iii llio male 

a Kriea of nrcuouluioes ipedal to it, audi u tliemore fretiuenl druiiken< 

lUl exertwa, ih« ttniggle of amiiiliou, tiie emoiiutu ttad ckhaiutiaui 

Moaaarilf aecooipuf sb active life. Tlicse GircuiimUiiiCBs certainlj 

BH Ifcs apteial influeoee of the B«xiul process on ihi; orijiin of in- 

f. Id vonea we fnqa«allf find tliat lite mote sim)>lD ioimt at mental 

I maj be luore cuily ooDCealed, and admit of tlie (laUenu iKitij; kept at 

■btl« Ibe same (omu coming on lu men trailer iini>EiiBible tlic cuntinua- 

, of Udt calliag and Iho mainlmunot of lUeir aocial jiosilioii. 

As to the influence of t/uirriagt or of celibacy, all accoontsi agrei'- 

. tfaiii, Uiat inauiit; is inure fittitii'tit amongst uiiuurriod men, and 

't snoDgBt womea more luorried pr rsoiis become allt-cl^d — a fact 

ihicb caD onljr he ciploined bj the earlier marriage of the female 

Of widowed p<?rEO»s there are more belonging to the femnlc 

this foay he oa-ing to their helpless and unprotected coiutition 

eIi drcumstaDoes. Certain statistics, as those of Rheoisli 

for 1856, flhow a lai^ proportion of widows. Keller, too, 

fpioperlj mnaiks in regard to tbe iiUlueucc of inarrietl life, that 

iDiIml, celihacjr uppean to preseut more occasion to mental 

It *till, in not a few cases, the inarriage connection and t1]e 

rtsultiofc from it have been the chief causes of Itie 



^ 87. 3. Age. — No period of life asaom »bsolut« immuDit; toin 
" aw Ual disMse, bnt all statistics agree in thia, tliat certain periods 
eolirljr and very oiarkedl}- predispose to it. 
During eXi/Mood (before puberty) insamtj is not frctjucut, but 
all forms of it occur. 

* I^dwi lob oit.i p. 103 ; K6»tltn, loc. C(t., p. 9. 



lO 




or ntsAMTT. 

an Uh tukmu kinda of rocnlul 

U> the most profound 

in the third hook 






m m 



conditions in tlieir 
Sometimes they appeal 
: initifailitj of vhanu^ : the 
, aN£gBiKDt, ukI even lu- 
i ■ s imi VtptKti mnnit^, or/^i> tvitM- 
tB tbit of Rdvlts (see furtlur oq), 
W tak^ im w^lt vickcdDca of disposttion. 
4 flMe aka fMwIal, bat more intense : then is 
f i .«)«M i t taakm lovag, coafunon of the 
of Ac sMtfiaaf, with excitement, which 
(■ttb Ac g wlif {■fHcmat of the mcatal dmlopaaeDt} ramctiinca 
iilo fntand Bcaul vflikncss. It b impossible definitdjr to 
I tin faai the voHlilD fcos of m&Qtik dementia : then 
. httf qM* ««■ Iv a aoiMnt; the^ talk incessantly 
tmi imiA mtw ti j, paj no ittemtiaB, comtontly vmnder abouli laugh, 
ciy.ln.; a tatm ia whad^ amuaC n g to 8tfpdft,> irith suitahle traO- 
■Btt the pB^oaJ B M Mofc ahogdfcg MhTonJiJe. Sometimes then 
an longer or aborttr attacks of rsllj derdc^ied mania. 



KamhwgCni^niliMhft,' iSgi. p. i;8}hu»eea the eutof a eUld6 
jean gf ag» iltictrt If a UM M rti aet to dc»tf«f, vbcnbjr it duked tmrj- 
IUds to |«n<i.nihli ilaiic the itiaet with a knife in its hawl and could Kiicdf 
ba held ia naliaU (oAM^aaiA nevrc*;). ladccdl, we oecanonalljr oWrre in 
alii jvaagv ihBihiia (of fha 3 to 4 jean of age) attacks of ci^iiip. of wihl 
nCtaetctinMa, rtrikiag. Uliafr dMJre ta d<»traj, which lut oalj tot a time^ aad 
m^ to be Rgvdcd H tnu auKU. Th«K tooHtiiBca altvmktc with cjnk^ 
iltaeki, wHk dwna. with stvpor. with ccsUtio c ri a hp tic ttil«s (in wbidi Ibe 
patitwta iMiaiu for boitn or vnta for d^ a> if qaite abfotbcd, with open cjes, 
lied rnwitrnMirTi. and pceaUai paeitjoo, eoMetimee suddcalj braakiDg oat in 
bud crva, Ac.\ u if thin aabtad Imm tka aoet Maaifbld iatcrucdJUe tUtc* 
between cpilepUp, cboiai^ MOuealMtbtie, and neotall; dixued atate*. In 
onCaay ehona, nenlal diMrdm in bj no oMaai nn 1 lh«y an aonatiaMi of 
a alight uature, MKh a* wnfing or biugtusg without motive, ohUiotej, tei»p«r, 
EHgetfnlneas, hallarinationa : toaietimcs, on the ooatntj, there ia an incmuag 
itala of genml mental excitation which pasM* isto Buuacal dotirium ; this, in 
Hie hdgiit of the cscitcnest, nutr tetaiiute in death, bat it tiui;^ *^ ctiil iu 




THI CACSKS 



IS9AMTT. 



I 



. dc VAoA. de iUd.' xur. i, tS6o, p. t.) 



I 



Tbe meUncliciUc forms in all their TariHi«s uc aUo cbsemd 
though nincli less ^-qacDlly, in the jan of rHldhood. If canfdSj 
lookin] for, hjrpodxindrU viU ulUn be foand ia duUxea, apecally 
where the potntJ aunifiBtt exectttve cm of the health of the duR 
Soch childRiii exaggmte tbdr slightest ailmeiit^ utcntiTclj dwdl 
Kpon then, and gracluaUjr lo»c all iotcnrst in others, jtut as i» mom 
in the hjpodioDdrasis of adults. Ihe children see that berauae 
ibfj ire tmvcU, all their whimt arr gntifted, and half dcwgarily 
nagnt^ thdr ills. Siisple iaeluicli(dic staler aim pnrat tbcuuilru, 
vbosc foundation >• a gcncntl feeling of uixiei;; and the iBfitaM 
that has been reimiied in recent timex of caaa of suicide in the 
jfmn of childhood (sec Book III, chapter iv) ought also, to a Toy 
great extent, to have its aooice in the codstcnice of a lelaiichBiic 
diapgaitiDD. The form of detnanamania is also sometiinea obasrcd. 
HmwoiHua, dd the other hand, ts tmoouunoulf mt, if it extsto at 
allf tn the jeu» of chililhood. Xo penifleut «^ is as yet Conned in 
•hicfa there could occar a lasting radical cbuige ; the Dobilitjr of 
Ihia igc docs not allow dngle iosane ideas to hecoioe persistent aad 
tyi'fiif*™^, as at a late period ; but, on the other hand, ib« vaiiim 
f nn a r j mental diseases having the eharacter of irritation, when of a 
certain doration, lead altooH ccrtsinljr to a state of genoal confuion 
asd damoatia : thelatter data, as the iDtell^eneeodt the child i> not 
fH oonfifined, rapidly prodoee anest of derdoplUBl, when tn addta 
they WDoU lalhrr havt caused nKpnomania. 

li is a genetsl casoitial characteristic of the niental diaordcn of 
ehSdhood that thej limit farther mental development. We are then, 
ia the otmcitti: oaacs, often ia doubt as to whether the states of irrita* 
tioa pnccdiag drBKstia, es |>eciallj the exalted forms, acted thus timit- 
mf^j, pdrhap* dutraetirely, or vbetfacr thejr were the mpiuai on of 
tbe atage of a cerebral disease which for a lot^ time bad tended to 
pcfHtcat change of rtroctare and d<^eDcration, and only at the 
flimwtfnrnnfnt gave for a short time symptoms of irritation. Uallu- 
dnitioiu oQil tixeil delirioos idi-as arc much larer in children than in 
•dflltaj the irritative foims afiect almost exdosively the apberv of 
Ibt MntinKnla anil instinds. 

As to the more intimate foundation of mental diseases in thfld* 
hood, the; appear to depend in part on an origioal irritability of the 



bnio (oAea bereditary)^ or produced aud muiiUuied bjr iujadiuoiu 
tre«tmeiii (hiliiuitUtioD, ill-tnatiiKot of miuil, inMltctiul over- 
exertion, dissipRtion), p&rll^r on deeper orftanic disease originaUng 
spoaloneoiuly, or after iujuries of the bead (upedaUjr tlioec ewes 
which lead npidlj to dL-mcntia) ; thry ohcu proceed fcom svmpa- 
tUetic irriUtiuQ of tlie braiii traasmilt«d from the genital orgtas 
(onaaism, approach and entrance of pubcrtjj. Again, chloro* 
anietnic utaifs from rarioiu caases^ rapid growtti, prerioua acute 
diseases (tjjilius, measles, &c.} are often circumstAnces of caosution. 
Alao uftcr rucorcrjr such piitieiiu are much diB}>(»cd to rclapec ; their 
nn^utnl health conlttineii in darigiT duniig the whole of their Uves, or 
they ocensioually bi-couiL-, withuut being actuallj inaauf, awiiig 
to an unfavorable change iu Itiejr whole cliaractcrj UEclcss for the 
vorld. 

Thunum euumemlci, from KfttiMin at 11,^33 eutsof iiutmilj, 8 aues in 
cliiUrcn unde-r 10 fcon of age. Hulnni, I'crfccl, £«quirol, Sputxbciin, 
Guiiiluiu, Zelkr, aiid rnjtrlf bive oWiveii cljililren triio iuffercd under weB' 
marked muaia, at tile *^ei of 6, 7, tj, 10. 13, 13 jeajf. Koriilc (ait, " Aliena- 
tion," 'Diet, dc Mdtl.,' i, p. 516) relates two eiucs vt tliii kiod. J»rdciu coinmu- 
nicatct (' HufciaJici'aJourniLl,' tol. \v, p. 334) llic remarkable cose ofaboj nbo, 
la cooKqucDCC of an Dccidcnt in which aame tm»[\ pieces of glau peaetratod 
into Uie toles of his (cet. became mantackl. aud coatinued 10 till llitir remoral. 
Pifpioooo (' Osterv. aullc Alien, meat,' Palermo, 1841, p. 34) meatioiia a caw of 
mstiid observed hj liim iu a bojr 8 juars of age, Motd ('TniU d« Ualidio 
iiieiitulM^' Pvis. 1B60, p. 101} mcutiOustlic Ctimoi »gnl, 11 jrean of a^ who 
liad attaoka of fur;, mid iiiccin|>tcd to murder licr mother and siitcr. Stolla 
(' iied. JaUrb. des Ocitcrr. Staals, Man, 1844, p. 957) namtc* a verj tuler- 
titlng CMC of mania in a cbild 7 jear* of age (ffilli luis of apnch and scriom* 
dcKcueration of the anterior corcbrsl lobes), la the sc?cral ioaiiiulioii* rcecatlj 
erected for tlie recepliou of oblldren e'f weak inlelieol, there are gcnerDlljr found 
alsu more or lus sifeoinl osses of meiLtal ditciuc. la Uie liutitutioa al Uario- 
bcr^, in Wiirteinberpr, I liave found Bspeciull; the iljjtliter slates of ma&ia 
{vtrsBlile fumi of meaiiil weakueia) rejireaeuled : ve sboll enter mora ininutely 
iatu lliiA subject iu Iho chapter on Idlocj. I Usro recenllj seen a cue of 
maDta couucctedwitli c|iilepij Id a childof 5 jcars; a case of morhid anaietf 
■ad hkliuciiiBlioiii, folbning cpilcp«;, iu a fary amM girl 14 jcan old ; sad 1 
eiMOf inrrita! dltorJvrnrter Ijpbus fever in a boy 10 years old. 

riutlicr eonlributiDiis to tiic atud; of ibc nienUl discnses of cbildrcn are 
found is West, 'Joumnl dcr KmdciknuiklieitcQ,' 1S54. lii, 7, 8.p. 1; Rascb, 
'Beuh. uber den Crctiuiamus,' ii, iSsi, P- 61 i Vcluwaute. 'Ann. M£d. P>;cb.,' 
vi>i 1855, p. 517 -, Paulmicr, ' Sur let AIT. nienlsles dn Sufuits,' Tbcte, Farit; 
Bfierre, 'Acad. d. Scieiices,' ; Jain, 1858. 



THE C&CSKS OP IM8AKITY. 



14ft 



<( 88. UeoUl diMsses ire more freqaeat bdircm tlic ages of 16 
Md 2j Ihw in the ye»n of thildliood : Ibo great majority, however, 
rfill CSM3 occur during tlic period oriiighcst mnturity — in the time 
of llie corporeal rcprodaclioa and mental activity, of marrtoge and 
of boaineas, belveen the ages of 25 and 50. But hcr« even the 
report* before as are not sufBcieiitty ^tisfaclory lo enable us defi> 
nit«I/ to detcnoioc ihia qunrtioa, inasmuch as the greater uumbcr of 
the calcubtioDs' arc ba<ed upon the ages of the patients when 
admitted iiilo the asjlum, with which naturally the age of the actual 
MlUDCDcaDCDt of iha disease docs not iteccesarily corTp:<pond, or 
tBumadt M only the nuniber of insane generally of a curiiiiit age 
It preKOt in a conntry w mentioned, trilhout at the same time 
pnQHf the total auiobcr of individuals of that age in the couutry." 
Were irr allowed to taltc as a ataadard vny carefully prepared 
statistic* of a proportionately snuUl number of patients,* it would be 
_ area Uint the most /reqaent age of the comDicnccment of insanity is 
H between ac and 30 year*, the next between 30 and 40, and that 
■■Imdji b«t««en 40 and ,50 the proportion i# remoikably dimioiahed. 
^For ttie male lex Zeller* gireji the period of from 10 to 30, and for 
the iemale of from jo to 40. as that at vhich ioBanity most frequently 
eoininen(-r9, and rxplaius the difference by the fiict that in the lutter 
period the bloom of youth begins to fade, and with thia the hopes of 
a fortanatc life begin to disappear : this, he thinks, accounts for the 
pcater Bumbcr of the attacks. The great nuniber of attacks which, 
■oeofdiog to ob^^erration and alio to Parchappe's calculations, 
oocor in vomeii of from 40 to 50 years of age, may be connected 
with the plieDomenn of involution. Above 50 year* of ng« iuMnity 
is still inorv frequent in tbc female sex. In general, from this age 
onwanb the predisposition begins to dccUjie; butj ne^'crtheleas, 
Uierr cotittnues even to Ihc Ubt limits of humnii life a certain 
iadiuation to nntat diseaje, and this at middle lifu is not greatly 
dimini^bcd : indeed, tnoie exact stattstica might show that senile 



piMtiot. 



■ 8m FdcIi*, ke. dt^ |i. 97 ; Uodelet, p. 443. 

* Vm eunple, Koatlia, loc. cit., p. B; Roer, p. 9; Bnd mMj olh« sla- 



* Xdlar, " Second Report on the EfficMj of the Hospital for the louie at 
WhwWhal." ' Medic ConcspoadetuUott,' 1S49, p. 143. 

• 'Jownal fur Fijeliialrit.' i, 1, p. i9. Id tlie Vieeu Aijiam, en Ihs 00a- 
tilfy,tte taauaiBViperiixl*Mnutobcia n«n bctften 30 and 4o,an<lia vomen 
bstweeo » ud jo ( ' Uspori,' Vicsui, 1 ti>53}> 

10 



146 



TUS CAl'8£d or IMSANITV. 



tlemeati& exists to such an extent a« to show a Urga proportioD fur 
the last yean of life. 

UocMTcr, senile dem en 111 13 bjDOniMita lite aolo form of inatuil/ eoeiimng 
Id tb«ie yt»n. £ai)uirot sav two vomca. the om cigktj, tV «t]i«r ei$hl}- 
four f un old, rccoror ftoin mania. Burrovi mcnlioni ■ one of n«la»ciiotii 
MdnuoidcinipenDQaj^ed eighty •(our. iMjtelfkiTe treated a iteeui eau of 
nukackolin in a pcnon ti^lj jean of agv, and couM oanata maa; oOier 
axi oT tbe tune kind. 

§ 89. 4. TI10 queuion whether toetal poaitioi exerts an eesenital 
iuHqchcc on the origin of mental disease cHnnot, os Fadts vcrj' 
pnipfMlv oltscrvci), bo (letrrmioed b^ calculations based on ibc 
nutubFr of admissions into pablic asj'tam^, tis,, naturallv, fxt mart 
[Kktieiits from Ihc lower cliusa ciit«r ibcae iotlitations. The onlj 
authority on this eabjcct which wc can quote, and which is kuowa to 
tu<, i» Jiiliuf,' vtio stales that in Eogland anil Walts there are 8.>oo 
jioor nud oiil)' from ) 100 to 1 300 veatlhy persons in public and 
private asjluoia. if wu cuiisidcr Ihiit there are far more jwor thno 
rich, vt can eaml; conclude that tlio two classes are abont eqiullv 
sabject to injianity : Qe(ertbcIrK>, tt is orditinrilj' n^sumcil that in 1I10 
better cla8»» of societj', or ratlier in the wfuUhy, mctiUl dideasra arc 
not 90 fr»|UFiit as in the poor. It ncn app««M that the circtiiu- 
st.-inct's uhicU act on the one aide tUrowgli grealer direct trxcilntion of 
the cerebral functions, are on tlie other compensated by hunger, 
poverty, and drunkcuncM ; whilu tlie powerful [nsKions, w love, 
nmbitioa, jealousy, kc, ore alike fre(|ueDt iiuil oriidtuillj is powerful 
iu all cloML-!, but where there is least inU-Ucclual culture tliuy o^^ 
moat insupjrortable and act most destructively. ^H 

As ta a >))eeiAl prcdisi>osilion which results from ecf luiit ttadts and emptof. 
Btoate, tlicre is olmott oothing lo add to iIlc foro^iog rcmariut rii., ihal protMblj 
thou claain nhn Ind a fnlif^iing niid opprvsscd life of hud maaul bbaur 
are more frc(|tieiti!; sttaoled \tj thii, na iudccd b; c^cry olber £teau^ than 
UiDsc viio arc eu^-oRRd in Ibc leu eibnusting mcotBt laboaror who do no work 
•t ill. Stiould, therefore, a marked prcpoodcnuice eiial iu certain kbdt of 
eiDploymDnis— for eiainplc, in lailort, dnj-kboDron, pcuuits, &c., or amongit 
meroliuili, offlrfaU. olJicor*, ftc.,— wo inual first eomjiaro the rclatire sunben 
cngngcd in auch pTofesiionii lo the ^cnei*! populatiou ; aad erea iken we vould 
nul ijc wirrButcd !□ cDaclQdiiig that it is [be piofcuion, as such, wfaicli cauaca 



' 'Bcitnigeinr brift. TrrvnticlUiiindri'p. 8. 
' Fuelir. loc. cit , p. 106,' 



TUC CAUSKS OP INSANITY. 



147 



I 

I 

I 



IW dWpodtton. Certtbi cmllingt do ii»t «f ncccuitj pre ri»o to certain claaMl 
«r ifi^rioas inflaraccs, bat tbt? naj present moTC opportunilies irlijcli the indi- 
*id«al Bwj vnlnntBnIj mut : for example butlers and talhn tre, from liabit« of 
iraaknateoi nrj [reqnenll; the snbjectaof ddiriutn trnneai. Tlie ainerltnii 
<f Feims, Ihttl lliOHi proTetstona farniili tlie fcrfnlnit numbrr at inMiic wliich 
MTolnt ih« I«u1 wnouiit oC bodil/ exeilioiii liu not been coaHtmciJ b; ui; 
tmtwortlij italiitici. 

4 90. Certain Tocfttions appear to enjoy a reinnrkafcle immunity, 
■Itile in others llic dis^iosilion to mrntAl disease ia considerably 
inocucd. Profc3«ional bc^ars, according to Ouislain/ do not 
ttccai e nmae; he ascribes this to the indifference of these people. 
FrsuJp prortitate? in large toiros .in; often attacked hy mentid 
iiaaae : misery, deatitutioiii ilruiikcimcss, violent [Missions, syphi- 
litic contagion, kc, wdinarily act together in tlivsc cMe«. llic 
ntunK-r of cases of insanity oecarring nmongst young female 
teicbrn and goTcrnesses is, st all events in England, very great : 
Bcttlau itcctvcd in 10 years (1^46—^5) 110 such young women. 
Here ■dTer*e fortune, want of rest, cxcessire tncntill exertion, and a 
fingrecable life mny be the chief causes. 

ImptiMtment brii^ into simultaneous action many influences 
vliirh are dangerous to mental healtli — remorse, longiogs, concentm- 
lion on one tmalt circle of idciu ; wmetimes Insnflicicnt nourishment 
■cd impure air, vaiit of rserciie, &c Indeed, iu all tiouses of 
rorreclioD, the nambcr of cases of mental disease is relatively greater 
thin in the firec population of the nmc nge ; -but the m^ijority of 
llioe casrs doald certainly not be tntireii/ ascribed to the imprbon- 
meat — fny commonly Ihc individuals arc already very strongly 
|«c4)^io«ed, and frequently the dlseaM is even more than half 
dBwIcqied before he b put into prison, inannnrh as during his pre- 
TkMU life Ibe crioiiiul lias been cipoacd to the inllucnce of all the 
CMwr* of insanity. The qiie'iion still remains unsolved, and ]>roba- 
bhr in the pn^ent state of our knowledge it cannot be solved, AVliat 
is tlie inflnrnrc of ibc various new systems of puaishmciit on tbo 
uaital health of the criminal? It appears certain that I he strict 
aobtarf confioement, applied indiscrimJnalely, augments the number 
of Dental alTcclions — that uinny individual) cannot stand it, and 
ihii cppttiaUj irritable and already batf-donmgod individuals by it 

'LrfODS orale*,' ii, ji. ». JoRi('Min.d6 rActd. de JM.,'t.ii, P.34S) 
r> U^ OB IliB otUi bud, female btgpts my frequcntlj beconw iBUse. 



146 



THE CAUSES 031 INSAMTY. 



become easil; affected nith halluciiutions, cxcit<'incut, and in»iuiiiv ; 
nnil ilien freqiienttj, iinmeJiatelj' on beiDg trftiisforrcd to ihc 
common prison, tliey rapidly recover. It ap|»e«i! also thai noinen 
and uneducated pcrsuns du not wi-U bear eoUtarf coufincmezit. 
VTherPj however, all n^ululious arc framed eatircly iritli a ticw Io 
the bodily and mcBta! licallli of the criminals — where, the period of 
Bolitarj- confinement not being too prolonged, sufficient open-air 
exercise is secutvd, antl whi-rti the feelings and ideas of the criminala 
are suitably excited nnd perhaps elevated — irliere, at the snmi.' time, 
attention is given to syntptoms of moral pcrversiun of the aenlimcnlr, 
and the Grat signs of commenciag mcnluJ disorder arc coostaully and 
carefully watched, nnd the individuality of the [irisoner tLt far g» 
possible considered, the danger to the mcnta] liealrh shonld not 
here bo very conciderable. 

Espenenoc lua sbawu, particuUrlj nt Lanunttc (Vented, 1841) and in Tiu* 
cunj, llist stiricl nolilar; cocifiiieuiotit is oontideMbl; more pKJuiioial to ncnUI 
licnlth llian geucral iuipriaouuicnt. Ou tlie ottior liftnil, Ihc «ioollcnllj coa- 
ducted ijitem of &oUtar; imprisaument employed at liTudisal does aot, acoord- 
jng to the report of Fuialiu, abow any in]uriuu> inlliieuoe on lli« mcutal b«kl>li 
of llie prisoncn. AIm in the model prison of PcntonTiilc (London), Moording 
to FiirrJBii, oqIj 13 CMC* of insanitj occur tntongit every loeopHsoiien. Suti- 
(ary conflociDCQt, boncrcr, does not citcnd there for longer Uian ei{[lileea 
uoolbs. Soliur^ConGuumeDtpacticuIarlydispoaulo WIuoInuLioDa of keariiiK: 
thii appears to result from the patieuis t<iUh>qu(Mug uid belicring tliat tliej 
bear ollien tpenkin^. 

From llic vcr; intenstiufi comraunicntions of Delbruck, tt would ap|icar tli»t 
mciiUl discaieamougst crimmnla is more frtquent in lliose who Iihvc committed 
crinici from puaioDnte ni'olivci tliiir in tho»ewboIiaTccoinmit(c<J ciriineB a^inst 
propcrtj. Il is luost frequent nJicc murder nnd moitol iujtiiy, tlicu after rape 
and arson. AtnonRSt crimiuals, two chief categorici of delirium msj be dii- 
liuguisbcd : — 1 st, caaot where a solttirj great orinie, such u murder, vitb ila 
oorixeiiucncir*, lifts subsequeatiy produced a mental disorder: iiid, where 
habitual criminals become tosaue owing to prediipoution aiid (he eiFeda of time. 
Ill the ficflt case, the aiiiijle criminal net is evidcollj the essential cause of the 
inunity ; it dctermiu«s tlie form of the ditetisc and tlic subject of th« ddiiiuRt. 
Ill Che seooni) case, tbe entire bakita of life and the caitoint of the piitoa f^ivc 
apecuHur iii^preii to the disease. losantty is gi-iicnill; dev(>laped duriug the 
Krit years of impriionnicnt in aolitntj confltirniciit in vliosa strcadj dialinctlj 
prcdispoacd; it often sbowa itself even in tbc first montb. la the delirioiu 
oonccptiona, the attempt to palliate the crime Or cotireljlo dee; it is often seen, 
or to picture to tlicmsclTos a ipccdj dclivcroucr. Ueullon of tliD crime asuallj 
evokes, in Ibow of t!ie Snt category, piusiooate exeitement or anxiety, 
villi iucreoso of the debriuus eiprtssiuuB. Itefuiung to work, eice*>c*, tcfnc- 
toriacsa, are naturally of daily occurrence amungil these insane prisoners. 



THE CAU8KS OV IKSANITI. 



149 



I 



I 



Fcmu(t85o)ftlt«iiipted to adapt the ntrious ijstcmi ar puniihmciit to tba 
tHiTcKut clM»e« of cnmiiult. lie dividct lliMe into llir«u Ml«t>oric» : — >>t. Tn- 
Idbgnl, oierKOliCk ud t«UUf corrupt indiTiJuala^gtiiinprovBbloBCDundrclf. 
awL Suk u poBCst i modcnte degree of intellisenee, a little developed 
MOM «tdatj — wlio »n indiSereiil lo fftoi Biid evil, aiwl regar(Ue»a at sbtnio 
aaddttfraoe — wbolitrcDO oppMiltnnto beilow la tliHr evil inctinitiQua. 3rd. 
Particv]ui5 dull individual*, w!ii> cannot cttimitic llic ligniltonce o? tlicir deeds, 
Md oftea even the cause of tlicir imprironmcDl. Tlioae or ttio first calej^oi? 
akoold, througlioat, be subjcetcd to tolitar; coafiii«ment ; lliosc of Ike lecoud 
iT^ttira nlhcr''JLubBrn'* S;>tctii," wilU quiet and volilaTy coullncmcot (turin); 
Um BiRlit 1 Ibose ofihe third eaimot at a\i bear tolitarj ooiifiueinent. The ap* 
plitatioa of fBcii a dauiftcation niust be vorj dIOIoiilt iu praetici^. 

On Uui subject, mc WUrtli,' Die ueue^tcu KortMhriltedca Gef»iisnceavuen»,' 
WteD. 1844 : L«iul, ' De rKmpriionncoiGDt eellulairc, &e. ;' Morenu, Cbiihioplift. 
'Aatttl. Mi'tl. r>]rcbol.,' iS^,), tol. ii; Jorct, "l>elaF(>^edluukl^i^lcp6uitcn- 
tiain,'' ' U^in. de I'AfuI. de Hid.,' xir, 1849, p. 319 (contains man; interesting 
isiKafLs u^n female priaaottt and their iiuanilj, and facts conceriiiDj; tlic 
'■ami tjAcm") ; Ferrus,'De« Prisonnim, de rRniprisoiiDeineiit, fto.,' Paris, 
1850; FiisOin, ■ Die Einzclhaft, ^V HcidclbcrK. 1%^; Dclbrucl:, ' ZcilsieLr. 
f. Paychiainfi' 18541 li, p. 571 xiv, p. 3751 L^iclra tjuula, 'Acad, de lilcile- 
ciac.' 13 JiBuar, asd 1; April, >8^; Selioli, 'Zcil*clir. iler k. k. GchvIU. der 
Amxeta Wira,' 1856, sii, p. 6,)^; Ibc Itcports of Mitlci^niucr in ' ArcliiT 
dea CrimiBalnohta.' 

$ 91- 5- We ROW nipntioii (Im question so often and 1:0 vnriou!>ly 
ducoHnlj of Aitf infinenec of fAc »e<ui/n» 0/ (he year in origiiiatin^ 
bwuiitj, merely to citll Attention once more lo the fjitluciousiirss of 
(tuaj rtcttsticAl reports, from the circumstance that, according lo 
LMiairol'a tables, tnnat admissions JnUi scTcntl af^ylanis tiial: place 
duiing tlic summer months (Msy to JuU), tfvii?r were sdinitted 
during vprbg intt autumn, and fewest in vintcr, it hnn been con. 
chided tbat tnmiitjr origiBstcs most frei|UL-attv in .lummer. This is 
s nry ctroDCOOi ooocltuion; for whnt a«yluni is »o fortunate as to 
laKwura I nujoritjr of its cases within two or even thr«c months from 
the conuDcnccinnit of the diwue?* There cxisla no constant 
idataoii bctvceu the oonmienctment of inuuiily and the aduissioa 
idU) an Mjrlnm, and we are »t perfect Ubcrty to frame conjectures aa 
lo wben these ca»es admitted in summer reallj bad their comuM-Bce- 
meul, whi-tlit-r itic greater diiEcultj of traTcUing iu winter has any 
efleet on th>c admisBiotki, kc Statistieiaiu speak al»o of the 

■ WinmnlWI, an tnaliiution solely demoted to eunUo eaMs, lecciicd in C 
ytui i32raM«of Otnontha' itanding. sad 150 of crca loogerdunlion. 2dl«ri 
'SUdic.CatTe»pondeBsUatt,'iiili, 184O. p. 143. 



\ 



TW the CACSKS on IKSASITT. ^^^^" 

iafiuence of Ute seosODs of lb<< year od the single forms of iosuiit;. 
Esquirol luu asserted, uid JKobi has proved the fact iu i8i caect, 
that in winter iKc attacks of mania lire most »eldoin — that they are 
more frt>(iuent in snimmcr, and fispedalljr in spring. 

With regani to ihe influetice of tie mooa, if not on the Qrigin^ 
at least iu iggnvnting and iDodifjing insguiity in its oour»t. 
This influence ia dcaioJ hj the gn-ut majority of medical jwycho- 
logista, and that pathology is d(>rid(.-d nrhich, for examjile, would 
ascribe the periodic^ return of tbo attacks of mania to the 
influence of the slitT*, because they eoincidr with r^'rtaiii regolnr 
ebiuigCB iu the hcawus. Because of this the iuflucnce of tlie moon's 
light upon the insane should not be denied, for crca iu ticalthy 
persons the lighl of tlit- moon can poculiarly affect the cotirse of the 
thoug)U8, giving riso, forf\ain[)le,to ardent and elegiac ideas readily 
disposiiig to scnlimeuLal poetry. In tlic iiisaue, who are more 
powerfully and diircrcntly affected than the healthy by Tariooa 
BCDiiiblR impre^on.'i, this uiny, vitli the nhsence of sleep, the vie* 
of the full and brilliant uioon, Ihe uncertain tight, the fleeting 
ahndows of tlie eloiids, combined wltlt tbc ■■'tiltueM of niglil, or tlie 
confused mummra whieh then Boat through the nsyluin, indeed, 
otalc still greater impressions, more violent emotions, rarioua hallu> 
canatioDs, &c. Jjs(|uirul prevcuted the agitation vhich vras regularly 
tomarkcd in several patients at tho time of full moon by banj^i^g 
eurlains on the windows.* 

I Sbctios 11. — Sjiecial Prediipatiit^ fhutfi. 

§92, 1. Jleretiitarg Pretlitprntwit, — Statistical invcsiigatiuns 
■irengthen very n-iuarkably tlie opinion generally held by physicians 
tnd the laity, that in the greater numbet of ciues of insauity 
a hereditary prediapoaitiou lies .ab the tiottoiu of the mshidy; and 
I believe that wc might, without hesilation, alHrm that there is 
really no eircuiiii^laucL' luore pDWcrful than this. Doubts have 
recently been raised as to wbether hereditary predisposition pUys a 
nioiu important part in Insanity than in any other dlscasD, or wliether 
it in uierety uiuat sought fur in tlmt disease, nnd therefore most 
frequently fonnd.^ It is quite possible that furtfaei adraiiocs may 

■ ' I.oe. cit., p. 5^8. 

■ ' NcuBuiia, * Pt;«Lua(rie,' 1659, p. t4i' 



THE CAD8KS Of IKSAHITT. 



151 



I 

I 



tbrt lurediiary predispotitkia exeroiMS quite as great ou 
in maov olhcr diseascsj especially when more positive data 
are once obtsincd oonccraiiig the tratuforoMtioD and transmiseton of 
{■ihok^cfll st«te8. At present we can cbim for tabenulosis done 
an inlaciiec of hcnditiirj circuuuumcea in 9aaie degree equjit to 
thtt tjhSbUti hy mental diwues. 

Is detaiU, however, th« reports difTer very considenbtjr, both 
■camltng to the experiences of the observer, and according to the 
nok of the individunls examined and tlic lociiUlj in vliich the 
isfcMigMioo took pbcp. 

The euormotn proportioa giren hy Burroirs (hcToditarf predispo- 
MlNn in f iha of the cases), or the estinuitc of Moreau, that in rsths 
flf the OHM hereditary influence have been »t votx, are proved by no 
idialile (Ulittics. lu tlic following paragniplui wu have united tlw 
rcmll* of a great niuaber of reports of German, French, and English 
aiyhnu. 

Jacobl, in 31o cases (of nunia)^ found hereditary predisposition 
|inwnl in only aboat ^tti; fie^mann (183H}, whose inre^ligations 
were United lo the •talutica of one year, detected direct hcrrditoiy 
prrdtfpoeilion in -{th, direct and indirect t^igcther in ;r(], of the 
csMs. Ilagen, in 187 cases, found family disposition in jrd, direct 
hrreditary dis]>o*ilion (father and mother mentally disteascd) in \tU 
— 4th. I'lemming found it, at Sachscnberg, iii the proportion of 
over -Kh; Damcroir, at tloUe, in 773 admianoos, found it in ;tli. 
Maflt&i, in Lcubiu, had in tffcaty>fivc yc^irs amongit the higher 
laulEa nearly }rd (i^tbs), amongst the middle and labouriog 
ctaHca aDtnewbat over -j-lh, " officially con»titutcd hereditary cases." 
At ColditE, amoiigtt 77 admi»«ion«, -^ths of the cases were proved to 
ha directly hereditary. Hereditary prediapositioa appears, an tho 
ooatrarv, to exist to a remarluibly smati extent in the lunatic mliun 
of Vieiina (1853-56). 

Id Biejirr nnd the Sni|>^l n&«,licTeditary predisposition was, accord- 
tog to an old wRipitation (8372 caws), present only in Ath; in the 
UanriUr) aaylum, Uiulard proved it in only about -iS^th. Est^uirol 
fuond it in the poor in more than Jth, iu the rich iti about {tha ; 
Parehappe, in wxni^wlifrc over |lh ; Guialain, in over tth ; Brierce, 
tDalnM»t liolf; Dagonct, in Slephansfeld (in three sLatiotics together), 
in about |(h of tlie casea. 

Wciwter (1848) fouud at Bedlam, in 1 798 patients, hereditary 
predispofition tn almost ',rd oflciirr in females; SIcac, in Bdinburgh 



163 



TUB c&usKa or iKaAXtrt'. 



(1S5 1-^3), in 248 aJmiwioDS, a little over jrd. In a large namber 
from Kngli*h asd Irish asyluiDo, collectpd by Jarris (1850), it was 
Jound, in 44,717 mt.-:ii,onlyin^lIi; iu 4,^,091 woinen,onl>'in Vjrd. 
At BlooiniDgdalL- Arvluia (New York), from 184 1-9, among 1S41 
palieiUs there wen 1 1 8 men whose fathers lutd bo«Q mentally dtwaseil, 
and 33 who had some other relative insa n e; &g womeD whose fathers 
liad beea insane, and 6^ who had other rolatives insMie (together 

Biui, in Florcuc«, Toutid licTeditar5 predispotiitioa present in about 
ith of the cases. It will be rcomilied that rcrj' huge st«tistic» 
(BicStre, Jarvis), which probably could only be made with material 
let* carefull; gatlMred, give a very small proportion ; while those 
6«m \tss vxtensive but well-iovestigated sphaica ol obxrrnUoa 
prorc it to be much more frequent. 

He still ooondcmble iliffereacca presented b; these flares migfat depend on 
Uie prcdcnni nance of oertain ciroutnslanaM, triiidi, bting ictj imporlsnt, ougiit 
lo b« more doidj oomidennJ. 

(1) Conjccnitol dixfiniitian to iitsuit; is more frequeat wber« mtrrUee* 
alo-ajs lake place unoni^l a limitr J circle of funilie), or erca ia tke aanie 
fainilirs. On tiie otber Larid, [lie truismistion it dtmiitidied bgr oonstant aos»- 
ing nith atranfcc blood. The lint circuniistaiin; is nty eridcnt amongit Uie 
ariitociac; of certnin counliifs, alsointiic Jciri&k popuhtion ; anditiacspc- 
ciali; slrikitiK nmong Ibo Eiiglisli Qiikken. Id tbo iVt.vlum at Yoik. iritUit ia 
deetincd to this religious stcl, dircci hcrcditarj prcdiipositiou et-n be traetd 
in one third of the [utieDt&. indirect (uicnt&l diseuc in otiier reUlivet) 
b anolliBr siith j llLcrerare, botti logetbcr.iii ouchalf oftlic catct.' ProjiicsiiTe 
uninterrupted transmission leads finally to the special dcgencfatire forma 
(Morel) — to imbeodiij aiui idiucj. atid with tUe diuiiiu»hcU ca|>abilitjp of 
propiEalioD ot bdiTidunls of ILo latter kind, the race graduallj becomea 
cxlinot.' 

(3) There exist farther ooiuidorabledilfL'renoesin the statistics, inasmurii 
u Nmotimw obl; lheon»s vLere the parents or gmnd-pueiiU haie been 
inuDe arc inoluijcd, wbilc lit oUtm tbc Buum|ition or Utniij predisposition is 
mnde wherever iiuanilj ia prcscat in aajr near ittlatirc (uncles— bluod icLitives 
— eousint)- Tlie Inllcrnppcart lo be the morcoorrcct view, when wo consider 
that alnost olwnjs, besiilr* licredilarj disposition, stUl further causes wc re- 
quired fur the outbreak of iiuanitj; ibat, Iherefore, the present disposilion my 
remaiu dormant from vaat of eucli f urtiicr causu in the nearest relatires. Thai 



> Julias, 'Beitr. t. britt. Iirenbellkunde.'p. 381. 

* Uonl/'DcsCuracleres de I'll^ri^dil^ daiis lea Maladies ncrreuses," 'Ar- 
eliires gdofrulca dc Hid.,' i85!>, September. 



TUB CAUSES OF INKAKITT. 



158 



I 



I 

I 



iHttwHHi txUla, hmerer, can be plunl; ptoren bj tte ioiuiitf of tAka 
idhthcK 

f^) Vfe do wdl not to oooeeirc ttt a fuiiilf predupoiitioa to nentd £Mttci 
M Ininlril (o UwH ftloDC, hut nlhet !« eonnder it u ■ dUpositiaa to tenooi 
cmAi« l >B«1 cetVDui dltea5cs ^ucrallj'. Il U not at all nra to aee tn k hmilj 
ocKiin Btmbtn tulfrncg from iosaMly, ollicn rram epJlepi;, aerere ipinal 
irritation, t>^tl«ria, neuralgia, £«. Itusb,' for example, rclatea tlie oue of a 
Bcduaic who bad Ito allackti of iotanilj — tlic bttcr of which coded liia life. 
AH bit >is (tliildrcD lullniMl from b«ad«cl>c, bat none pitMotcd tbc leaat trace 
af baaaitj. In lliis and liiiiilar cawtt wbioh are bf no meu» rm, Iba diipo- 
liliea apprars la be able lo nanifnl iUelf in viriou bma, and OMMMaaflj 
CTCO a>c ttt tlirougb KTVral gfcaeratioQa pathological itattsof tba Mnoai 
■5Stcm wliicK It first gnduUy iocretse. ud «Bd bf ptanig iUo 'lamdXj 
fnfv. 

(4) Aa original aiMMakiiia dbpoiilion is also not to be dented ia thoac <asca 
wbm Obe or both pareali, altboogh oot auSeritig nnder iiuanttf , preacat a 
atdkiag COCcaUicilr or eitraragapce of diaracter, and a norbiil cialUtiiMi 
of lb* pMtiOBi, which ilronglj approach lo ioianitj; io lliOM tuci also 
arhtn aennl imtanoa of suicide bare eecurred in near nbtirca. for 
■■wide, ia BUj casta a sjiaptoai or developed acvioiB aieatal diaeaae,la 
ia toMir ubera at Icait Ibe endence of a vearinea* of life resilting (roai a 
Morfaid atatc of tba o^RDiin, anil which it to be numbered amoafpl the pri- 
■ai; focB> of iaMaily, ndKncboUa; and expoieaoe haa rfcijtienily tbova 
Uiat Ike todinatiaa to iiuejdo, which oA«b conwa on tn all ibc ciewbtn of a 
(anil; at Uie ttmc age, coiBinunicatu jikU bj bcmlitsr? deaocnt. Wc will 
alaocaiiljeompreheiuihowihal weahncaaof clikiactcr ami eieeaaite f«MkiBaU- 
■caa bjT wbtdi Ihia iKxtdiUrj IcDdcecf ia m ficqueDtt; abown, naj, bj the oo> 
opatalion of wttoonble cimiauUmM on individnata ao iCEcted, beget tamiui 
trtioei In I^ manner, we oecaMooallj lee iaoerlamfaMiliea iaaanttj, aoieide, 
■lil. tba rctutt of the ialiuiate coancclion of eertaia diipoiiliou o( rifCter 
ijoinihirifiil with each olhcr, aliemoliag in a deeplj deplorable amaner. 

LaaUid [OpfMabeiai, ' ZdtKbrifl,' vol. sii, p. 16) relatn the foUewing cne : 
A ba^aad aad bia wife, Ike romer 43, the Utt«r 36 j*±n of afc, brtawt ia- 
•aae and eocnniitted taiciJe, the one bj ttnu^Ulion, the olber bj drowning. 
They Irfl faehtad Ibcoi Ihroa oliilda-n. The cldeal dangliter pottoned berwlf 
al Ibe age of X4, after having lived for a lo^ time ia proatitatioa. The aoa, 
■Oeaiedof aMaMioalion, atnngted UnncU at the age ot ir. Tbejouigeat 
dnachter, b the wlb month of pregauMy, threw henell froaa a roof. She left 
bdiiad bar a aon, «fao, ahboagh T07 jonag, had been tental timca ia priaoa, 
aad al lait went on la edfeatim to £^t. 

HJM U — , of Ortava, Kt. 30, of an old noble Spaoiih tamij. never OOB* 
tiaiaaled bj aaj mliaiUuicc, became iuane. Tbe diaeaie preaenled the rom 
of periodical ehengn of nelaBebolia aad mania, with a teedenrj to *uicid<w 
Ud gnadTalher oomnltted mkaie ia hii Oflieth year. Of hia three tma, two 



* * lied. Cnten. iber d. Sceleniniikb.,' Iraualatedbj Kiaig. Leipiig, 1815, 
p.j6. 



104 



THI CA08M OF IlUUUriTr. 



rftkv; 




lyoiiaBnvtl J cadad tbcnUrata IW; 

tains. Tbc thinJ. ihfl biker (f3Ua 11- 

a>t b« «M tMMiimd alMtl MBM. Bia«M(ll«Oilr 

hdj), vbca M 7«a tf IK Clmv Undf Mb (kc ■% taoMB kc I 
Ideiiij Af hu U^lot«. Ha Mtar, ilrfcinfc fa>v Ik tW 
nbtiPM <f Ufe, •bovtd so Hd k diifMWn Ibii W I 

Sat lOMcUiiMa >l>o «c And in UioM Euyfin ' 
froa inuily, oUien of rcmufciUy MpoiM »ld%eaflc viik V 1 
Ifieitlei. I cDuiit auM t«o m^ eua^ ban MMag IW (nat 
OdebtitiM of ou own luDc It is Ml OBpnUfa Uat gmft 
1^ Mnbnl pMMHC% Md era* Uum nwalal pwttriiicj vlieh i 
dinteabniBiiitoMliingntoudrowatricitj, wy a gtfcw^ iiig hwnUt 
aUml eiiesatUMn Bud perfect pbjtieal h tt kj, tf f mt a Ike faca of w- 
orMMd Mtnitj ud caoiq «f inuUect, ud ongiMbj ol ifcanJt. Idvtn 
(' Pi|dolagie MOfUdt^' Fuif, t6$9) ktt reecailj fatoo^ lbf««d tUt foMtioa 
ud pn ned it bajosd iU Utnita. 

Tbe mliTc uMinptiia tint ktrediurj diipOM l io n cnenB; phjs a j^i^irt 
part m tlw ctiologj of iaiuitj hu btcn aUacked u iaooneet i^ SM^ger 
CZcitarixriAdcf k.k. G<kU». dec Anle u Wi«B,' iS6o, No*, 34, 35). H« 
ntj propcriy oils atlcuka to tbc ucaudoita nanner in wUek oeoaian&ll; 
the bcrtdiUrjr preditpOHtioe '» praT«d b/ jibjMMaa. He cobSdc* hsMclf to 
Ibe RK»t limttal HpaBnlkm of (be void .befeditarinea, aad oolj admiu 
aacb OUM at herediUiy where before or «t tbe Uuw of proarc»Uati one ut (he 
pKitats WH nesUUr diacascd. Acoording to tbit princtplfi be (ixwd b«c> 
ditaiT predikpoaitiiQft preteot ia onlj four pet CMit. of (he cosca. Tlut Xim 
crilM onnboola Iki muk ■! once be«oaea evident, if w« wlMUlule Ibo 
qontioa of familj di*po^lioa for IhaL of bertditaij piednpoaitioa. In p^p 
]^oftbe'VieMrBene)il' (Vienna, ■858)lbei«aiealM)foinidaiiflGientgioanda 
for ibe nuall uumber of butdilaijr caacs admitted klo Ibe isjliUH tfacte. 

§ 93. !Ks<iuirol Miamci], and BailUi^^er^ Ima provitl bjr the 
«tAtutic« of 433 aaea, tint insanJIjr is more frcqucntljr tratumittcd 
{iDdcMl, about 00c thinl oftcner) from the mother than from th« 
falher to tlio childicn. tic toaai, at tbi? eamo time, that irbcii the 
tuolhiT wu inune more of th« chiklneo bMamc so, sod tlut the 
Inn^uusfion of ioatiity to loiu U as frequenlJy Erom the oiotbcr 
as ftoui tht* fathtr: on iLc oontmry, iu tlic c-asc of daug^ten tho 
(tiRpositiun to insatiit^ is inherited tvicv as frequculljr from the 
mother as from lli« father. It follows from this, that throu{;h 
uuuuitjr of the mother the childr«n gcnemlljr arc more endangered 
than through insanity uf llic fLithi-r, imd also that it is more cspceiaUy 

> ' Aiiiul. U6i. Pajcljol,.' Uai, 1844. p. 3% 

* -lUi-b. t(tiU«t. ■« I'UfftditJdclAFoliV'Aiinal. MR PtTcli..' Ual, 
1844. P- 33O' 



-FOR CAO&SS OP INSAKITT. 100 

I of Uie feoule hs who inherit this uofavor&bla dupou> 

loteorer, exprnence shows that children who are bora before the 
I of tnanifestotion of the mental iluease arc les8fiequeD%altAckc(l 
Uiao tfaose born tflcr (he parents have bt-TOinu insuie. Occai^ioiiJill/, 
tberefore, csscs also present tlunnsclvca wlicro tbc cbildron become 
■Acted bcforo the pcionts, becauKe a iiiiDibcr of tuases fnvoRiblc to 
tin outbieak have acted on (heiu, while the i>areotji, more fortuoatr, 
Kcwt to a greater age lbc»c further ! iiflucnctw. 

SametiiUM herctlilan- mental disorilcrs preaciit eucnliatljr the 
MUDo cluracti-T in parents nod children, and occa'tioiially also in a 
whole line of brothers and nsterii, appetirinj^ nt the same nge aiiU 
Icmtnating in the fiamc mflnner — at, for cXAmpIc, by suicidt*. 
F^omUj, hotrcvpr, tbis is not the case ; the pf^cliical disorder 
maidfesU itwil in differvnt vnya, partly dependent on externa] 
einnmulancea. Mord, who hastec6ntly inve^ignlei) thU subject iu 
ft oomprehentive and judicious iimouer,' mfutioiLt tlie fallowuig a 
thr Irtiding niodi-a of innnifcstation of hereditary mental disonlrr : 
(t) Sticb as appcnr mthcr ia tbc fonn of extremis exn^gtrntioii of 
tlie Derrooi tenipi-raniont of the puKotti. (3) TLo»e in which tlio 
dtaordcr principally shows ititrlf iu rvU df^ircs^ coceatricities, per* 
nncttcw of every kind, the intrlligcncc beinfj well jircsrrved, the. 
&eue shoving ttsclf far more by su-nspteit!) notions than by insane 
thoaghu and speech. (3} Those iu which then- nirendy exuls an 
iocrrmaing limit alioD of the iiitelk-ctiial actlrity, mental dulncss aod 
weakoCM t Tcry Mnnmonly, also, it i» with great diflienhy that th« 
iodiridiulg affrctrd ran direct their enrrgic» to useful nnd moral 
otd*. Fteijnently tlicre is found in th«t)c t-asea all sort!) of evil 
incUnation^ and oceasiennlly even jmallncw of the eknll and 
Fteiility. (4) Lastly — Dcmciitifl i)ropfr, from imbttility lo the 
higlMit dcgne of idiocy and crctiuL>m : thcfc individuals liavo often 
rudtnwBtny genital ofgaus, are dcikf nnd dtiiubj chibfoolett, &c. All 
theM' various iialhological atates arc (according to Morel) hrnncliea 
of tbc sanu: tiuoh in oertBin EamilKs, The disposition may dis< 
appear by constantly rcnewinf- tb« blood by roarriaite with jicrfectljr 
luallhy families ; it in tnerciised nnd devi-lupctl to the nto»t dt^-nc- 
tBte furtus by further iatcrmarriagcs* by drunkemieM of fathers, &c. 

' 'Traill dca D^nfmocaoe* dc TEsp^ hutnainc,' Puis, 18^1; "Tralii 
in UaUidiM nralalo,* PkrK iSfto, p. ];i,i ; ami llie iilMvc-n»pn(io<i<il irork ia 
tW AncdiiTd. 1639. 



Ud 



THE CADSM Of ISSASITT. 



tn tbts RtAir'ninit thm* iii a preat AttA of truth .- ertrj jbjmaaa 
who (lipTtfl Ills Biti-rilioii (o this mbjwt wH\ iitcorrr m uuu i j i ii 
oxuiiplo iir it, not only iii the nsjrlums, but far moie foqaatJ^iB 
onliDary lifi>, wliirh cannot well b« defioitcIydciaoBrtnted by dM»- 
ttm. The (IrtiTnonUon of a vliolc nee, as well ss tiie spedd 
(|i>Knni<rfil)au uf ft {uirticiiUr pntimtt, gotu^Ur occun gndiuUljr tnd 
[tniftrnMivrljr, for it lou^c tioie lliv bcredilai; inBuenoe can be 
finimJ D»l^ in crrtniu mi'mbera of s fainil;r; benJc«, othen often 
rcml«'r Ihrniwlvr* coiiipicuous by their uncommon ni«it*l powers 
niiil ihp niKlljr dr)i;cDonitc cbanctiT uf ihv disease uuy not as jet 
nmiiifral itMrlf iti Uwtv wlio Arc attacked. It appears, atTCitbdewj 
Ibnt brri'ililary iiilluenCM umt be highly luid qoicklr tncressrd hr 
druiiltniiim, by ditCMr, and, in short, by vaiious intercurrent 
dUordrni of tbr |«nmlA at tlm time of procreation ; pcrha|» aUo by 
ewMnlii rxt4TiUil influfiwwi, «pcci»Ily of an endemic nattirc. Thus 
tilf •fvrrr fomii inny uri)!iiintc iit oatx, and scrcnd or all thccbildrca 
pri>rrr«te«l uiidrr nuvli circmnstnuoea may niffer. 

Of ilio (fi'iii'ral diagn&stir rhomctcra of hereditary iiKntiil disMse 
lltL' fiJlowiiiK may (accontinff to Morel) be considered the chief: — 
lltii kind of inaauity gvncnidty breaks out suddenly from iosiguifi- 
call! exlcmd musm : it ehovii iliclf oflrti iu marked emotional insauity, 
lliu iHlelligoncv remaiiiuift ti'Utively intact ; then? are considerable 
ri'iniisioiiM and cxAccrbatiwns. Strong halluciu«tiout and paralytic 
(Icniriilin nrc H>mewhtil nn- ; while, on tho otbL-r hnndj tiicre exists a 
llrong ti'Uilpiiey to delirtoux conceptions. AJtliuugh slill in n 

odition of n'latirr henlth, sueh individuals render themselvts 
reiitarlnhlf by llicir firv»t emniional excitement, and, tttt^nTore, 
tlii-ir ghiiter dcpetidetice on the influence of the cxtem:d world; 
fn-(iticnlly, by nil kinds of originaUtics and eccentricities ; and 
nrci»i»nuUy, aluiig with inteUectoal and cmotiotial j)crv-crsiou.<t, wc 
Hud them endowed with certain one-sided cxtroonliunry gifts or 
aecoinplishnienlfl. 



$ 94. a. Education, — The direction which the understanding anil 
will of ou individual receives iu childhood cxercisu a decided in- 
flucnee on his whoK^ future life. The moral and intellcclaal influence 
of the parents upon tho child is, therefore, to be mentioned next to 
luffvditary infiuencc as of the utmost importance. With Idder, we 
are of opinion tlint there arc ca»c» of so-cnllcd hereditary insanity 
itbich can he traced, not so much to the transmistion of orgauic 



Tue cAiiSES or I^s&^'lTT. 



t 



ilapasiliaD as to n »ub*«<{aent [UTchical coniiauatiou of pecuUariiica 
of dianc4er, inasmnch u certoia eocentridties, odd and pecnliar 
news and muinis, hue been ptt^cntcd to ibc child for imitntiuii. 
InihieaeM cf this lutute are, from tlic tirsi, dcciilvdlr advene to llic 
drretopment of ft hetlthy sool-tife in lurmooj with the rxtcnul 
wocld. tbtis, in the nme wtaoKt M bfsteria is tna^mitted fron 
tbc mother to the dauglitur, so ue pcydiieal prmnioiu trnn^mttled 
to their cHildKo from insane of eillT parents, and pasnonatcncss and 
nil incUnitioiis are impressed upon llic voothful mind. To this 
circiiauitaace, not oufreqiieDtly, aUo, mar be traced th« fnct tint 
htttilj lift u oftm di»ordei:«l, and tli«rebj th« co-operntion of 
thorn fvionhAe circaouttooes so necessaiT* to tbc lurmoniotis 
dcTckipaieot of the intaotik chanHHer ia dutnrbed. 

Amongst the special error* of education may be mentioned, in the 
int instatMf, pretDatore taenia exertion. This, with the undue 
prtoociljr of the rariotu mental processes therebv ucctMilatcd, pro* 
|xirtioitat«ljr retards and hinders physical development ; the brain is 
fmrvKiOKbt, and tlie germs of future viaknesn and disease are 
anrdy laid. Still more mtmiu, hoircier, arc iKtrerse and onfavor- 
able ioJltifiiees on the senntioD and vill of tlw child. Ther« are 
caMf, (or example, where, by uudue bcvoHIt, by the eold and repuU 
me dcmeauoor of parents towards cliitdmi — by protracted grief, 
tnUDtlioltun, or harshness of sealiioent — the deTclo^iui-nt of natumlljr 
bnevolcDt diapontiona ii hindered^ and tbc gentler feelings ttiflcd. 
TtKiebj there b thus tAsl^ implanted in Uic individual 8 painfnl 
op]Ki»itioa to the exteroal world. Thia ia especially appanrnt in 
eertsiB atrotig benevolent naturea, whoM varm and generous incliua- 
tiana urtsnctireljr seek, a return of affectiooate sympathy, b,v tlie 
absence whereof they are necessitated to take refuge in an imaginary 
world, and so a pcniicions imo^nativc tendency is awakened and 
■oitiUicd. Finally, still more destructive to the child is that over- 
iBdolgcnoe on the part of parents, which curbs not the vaynard 
dcrdopmenl of every desire and inclination, which incapacitates tbe 
child for coduriog snffering or pain, which renders him incapable of 
sclf-oontrol or re«igiiution, and dcvdopes, not a strong and lianly 
Mint*, but a weak, soft character which cannot stand tlic test ; for 
aooBcr or Uter tlio rude encounter of life must be met, and. 
unable to support himself under the fierce assault, be falb a victim 
to all the ngitAting emotions and hcalth-disturbiug influences of 
TudfUt paMiun. 



I&U 



TUB CAVStS or INSANITY. 



8Mb ia thu fallowing book. (Ju cue tUBlioBcd bj Paui {' Tniti de FAIitea- 
tioB mouUle,' p. 1 59). 



$ 95< 3> Mentat and fihgneal eojutitiUion. — Our dcdsioo as to 

the phjAical coiutitutioii is gnitnn;r fonnded on certain etnking 

anstomical difTerences amongst indiridnals, especially in reUtkin to 

Die dprclupmeut or tile mcuicular system. 'Vie mast renouaw the 

attempt to discover anv prediaiiosilion to mental diseases in .<uch 

tUfliirrcnna ; for daiijr oliecn'atioo tlwwx thai tbc weak and ibc 

mnumtAr, and likewise dry and moist constitutions, are liable to tbe 

nlliick of iii5auify in nearly ciiiul proportions. On the other hand, 

there is another con^litalion, somc-tiiiws cuogi-nitalj sonietimcs 

acquired, which ve cannot recognise anatomicaUv, but vhich phy- 

Hiulo^t}- {termite ua to apprcciRte, vhich materially predbiMwes to 

mciilal discam. Il is the so-called anvous coiutitution — that td»- 

tion of the ccoitral organ which we may generally define as a 

li>i{iropflrtioii between reaction and irritation. This state ma; be 

^conllucd to certain parts of the central ntrrous system ; foreuiupl^ 

in tbe spinal cord or in the brain. Very frequently it it obccrvvd 

etiaally in all uervoiu acts. In the sensory nervous gttcm, liyper- 

Rtstbcsias of various kiadd are obBcrvcd ; great scnsibihty to UDpr»> 

aionn of Iriiiprrature; spontaneous changes in the aensation of beat 

and cold; but fspmally the prcKHCC of nnmerous sympathetic 

iicn»atJona, and great diaiHwition to pain. The motory nervous acta 

are characterised by the vithdrawal of all force, the indiridual being 

camly exhaiutcd; by a disporition to itadden exteanrc, but only 

alighlly, Piiei^ic inovcmenta; by increased tendeocy to coniiilsion?. 

In the mciitffll ephcre «v observe, corrcspooding to the analogous 

atales of sensation and motion, great mental sesiMbQily — susceptibili^ 

to mental pain, mid to tbal condition in which crei; thought beoomes 

an emotion. Ilrncc tlie rapid nttcmations in edf-coiiscioasneas iind 

voiilian, Icadiii}; on the one side to weakness and inconsistcncr of 

will, tuid ui\ the ollu-r want of encr^v, with abrupt and i^angeable 

plans. Tlio iutt'Uect at the satnu time often presents the same con- 

dilion. This is soeii in those who, even in childhooil, arc very irri- 

tablo. Tho iii1clh-ct is disproportionately developed, and constantly 

presenta something ODitable. In the case of lively imaginative mind? 

which, however, are deficient in depth mid ciiduranw, incBpaUe of 

coiitinnons exertion, becanse they address themselves scrionsly to no 

single vocation— in the cajc of those imaginative secoud-rale but 



THE CiLUSES OF INSAMTX. 



I 



qtuiot iDuncuuis utd poets, or those tnisgnitlcci auivenil geniuse*, 
nho, with ft certain vivacity nnil vnritty of thought, never can find 
compDsare or repoec for any arduous work— sUoald such individuals 
ia the long ran fall into insanity, vc find in all such cue* • confir- 
BitioB of the Joclnne, that onlj he vho has had a correct ander- 
ttandins can lose it, while, iadeed, a really wand devdopmcnl uiid 
coltintion of the intellect is in uo respect favonible, bat, on the 
oontratTj is deddedlj unfavorable, to the approach of insanit/. 

In Ibo iDAtal sphere, tbo noro inunedUle ooiiMqneaoei. tlie ntenial modo 
of appMmuc, of too ^rcat initi&IlitT, of /Ir irrilahU irtalnfa (see p. $5) . an: 
itjj nnoiis. Muij of tbcM apponnccs. liowcTcr. max primirily be traced 
to a gfeat ieoAtnej (a ntenlal pain. Wbera tketc exitta a vcrjr cxtessire Kphera 
tl i^utioe, tkc Bieata) equililsriuin ii n»re ea«]j disCarbed, tlic /yo mora cMilj 
■Serted : fran wtieiwe diicQ; resolls the erealer rasceptibilitf of tkow indi- 
tMuala «lio be^re »oinetiin«s impalMiitlr, are eicit«d, mIoleniU of ooain- 
didJon. ifn^TeuiTe — at other tifoes, eradinjc all nMolal imprcssioas, tliej merr* 
edi; Goanntnlc their tliouglils «pciR tlieintelns. Such individuals, beipabk 
of latiafjiinclbciremoUonalcraTfaigtbj external Mtioas, direllin tlie nalmsor 
imafiaatioa. T»lbem the world appear) eomnOD, aad Ikej fane; thenuelTes 
too good and 1m noble lor il* pnrwta. Ulna btc produocd Txrious nodcB of 
nn&alalioii of the sudd fnodameatal itatc, which neiectbdess agita geoeratljr 
1b tbb— that the disproportion wliieh esl^ta between the reaelion and the im- 
presaioa appears in the hightr degrees as eitraiagance and exo»s. Tlie re- 
wM is, that ihe loJividual, wilh liis wkiou and nnutnal raodes of tcaclioii, step* 
Mt of tlw ocdtMrj beslea pth of bnnianit;, and panes in lli« wofid as an 
an(iiiaJ( tiapilarinan. Sueli iodtfidaali toinelimea nklbil a pniurul decree of 
•cni|NloasaeM awl trifling pedanlrj (ftei]ucntlj lliis is aswwiatrd «iih rac- 
itaahal laknt). At other tinea the; are lemarl^ablr for frivoliij, iirtsulariljr. 
•MBrtnotj of tbtniirht snd action — somelimn for Dicir eoolnois nod apallij, or 
cna for their corcitiric ardonr, tnewlutioa, or nudocii 7. thty cibibit alriking 
pMsUarilin — at our tiae lowneas vf apiriti, at another tim« ciithii»<««n ; hat 
ibtj an alvBja cbangrAble, alwajl rlolenl. Tho moda of rcjtclioa diSora in 
MOh CBwa fnxu that of tbe avenge of manUad, and Iberefore aeemt dcakbh. 
In thoac paasionate, eccentric, often iiiTtudlj diaconlaut and diauaited naiure^ 
bodOj disonkr of ercrj ducriptioo tanj bccorae truljr dangerous. The; oflea 
bli^ to rapid dCTelapmcat the ciuling lattut germ of mf utal diieue. 

i 96. Tlxtte mcDlal dispositions are undoubtedly congsnilal and 
inhadted ; tlicy are, »o to speak, not unfrMjucully the media of the 
heivditaiy predispoiilion to insanity, and arc early evinced in the 
mental life of the child by peculiar dircctiona of taalc, uncoiamon 
MMwibility, volatility of tbc inclinations, and littlr dtiposition for 
atndy ; so tbst tocH individuak ore frcqncnlly, from the very first, 
objects of jolicitudc mid grief to Ibdr piumita :iih1 teacbcrf, itliils 



160 



int CAtlS&S OV ISSANITr. 



the/ ar« occaaionnll}' tlie objccU of iujndicious votkler. Mzu; of 
oar observations, bucd oa the ooafnsioDa o( palieats and coDvalo- 
cento, coinddc with the atatciaents of fodpri,' ilwl io tbc subjects of 
such dispositions tliere in fm^ueutly n prcinatitre development of llic 
sexual ]>aiaion, and coDseqfUfnt spootaneoiuly derdoped oaanism, 
togdbcr witli koiW ImrmoiTlioidul disease (tbe latter probabljr in 
coiaeqoeiicv of Ihu irritation of tlic genital tn^ana). 

Altfaough it nuj be doubted vlietim such circonifUocea act as taiuea of 
lliOw|wjchiciJpc4;uluiril«»,itiia«*cfifctfeiairortliyofciu«rulcon&ulemtio)itbat 
titcn in ca*o wicrc lliccc ii no tncili cooganittl dii|>«ili«D*, wc vcrj froqucntl; 
tiKl the »tin« iM^cliiul BBoinaliM developed in later yein id conseqaenoe of 
klructnral diMU* of ihe geniUl orguti.- It need Marcel/ be ilattd bere lUal 
bysteria, which presents lluti condition of tlie nervoiu iiroocts ckJellj in Hit 
•pinol, but ftequentij alao ia llie certbral ajriten, often u'aa from dUorder of 
the awMii proc waei . 

Other diseases, capccialljr all considerable losses of fluids, and the 
ftatea of uuemia and exhaustion nsulting therefrom, nre ofteu 
reco^tsable as caiuca of tbe acquired lurvoua constilutiou. It 
a]i{ieni9 ut other times that local lijperasthesii), ]>rolonged irritation 
of any parlicular iien-e,* may product' such chroiiic states of inila- 
tioa of the central nrganii — as in acute tetanus. Id the ceotml 
organs tlieuiselves there may alto exist localised inflammations, and 
causes of the di^en^c vhich evade anatomical d«mon«t ration, but 
from which we niuv approximately* usccrtain the seat, perhaps, 
lluongh the sensibility of ctrtain parts of the spine, headache 
(afTection of the fifth pair of »ervei<}, &c. 

In like manner, those depressing mental imptwaioiw, shock, grjrf, 
&o., which are ao freqacully met with u cattaes of the DC^^-oua 
cougtitution, act by provoking a violent irritation, instantaneooa or 
persistent, of a more or less considerable iwrtion of the brain — if, 
indeed, they have not already (sec ^ 99) indirectly produced a 
sccoiitlnry crrrhml iiftectioii. 

The casts are proportionat«iy rare, but cannot be questioned, 
where such mental anomalies, after being developed, pan slowly and 
gradtinlly without furllier appreciabl<> injurious influence into actual 

' ' Ruai midioo-lt^gal mr les diverses cipeces do KqIIp, Ac,,' Slnub., 1833. 

* Compue ibc 1 15 cuscit of LuikiuiiDd (' Drs PetlM s^mltiKles,' Pari*, iSjlS- 
41). It is nstontsliinK how, aliiioit wilbout cxceplion, these piiticiitt present 1 
cbitngn of llieir psrcliii^nl ron-dilion in the dircdiuti [ lijve hocc indicitcd. 

* liOtEC, 'Ailgcm. fitllivlogie/ 



THE CAUSES OP INSANITY. 



1«1 



i 



BHOdty. tfnch moie commonly the ucrvoiu constittition is hut a 
{mdvpooing ciiGunuUmce, be:<)(It:s nhicb somutbiiig ehc is Mcniftuiy 
—* KtX enac, cither a physicfi] disease or a inorsl influence — in 
ordn that tliL' simplo dispositioD may bccomi! a<.-tual disorder — tliat 
lite tDodtntc nicntat aberration mnr pass into profooiu) iasuiitf, 
■•V become cQ acUiol cerebral diaease. 

After wbtt b«s been »id in tltc (no preceding paiagnphs, ire ma; ditpeiiw 
mink Um farUiear diseiuaion of tlie BO>caU«d ItmpenmemU in »o fu tu Uuy <!iB. 
poM to Biental diNues. la ooninioa vltli mouj ettccmed InveBligatont (G^l, 
Qaorget, LoUe, ftc.), we cannot nuord anj rail importance (o Ibou four olaues 
of t«^«iHMinl« taken from tlie ftocient bumond palliolom: — ailiTiuott which can 
loanrij be adhered to, as it has iierer been enpiricallj proTed aud ia of little 
ptactjc^ DM. 

BMtdea tkeoircaautaiioei wbich ha?c been iptikcu of, tlieie nn ftlUl a number 
»f wriou ehranedUtMCtirbidli ought to b« eomi'lcKdubodilj predispMing 
ca — M . \» bM been slrtadj rcmatkedt mcutal diacue* orEgiDB,tc under the 
isflneiMSe of Bemnl nnfiTonble co-operating cautei. that in cert&io casea auch 
■ wrabnl diaanantajaLppearimder theiufluenceofwttaingirmcifcuMataccia 
vkieli BMj be tnccd to Ue prenona deterioration of the seacral hcottb in con- 
•eqwAMofohiMuodiMMeia toaieoUiet organ. We mutt be cueful, havcver, 
kot to aaaanw the eiistcnoe of aeKr« chronio gcucnl diacaaea mcrei; from 
ocTlain atifthl or obtenre tjmftava, and in the nbacnce of neecsMty paUiologi- 
e«] proof, bMaoac luch BunnptMas frci)aeiiUj^ lend to sii|ierfluou* sod cten 
violeBt Uottioenl. To eounenla all tlioc ditcucalwould be to re|>cat the 
calir* »]»cci»l i)atholog7. Tbo moat iinportuit of tlwm will be coniidcrcd, and 
Ifcetr nwdc of action to tbe produelion of insanitj painled out, in tli« cbaplur 
■M I'h^Ical C«usts. At preaoni wo ^all morelj once more call to miud llic 
intiaula rvUticn «kich eiiata bttwcen the prcdiajicisiag circuoiataucea and 
Iboao wUobi atricti; apoBking, arc dtcuniBtiiDCfa of cmisaLion. 

Th«t a foraitilj ciiating inaaiiilj. ihougli now removed, predtaposet to a 
rdHni of tbe dbcaac. need not bo further ditcuaacd. Co&oenliif nlapM, wo 
lbs chapter oa Progmai*. 



n 



ciuPTEa m. 

THB CAUSliS Olf INSANITY (CONTtNUBD). 

I 97. Althodoq in the inajority of caf«s mcntikl dtseasea am 
produced bv the co-opt^rstion of acrcral, it may be of manjr, aii&vOT> 
able circamatances, tbcrc arc, bowercr, ordinarily several amongst 
tlicsc cireomstancc-s nhich api>eat' so especially importuil find 
efTccttul as to merit the designation of special caoaes; ot, in othet 
wonlt, cue< of illucu present theinaelvea which c»u ml; be BKribed 
to the iollaeDOo of a angle unfavorable rehtion. In tlu diieiunim 
of these n0T4 tHUnate cautet, ve ha?e to consider, cm the one hand, 
certain external bjuries ; on the other, the adverse influence of health- 
destroying habita; and, again, certain abRonnnl o^anic states vluch 
can be the immediate cause of such diseases of the brain. It irould, 
indeed, be imposHble to state with absolute certainty the mode in 
which all these csuses act; but if, on the one hand, we consider ibc 
nature of the causes as they are nientiotied further on, and, on the 
other, the comparatively little which is known regarding the special 
lesion of tiifi brain in insKoity — moreover, if we compare with these 
two series of facts which we Icam by observntion of Ihc patients during 
the period when the causes act on Iheni, we will, with our fxoaaxt 
knowledge nad camprchcnsion, arrive at the following oonelusiona : — 
III many cases tlie cercbml ufToetioa in insanity is not palpable; it 
depends either on simple ncnous irritation, or on alight clunges of 
nutrition which lut ycl cniinot be more definitely defined. Often, 
thou, the causes of insanity must act in such a mannof that even 
vach impalpable cerebral disorders can be proved. In many oilier 
eases, insanity is a symptom of a rerebral disease, of which we do not 
yet know the minute anatomical changes of the first stage, bat 
which, at a lut«r period, leads to atrophy of the bram, to chronic 
hydroceplulu? : tlivsc miut he disoiders of nutrition, n-hosc inflain- 



THE CAUSES OF INSANITT. 



163 



» 



iB>l<iC7 mturv is at least doubtral. In otiien, hovevcr. nuuiit} 
itallj depends oa lixed influam&tory processca in the cnuiul csvi^, 
whidi ue knomi to us as well is th« tiulj sUges ks in thetr re»u](«. 
KiuQy, disorden of the cireolition vitlun the cranium tfptar to 
pUj Ml tmportADt )>ait in the origin of insauity: in the one cose 
tKcn ia amemia (origuutiag in various mja — «e fattlicr on) ; in tho 
Other, hrpemnia of the brain; and, lastly, kindred stales which majr 
oitt 01 part appconnoa and esscaitial clcmctits of inflammitOEf 
procesMS, as well as alone and independent of anv iiiflammatoij 
alate. 

Vic can in geaeral trace Uic iofluenee of the cauKS of insanitj* on 
Uh origin of these various cate'goriM of moibiJ events, but we will 
be eompcUed to confess that this gives us but a Umtted view of the 
apedal node of action of tlic causes gencrallj, and that there ate onljr 
s few of the«c catucs of which we know with special ocrtaintjr the 
mode in which they produce such changes of the brain at have been 
conmcratcd iii diaeaac. It is the same here aa in other patholc^, 
vbere, aa a rule, the mediators between the causea on the one hnod 
ud the cffecta oa the other are always what we know least about. 

t OBBBOt sew ttlribnU to mueb bipotUaee to tlie lijperRinia* witliio tha 
oasiBK aa I did in thelnt cdilton of lliii wm k ; ahliough, liace ill pnUicatioa, 
npenenttd Medical pajtliolo^sU lav« UMaled la tke ofHtucms Uicr! *(al«d. 
Bat adllwr aiioaU Itu kjpcnemiaa be naderralscd as i^lliDgeaslia oirciun- 
ttuim, to which tt preseot ll;eTe exiiU loo srcat aa iacliattion in Gemiui 
frfirirtr II is rerj ettdeut thai in nuny cues •ctiTo cerebctl CDngrslion 
fneadc anil >ccoai|MBj the ptnajsnu, for ciampte, of aiani^ of meljiDcboUs, 
of bjatcfu ; ilicM oesgotWBS ma naturallj also pnual IbrandtM ia quite 
tamam tadiTidnals. Hjpemiua or the braio, wkkb can acaiett; ba oenudned 
■aiite^ at 4 pott<aM>rt«ai phcaoveKW, is aa anstoiDieal eondition nrj oooaioioJj 
ahatwaJ la taeaal otacs of iauaitf: lUgnmion, *!owdcm of itu drcuUUoD, 
wish onweqiMit More TeaooJ ooDgtation, Dia; result from dtmioiihed cardiao 
powv, ffMn oriaaM chaagM in the Cf r«britl trtcnc*. fttocbaoioal itaui in (ho 
nba aX oafrcqasatlr ibowi iladC ia roccat caara of diicaac, at least ia Uw 
amtSHMS bj a general dight ejaaotie lind oolotir, dark colonr of the nugb' 
boorfcood of tlw tjv» aad pgiat of ibe note, rcdnets and loaiclima erea eodtj' 
■ads of the eoajonoliTi.prowiHnecoftlieTriosof tbe Irmple, neek, fto. lbs 
oaaM tt this coogMtioB of th« tcoous ft^Rtcm tti%j be bMit ditcase, runctioatl 
vcalueia of tbe left hewt, in orcrfalucM ofllie ligbt Ix^srt, rcauliing fram pro- 
Loafed iiieompl«l« reipinLioD. Tfae dvprcuiog emoUotu wbea losg conlinaed, 
griof or auietj, naj, It ipptan, la (Uia way, mum »l«*nn« at the mptntion, 
thfoufk wbich tbe Icuer eimlition is retarded, and Trooui ooogertioa 

In tbosasMBiiaaernujbecipUiurd tlioopprtationfcllaltlicchcat (sighioi) 



IM 



TUB CAUSES oy INSJUflTT. 



md Uictnallseu of Ibe pnlx. t)io teaikoej 9f tlie citrcinitic« to become oold, 
tlie dark Hfipemnce of Ihe connUnance, tlie |^; circles roand Ibo tja, ob- 
ttmi m individuaU so ftffrctci). But tli»o einoticaa liave »tUl Ot^ ud not 
less inpottimt effects, o( vliicli impninncDl of Ibe geoenl BUlritton, lieojAaf 
ucu, nud diuiiQutbn of tlic l>!«i>d- forming povcn are the chief. 

Vfc do not bdicTc (hat gcDcral tionple tijpcnrnriftof tbe braia aloot^ vhbout 
tht eo-opcntioa of other more ciscnlial, wpcciaU; prcdbpoiiiig circniiutsncc!, 
caatM BtutiJ di»e«ac. We mutt ujinit, oa the other hind, liiat «!»■ IbcM 
oircutiiitnDces exist, this ooodilioa co>operat«s to i great ateut in the iirodoc- 
tion of Uie dl*e*9e. 

IVliere itelNtnarked ud gnent pltihont €jcuk, the csngcstiTB states in the 
period of tlicir &n\. cammeDcement, or in mote truaitory nealal diaoidn*, 
tu; juslif; tbe Abelmctiaa of blood. A plethoric jreniig snin, who had high 
hopes of obtaiaing a siloatiou, wu taken on probation : lus sef«ioes, however, 
wen: not accepted. Ho learncil Ihu result at clgUt ; UU tticn he bail been qnilo 
well and cheerful, bul all at oiioa tic fell into a state of great dtpraasloo; be 
pibufd a alecjileu uiglit— he couU not remain in b«d, fcral speiit the greatar 
part odlic night siltiii^at an open wLadov. Slight d<lirian. In which lie 
iiituglucd be wai buuling, set in ; k»q Tlolent headaehe and general Uloesi 
cnmc on. 

Next moniiiiK, Ibevholc head naaof a dark^rcd ooknir aad Terjr hoi ; the 
e}rcs injected; Ihc jmlac small, quick, had rer; irregular : there was also fioJcnt 
Lcadiclie, i^rtRl agi^tatiou, foul tuii{i;tiei anj incliintion to TOniit. Talicnt 
hitd to I tb. Tliis vus iintiiediiilvly fullowtcl b; rapid improrenirnt of 
all l.lin sf injilomi ; tbc potienl declared llutt, after Ihc blending, tbioga suddenlj 
ci^iiicil lo Jiuvc tliv beavj and »iii) iippcnnuicc irhicli Ibcj formcH; wore, and 
Hint lie coali) profit bjr advice, la the afternoon rpittacit tpontaneouslj set in, 
which waa followed li; complete iccorcr;. 



Sbction \l.~P»yeMeat Cautet. 

$ 98. yif. liavc tiQir to discuss iu detail the priiidpal imtHediaU 
causes of mental diseases, 'i'hcj dtx) so numcroiu — their mode cf 
action, of whidi often little is known, is so vAriou?, that it is 
impossible to form n logical cWsificatioii of them; therefore we 
will merely arrange them in ^oups according to tlieir iraportance 
and signiBcancc. 

Tlic jMjchical eatues an;, in our opinion, the most frwiuoiit and 
the most fertile sources of insanity, as well in regard to preparation 
as especially and principally the immcdiat* cxcitatioii of the disease. 
AVe recognise, mcouvfliilc, tliut this view rests not only on statistics,* 

■ We eoiJd tiuote xtasy statistics in favour of Ibii view, eapceially Die stilt- 
meat* of Parcdiappo and Bricrre de Boitiuotit, in oppusilion to tlic catcuktions of 
MorcBfl ('Complcs rendu*,' ivii, 1843, pp. 134, i;ij). We condder, however, 



Tni CAUSES or insanitt. 

bat also on the collcctiro baprcssioQ of man; olisetvalioiH ; but if 
ve coald fully appreciate the psychical cause-o, trhich arc odea 
roDccalcd in their most important details, this impressJOD vould 
pmbshly be n slill ilrungcr one 

Vader psychical ua«^i, wo aw b«forc all to undtratand former 
pMMoiute iaA emotional states. It 15 an abaolutu fact thnt intel- 
loc<ual exertion, unaccompanicil hy emotional cxcitcuicat or other 
(urther powerful causes (for example, all kiiitls of excevses, *Uap- 
laWDcti, ■itilicial excitation bjr excitants), leads only in the tskivsl 
cut* to insanity. 

He contrary is undouhtcilly the cafc vith the coDliouous or 
rioleot emotious, of which disagrt.'i'abk-, adviTJi-, or depresslro ntates 
of anotioD merit B]»cciul attcutioa ; 'nbilc immodcra-te joy alone has 
handed orer to the asylums very few, if any, ^jatients. PItm:!, that 
nodel medical psychologiiit for all timrai, was so convinced of tbo 
truth of this, that the lir»t qoesljou which be addressed to a new 
pat tent was alway», " Hnve you lulFcrcd vexation, grief, or reverse of 
ioftoM?"^ and Dow-a-dnys il is quilo as rare ns it vss then (o 
rtodre a DegaHve answer to thb [)uestioii. In individual eases thcM! 
psiuful emotiocal states may vary very much in their nature and in 
iheir cauns : sometimus it is sudden anger — shock' or grief cjtcit^d 
by iojary, loss of fortune, a rude intr/fercncc with the modesty, a 
andden dealk, ttc. ; soiDctimca it is the result of the slow gnawiiigs 
tt disappointed ambition on the mind, regret on acconnt of certaia 
inqttflt action), domestic afllictioii, unfortunate love, jeulouxy, error, 
forced sojourn in inail«(uiit« circumstanoea, or any other injured 
Mirtfanent. In crrry case there aio iafluenccs which, through in- 
teoae dislurUaocc of the mass of ideas of the lyo, cau»: a inonrnful 
diviuoa in consdoosness, and wc always sec the most powerful 
rfEeela where the wishes and hi>|)es have been for a long tune cou< 



Cci Ihe reaHtu tlaltd in { tfj-fi^, tlut it a iitipoasilile to Mlve lliis i|ue»tioiD lij 
tlHi*'^ alone ; lUll it mj be nKntioned Llist Guislain ilto (* ix^tmn anies,' H, 
l^Ct P- ^\ tannd nionl cautet to exStt in (16 out oT loo cum ) which >]uita 
fnitr""" with the figum ptta b? fiuitlain — 6^, and Uara 66 per cent. 

• Geo^et. 'De k Volir/ Pui*, iHio. p. >6o. 

■ See two csiDplm of inssaity cwaxd bj vwlent shook, by Ellis ("Tnit^,* 
t4e., tni. p. Arctiuibaalt, Para, 1840, pp. 108; 109). Ellis bere sMritxs tlin 
tfecl Iq t^B ftltcted cardiac ■etivitj'. Guiilaiii found, smonpt 100 patients 
•bo »cre sdmilted in the ooune o( a ycir, sliock or sniielj to be llie csuw 
of tlw iasMiitj ia niaa bstaaeM. 



166 



THK CAUSFS O? INSASITT. 



oentrnted upon n ceriain ohjfet. "Where the iwllvidual has made 
entail! things indispeiuablc to his life, and when tbne ore ForcihtT 
vithdnnu, iiu: i>ustage i>f the ideoa into efforts is cut vft, aad 
accordiuglj- n gaji in the t/fO tuid a viotciit intccnftl strife rcHiilU. 

Tine effect or these emotions in the proiaoLioaof UHuitjr ia to be judged of 
Moordiug to llie strength of Ibe Snt shock, aceording t« jif longer or ikortcr 
dtintian, but more c*pcclal^ according to tlie preteot mcnUil dbposttoo of 
Ibe patient. Tbeo, again, the deitree of ri^noe of th« first unpieMioB, it* 
nioro nfii ce&Mtton or prolDOKod rcrcrboration, depend to « gnat 
utcnt on Ihb diiposition. In niao; cases, the fut tbat iDfih ktag and Ttetent 
atktc* of pnuiou or il!-liuntoiir could mibc is of itself a lign of this ((Jroul} 
^wkenof ill f 95) {isjcliirral iteculiaritj ; audit wastliesiMciiloi^oiliniUbilitf 
ud pMuotiatMeas of lie iudivHuBl— tin? itlr«adr eiiitins dispoailion to emo- 
tiona, and to aadden dtiuuiing of ibe coaKoiouucss, vliidi fnMii a period dating 
eroii from tlie jean af cliildhood could oft«n he pointed to >s the soditc of 
inenl«l sickncM, often ns tlic cautc ol tlio iul»equcut liKliits and aclioiu of tlie 
patient. Tins dieposition nay Ijc raauifcitcdbf diionlcilj coudiacl, idtencas, 
de»itie for fashionabtc foUicR, love of [ilca*ure, and political extraTagaute; ot 
bj religiuus calliuaiMtn nnd asocticiam, hj misplaced friendaUp and lorei and, 
Hnallj. 1)7 Ihn tiioml bnnkniplcj of a lifnlimtlicil iiifolliex. Od Ibe fiam wtiich 
Ibe rmutiun rcccivrx from tlic cxlcrnnl ciu.ic*, rcr^ Utile nuelj dqwtida: eaob 
race, cicli {loiitiouin life, radi individual rccarca his mcntai voonds la lliat 
ipbtire which nature sjul external oiiciitnstniieta baT« proTidod for Kin ; asd, 
moreorcr, ctcli. bas a |iotut oa irbicli be is mmt Tubcnblc, inotbcr sphere 
frnin which violent shocks ni«»t cmi!; proceed ; in one it i* moaej, in 
anoLlicr tlie csliaiatiou in wliicb ho is held bjr otlioD ; ia the third, hi* fediap^ 
his faitli, liis Icnoirlcdg^, liis fnintljr, fte. But the eniolians mid patSiohi 
lire noL Ibc onlj prcrur>ori of intanitj; the itaU of cihaus'iou of tbc aeou- 
bihlj whidi they pruduoc ia also a very frequent cause. ^Vlierc there is no 
strong iiitclligrncc to govern the illusions, Iho mental culJucsi and waiutof 
interest— where cverjthin^ sccma cold and stale, the hcott hcnuiabcd, tlio 
woild bDcoiiie empty — llieso metital slalea very eoamnonly end iu melanahoh'b 
suicide, or profound iuaoiiity. 

Althou][h, in f^nend, it is ehiftfly the iirng, aontinnoua emotiont vliieli hm t 
powerful iiidueuce on ihe produclioii of meiitid disordors, tiiere ore alao cuci 
wliere an attack of insanity, cipccially of mania, immediately follows a sinRle 
oiithural of violent anger or mga : such eases, also iutercating in a foreusioal 
point of view, frequuutly occur under the co-operatin- influence of spiriluous 
liqiien,eTen when they have l)fcn taken in very iiiuUl gusnlily. Tl»i« woa!d 
uul be hkcly to occur in auy but tljoae wiio are strongly predispoeed. 

$ 95. T6e moih 0/ aetim of these psychical causes is eithCT 
direct or indirect. 

In Ihe Cnt cans, the emotions, pnrliouliulj the paswJ-olT psychical 
phenomcnn. Are the imntediat* originalora of IIk mental .diaeiiM:, 



TOE CA08B8 OP INSANITT. 



1S7 



» 
P 



Uuwmtich M they projacc s ttstc of iutcDse imtatiDti of tbe brain, 
vlticli DOW continncs. 

Thus, for esatnple, fright, which is so dnngeroos to the female 
otgiBMlioD, taay loimcdiBtcl/ give ri»e to oil iuwiity vliich foe 
ynn vobj present Ibe chief dtkneter of Ihe phy»iologicol effect* of 
fc»^-tbat half convulsive, half psralTtic Blat« of torpor, of thoti^t, 
Bod will.^ At otlier times ire see [oiig-coiitinuMi moderate psychical 
pcnrervioii, persistent snger, grief, inxicty, owing (o direct excewnvo 
bfitatioa of the brtin, gradiullj increase and pus imtnediiLlelr into 
tbc fint «t«ge of in«Anity which very ofteo presents the Eiiceiol 
dmractcr of thoc kinds of psTchical pain. 

Hereilsa (locording to the preceding section) it iao^n difHcuH io 
dirtiDgmsh carl; mental prcdispoation from more immt-Jiatc 
psyehical canses. TloBe eatues may aUo here be mentioned, in which 
iueril.ll pfTiiliarilips of long ^landing, which linve for a long tinoe 
gained for the individual the title ofabolf-foolifb, crotclietty candidate 
for Uie madhoiue, gradually pass without further appreciable caoso 
into actuiil iiiiEanity. 

Jlorc frttjucntir, however, the insanity originates indirectly — 
through the medium of a pathological process — from tlic ]wychici>I 
caoses, uuvmuch as they, in the first place, briii^ about further 
deriatiotu from the normal or^ic prooesscs in other parts, fruui 
whieh tbrn (be ocrcbnil ditenw proceeds na n Ercondary result. If 
T« ooofidcr the fact previoufly tpokoa of, lliat the emotions 
ordinarily distorb n-mpalhctically the functionif of the organs of 
circulation, respiration, dtgeetion, and of blood formation, we will 
easily Bndentund bonr these, wh^n long coatinued or very violent, 
must cause al^ht disorders of these functions, and those individuals 
■re moft easily alTcctei) in whom (owing to congenttsl or acquired 
dtspoMtion) cnotiaus are most easily excited. 

Very frequently tlie ocrrhnil discajw; only cuinmeiiccs wiicii, after 
lot^ oscillations, sooic scnous pathological c!uuigc has gradually 
triacs in some other organ. 

It ta by no nicans rare, for example, after some luilomud event 
which imnmliaU'ly canacd iliiturbance of i\v'. eercbral procemcs, to 
see the indiviiliul become again mentally ({met ; but he begins (a feel 

' Wa may call to wiai llw limilar iu<l<Iea ctTcel of thock In the jirodiiction of 
ifilnlioaUaDLi. Ao^mj art nu'ilt m nuditraly. Inttieiccaaesavnjrapid 
Md MUne riuwgc ia (he collMtiTs ndivitj c( tke liniia ttilie* plflcc. wlii«k 
tmm to act vrty ininrioui]; upom llmt trTjnit 



les 



TBE CAD8EB OP lySAKITT. 



ill, to suffer ia various other organic, and it is only after yean of 
contluittjr iDcreoting dctcriontJoa uf tlie oons>titut)on, owing to the 
dcvelopomcnt of amcmia or other chronic diseuej that mental di»eaw 
is Mlablishod. ThcRe edfeotB are particalirljr evident in states of 
continued but carefully coaoealed meat*] paiu : those tcon which 
tave be«u long reatrointd and conccnlcil vitL miilce or pridf?, or 
hbebood, show tliemsdTM almost uufiLilIiii>ly in tlie derdop^metit of 
chronic discasca which secondarily give riac to a cerebral affection. 
Wo aee that under such circumatanccs the individual soon beoomea 
emiouted, digettion suifers, and th« intestinal functions beeome 
wfok; that slceplsisen, paljiitatiou, cough, all kinds of anomaliea of 
•ennbilitT, ccrebml congestion, nervousness and bypocbondria, es* 
tablisb themselves. Iji tbc female sex, tneoostosia or irregularity of 
the jwriodj, anemia, neurulgiu, luid ^c grouf of symptoms of 
hysteria appear. 

Wo MO that, under tlie influences of inch dreumstances, dia< 
pontioDs to disease wbicfa had hitherto been dorniant — tuberculosis, 
ehronie heart diseasoe, &c, — arc now awakened or ntpidJy aggravaled, 
and thai out of these pathological mediators between first causes uiid 
ultimate results, mental diseases proper arc finally entablished. 

A mediator of ibis description of especial importance nnd 
frci|uaicy iti connection with menial di«eaiies is oonltnued aU^ets- 
nax, vliich oft{>n uL'compaiucs Iho depressing emotions, vhieh over- 
cxtitcs the brnin, and lovrcrs tlic nutrition. It presents, therefon:, 
in the prcliminarjr stnges of inaauity, a sytuptom vbich may be often 
pfit'cluully combated by therapeutic measurts. 

Most of ttic relUtons apolccnof tn this secliooore explJcjiUft thrau^tltoiafla- 
eaoo of the uorrout centres oo Lbc wliolu ctHiuooi; i uiU il is easily oomptalieti' 
sililo that these conscqu«ncus or ihtt eniotions sre oiosl Crequeal and most dan> 
l^r>us in tbc pciioil o( tifn in wliidi the orgMiiMii !s tubjected to the (;real«t 
cipi^ndilBro of force in order to iU proper dcrclopmcnC luid fiirtlicr gro\Tlli, 
mid in wliich it generally is moul eapuhlc of iliicAsc, vii-, nt llie period of 
pnbcrtj, during pregaaacy, ohildbirtb, Uic climacteric period, &c 

Tlie csuic of Uie depre»siaj; emotions, tlio groups of idcu around vUidi it 
reTolrn, ciercise frec|iic>illjr (bul uot alwny), mucli moit decided in tlie tninarit; 
of case*) a deciding influence on llie subject uflhclnsane ideas. Thoi.after the 
loss of a loved roktivc, tlie ileliriuoi vill long rcTolrc nroaed thoie idc^a wliicli 
have tclnliontotluiIoM — arelstion vliiott coincide* to scettaiacitentwitlithat 
menlioned sbOTc. in these cases tlio bousdarjr bctvriit the physiolc^Jeal 
statn of cRiiOtion and insnnitj i» often difficclt (o tracR. At leuti it maj 
den)iui(l profound coaKderation ; t)ie Inttcr niit; sppcar u tlie ininediste 
eontuiuilioii of a plijitologicat stato of tiie establisbcd emotion. 



TUB CA(J«E8 or IN8ANITT, 



1«» 




Thtt eMCfilid <iifliereMe between tbe two, Lhcrefare — b«twcen ndanicbolit wad 
ft glmnj dnpMitkitt— coiiiUts io Uib, ttut ia Ihe fomer tlie pUieot cmnot 
vuhdraw himself frooi bis ilUbamoiir, because it lias faeoone fixed tlinagh lbs 
■< Jilt inn of aboonDol ofgnuio plxaomena : tbesc tatUr tn^ in eertaii 
■rwimtinwa be verr ioiporiut Id teffud to iliigiKwa, 

BeaUw Una tcgnlkting bllMnoe of tha ana* of Uu dtpmnag MaotioM «■ 
Mm mlqcct of the deliiisai, Uwn vc cerUia dcfinila Bont ooHi wUcft |nr« 
(bsl not alvsji) also t peeoliar elimraetor to Uh iinni^. Ikw, Iki JMMJIy 
ohMfvad w voiDca after djaappcautmnit ia love it ohmotarind gsMnljr hj s 
dMpnelanobolied^rtaaion.ooauiaully puatafbloitiiinr; hj aUadnqpla 
MJciJe hj hf9tencalmiB|>licatHuu, gnat bodfljcaerratioii, frequent lenmsAtwa 
In luberoulosb. loMuily from frigbt moit comoODlj pfeteau the diandcr 
vt ■lofanohelia vith stupor, with or vitbont coosdiiMot sania, Ac. 



filCTlOX III. — ilUed CM*tt. 



$ loa I. i>/ii«in*eM Rtandsmidwajr between the pfjrcKical anil 
tbc phTikal raancd ; its effects are very ]»ircTful ss well tu very 
oomptex. On the one han<l, tlic aclion of iloohoUc eiceiMa k 
prindpalljr pnrely pbj'skal — iu part direct, by eaiutag tnitatioo and 
chaogts in the nutrition of tlie brain, by tbc develo[imeDt of chronic 
atans within the cniiium ; in yxti indirect, fay produdng drankard'a 
scotbutm, fatty degeneration of tbc liier, seriona gastric dbeasM; in 
»bort, by complete ruin of the ooiuAitation. Dut, on tbc other hand, 
drnnkeniieM produces also important psychical caoaes — portly in those 
cxoitemeiita, noisy quarrels and bntwU, which drankenneaa to fre- 
quently occasions; partly in the sad menta! impressions whidi it* 
ordinarr conscqoeoccs — donKstic ditcomfoct, ruin in bonncss, with- 
dnwal from tite family dnle, loss of self-respect — must gradually 
furce home, l^ioally, as a third cause, it is to be temciubcred that in 
vmaj caacitbe dnukeniKaaia not tbe cause, but tbo cooaeiiiKDCe, of 
audi inproaMODB — domestic sorrow, grief, annoyance, and veutton ; 
bccBUM of which, relief and consobtion are lODght in dimjistioD. 
Under (be aimoHaoeous actioD of two audi powerfal caiuea, tnaanity 
la gnetaUy very rapidly developed. 

Tbat intoucatioa, vbea carried to a certaia degree, as a ditaoy ModiUea 
villi aanitoaa baUaaaaliDas and iUusioas, teaUy iBsamhlta Isaaatty. U easilj 
BBilontood. SoBaUaiea we aae iodlvldaab wIm>, after partaking of a rtUiivdj 
•■all qiaatilj of spirits, aad vilboot being in a alata of deep ialosinuiun, but 
ii<^iii^[ WSiJ their conacioosnas, preaent a great tendmcj le eommil rnr 
■lIlBinanf. aoi^, and fooliali acts; a aroacaataaee vliidi oiay l» truly 



170 



TBB CAUSES OF INSAXITr. 



ooBHiierod M a tjvptom of predi*pi»itKia to nienUI dUcue. ^loreover, tlicre 
occur ia draoknTds sudden conruliive *Ulcs wlich retemfale epileptic altwk*, 
and wbioli sk tonidimc* fotlovrei] bj s coudilion of forgctfalneM and tranquil 
Ulritun, It other timci bj outbreaks of furious delirium, iriiidi haa been termed 
ILc coarutsiro form of inloiinlion.' 

Tlio hkbituil druslLiid, in vhom the liabit ii >lr«*dj Ur admtoed, presenti 
•Jio, even wbeo be i> not to ■ sIaIc of intosiulion, idbiit ligiu wbich isdicat« 
Uu exittcQOe of tin tdrandng chronic diuuo of tlie bnin. lad wbicfa iniJte bim 
oIokI; roicmblo llie mcntuli; djieaitd. Indeed, tiiii conditioa buj grvdutUj 
|MU into isNinJtj. uid psrticiilirlj into demeatu; and there ire const&nUj 
found in the hniini of habitaJ ilninkftnls, u in muj of lb« ]iuuw, Ibe renilti 
of pauive conge»lioii — chronic opHciliea ud Uiickeniop of itio cerebitl 
nenfanutra. The appctHa Mwinircd fa; liabtt in u povmful in tlie dtunlLvd, 
Iho idcu wbich might oppoao it arc so veak. and tbe wiU bai beeone m 
panljr&cd, tiint lie, cvrn tliough he i» aware that be rcnden himielf d«pited and 
qpntemptiUo, <iaderiniii''i) hit conititulion.diblurliii his domeatiobappiacai, mini 
bis buunett, and ever; dsj postpone) the Rood rrsolulion which lie perbapi 
bad made. The craring, tbo diiziuess, tho duloeu of the secM*. tbe muieukr 
feahbam^ llic atomaeb csnpbints lr«ni whioU be Buflien, are, each Uine he 
partakes, aUeriated for tUc moment, and it maj, perhaps, be partly owing to ths 
faot tJiat ibeao diaotdert require caeli dxj to bo rcnxdieJ tlut drunken i)c*i is 
orteii lo inveterate. 



Serioua mental (ligorders nifty coTnmencc in ilrunJcarib in varionji 
ways. Delirium tn-ment attacks liatiiluul ilrunksrtU, and sometimes 
ftlso individuals wbo art- in the habit of drinking, but uhu very 
seldom become intoxicated. Occnsional!^ it roineii on ^uildti^nlj- ; 
geDeifttljr it i» preceded by.sierpkssDcss, or b;r disturlinl sleep from 
confusvil dtratnx. Emotion;, jinins, neute di5ni9»r;> (tsjieciall)- pacu. 
monia), iKcmorrlingcs, wcflkeutng influences of any kind, sudden 
suspension of idl nkoholic drinks, fa-rjuciitly di-tenninc the com- 
uencement. Its cliaractmstic symptoms arc sl«op]c8snc»<, twaior, 
tendency to pnntpire, hallucinations ; tlie monlal st«t« is generally 
that of great rcstl&<)snc8s and ngitation, chiefly drprnding on th« 
bsUudnntionit — therefore in ecrliiin circUmstaaws tlw jmlicnt may 
become dangerous to those nurrounding him. 

or all the vftrioui forms of chronic insanity, druiikenne^Ji fspccialiy 
appears to posscw much ia common with general paralysis. Besides, 
incoDipkteiy developed forms, trhich in a nicdJco-It^al point of view 
are ufteti very ^ithcidt to judge of, are very cominoD. These slight 
chronic ueulal anoinalics obseirod iu tliu druukard ore nuuiifcBted by 

' 8e«Marc,'I>ieGei>toskriin,lfaGiten,'ii, p, 4.11 ;DnVc.Ia}fasM*B'ZeitM!lmn 
CBr Aathrofiologic,* 1834. p. 924. 



THB CAVSKB OT IX8ANITT. 



171 



tarcDt mental diilncsSf I093 or Uw afiuc of duty, uid in 
of ell Uiv IiijfWr smtiment:'; ron^cii^cc nnd Ui« tense of 
tmtli arc biuiitoi ; iIm? iuti'Ilci-t is gciietaliy ciifoeWcd, fsjicciallv llic 
ncmoij : lm|UL-uUy bliglit or wcU^tnarkL-d lialluciiiatiDns also cu5t. 
NnniFroua other snomalics of tbe nervous Bysiein also ]>reMiit 
th«nB«]ve9 — tremofj of ilie hnnds mi of the tongue, deodcning of 
(be sense of sight and of touch, debility of tlie geDit&I organs ; the 
patient hns formicslion and crampa in the limbs, giddincM, sometimes 
yh p li e attacks of greater or less severity ; sooner or later mantsmus 
aiid dropff may set in, irith the naual local affections (gastric distaae, 
cnphjTBeiiu, ctrrboeis of the Hrer, Bngfat's disease, fto.). The chil- 
ilren of dninkard;! vprr frequently die pnrly from convuUioiu; many 
of thcui arc idiots, iiubecdes, or microcephalic ; or in later life they 
p«MsiL the mnc difpoMlion to dniakcniteu, insauity, and crime. 

We cannot state generally to what extent drmitcnncss ads in the 
pruductioa of tlic menial discosn ordinnriljr met with in asylums ; 
the vaiioas nations present in this res[)ect very great diffcrrncca, 
i and tlie lUtiaties whirh we poweu can be only to n slight extent 
comparod, because delirium tfemcns is somelioics includei), somr- 
timvs Dot. Amonj^t 747 cases, Halloran found drankL-nucss given 
ta a eaOM in more than 4th. I^rickanl and Ei>i)iiirol aacnbe thfi 
bair of the aUacki in England to this cauw. In 1 848, Welister, in 
UrdUtn (704 cases), found t-hti to be a cnuM in only ^.tb — ith of 
iheoaaca; llortson, in Ucdhun (141^ casea), iu scarcely ii\ Mtid 
aaongsL these there are ctrlaioly included screnl cases of deliiium 
tftsOH. It is generally known that in later times (he abuse of 
fpirila in England has very much <limiiii»li(!d, and Ihb csasc has 
proportiouately decieaaed in the etiologicnl list» of the a»yliim9. I 
bare bocu assured by very oompctcul authorities in Dnglaud, Uut 
this giatifyiog result is to be attributed, not to tcinperaiico itocictieSj 
bat to the inflnoiee of the curn lan-s. At (be present lime ilmnkeo* 
nns Dovhcre appears to be such n powerful cause of mental diseaee 
as in America. Uosb gives this as the cause in !rd of the coses in 
ibe hospitals of Pennsylvania, and later flati»tic9 of certain American 
wylums sbow even n larger proportion. From (icrmany wc hare 
important statistics by Jnobi; tlcrgmaiin (fur Hanover, ,',tb); 
Ds^oet (1856), for Slephaiufold, give* 1th — ^^th of the cnscs as 
the arrragr. 

DtodKanm b Mtanli; s norc imiwriuil aad ffcqnait csusa of iasuiLj la 



{ 



178 



TUB CAC8E8 OP INSiNlTr. 



men Ibuiia women; still th«re alio occaiimoogttfeukiBotoiIjflf IlKlom 
elaai — anongit proslilutos— wlMre, wilbout doubt, tliim dninlcas BuiI&uKrT 
fteqaeiit— bat klao in the higbcr dassu, amongtt lifstcriod Itmala puticaltrij 
duiafflliO ^iiBMUrie period, eumplet of druulceutiut and rMullinK icMiii^. 
8utt«n mentiona ■ cue vlicni, ia a lulj, dtlifium tretncn* nsultod Inm Ibl 
exeeniTfl uie al tincture of kvendet Tor slMpleuoeM. 

Dipsonuuiin, propcrlj tio cftll»J, or iieriodin: intcrnuttCBt drankeuuH, ifcotiU 
not be considered lu a cauac, bat rather a Bymptotn* of periodic isunil}. 
Scvcnl CMCS hi(e been oliierred— ^nd I myacll know o( locb — in wbicb fron 
Lime to time, BmullMievutl; wilU oilier iierTOu sjniptoiiu, licadkcbn, gmi 
prortratiOD, sletfdenseM, wiuea, puwiog wnMlion in tke •pigaalrio ngim, 
mental jicrrcnioo, general iliaooinfof t, and a certain degree of mdaMilMl} aril 
in, whiob. after ■ lioie, it sucMcdeil by mtlcnncn; Ibe pitioBt begiu 1* 
Frequent tbc tarcm, ftnd gcncnll; drinki Lard for Mvrnl dsja Qoatiaooiu^. 
The dnmkmncM ia tLoac caics ^acnJljr attoioi tJic proporliom of an attol 
inaaiaoil attack, from which tbo paiieni cmcrgn MmBtimes quiokljr, tometimes 
aloirlj la a state of deep dcpreatioo, and oficii T«t«iat fer a loog tine a almf 
BTcnion to ■piriti. Generally tbeac attacks are repealed. In their diagMiii 
we haTe to inquire partlcuUiIj wliclber or not tbe attack baa been preeedtd 
bj B stage of mdancJiolLA, wlictbcr there be anj tiereditar; ptedispoiition, and 
wbetbec the ordiiiir; habits of tbe patient be tboie of sobriety, or, on the 
contrary, be cxbibitH au iucliualion to drunkennesi. In tbe hltcr caM it ii 
vtrj problematical whetlicr tbe nluek of diptomania be the rtsult of diseus.' 

In Ameiiea, and aUo In Flngland, coses enter tbo aajrUms in whidi Ht 
•buie of (gntna tccmi lo hare been the cause of tbe ittsauitj ; such cua preaent 
■lao Ihe general appcorancr^of cbronic opium-poiaonin;. Thimce^ wlien indulgtd 
in to ciccia, and in so^mc cmct even ita modcistc mx, niaj ooosidcrablj afleol 
the (unctions of the entire nervous system. Although there leem to be no tacti 
ivLicli might lead ua (o tuppOHc ihiit tobucco ojodc can become a cniuc of jnaaaitri 
atiilit cannot be denied that inmany iudividiuU with venk andditturb«d mental 
fnnetioiis it may co-operate tothiaeud. Tbe cerebral affection which is produced 
by eArcmic 'm/'/K'Lium'Myprcaciilsionicliroca many analo^cs to liclirium tremens, 
pitrtioularly as in bnih caaea there is obierrcd an eicited muttering delirium with 
tremor) but in Icml-poiiouieg tbe excilDment pasies rrcqncntly into atupor; 
beaidfls, there arc oftco cniinpt and pnriLlysii t the prior eaiiteitce of Ind-eolie 
and the grey lino round the gaia» may astitt in forming the diagnosia. Uortaa 
(Annal. U&l. rsychQl., vii, it^^. p, 639) narralca a caw of rtupor altcnulioit 
with maniacal excitement afUr the cxtcnsivB USB of a pomade wkicti contained 
ft great quantity of Ic&d. TIjc diacaic commenced after the pomade hod beat 
Hied for fourteen days. In tliia case Llierc wu aUo colio lad tbe grry 
eolomtioa of the gums. 

§ loi. t, A complex action like ttiat of drunkenness, intluenciiig 
tit tlic mmn time the mental nud budily liealth, 7G»tiIt6 in « life 

' See Brilbi-Crarocr/UcbcrdicTrunkaiiclit," fie, 1819: Uohnbausi. " Uetitr 
die payob. Bebaadlung dec Truoksii^htigen." NasK's ' S^iUohrifl ftir psycfc. 
Aente,' i9io; Marc-Ideleri ii, I|C.> Huss, ' Alcohotismua Clirociaus,' 



TUB CAUBK9 Of I.NSANITT. 



173 



in disqaietode and tamolt, in carcle»9ne»s and ilissotute- 
wc mnj also add, miscrj and privation, which ore vcrjr im- 
iltantj and frpqucntlf the only appreciable causcB. Haw often do 
find to llic antecedents of the iiiHiiie, an irregalar life, diaturbcd 
bf adTcntuTvs, clutigiiig impulses, itnd [ii-culiftr campitcittiDiis, full o( 
fortune?, hnrdtihipit, misery, and excess — full of incidents 
aa muat afford fertile soiitcia of coiiflictd with the -vrorld of 
excitement and deep disappointment I Uotr often du we sec 
iration and poverty which lead to mental pain and dcsiiondency, iu 
Lbi: individual can no tnorc Hurmount the misery of his 
1, can no longer resist Iiia miser}*, nnd fulls into melancholyj 
ide> or profound insanity I But there nre other influences thaa 
which arc directly mental : the bud uourishtncnt, hunger, cold, 
and ortr-cxcrtioii, which must necessarily accompany »uch 
Vaieimportantphysical canae?. In all disorderly and irreji^ilar 
whether voluntary or compulsorj' (as fatigiics of military liff> 
wVj &v.), we ordinarily meet these two kinds of injurioas !&• 
aeaera together. 
3. Senat exceue* bare a similar double injurious influence, in 
maequmoe of the mental excitement which is frequently a«8ociat4;d 
rith, and owini; to the physical exhaustion which results. The 
may be said of onanism, which is likewise an important and 
cqucDt cBoae of iusanitj, at of aU other physical and mural degra- 
Beiides the enitwion of seioon, and the direct action of th« 
ScD pennanent anitation of the genital organs on ihe spinsl cord 
d the bralu, onauism certainly has a stQl more injurious nctioa oa 
e mental state end a mon direct influencQ in the production of 
uanilj. That constant stru^le against a desire which is even ovcr- 
Dwering, and to which the indiTidual always in ttio end saccombs — 
hidden strife belwixt ahame^ repntancc, good intention*, nnd 
ion, which iinperiouftly impels to the act, we consider, after not 
Uttk acqoaistance with (imuii3t.«, to be by far uore important than 
pftmary, direct phyoicnl elT««t. Tlie share wliich each mode of 
exrrts cannot he di«tinguished in individual cotes; but, 
\y speaking, the effect of oitoaiEm seems to be greater ia 
a to the carliness of the age at which the constitution ia 
aod the patient becomes markedly nnieraic, the degrte in 
it is accompanied by tlioae painful emotions, and in which it 
the cause of local disease of the geiiital organs (sec § loS). 



m 



TUB CAOSBS OP INSANITT. 



Witea tkoc tlire« iofluencn fail, ttastiirb«Uoi) UseUom fQllowcd hy 
serious coBttquences. 



EUis ("Fnit^tU rMi£a>ti«a,' p. 133} ksmbci the m^otiljr of all the 
IrMtcd in pnbUc aqrhuiu lo onuiiai. OUmt«i u Ouisbiiu ud Putb»p|]e, in 
Ui«ir Hiologiotl UUea, tttributc U tlaa cuue Ixit & tntll profOrtMO. Comi 
Uic trotJM 00 like relalMcu of »elC>abuae u a Mua of tnianitj in Jaoobi 
NuM C Zeiudirift,' i, 183s. P- 30$). Bdioger (' ZdUduift fur Psji 
ii, 18.45, P- ") ooomitn, froa cuefnl obiervatioa in Winatn U iil, tlut 
b ■ co-opcnling iofluice in Me Mli of tlie cuea. See Ifiaw, Ht&L, 
p. 3C9; CUodc, * Itenw UJdiwk,* t84j», Uu, p. 959. 

In Uti* Ktita of camM we nut evefulljr KToid coaTasion. Il U doI 
nn lo »e at Uie oonmautnient of hnoitj (or ntliet tu Ibe ttige of Inu 
of Binodcntc degree of inelueli(iUa)iiL6inwua}tlu pklienia eibibit as ini 
hmbI iastinct wliictt nmj lead to ooaalAin or to frequeoUBg Ud kgiua. 
tliii ve reMpiUe. not n Auue, bat R sjrmptoai of ntnUl diseau. Is umj 
wbcn: tlie riiuI esccMca naily at Ibe time appear to be nuin of tbc i 
they in CDI5 the immediate couetiuetices of a morbid irriUlioD. of 1111 e 
tkia of Uxng kUndiog of eettain porliooi of tbe nerroiu sjvtem. la partioi 
ODaiiiiiic BpODliujcotisI; oointneiioiii{ in earlj li/e, Ion{ befott pubertj, maj 
almoat with abMlutc ccrluatj ht ascribed to inorbiil irritatKui ejf tbe gcitiul 
OfgBtUi whiob esueidc* vilb ilie entire serTous co:utitutioti aod viUi a pcedfs- 
poaition to Btental diMue. 

The nientA] ditordcn nhicti Ofi{;ioate under the iaSuencc of ouninn have bO 
ooQitant apeciHe chnrDCtcr, but thcj In tlic majorilj of nice betnjr thcniMlYo 
bj profound dulneu at ttnliment and menial exliAuelioii, bj UkUucitialiona of 
bearia^i bf a icligiuue diaraoter of lUe dvlinum, bj a rapid traioitioD to 
dtmentiM, and coiuequeuL fiequeat incurablLitj. 



Seotios IV. — Pijftieat Caiues, 

§ 102. As we do not eomid«r it posaiblii that (mw §$ 79 aud 98] 
till? question wliethcr iiunnity urij^nalcs more rrtquently from p»y- 
cliical or from somatic causes caii be solvcil hy statistics alone, my 
discussion of the statistics rcl-iting to this subject, from the daya of 
Ptnel to the pres^int timo, may be dispeoted with, io th»t tho 
reader in reganl to the investigations od this sabject is lefetred to 
the old discussion which has been carried 011 hetvecn Uoicaa do 
Jonnci on the one hand, and Parchoppe and Bricrre on the other,' 
with the remembrance that all such tables afford rt-sults intdmbsible 
and uitreal, according as the individual titles arc vague and abstract,' 

I 'Comptci rendu* Je I'Aoidfimie dcs Science*,' 1.1 ii, 1S43. 
t Mon^au lins, far riamplc, a quile iacomprtljcnublc and rague lilie, " Icnta* 
tioa exctuito," wilh a Uigc nmiibcr lo it. 



THE CAUSES OF I^SANITK, 



175 



I 



I 



'■bJ idiocy Ins earefultf se|>aratcd from the other mcatal diseases.' 
Il is evident that ia maDy cafcs insanity may onginatc from purely 
|)hyeic&l CBU9M; (lutt> on the other hand, onder their oo-opcralion, 
|)^cbicaL ratues leatl more rapidly and more markedly to the pro- 
Liliictioa of mental disease. A hereditary or acquired diapoeitioD 
fmjiKiiUy, though not invariably, be made out; il often 
»ts iUuM, bcaidca (he symptoiiu wc have already mentioned, by 
origin of deUrium in aout« diseases, even though of buL 
sily. In auch indiridualv, in dilTcrcRt dcgrcc3j any 
llwdily disease may, through secondary affection of the bnuii, 
! B cmme of insant^ : on the other band, however, somatic 
I do not only act in this way by exciting disease ia (hoa« already 
i, but by th«in dLipusitiunv nn- origiuatt-d which nft«r- 
onder the inilacncc of moral causes, pass into insanity, 
phyaica) causes constit partly in conditions which, although 
I phynological, cxpoK^ ttic [uilcnt more to disease (as childbed), 
Jy in alr^y dc^'eioped acute, or (o a greater extent in chronic 
diieaaes [t.jf., tobcreaksis) — pnrtlyin certain external injurica (ff.y., 
iajaiy of the head}. In thm cnumcrntion n-e shall commence with 
those wUieh act directly od the nervous system. 

5 10^. I. Imtaiiify originatittg from clMr ne/coui d'ueaies. — 
Ho>t diseases of the brain, even although I Iiey do not at Hr^t present 
Ibr dianctera of mental diseased, may in their further course 
h r mm e such. Acu{« meningitis ran only, when it hns become 
chronic — that Is, through the metamorphoses, aad the other 
louUi of the exudation — be immediately recognised as a mental 
(Kseaae. The various affections of the brain which may give rise to 
ytfyy in sometimes connected from tlie Griit with decided tueiital 
fatobanoe — intamitting attacks of the former may evcu preuedo 
the intermittent convalsions — sometimes it is only after the epilcpay 
bM exiatcd for a long time that tliose uiurbid prooesses can become 
tiK ongiiialon of tneotal diKasc^ (either because the affection — e.g., 
thicoic in£amnatioo— originally silunlcd in the interior of {he brain, 
oUads to llw soiiaoe, or through consecutire atrophy of the brain, 
kc). It is the same with apvplcry .- it can, besides the pandysis, 
WfoUovcd by an insanity (almost always in the form of demvalia~- 

* Iha ■■« aatbor beings forwatd iodic; vitli aa enormous uumtxr, ai one of 
lt« (iTiiail naUH of mealal disease. 
' Set, fitrlW on. Ibo *pecl*l JeMription of epllcpy ai a oompUoation. 



170 



TllB CA«SKft or litBANITY. 



round 



M>mc4ime*, liovevcr, of mnnin) which U sometimes priinarf, exi>tit)|j 
bom the comiDracvDient — soaielimu secondary, owing to thcwe 
dcgcncratioiu which apoplrxy gives Hrc to within (hu hnaa. Soine- 
tifiMs ihc mental diM^rder is vvry limitci], afTccLing only certaia 
■erics of iiiens: i( mn;, liovcver, extend to genemt nnd profound 
nciDlal we«kncs.i. 

All aeeere iyuriea io tie head arc ackootrlnlgcd to be of 
iinimrtaiii'd iii the production of insanit}-, trhMber they ooosist of 
fracture of (Itt; vkuU, rxtmraiiation of blood, loss of ccrciiral mb- 
sUiice, or aimplt.- coucusaiou. While in tlie most severe of these 
cases the resulting mental disturbance (dementia, deawatii vrilli 
natuft, &c.) gcncTaUj* appears at once or on recoverr from the 
ipjun-, in otlu^r cases it does not appear till much InU-r — oik-, tiro, 
MX, or CT«i tea years after the Bccideot. In the nuyority of these 
cues there muy be small rcsiduous purulent patches which long 
Rmain without nny injurious conaccjucnce, or small apoplectic cy^if, 
chronic proccaaes in the dura mater, kc, srouud vhich there arioes, 
later, without nny cause, a gradually extending inflammation of the 
delicate iDembranes or of the cerebral substance. Iii oUior caaes 
there i3 slowly formed aa exostcsis, a tumour, or chronic cariu of 
the dtull, from whirli hypencniias and exudstivc processes proncd. 
Occasionally, howcviT, nothing of (His sort can be perceived ; it 
appears that in certaia caae^ concussion may, without tbere being 
any anatomical lesion, be fgllowed by such results within the brain 
that it reaia.in!i for ycArs after very susceptible to disefl^e, so tliat 
af^ the jilightcst e?tciting cansc (for example, a moral cause' 
ituauily U produced. 



It frequentlj liAjipcns Lliat oti miuute Iiicjuirr tlio plijsiciui leanu from 
reUtifta ot tlic patieot of former ciraanstaiioet of tliia kiad mihicb bad be«n 
almoit forgotten — a t«rcr« icicle from t, hont, a Call ox blow on Iho head irliic]i 
TCI followed b; iiiscntibilit?.' Sometienee tlio friend now Temembcra for tlia 
first lime, ihat ttncc tlie acoident a certain clmnge lie* taken pUce ia (Ke chs- 
raclcr of Llie patieiit; — that [>c l>ad t>ec<>ine fretful, irtiuble, pcrrene, £«. This 
duDgei baweror, bad been little licedeJ, and Imd not cvca beca recogiUMd in 
its trae tigniSeaaee — oa a jireoaraoc of insaoity — vhcn tlie diacMo broke out. 






14 



■ In a simiUf manner, we frtqucntJyHij||B severe tplnal neurosn apfwu for 
the llrit time longaflur llieac-cidnit. SaintKhrak; ('ChnrcaSt. Vititnaniati«u 
excmptum,* Kralaii, 183^, Gratulatigiiitcbrirt) rclatci a C(uc of St. Vitus' dnnni 
of tliit kin^ nltieh Ap]KArrcl sftvernl monilis after the reocipt of a kick ou 
buck froiu a bone ; «ubsci[i]ciit recover/. 




TBR CAUSES Of INSAXITT. 



tfe quote tko foUowint Ccom the iatcrcatto; work of Schlfii^er, " Ou ibe 
Henttl Diiorden «lilcb r«iult ftom. Cnncusiioii of tlie Jtrain" (' ZeilsGlirifl ^er 
L k. Ooalb. der Aerete eu Wka,' slii, iSjj, p. 454) : — Amoofist qoo |)n,lieuts 
ths Mithor daooTcrcd 49 (43 main iiul 7 femsica) in whom tlic (Icvclojimcnt 
of Uu ncntal diaordcr ttood in dircot relation to llie coutcqacnci.-* of previous 
oounnloB of Uie bniu. In it cases, Uie injury was rollovcd imnkcdiatclj bj 
loM of eaudansDeai ; in t6, by ainpte inaitDl eonfiuion, w&ndcrms c( tba 
Itev^lttt ill i>il)T duU pain ia the tiexd. In ii) cuet the iiioottd diteuo 
oaraoeaeed wilhin the fint jear ift«r the accidEiit, but In the ptal niojoritf not 
■BtiltlwlBpM of ■ much longer time; id 4, after upmrdu of ttti jeun. Genorally, 
the ndtTiiliula nuuurnted from l!ic time of llic iujary a tcndcac; to oecebral 
OM^utioo tlitr the a*C of ercu a euudl aaiouut of tpUlii. nftcr mnital Mcite* 
Dinli mlao io scTcrol cue* ociUu hjrporattieaia.' (aiihjcctivc impicuions o{ light 
tai of mIoUi tihotojpbobii), orten unbljopia. Tn 1 ,', ou», there nppcArcd sliortljr 
btlot* And daring (ke exiatSDCe of tlie cvrcbrnl dixonlcr hlock iipccki, nhicb cxcr- 
daad m deeidios iHAunee od the duractcr of the dulirium. Very orten obo the 
p«UeaU espcfjenccd ringing tkud noise* in the curs: in 18 cmgs there vu 
datacnof hc)uixij>;ia3, ibnoriDiil aubjectuc pcrccpliaos of smell, cliangu iu the 
pttfSt, \'ttj often the chftraeter aud diapoKitiou cliso^d: iu ao ou!ih great 
InMibililiri la ugry pMaioAftIv manner cvtii to Ibo most violeut outbunts of 
1 1 win I «■■ nwukcd— test frequently oTcr-ettimatioii of iteir, proili)nilily, 
lnltwiBMI^ disqilielmic ; in 14 coseilbere were attempta at xuieidn^, frvr^iicnlly 
vctkBcn of BKBorjr ooafiuion. The prognoiis was slrnoit always UDfaToralile. 
SercBof the caaca taded in general paralftis, 10 euta came to po&t-mOTtem 
esMBioalioB. In these thctc «ue found occosioaallv oswous ciealricca, 
■Acrent dsn msttr, opseit; aud ktoub icGllr&lioii of tlio delicslc membranes, 
man ot leat bjdroecpbalas clironieus, graaulalions ou the liuiug mcnibmne 
ftf th» ventricles; in one cue a cetehroJ iiiduratlnii, with nlrcphjr of the 
ban sod chronic itifl«iBmatioii of the delicate niembmiirs. Iiijnrj of the 
em^ bone* resden (lie prubnbitil/ of coucquent psichicai disturbance mucli 
Ihaa simple injur; of (lie soft parts. Verj inlemting exnmplea of 
'tjtautvuat apoB injurin to the bead mij be found in the ' Report of the 
iAiiyIiiiii'(i8s8,p.4:). 

Ums« eases *hiob result from disnsea of Lbe boaos tn omuequeneo o( 
B17 b* added iuaauilj from cuiies of tlic iktiU owiDR Io internal canses, 
ftjienall^ tnna caries of the temporal bone, intcnial otitis with ils nstillB, 
■teuingilii, He. Jaoobi' has ohscrred 7 raics of the hitter kind ; 
IhtjT asvcf adnit of recotery. aud but seldom of iatproremeut. In the asylum 
■1 Srm Tork. 7 easts ocoumd la a sinKlo year in which mental diaease origia- 
ated from disesHs ot the inl«nal ear (flankurj Smith, ' Aniuil. iUi. Psychol.,* 
1B54, vl, p.4So). Casea hare been obserred in which a violent uttsck of mania 
CO eeaaaliOB of a purwieol iliacharse from the ear, and ceased, or at 
eoatiderafalj diutiDtsbed, on tbe rctuni of the discharge (L. Heyer, 
'Ceatwfce Kliaik,' i8j^ No. 6). 

witb injuries to the head we msj aUo mcatton iitttl^titn u a oaiue. 



ITS 



TBS CAUSES OP IN'SAMTT. 



Uioagli not of rreqiMit ocenrtvnM; of mmtils. "Kt aeU, pcthape, lij uu^ 
gnat tcnbnl lijrpr iw ii* (mJ mitvM f) z ftcriiajw Ui« inuiulj i> duB to u«»- 
linncrroiis irrinUoB' of tht brain oucil bj prolonged ex poiuic to Ibc njsof i 
bunuiig MB. EOitincalMMU tvocMei of inujut j caiued bj insoklkni-. OKof 
Ihen (odtd ii iMOTerj, the other in dcawutu. 

Hioae cases in which iusanitj originate!! after (aod, without doiilXi 
in cODsequcQCc of) a rtlativdy inwguificant iiyVry ?/" « pir!jti<Tai 
•tnt (abore all, woands of tli« mft tjsmes), or disease of a nervs of 
■eon comnMDcing at the penphtry— for example, penpbeni iW* 
Deu— ^te of Tcry great pathol<^cal iutcicet. Thus wc have swa ao 
attadc of profound mrlancholia oocui in a hjxleriool wouan afi«t a 
alight injUTT of (he c)e caused by a splimer of wood ; inaanity has also 
been obwrred (Ilcrzog) to occur after the opcmtioQ for strabisniuf.* 
Foville* mentiooa numerous caitea of superficial disease of the cere- 
bellum in the insane in contequencc of priplieml disorders of the 
fifth aud nuJitor; nenes ; to this pathogenic category belongs abo 
(lie case alreadv quoted from Jordens,* of a boy who became 
muiiaeal through a smnll piece' of glosii peii<>tniling the sole of his 
foot, and continued m uutil the glass iras removed. It n vrrjr 
probable, too, that the cases meatiooed bf ZeUer,' of iasaQitjr 
consecutive to simple external weands of the head, maj also be 
ranged under this head.** lnTLamuch as these cases vividly remiod 
oa of the delirium netvoiuiu obsen'cd after and sometimes duriog 
opcrabionsj this cerebral affection may be compared to that affection 
of the spina! cord which determines traummic tetanus, but with thii 
difference — that tbe spinal cord and the bnio always react according 
to their own peculiar energy. 

In the next place, we may here mention various other powerful or 
long-continued ncrrous initalions from the periphery of the orgnninn. 
As an example of Ibc Gnt series, ^c mny meulion that remarkable 
oa»e recorded by Es<iuirol, of mania occurring after a strong im- 
preasion of smell ; of the second series, perhaps, e. g., the itritatioil 
produced within the bowels by taaia oud other eutO£oa, or cvca of 



) 'Traits dc I'Aliiiution,' kc^ par Archimbault, 1840. P- Si- I 

• Oppciilicim's • Zfiiidiritl.' wi, 1849, p. loi. From ih* * 8*. Petenbulj 1 
Trail MCl ion),' where I, alul could not read tlie nw is tlieoripoiA. 

» 'Now nidieAcadimic, l'Ii»liliii,'Jao., ift(3. 

• • IluMand'i Juumsl,' vol. i», p 344. 

• 'ZoilichririfurpRTcliUlnc,' i, 1. p. 49. 
■ See niotcovct Uic caw meBlioii«<l bj Uiiuli (' SpinalaaaHatt,* p. t^x). 



TUB CA08EB OF INdANITY. 



179 



tftBtoi chrouieiu. Very severe paia may also cell forth an ottEtck 
of inKinity in nn iiidividiml who is pn-dispostii. Tlic ' RrpurL of 
lite Vienna An^lum' (1838, p. 60) contaitiH a case of this kiud, iu 
coii»tqu«ncc of tererc pftin resulting from Jafiammatioti of one of 
th« icodiuoiu slieatlia in the i>a1ib of the band. 

4 104. Formeriy existing *piaal Hturoiei, whether manifested in 
8t«tes of dwi-lotied hysteria, or merely in hmiled convulsive or 
oeanlgic allectious, may become important causes of insanity. 
Here it seeing tiiul tnent^ disorders may originate aa well from 11 
gmduul extonsioii over more consitlerable portions of the neiTC 
centres — and this is very frciiuuutly the cuse with hysterical persons 
— as from n r^pid transition from one part of the nervous system to 
another: in the latter cnsc: the insanity may frequently, and even 
periodically, nlternalc with other nervous alTection!. Thus lirodie' 
narrates llic casr of o lady who for tt year suffered from permaDCDt 
convulsion of the stern 0- in Rstuid muscle; suddenly (be convulsive 
state ceased, and she fell into mrlanchoHa. The melancholia lasted 
for « yvai, when bcr mentui heulth returned ; bat the muscular cod- 
vuUion returned aUo, and continued for several yean. In ftnotber 
case, niso rrportfd by Brodii-, u neurui^c slate of the vertebral 
column alternated with true insanity. 

Concerning Ih/ntrria proper. This general affection of the nervous 
system is mamrdetl somctitnct more in one, sometimes more in 
another part of the nervous apparatus : only very Heldoui, however, 
do the mentnl fAcnltios remain entirely freu from nil diiiturbance. 
In the ordinary slight cases which cannot as yet be considered as 
mental diseases, wo Ke, sometimes together with marked motory* 
sensitive anomalies, sometimes wilhnut' them, as a predominating 
affection, the peculiar hysterical disposition, vis., immoderate serin- 
tiveiiess, especially to the slightest rctiruach — tc-iidency to rtfer every- 
thing to themselves, great irritability, great change of diapoeition on 
the least or even from no externa! motive (luimours, enpriccs), and 
not the alightest reason can be given for the change ; they tiftcn 
exhibit tender sympntliy for other female individuals, peculiar eccen. 
Iridties, very hvely intellects (in young girls, pleasure iii Ifarning, 
ftc). This general slate comprises many peculiarities of character, 
often of quitt^ aiiollier kind, ru teiiileney to deception and prevarica- 
tion, to oil kinds of misdomeanours, jcaloiuy, malice, &c. 

* ' Lectures on certsin Loenl Nwvous Affeelion*,' London. ift.-j;, p. 8. 



. IB 



iitrioiM h;^ft«rical mrnUl liisortlcn are manifested priucijMlIt ift 
two diffenut rorms. In the first placp, u ttmtt itUcks of delicum 
■ad exrilrim-iit c\-cii lo deietopnl fflania. ThcM ue dcnlt^ 
MUoelitDrii rroiii urdiniirjr hysterical coaruLmTC attadu, wliidi^ bo«- 
tnt, may be wry slight ; somcUina tticy ajfpear to occur iottoul of 
tlwm convulaiTc ntlackflj whidi arc Uicd eDtinljr abecaL (at occurs in 
F|i)l«-p»j). Suc\\ mantacat attacks are aometimes obaerrcd in ?ctj 
jraang girli, and naaitut thcmiclves bj Toctfention, noging; 
raraing, wmlcM w;in<leriiig ; occafioiuUjr by mofc fomud ddiriam, 
allcaipta at suiddc, nyippliOBaaniaf 1 exdtemrat ; ocxadouMj hj 
d(4iriuin of n rvligioiu or demooiacat cluracter ; or there are altaclu 
of all kinds of notnv und pFrversp, but still cobeteot, actiooa. Ib 
cither case Ibejr rctam but slight remembrance of vhat took 
during lite disorder.* 

The ekiviif (una of hjrelerics] iasaoitj loa; thoir itsdf in 
form of (BelRncbolia or mania. It commences soDetimK oaaaiuir,. 
^fMlual incftaac of the linbituai hjrstertcaldispaaitioti; thceyin|itoms 
Itndinlijr appcu non persntent and more inteniie, the patient 
bfconta mon and more incapable of edf-coutrol ; sometimes it 
ci)mi»«tit<ra aciitt-tj under the influence of mental emotion or 
OMHUtriiAl (IcraBigeiuBt, weaknCM owing to ruioos acnte diseases — 
kftcr a few slight, periiaps iiioom|>l«te, hysterical attadu. At fint, 
Nu>dvnit<i, hut tmnly nutiocdf changes of character arc obwrrcd; 
gNMat •MtouaneM, i^otiim, crent care of the health is manifested — 
tnAnnfon ucl abtaim of will, impatience vioicnce, tcndencjr (o 
ikiigtr^ The patients ilwaTS grour lean, uuemic, oocasioaaU;- quite 
WamaBu^ri (hrv >iiifrrr from constipatjon, from disorders of iligcs- 
ttui uid DK-iii>lruntttvii ; occnsionally the more serious chronic forms 
of iiH-lHiichivlia lutd nuinin arc developed ; lempoiurr exaccibatioua 
rtmpi«-)tlly orcur, with marked cerebral congestion, swelling of the 
up]NN- hp, viiilrui hcfldacbe,ori3rmptomsofdiarrb(ea. Tfaesymptoms 
fctmtwt alirtijri become nggrarated at the menstrual period. Au 
Vh>lii' rIniKiil inAT fMNpK-nily bo r<«ogni»ed in the disposition and 
drlinlim of throe lutuiilii; in mati; instances it is very slightly 
nmrkrd, miit not unrrcqufoUy it is altogeihuT absent, fcitatio 
•tale* art) ooMMomdly pttat-nlcd in llie higher grnJM; liyslrrtcal 
huMity paaan mon ftcqueuUy into dcineiitii Uiun one might at 
flrst beliere. 

• 8«o L. ilujn, "tliftfr Aeule t6^ieba Bjtierie." Vtreliow's • Archir,' ii 




THE CAI7BBS Of IS8ANITI. 



181 



I 



The iJugnofis of hjrstoical insanitj is ptineiptUr basc4 upon 
lonner pcculinriti^ of cbftrnct«r, jtrescul or pa^t existence of globtu 
fajr^Uricos, iDvl«orisuiU9, convulsive aUacks, toeal aiuestbtsiiis and 
lijpcnBaOKsiu, sjinptaais of panljsis. Vcrf fraiacBtlj vc find in 
tlie«e indiviilunU a veiUmJ^ked hereditary diapositioD to uervous 
diMues, chttiTotic appeannces, disoriiers of menttnttioa (vhicli. 
IkwctCTi ofkn disappear wilboat mj improTcmciit of tbe hysteria}, 
and — of the greatest impoitance in regard to proguosis aod trcat- 
mrat — local diseases of the genital organs. Some eawa iiiaj 
doubtli-u be ntiribotablc to non^satisfactioii of the sexual appetite; 
bat this if, M n rule, much ovenated, as the cxiitmce of bTsleria in 
girU who have not reached the age of puberty, its great freqneney 
amoogit marrird vomm — the frequent injurioiu influence of marriage 
pngnaocT, and cbililblrtb, aud tbe (retiueucy of the affection amongA 
prosbtatcs, show. 

FoUy dereloped lijateria ocean also, altbooglt more tard/, in Jtnag mat 
(bnidcs nuj othei caxi. I hme reocntlj otiKrTcd sncb a ooc «ilk dittiDCt 
(lobu and coniruUiMU ia ■ Toaag iBWTKd, very aoaaiM; ataa, wboM viTc «m 
pnuBnt). Iilo M( kaov, bowarer, vfacUiei fayitcrical iatani^ lua ever been 
ob>«md ia men. 

^ 105. 3. ActUa ftihriU dlteate* of dlfTfrent kind* occaai(»uIlf 
^ve rse to an outbreak of tnaanity ; the dJKirdcrs which tb^ 
occaaioQ wjlhia the orgaoism leem to be the only caasea of the ' 
ty. Typhus fercr, intermittent fcrcr, cholera, the acote eian- 
pncumonia, and acute rbeumattKin, are the dircaaca in 
which it occurs moat frcqacnily. In regard to the Utter, the facts 
are H yet httle known and atadied: wc shall here give Ibia 
mnark^e cause of mental disorders the coneidcratioa which it 

After typhus ferer^ and as well after a sUgbt as after a acrere 
attaclt, it is not at all rare to ae« a slight degree of mental disorder 
irUeh may be placed in the same category with the slight afTections 
of other parts of the nervous avstcm — incomplete amesthcsias, tran- 
tietit panly^ea of the extremities, fcc. The patient, now quite free 
{torn lever, or even become eonTslesccot, retains either tome fmg- 
neats o( bis fonner delirium, or he exliibiu, independently of tbis^J 
all kinds of perrorsitte&— erroneous ideas on various sabyecis, some*! 
Ubws eren in regard to himself '. also ballticinations, with nenrc 
pxhaoslion and wrakneu, ititbout profound excitation of scntiniesit. 
Hua furm of Daental diatutbancc, tliia species of fngmentaty, 



THK Ci.CSES or IXftAKtTT. 

ddiriutn, admits of an altogetlier faTorablr prognosis, and almoA 
aliravs diMppcBTi rajiiillj «ben tlie niiirition ia impruvcd anil tbe 
itrength inerrawd, even thoagb, as sometinies occur*, n certain 
degree of nuniacal ciritemcnt be ns»ociaIed wilU it. But there are 
also much more Mitre cuks o( true chronic iDssniij wbicb coui- 
tatact during conTalcMencf from typhns fever, or can al least be 
traced to this and lo it« bIhw ooioincoceiiMnt. Mclnncbolis, which 
gmdoailj iucreascs; occasiooally it ia accomponivd with stujmr — 
sometimes irith ideas of poisoning, refiual of food, earlr iatcrniiilare 
of sjrmptoms of mental weakness, and transition to mania and pro- 
foand dementia ; — »ucb is the ordinarr courK of tbcfeooMs in vfaidi 
recovery uf the cerebral functions dncs not lalcc place, which 
perhaps dtpend on permanent distarbanire!: of nutrition of tbc brain ; 
but, nt at! c\'cnt«, the progiuais ia, according to eipcrienct, alwara 
unEavomble. 

Tboie tIio liaTcwriltni upon tjphm fever — fnr riftmplc, Chmd. Louis (it, 
p. 33, and cd.), Simun {' Journal dc* C'uiiiials. !M^J. Ciiir,' Au&t, 1644. p 53)< 
BauTCi (' AbhbI. M&L P>;dioL,' 184.'',. ii, p. »2i), I/ciiilct (ibid^ iSj^Ov p. 148)1 
Tliore (ibid., p. ^96). Sciilttser 'OHterr. Zdisdirift fur fnkl. Ueillc..* 1857, 
33-35)> Tuu);el (' CliniAclie Kfitllietluni^ii,' Hkinbiuj, i860, pL 18) — Iwta' 
cosiffluniciCed cues of tbit descriplion. JMubi, in one eitibtb of hu mm* of 
iuii>i», Mcribrs ilic ducose to tlie cootcqiimcr> of tjpkuft Tevct : it appon lo 
me my doiiUTttl, liovctcr, wliclbcr iliU lios kIobj} been true t;plius. Scklagti 
founit twonpM ^00 ntciiltilU di&cM^cd, 31 I'Ai^'S wliicL could be tnad la l,vplia« 
fctcr. I CAiinot ondortn tlie opiaion Hint tlie fwiDiiaiioti o( these cajes h to 
be sougbt in Ibo hypenemia of (he brain wliioh r«mauu sfler tjpliuA ferer 1 till 
point ntlier to ktales of anKmia and ekliau&tion, oooaticti&llj even uitli rem* 
nanti of llie fcrer. lii eiceiilionil cam, these diacaics inaj be caused lij tlie 
pTcacncc of utiguinconi clot* in the ainus of tbe dura lunler, jKrhtfii hj 
mciiiiigitti or bjr acute atropby of tbe biain. 

Tlic relation of certain ciu«c» of mental disenut! to tnlfrmUlf^nt/frtr 
hfli^ bi^ri observed since the davs of Sydenham. Hire, too, a vtty 
difTcreut rebitioii of the tvo alTcctioiiii to each other is to be dis* 
tinguislicd. In tbc one, ptrbojjs ibc tmiallcat, scries of cases, we 
see that in localities whprc intennill^-nt fever is endemic, certain 
individtiah are altiickcd, instead of ordinnry ague, hj an intermittent 
cerebral affection vrbicli manifests itself in regular (tertian, quartan) 
attnclcs of iniwnity (so-Cftlli'd interniitten* Inrvnta). There arc bere 
Kenerally certain signs of the ^tiiges of tbc allack— yavniiig, rigore, 
heat — to be observed, and it ia the hot otagc espccinlly which is most 
frequently complicated with cerebral congestion to »uch an extent as 



THE CAUSES OP msANirr. 



188 



P 



I 



I 



1o prodncr. msnia. It is, therefore, not an existing infennitt<^Dt ferer, 
i but the endemic cause of tlie Tever, vrtitcU is the cause of the iunnity. 
I The periodic nature of the nltacks, and especially great increase of 

tanporaturc during the nttack, together with tlio tndemic cluunder 

of the km, are the principal diagnostic agoa. 

ExxKrLfll.— Ajouog ininbadflTCkltackioriiicntAldiiordcr.onceTeFjotbFT 
iay. Tbv altack oomnoiced, aftec verj tli^lt rigors, vitb nu iu<JeaoribitbI« 
Gedh( of pwn in (be oardiao nr^oa, aud iwlpiuiimi, vliicli n\)id]j incrciutHl to 
* able of eilrcnc knxietj. Tiii* formeil th« 0(>minct;cenicnl of tlic deUnam, 
Q«t of whicli ibe pXient tMnerged bat lied in pcnjiiration, *r[er ■ drcp tieep. 
Be loea rwotcwd under tlic ireatment for tcteruutteaC te'Uft. (Flcmmin;, 
•PijdKiNo,' |>. 8;.) 

XXAMfLS II.— A alronjt labourer, el. 30, vho liad never linil interniiltGot 
bnr, bat who lired in one of tlie manjr fnicr diilricti n-liicli turrouifd HitRburg, 
*•> vMatij KiKd witli miDJa : he considcml liimulf to bi- Christ, and llione 
taitaai kim to be witches ; be abused liis mailer, &c. The b^ad va« hot ; the 
tjtm nA and foiling wildlj ; (lie tongue wliit« ; rpigmlriuin dintcndcd ; llic pulie 
iBMWbit rapid, noi fovcriih ; tlic feet cold. On the applicaLion or ice to th« 
•haven aealp. te., U>e patient becKine culm, and during tlic two fulluirin;^ dajs 
wened to be rDenlallj hcallbjr. Oo the ftnirtli da;, euctljr at tlie same tinur, 
tbe aane tetne wit repeated (sal aiTinmDiuc, exlr. trifol., nad tartar emetic), 
A third tttack occurred in Uie quartan type, but milder, iljortcr in duration, 
and i te Milad bj ewesting : atter this. Ibe ajmptomt diiappearcd under the 
HH of qiuuBC. Id spile of the continued use of quinine, there occuircd after 
Bffc WMba a fourtb attack of lliii periodic inaanit;, whiob however, like a tub- 
■Mfwrat one, which wa* the loat, Anallj Rare way under the admiablratiaa ot 
huk aod quuuue. (Foeb,' Zdlachnft fiir Ptjeliiatrie,' v, p. ^^6.) 

At utlicr times, after an ordiniu'7' int«ri[iilt4'nt fever has lasted for 
a certain time, tbcrc- appear, instead of the paroxysm* of heal and 
cold — 0:9 if through a leap of the nffectiun — intcrmittiug jtaroxjrsua 
of ioaanity (violeot nltncki of mania vith delirium, also iinpulrire 
Boiddo during the fit): th»c (tatca oflai, with di»ppcimucc of 
dcdded pmodidtj', BMUino the rcmitlcat and continuous tjpc, auil 
poM into chronic mental diieue*. Fioftlly, there is a third mode of 
or%io which is the moiit frequent of all : the insanity occurs as n 
diicsae conscqui-nt upon intermittent fever whieh ha.<i disapiienrod 
either iu the early itage of eonvotewcnce, or not until sevcml mouths 
after the ocaaation of the ague. Ii is tspociatly after vcrj* protracted 
and M-ver« (•wpcciully quartan) fcrors that disordcra rctnain which 
iitajr produce ttwuiity. 

The mental dinase freituontly continues as a uniform peraistent 
eiraiK •AMlioDf ind tbe ■ymptome of the iutcrmtttvnt fever arc no 



Iftt 



TflB C&CSES OP IKSAKITT. 



loiter obaerrefl. Or tract* of tiie teva rmj still be present ; the 

Bplcen and Um are enlu^ed, cacbcxic exist, asd iir^ular paroxjrBoa 
oF »giie appeal from time (o tinK (during the Binitul disease). la 
cuiB of the latter kiiid especulljr, the insanity rrciiuenti; eeosa, 
aooner or later, irith Qx retarn of an acute serica of serere attocka 
of intermittent fever^ but bjr tlie lue of ijuinine tbc ooUectave ioter- 
mittcnt disease ma; be temored. In the origiD of all eases beloaging 
to the third cat<^nr, it is certain that, on the one liand, tbc 
cndiectic-aiuemic state which the intermittent ferer leares Ixhinil it, 
and, on the othef, the meliuiicmia and the deposit of granolir {lig- 
ment in the oerebral vessels must play an important part (on tltii 
rabject see my paper oa infcctwns diacww, Tirchow's * Pathologie,* 
ii] tus the latter can aim rrrr probably call forth severe scale 
cerebral affoctionii (corns, apoplKtiforu attacks, &c.) which arc 
Eometimes observed in intermittent fever (oecamnal cases bdoDging 
to tilt' Urst sod second category}. Slill, post-nwrteio examinatioos 
occur in which no pigmentation of the brain can be discovered.* 

Jnrobi hut rcpottfcl tliree cuea » wLieh ttineki of ague oeenrred indod of 
iounil* (chronic) which niited, and iritfa tliote llie dtiuac erased <a n.called 
critical pliBM of inlcmiittcBt fever). 

Koaler observod that in 34 cases of iasanity in 8iegbiii|> who look Iatemiit> 
t«nt fever, 7 rceorersd, 7 were inproved. and in lo no ehknjre resalloi : mnuogit 
llifl latter, liowerer, IheiV «cr« many chroDtc >Qd Iiicumblc ewes. Amoogit 
the futiiiKi Oirre vere also ^ercral in wbom llie tirotinoiit liiil brcn eoBud«Te4 
uuraronthle. G»Jt, in llic Schlciirig Aiytuni, obtcrrrd in ihrrr rear* ^6 man 
or intemiiUciit rcTcr in insuie paticQls, "but only ciccpliomilly have faror&blc 
rcaulU ooouR«d." 

Sec Scbutiu), " BemotkaiigCD ubcr die Melaucholic and Maaic ah NKlifcren- 
keilca der WechselGeber," ' Uorelanil's Journfll,' 18*3. ivi, p. 3; Monf^lu, 
'Mon^TaphisiInlR-italioiis jntennittentes,* Paris, iS^y, i, p. 638 ; Lippicii, 
" Ucttrnge iiir Pijchialrwi," ' Oeiterr. Jolirbilcher.' Juni, 184 J, p. aSa : Bakar- 
|i;er, '' Sor 1> Folic k la tuiU des fii^vrea inteitnitteatc^" ' AdimL MAI. Pty^iol,,' 
•843. ifi P- 3J» ; Fockf, •• Uebcr tjpischca IiresciD." ' Zcttscbr. f. Psycb,' t, 
1848, p. 3;5 ; Koslcr, 'Dm..' Dona. 1848; 'Bendit der VTicnet IrrcMostalt' 
OVieo, i^5S).p.5i. 

Acute mental disorders ocea.<[ioiinlly oecnr aUo nftcf ekoitn 
(n5ifltica]. Sometimes it is transient dcliriam, absence of mind, 
perverted instincts; sometimes paroxysms of mania, gcQcrolly of 
short duration (several days to leveral wofIe^), wliicli terminate in 

' Hoffmuin (' QiiMburg Zeitsclir.,' iv, p. 365), The insanilj bad «rig{nsl(id 
oflcr intftmiltent fever. The autopsy abonredatropliy of Ibe brain; "eortiol 
lajcr pule, paler than tbo centnl grer uauM," 



TBK CAUSES OF ISSaNITT. 



186 



I 



cxhaiuUon nnd »l(«p ; oocosionnlljr, atw, m«1aocbolta of eomerrhat 
I Iragn dnntioD, vith insuie iiltas, and, more or less, vith appear- 
moca of mental weakness. The prognosis is generally favorable, and 
' iBoat of tbew cases do not Cual lUrir wa; into tbe a«;rluin«; tome- 
timn the indiiidunls, already u'cnkened by the previous serious 
iliseose, die during an attack of munia ; occasionally, alaoj tlicy pasa 
into the incurable forms. 

Sm Fischer, 'Pra^r Vi«rt«|f»hnclirift,' vol. xiiii, 1851, p. 85; Ueluiauve, 
'Amd. U£l PijcboL,' i849,91i]mS^.,to1. ii NcumsoD, ' Lcliibi d. Psj«liia- 

Those rases of insanity arc roiy interesting whirh nppear during 
the course ofpneiuKmia (geoerally acute maniit). In these cases the 
insanity vs rnrely developed at the coinmt-ncemeut or at the height 
of the iHwase, hut more frequently at the time when the fcrer ceases, 
or trtn not until convolcscx'nccscts in : these cases arc hy no means 
tu be confoQoded witli the ordinary dcKrium vliich so frequently 
■DeompaniM the more severe ease« ; thtr ak gencially of short 
dontion, but tend to pus into chronic insnmty, so that such 
patients ongfat at onoe to be placed in an asylaoi. It is not 
unhequcotly slight and litoited ))ncumonias which arc followed by 
mratal disease ; hereditary predisposition or previous habits of 
drunleancas may frequently be reoogiused as predisposing circura- 
■taocc*. llie mental difiturbanoe aometimes passes ofT so rapidly 
thai the existcnee of a palpable cerebral disease is very improbable, 
and u most likely dcptudcnt upon acute amcmia of tlic brain. In 
other ran eases tho mental affection lasts for a. longi^r time ; it 
approaches d em entia, and is associated vith certain paralytic appear- 
ances in the muscles. It is probable, tlifrefore, that there may be 
in these cases sanguineous clots In the »inuse.i, enci'phnlitis or 
localised meningitis which mny gradually di^appesrj aonetimeii com- 
plrtely, somrtimcs iDcomplctelj. 

Cmc* of menial diseaia coBweatire to pneumoua nuj be foand in Jacobi 
(•Jill (OAMple or mkbiii). Tbon (' Aiiasl. iUd. l>>;c1io).,' Mm 1844, p. 381^ 
nd ifay., 18301 ii. ])> 5^ bsa sartnl rci? intercslin^ cawn. One of tJicse 
jatlaiH bad Ivo Rieettsits attaeks of pnGumooia. tteh of wlich wu followed 
hj Bnattl diswdcr. AnoUi*r ease h inoulioapd by SncH, ol munia aTler pneu- 
noaia in a child of aiac yean (' Zeitiebr f. Paych.,' lili, fS^6, p. 1140). Two 
of theae nra* caacs cane under mj obaetvatiun m Ihe cliniqne at Tiibing«ii, 
Mb (n the lame vbter, and another recenClj at Ziliieli ; two of tbem belonged 



ISO 



thk cacsu or ixsakitt. 



lo Ue Bnt, ttie MM b IWngm to Um Msadt, af IW 
Ottcirorka. 

EXAHru III.— AMMMsia ; tnmritnl mtmUl im t itr m Hi iiimffw ^ J 

Awr.—C. 0—1 R>. 3 1, *i|pire<KMi4 robai^ wia, oa the 3^U offtUiy, ifi 
twMcnIjr uiKd vitk ■ Mverc rigor, blMdinK >t the warn «id gUdlHW. 
>■» B(l»iilcd into oif dinial ««») oa Fahraatj attlk Ob ■■■■JMitrw. 
nu ronoil pncumaiiia of a portiiM of the n^ lamet lobe, lad *mre lj| 
like •jFin|ilouu«ilh |>ro«mUaii ; tlien «aaagood4Mlo(i|«tel4MifnHit 
nlkia 3a— 4et pulM too — 1041 UBpefBtan40'3°— 4i'e°C. Ou Uw 
da; of tlia diiMie, hvtpes litaialia tfipeand. wkicfa itid set dneJop 
On Uw Ibarlli, ihe lenipcnture tiank fnmi 40*3^ in ihe oMMuing to 39*'° n 1 
tftning ; pulM 91 ; ilio iwiiriit became nore deliiioaa mni abtcaL OuUk I 
daj, tho plijaictl liirii* iiulicalol cooifilele rdroptarfoB of Uw local | 
llic laiiipctatiirc iiiinUcnianiii'g jS-|%MHluiUiecTCiuaK3S]°C. ; |>ulv< 
71, Miiiiuliiuei iiitetiiiitleiit. Thu coviitaiMBOe is pafe; I'm p*bcat b qu 
•lUfUui aoine — kuciwt >«i «li«r« lia b, dvrs uot raoollect llw siaiploat cv 
lalktfonataiiilyaud delirioualy, and toiraf>la vifjax beMmea rwj rriUcMi 
atiruljr (inot{itiia). Afi«r paating a terj rettkia nigbt, he nest nxtmiug liail a 
huitt and i|iuc( ildcp : llic face wu \KAt, flii^tl; coDTubed ; mpiralioa ilov, 
irtFiulM ! {iuUc6o— Mj tFin|>cfatuK37'*C. FromtUUtiowtia'patieiit coa- 
tintirri frm from fnrcr ; the drlirium. ringitig in Uic can, wtd tctUko ooutiDued 
(uT two dull* longor, after wliidi lluty ili>app«ared ; the pulae slill prcwnlcd 
((nal irrrKiilariijr, and from the cipililli lo ibc tculh dij o( the ditcaaa fcUu 
^6— 4^. Oil IIiG tliirl«eiitii dar, resolniioii of Ibo paeHvmia waa oonpUile^ 
liio iiiciital >lalc was qiilic iioniml.— Tliii com i* not to bccomidtrcd aaeof 
ftihrilo delirium i tlic mcii'iil ilUotilcr wiu quits a different affeclioB fron tlie 
jirtiliioiiiaijr driiriiim, niid did not apprar till llie f«*or bei^u tu c««»e,' the teia> 
IKfaliirc to diii>iui*li. aiid puke to become alav and tiitcnnJItriit (tlie unlj 
medioine uud was nilre). Tbe cue wbieli reeeiilly oime under mj ol>- 
Mnrttion in Ziiricli vas Tcrj dBiilac lo tliia: tk« (bitowiug ■*, hovever, vet; 
ililTmiiil. 

KriMPLB IV. — Pufwrnvnta, mttaia, tUgll hfmijJtyiti, toii»tciUir4 mtMlJ 
iTMJbiMi.— J. II — , ieI. 14. a labitun'r, whs adaiilitd into m; eUnique on Uu 
tul of Jwuniji, ■%<)- Tliu fnlWr of lliu pilicat liiod in ha £ltv-9ccoiid jroar 
from a clininio elicit alTcction, witli dro|ibf. Uia uiollicr vtu aliro vben tin 
fiatleut e>i(crcd llio lioipitsi but dtiniig lii* reiidcnoc there die eomniitted tuiciite. 
Il— liaJ, 01) tlir wliolo, alnuj* ciijojcd ggud licallii ; Gtc or tix ;«tra a^ be 
Kiaaiidilenly Bfitcd vith wnkiieH mill lot* of coMciousneas. tof^ther wuh 
lliOiLB>aof llie liiiibt: this, liowrvcr, diwippcftrrd in nii hour, llt^badiiutbecain- 
tnii|ic(BlL. Three yean ugo he fell Ironi a Ircc, but after Ijiiii: fur a ttott tiOM 
uncDiiiciout ho rnpidij rFCorcr«d. Al midduj. on the ifiHt Junuar;, llic jinlieirl 
Taa andilailjr aeiMd «)lh pneumonia ; tic inu bled, llxd not bivu iklinwis al_ 



' Meta|!«T(HentBiindPrcuror, ' Ztlticliiirt,' tSjR.ir, p, jio) has alM comnd 
nlcalwl fuur iaataiicv4 uf tmntient inaoM in pncunioDin, wliicli, UoweTcr, app 
lo have eoininoiiccd at the lieigbt of the diiease and ef tbe fcTer, a»d Itierdisn 
liR*a quite a different BigntflMLian. 



TBK CA0SK6 OV IX&AXITT. 



187 



naw, bat on tbe ibj bebie bin adanU»!oa be sfaovtd ajnpUMu of deraBge> 
9tali during the uiglit of tbe »oUi — lltt \ie (poke in ■ mon Uxttj tauotr 
ikuMul, u>dontlMMonuii{;«f lb«ii»l,wbilebeisg«oii<r«^ta Uw bniiiult 
k wmCTCBd to bs dcbrioDi: be tcrtuDtil ta Uie r«bicte>a»d ha neiU* 
■nt i uwMml a* lie «p|irat«lied llic towu. On Lu nitnaea tolo tb« diniqw, 
Ik «m ^dils TcJd tiT wnu. lodied perplriciilj iboul, kbetcbed lui imn titidlj 
Wore kiM 1 liii \iM>A» ttaiAtA ; be ^>e no aM *er», or if be did Uw-j were 
^uic ineohntBt. Af(cr a Cc* boon he [aiiliallj rcotncred bis tviucs, B&d 
etakt far Ue £nt tine, be nintt^l; exMiiiicd. Hi* f«oe «u mote tutbtd 
tbm tl«nng ibc driinun ; poke 70, full ; ili« left jnpil aivn dieted ibu tbe 
i%l4; Md ibn left tide of ibefueMeroedeighily pml^Hd. A pbyiied ■■'«•. 
lylhw molted in lbs dlteoterf of pMunouia of nodente exieot of tlie right 
Itiirer totie. vfliioui oonptcte dulnewt ; olhcf o^uit Bornul, urine fnc trem 
■Bwim or bill-, tempcrKture 3lt'4 (marktd r«iiiiMi«n of tlia fcrcr on tbe UUi 
dn o( the ]iwanona). Oo tlic foilutiiiiK dtj. tlic lem|>cntBrr liad iacreued 
tmm 39 7 in t)ie muit.in)( to 40 T in th« eveaiuR; mukcd ercfal&tion tii Ibe 
ntU luff 1 tJK (Kieuinotia hu not citeodcd. Tbe pubc vu jn tbt maniag 
01, in (be rrminf! leS ; minnlioii 3^ — 44. Tlie jiatieu is in ■ Oale of ton- 
•tMt nulenl at*i<Biion, eonlinusllj atk* for tooieihing tiT Otlier, b imt*Ue, 
vdmm m-iyil'ui;;, un) ver; rmrtlj ipiits k comet utwer. In the erening hit 
ttato fMMd iiil<i complete ntaie, to that be ImI to be pat iu(o tbe almit- 
jMict rad bla ■ ceil ; en thU befac doiw, be afaowed gml acvtcncu of Ibe 



On tbe werxq; it tbe a^rd, the lempenture bed spin Uln to 38, vid b 
lbciTe«ni(rio 37~S: tbe perc«M«OBnUeveitoine«bit clrirer: Ibe crepitatHa 
djw iw p l "^; pulic Bootee. Tbe pktieat wee alill delirious, bet not mi rciticu- 
(re^aeMlJ; gm tomct wiawcn, »leT>l occntionilljr end *p|iesnd tft; lired! 
Dtti «■ tbe fiilloviag 6»y, wbtle tbe pneunonie bed conipleleljr diMppcend, the 
fstint f\bibilol total unfueian aad abeeiite of mind ; denng ncvlj tbe wlwie 
of Ibe e^hl be MB ■bo«1, drftvinj; off end en his ehirt ; xirn no anscr*, er if 
be doce tlifj ere ifihe ineabeteiit. The lenperMnrc could not, ia tbcae cir- 
foaalnMea, be taken. Tbe puke vei ibiv, 6S -. Uie palifnt upp«arcd p«le and 
cellapacdi the Itft pnpfl Mill mcwe dilated tliu tbe rif^i Lbe left tide (i| 
the bee aliRbtl; fvraljMd ; uq Irare of paralnii of tbe citrenitiee (tbe nott 
|]iBbebli eMppeeilion «o«ld be cecepbalilic IsBmnftlioa oving to tlirontboali 
eftlwiiMn). OntbcnNftiiiiitortbBalkb, aflcfflbeiielkirt bad Bpent glMoil 
tbe wbolefeicbl Muubn-;, creelttlrnMof tbe lovereslnatitiet op totbeaaiddb 
ei iJw tbifh «u (oiiail (ibrambMit ol lbe ervnl T<ine) ; lb* tffiffrtlMfTi w 
Ml eo bifbi pnUe 1141 lbe audiwimpuUe itraeg and full. Tl.e |i*lmit 
teas Wn, awl foJi ; bat be leenis aa if tbe *«Marul imprrMioo* wtn Mt 
dabontcd: br ofitUnlij looks arowidbim rith aoaxomabed ivprtaticB, ud 
^^Upite «>lhout intr'il lattice (lofusunt twnnac-, a bliiitt). 
^^Barinf the noit c^>t dajt, tbe tcntpemtuie— wiib nodrrale vuialioM— 
^^^dnallj nhk to Uw noratal tUndnrd, tbe adema of Uie lower eilnmitWe 
B dbe|i[— red, BMW and then perejiimtiona eecKirrtd, Ike pulae reniaiotd between 
' <4wd8a Ttwbxalijmptomi of tbe pieniBDnin bad quite diupfewed. Tbe 
I diMider eaktinoed, but varied in i>tcBiilj. 8o«aetnnw Uw |atitat na 



188 



TRB CiLDSBB OP tKBANITT. 



•eatopid lud coiifuied, lli&l he seemed to Late entbcljlotl hb MaM«; aoneUfliM 
Ita •umed lo uncleistaDd Wttcr «1iil hui mU to liin, ind lo cipms kinadra 
link Tnore coiiiiccUUIjr ; KomeUuics be iru more oKoitcd, woaU McapeiiAo. 
Now u\i tlicQ he imd liaUucUialioni— uv flguru, bcud Qtias; ftc. Hi) >[>■ 
pMiroiicv WHS lliul of otjB wlia Itadasrriauft cerebral dueuc: tbccje wa^ fixed 
ftud injectftli tlie loft cjctwll wuKicncirljat more pmoiiBcat Hum the riglil, uid 
turned filiRlitly mwanls ; the mjdrksii oaa much dimiaisbed ; Uh toegue for 
ttverol ciaji inclined > little to llie tight. QmiaiMj ibe pitknt eowmeaced 
to walk about ; bul lie t\mji tilagticrcd, anil, wiilioiit any s>mptoinB of pm^fsb 
of lite citrciiiilics, it vu remarked lliut lieolloved the whole ol tbe l^ft side lo 
baag RomcwIiBt. Tito paiicul rcouiued iu tlii; diaique uolil the loth Haj, 
t8gj>. Ho miu at lliis time Rnlia'ly witliout fevcrislineit. ilia mental itale 
waa nt lint tliat of profound, and ariRcniudi tlint of dcclinic); dementia. At 
Ont lie was rjuite etupid, quite incapable of deliberation ; lie spoke none at all, 
or aa if lie went iii » dream, and i^ucrall; about uoliiiug but ealini^ ; it tlie 
Mine lime lie afi|H<an:d to bo in great ansict;. B; slow degmi hia meatal 
■lata coinmruef d to improve; he became cleanly in bU bahit* ; ou aomo daj* be 
gave correct and on oUien retj iocorreot aiiairerj. Bis bclisTiour owtioucd to 
Iw verj pliildisii, jcl il gnidiiidlj bcPimo more chfRrful. Tbe Bjmplams of 
wenkucta of the left tide ionprovcd ijnilc naalowl; and ineouijilcleljr us ihoseof 
the montal disorder ; crcnatlho dntcoflhcpaticiit'sdismiajBl, tbe left pupl naa 
■lij[bllj dilated, the louguQ inclini^d sliglitl; lovords the left side, and when valk- 
iug Ibe loft aide of Ibo bod; w.u still a little dcpendoul. He oriCD complained 
of tiredncii aud of frontal headacle ; occasioaally also epitljucis occurred. It 
vaa a verj remarkable eircuuistanoe that, ou the cesaation of the fcrer, poljuria 
set in and continued for «evRral weeks; the pale uriuc, Mio quantity of wbicb 
sodictimrs nniouiiled to 4D00 C.C.M. in the twenlj-foiir koun, bod a specilie 
grovily of 1006 to too.S. The ordiuar; ausar-tcat afforded a uef;ative 
A miuute examination in the clicmioal iaboralorj showed thflt it also coal 
no pboaphalcs. Tlio palietil Mxnctitiica coniplniued of stigbt paiai ialbc 
of Hie kidneys. Thia diuresis disappeared during the last week i>! bis rteideoce 
in the boipilal, when alao tbe uutrilioa bceamc quite nornial, and the |>ati(at 
quite well. On his diAiniual un the lolb Mar, lie undentood all that was sasd 
to biro, nod could express bimiclf quite correctly, thougb with a little hcstta- 
lioD, OD ino«t aubjcci*. He oolled about fourteen days afterirardt, tui there 
was no allemtion iu bis mental atato. 

Aeuti rheumalitm, like pncamonia, causes the devclopmeat of 
mental disease but very rarely, and we ftliall have to conceive of the 
relation which cxUla bclwecii tlie insanity aitd tbe acute diseise u 
eomevhftt difTer^nt from that jiut spoken of. It appears, namelf, 
thftt these uientul diaorders ought not to be considered as seqvela 
or teoidente of convalescence, but that iLey arc oiilr a protracied 
form of that ccrebrul nITectioii appeariag in various form-o, nnd in 
ita acute dcvclopmeiil often so very tlRrigerou!^, which frt-qucntly 
ppcwD ia acute rbeumatisDi, cither simple, or coinplicatcd with 



ipeciGe 
r^on 1 



J 



THE CAUSES OF INAANITT. 



189 



line inflnmuiationsj wliicli Icuvcn bcliiad it no <U>finiie nnato^ 
mieal diaoges, aiid tlicrefore is most conveniently ilv£i<;ii!itcd rlcu< 
matic ccrebrnl <ii5orcler. The acute cerebral symptoms consjat 
here KtmetimeK iu acute delirium aud tnniiiacAl i^xciteniciit, uliicli 
najr tereUDite in dcnth or £ooii disappear (in oilier, etill more 
sTTJoos cues, the syiuptonis arc chicBf lliose of coma). Sonietiuica 
— and these arc the cases which now occupy us — uudcr tlic influence 
of accessory causes, we fee prolonged melancholia with stupor, 
mania, mental weukness, &c., occur — in short, the developmeut of 
nclual mcnUil (liscaFc la various protracted forms, sometimes iisto- 
ciated with cliorea-iilce attacks. In t1ic«o as in the acute cerebrsl 
fonas of rhcamatism, we frequently sfc the articubir aflection 
dtiiuai*h or even diwipiii-ar with tlt« ap[>ejirance of the mental di»- 
turbanoe, and occasionally there iii nn alt«rnat« improvement of the 
one and aggraralioii of the other, sometimes cvea a decided relru> 
gressioQ of the latter on the reiippearance of the former.' 

£]LUiru V. — ComtnttifmeiU c/ innrmly during aaile rKemualitm, uUk 
4MffMtraae» of lit arlicultir affifeiion ; mental improeemeMl leilA return oj 
flu dheute is lAe JaitU ; fitieluaiing tlate; rteoBfry itt aloiil {hm mitHtht. — 
K. D— . stt. 50, a ver; poor uiiniarried woiiifta, wu on llie lolli of Marcli, 
1S5;, idmiltcd into iLic diuiquc st Tubingen. Tlic TolloniD^ ma Ic&nicd con- 
cerninj; bcT :— IVeiily yeare njEO, irtir Ler s(>cond conHncmciit ibe became in> 
sane ; sbo, liowcrer, reoor«re<l aFtcc llir«e luoulliv, aud siiioe tlicu »lg« bu given 
birtli to anoilier cliild wilhnul anj conscnueiit diioriltur. For the Inst (en 
yckrt »lio liad Wen in the coniinuous enjojiinenl of gQod liealtli. Abont roiir or 
five weeks ago slic suddnilj liccJime dl : at first alio ouiii[ilninc(I mudi of toolli- 
aeWt ; she bceatne fcrftrish, and man; of the jointi of Ihc upper and lover 
•Xtnmitie* bccsmc iwollcn and painful — aculc i-ltcumaliim lind ict in. About 
ten dajs after it« Grst ippoatancc tilt articular alfectiun diuiiprurcil ratiter sud- 
ileal/t and at tbc tame time Ibe pnticnt bi^omc mniilnlly di^mngcil. S^lic ^lu 
ilGlinous, underatDod uotliin^, altuciicii tiioac about bcr; wm Mjmeliincs vcrj 
i)uieti at otbon very loquactcit^ ; rui 3>bout eryiiig all iiiglil ; urnrelicd out all licr 
eflecIS) aa<l tlirew llieru about: in short, slic bcliatcd in all rupcctt like an 
iuiane peisoo. She »Iept and ate very litlle, driuilc a great dea!. and occa»ion> 
dUj- rcjdied in uswer to iiuestiouti put lo liec that ever; pait of Ler body was 
I«ktfill. 

On admiuion, t!ie patient, who oas verj ttrong for lier n|rc, appeared pale: 
■be WM ptrfcctly free from fcTCT ; bad no oardiau alTectioD, tier pata iu an; of 
Ibe jolats. She wu iu n slate of wt-ll-miirkci] mcliiiicbolin with klupor (itieltn- 
efaoiia attonita) ; hci took wu .%liy mid onxiuus ; sho woi quite coucentisted tn 
kecBctr, Mdcvideatlyin a state of prolonged dreamiiig; shCApokcvcrj lillle.and 

' See tli4 aulbor's piiper"Un llic Protracted Form of the Rlicumatic Cerebral 
Disorder ;" ' Arcliiv der Ueilkunde.' i, 3, 1860, p. 235, 



TUK CADSES OP 1N8AN1TT. 



r. Ste Tfir*Wir* a ikis iUl« for Ivo ibjs aflec liet adaiaJM. 



Ob iW MctwJ ^ (isik Mafdi) •!« (kcum ■nramilBM, aail spoks omliw 
OM^ dwBf Iks tMc of the nsfak la Lh« itKinuiig> absapoke fsenenlljB 
Afwm: fat «M»»fa. " G*d kmn wW t trj Tor, He »«» wlut I erj lor, wj 
B»hii»ypf«3ir ahill I im Hi« tlww g* >c. Ifuring the ristl, abc Vntt 
■Ma IB Biihwrt of upr, aonnd ten ptMant of hiimp tik«n her cbildm ; 
ala had ts be edalMJ M & rdnMoty wU. 

0BUNt4tiHvtkaitBaaa(thBkMMreureinttiaKtia: IhepalicDtmrrae 
5a« fam; iW fabc aim: bomU coiulip*lcdi nriae free from albuniM. 
Duii| Ike iaj ihc vn «Mdh qaider, ilw had •amcroui tul'ucuwliau oJa 
^May efcfirtiri ihfii Ue liigki ibe ^ma heeuM exeiud. Duriag lU 
Mvmagdkp Ikt •dMnofUie feet bunuedjaMl append •Iwia llw faandii 
n tka iptk Ikfiv afi(«>Rd, logrlher with iheiBdfiBt,radiicu aod twdfiagot 
tW fagcr-jaiaU, vbieli «cre Tcry MaritiTc to prmure (onl; sLown bj !;(*• 
taraa) ; llw rigkt uUt^jabii vaa kI>o Tcrj paialiil on picsaurc. Perenuin 
ami Mfihitiaii of U« batt aad orgam ofretpiiatinp »lii>«ed not the >Iiglit«tl 
cAMgei palaa 84 Ml; akiidif ud vara; appallte iHDderalOi bowrh rrtn- 
hr. Thl (tliort k^ b bed, mb quiet ; <m heiiif quutJoncd, ati* gmtnll; 
■adeaawylj— «l inoricwaaioDaBy, agdJowlj, yeaotno ; ibe plijiiogtmnnil 
npiiaiina vn tlial vl iaitSentm and afiaUtf ; aov aod Iban stiBaaardied Ihe 
vrfl HMud Wr br^ and acana ^tc lo a dmm (Nitnsij). On tbe IuHm* 
bf ^j Ibc pain aad satUii^ of llw jaiuU bad a|t«JB almMt diaapprared ; Hk 
»pi» brtameauidi mott rrtllfi, *<rj lalkatirc, tkid ihtt bcf ehiUrrn wereoul* 
Niewd Ottjrfcl to be beheaded, Ac- From this daU, 30lb>Iutb,lliepal>cnl con- 
timmi bifeiUte vbiehltvouldbeDodleMtodetcribe ibj b; da;. The rtuit- 
■atle aHteuUr afMlkm ncTtr ■ll■tlll^J lo mnj gR*l tuieiiiiij. bol thmtt tret 
rm|«eBll; a inoderaLe drfrct or avHlinjc and at pam in certain yninta nf iht 
bcm aad feci ; ^le Lficn eoMipluanl of pain in Ibe livlia and joints, tad 
ofaliAiniof tlicvbsk bodj. Shewn coaaequentlj alwoat alwajs ronHnnt 
lo bed, but free (mm ftmi tbere irat nerer an; oardiao diurder ; tlie urine 
enuiinucd iK>a<«ibunitj)QU); appetite and fJerp akiwij nnuriwd (Culeiijciin) and 
0)»um)- Tberewilh ibe palieat, wjib nanerotu jnlermplioos of rcaileagims, 
coufiMton, and lu^nacitj, becane gtaJnaHj more eatn anil more rmoBablo, to 
Biaiiirm a mora lirrlj dbpoaiUD^ and b;>aod>bT ooniaiciiccd lo do i Mile 
work. She bad nottbe ali«litesl iMalleetioaol tlifBret period of hivt naidaicc 
(itbe JKWpilal. Bj 1li« nkl<tle of April llie palieat d^uld be coeaidercda* 
quite leeovned in miuij : for aoine lime aflcr, liovevcr, »lie ooeipUined of fre- 
i)uentstuii>g%giddu>eM,Bndrin(ttiigin the eat»; andtrtM^of jiaiii and swell- 
big rcnaiiwd is aone of tbe }oial4 nniil Ihe bcginoins ol Maj. tlieas were 
diapelled b; tlie jndicioa* me of baihs, and on the lath May the patient «ai 
diaviaard cured. 

Sxxtns T[.— A delicate bdj. 30 and odd jMra ornffe, «)>o had bltlirrlo 
onjfljrd f;rxid brultli, «as t.cii»c>lial dcbililatLsi br lier lut oonflntmcut, bii4 
had a Icdiooi rrcovcrjr, oving to an alUck of articular ilienmatiam. ModiM 
hjdioiiatliio In-ainient *t»» eniptajcci — colli fumnitaiion at llie affMted parta. 
TliG pain and ivcllinz npidlj disappeared, nod Ibo limlis became free aiiij rnov 
able. But inintcdiatclf ahe began to ooniplain oF drawuig [lains along the apinc, 




THB CAD8B8 Ot IHSANirf. 



101 



lad ■iKtehing, tlniain;, oecaiinntllf j»k>kft wweneiU is tlic 
olicnntie*. At Ihe tame lime llictc ii[i(«arcd in ■ few dajs a •tat« of mciiUl 
d «pniM i nra . ■hich rapiiilj; iDcreuni.anduaumcdliwfonBofsjiathj.and IIii4i;i>f 
ea«|4EUi tiuenuliililj. Tbe patient wu aowcoDdnod tobrd; frU ditiacliacil to 
moft, to dreu ticndr, aad even lo oat ; ftlie was nutc and jodUIerait to all hut 
rrrj' tlrang iBiprrMioN; ia a aliort lime aha prcMoUi tlio oharMterutio ■■»• 
I of nelaacbolia attonjlii- Tb« vbote exprcwiOQ Mamed Im to betnj 
1 paia than oonplete iadifferenee (eTen to ordinary penonal dctnlioeaa], 
lagtlbcT witk aa ar«nir>n to all kinds of eicilemciii, wliidi was mauilutcd b; 
ftionit ^iprcuiona of displrasure (thro* iiix, Mnkinjr, ^-)- 11ie diaose tcr- 
wituAed hvnrMj; llie patteat ncatend cmilcr llie iofioPBre of batb on- 
UttuBg Halt and tall, as imuc ia Uie ucck, tjiag bliUcn appliod to the H>inr« 
aoeniU with gaaiaeusi, and aficrwudt Ma-bailiiDi;. — (IkdUBkig, * Fi^cboaa,' 

UenU] disease lias aluo been observed, though venr nrel^, lo 
originte rspidly after tnuiUpox, measleit, aiiil fTy*i|)eln« — indeed, 
cmi aftrr the ncute anginas. Thtst iv^cmble the coses uccurring 
mfter typlina fe«iT and pm-umonU. Iti all th«se caan, htrpenetDta 
of tlu brain, and oocasiooaUy aUo tiiromboeis of Ibe BiniueBj my 
pU; ao important part* 



( Io6. 3. Ciromic eon^tUiitioHal <iittaM* yttj frequeiitlj^ cau»e 
the devtlopinenl of insanity. Of thew, we may pUce in ibe first 
serin all states of ncaknca and of uiiictuia rusulting from great \of9 
of blood (in cbildbirtbj for example), frocn continued hunger and 
■liMiy, from wlf-iiiflicted fantiiig (religious oicpticiFm of fonaer 
lima), after too prolonged nursing ; finally, in con^fquencc of the 
nooi variotu general and local niiilndifs wliidi iuijuiir digcstioiij 
blood- fiKtnalion, and nutrition. Aonmis likewise plays a rery im- 
portant part in the production of a numbiT of other itcurowa ; aiid 
ve >c« that, even within the limila of physiology', a bodily condition 
in wfaicb the nDthtion it lowemi rendcn more easy a state of irrita- 
tion ia tbe functions of the nerTous jystem, more or los disturbance 
of limp, &c. Of all purely physical cauaeS] I might almost attribute 
lo thcae Tery rarioiuly modified uueaic itatea the grfateal wetgbt in 
tbe prodtiction of iujaiiity. Tliis view is cotifinnifd by tlie fact tbat, 
m the great majority of casc«, a nutrient and re^Ioratirc lieutmeot ia 
followed by the best results, while an aotiiihlogiatic system of treat' 
Dent aggrantes the diwaw. It is evidt^nt that the older pliysicians 
bcld tiw aame idea whcu lliey apokc of the " uthentc nature" of 11 
great many mental diaeaaee. 



193 



TUB CADRKS OP INtAKITT. 



The cues of 'ui%uuij eoawcutive to Mute diivMn Monfr, m farnurlj 
mukwi, in a grot mrasuro to Out mkgorj i Vkewiae muij cu^ of hj^e 
■wnUl Akuc : Uie prtnliaritics ud ofiricci of TC17 cblorolic indiriduab I 
come freqacnllj gnduallj deTdoped to koluil mc&Ul diaorder. UormrrrJ 
b quite tiactxtUB vbcllMT, ia bU IbcK cues, tiuraui of tbe bnia a to 
CMoidnMi u the immedLite determiiute mdm ar llu insanity ; eraenl ucn 
naj be aooonpuued bj Imuient and erea pcnlaUnt lUlct of coagcalion 1 
Um btaln, ud tlw Int is tcit frcqaentl; ttta in ita(e« of nerroaa and dkoUI 
cxkltation. 

Gw n ft f «<igi n if tyfiitw does not TOuUljr lead to iDsani1> othenrlm 
tliun tlirongh palptble diiwei ot nutrition of ilw skull, of tbi? brnin 
Qitd of ita inembniies : in this Klation. hovcTer, it merUa nrf 
•erimu oonaideraticm. These dbcases are {HrriostiUit vitli slight 
inflitnmatioD of tbe dun roster oud delicate membntites, itt^oc 
chrouic mcciogitts uxi cnwphnlitii ; Actukl exostoses of tbe b«i« 
cranii have al«o berii fouiid in freiicxal paralvau, Headaclies of lung 
atunding with uiglitljf eiacerbatioo, nScction of the nonl boucs, 
superficial tophi on the ikull, uotl tlw n-ell-kuovn s/oiptonis of 
constitutional sjpliili^ ia other parts of tbe body, render (he 
diagnosis cotnparativdy simple. 

Sm tlte srtide b; llie nulhor, "Dii^ioil. BemedLunKen uber Hiniknnkliei- 
(en" (' Atcliii' der U«ilk.,' i860, i), in vhicU n rare ciuc of true >jpliilitic me- 
uiugi lis with d«rnoiitia ta commuDicnted. Kcaullj (lie opinion has been ad> 
nnced, ibit 4]) ibe cue* of genenl pnrnlf sit of tlie inMiie ilk to be ucribtd la 
tjrpliilia— ■ rerr itnprabkbk usumption, wbich, bowcver, ma; do good by 
Muiing in future mora at leutioa to be paid to tbb important etiological cir- 
cumstance. 



OtDflH 



Tttbercvlftr eonatituiiQiiat diteate apjKors Lkenisc to be sotm 
times the cause of tbe developmeat of insanity.' Isolated c 
considered as cases of mental disease, even come into tsylunn in 
wbich mt-ntul disorder (not generally, however, withoat more or 
IcM coexisting motor}' afTccdoii, sometimes also vomiting, &c.) bu 
beat caused by tabcreular deposits within tbe eraniam, tuber- 
cular mi-uingitis or tuberculosis nf the brain-subslancc itself, 
or even bj slight basihr meningitis of a somewhat protracted 
tj^pe.' Cases of recent incnt.nl ilisease presenting indtcntions of 
contraction of the thcsl, in which, on csaminotion, pulmouarj 
tuberculosis is diiicovcred, or even only the probable icmutns of 

' Vte sliail artcrwRTils i[)cok, in tlic (uurlli buok, of tbe oocurrencc of luber> 
culoais in fttjrlums in lliosn nirmiily iitiianc. 
' L. Mcjer, 'Zcitadirifi fur Paycbinltk,' xv, 1S58, p. 713. 



cursES or isbxm. 

tanpeAj exirtii^ tubfxdei, 

eoiuidentioii. AH tlsae cases t gTi'ii^r Sob nnnL i mns 
Ot&aAj, hcnrerer, tniwRBka ad aBscj aaut 3l iui*rjmm 3^, 
tion to each otha, and the imKn w^y^ s. £> iiloum.,* nmmB 
fonna. StMnttimes maital dacf d a a aspc^ a ^ ""■■■■""-'*'—■"■ ir 
faring the earij st^n erf [■***p™» essbcbul -vims » i^ni^^ng 
Bot discoTCied. Etoi later, t a a tt^^ ^m -sm ~sm keuw 
obaerrer I7 the nn^tom (rf ihe ase^a^ M w^ i a Jmfe -loa 
tecogniaed bf the inoeasng ■ani^iB md. itaat n^ ±jic if 
c^edal intenst sie Uw eaas b «1k^ «a vspi^ if ocokk 
en^estioa, mpUnrfaoKa or h^b oobs n BKnaais «i» s vs 
pnsent no cotam aynpli^H of p^b^bbt ananiaBi: he idi^ 
the BMntal diander haa existed fir a Aoi ok^ moia ™ mpm»» 
tf jdithiais ma/ be rwngnwwl vidi vizA ac ^nvTrrt: sessmet shir 
free and dearer, and the Boriad BeBiI mt^asaa inae^t ir 
altogether dia^ipear. GaMxallT, in Aeae oaet svina.^ t™»""*'_; 
bu been cured, the tnbcrenlaai raas a a^sd aid iiai. tatatz 
nererthdeaa, enu hoe a mmjirtr ancM ~<a>^ ^ ae 1 ifiiia iimm 
proeeas aometimea takes plae«.* Ihe rmtiimmte di oc y iifaga m 
of mental diaease in socfa asei caBiel t^ ^ **7i'«^p-f ?!g- 
explanations by " crisis" are mr proptx^ ApAiarf. Ir laer 
caae«, alao, the inaan^ ^ipean, im the £« taae &Bav "it jkuz 
stages of confirmed {ribthisis, in the facB ^ ■■JMafmTi, 11 aont 
freqoentljr as maniacal attacks ; oecaacaaOr taeK bus dor &b 
appeuanoe sbottly bcfisie death. In Ae bcr ^xsatle faaea -:/ ^u 
Innd it generally happens that the leadbag ivBpceaa 'Y & joaiau, 
the congfa, expectoration, &e^ difpear ca tjse oseceaic '.f ^ 
mental diseaae, and even the uutiitiu n di^t^ isproTf*. 

It hu not been prored that the inaamtr vfaieh is wujm^maiA vt 
or developed from tabercolosis }KescDt« any pceaBv oscKVr. 
Jacobi ascribes to it a certain c^ricionama, a ati'iiaii il SKsudeyA 
between extremes. Xenmaoi^ states that, from the vmaus^xmtst., 
tlqiression, self-absorption, great irritabilitr and i^tmuua&jX^jrjKL'i 
and tendency to swear, are present, and that at a Loer yarM a ^x*. 
gentle disposition ia developed ; but theae charKterMJca u*.\it ut 
means constant. In diagnosis, the pbyncal sigU) in 'fica^tX^Mi 
vith any hereditary disposition, the history, &c., can i^/u-. \^ 
riii|>loyed. 

' 'Wiener Bericbt'(Wieo, l»J5<»j, p. 55. 
* ' PiTchntric,' p. t63. 

13 






tM 



TBI CAVBES or IltSASITT. 



I* atMa*kidi(HMute«7 ohnmUom Uie serions oeretinl iffcetica 
«Bh ftaa^mk ■w il l l y ptoiM, m an iodivulBHl ia tfct Uot tUga of pbtbiiiK 
dBfniW M A 1b|* eoag^MB a tbo uaw (see ' DiicikmI. BaMAnofcca vbti 
KnkmUMtaa.* p. &4V Tte tirotit iasuil; vhicb i> ierel^ped io Um nf 
wa hnt dMcribed ia pMUmmmI ptraon*, «i1bo«t palpable dJicm oT ttc 
V ta be io wweeHii vitlt tfaa genera] conatitiitioBal diitin 
, h pMMM f— JiifBieJ, gmtt iwmmt ictkabiillj, foAaft ibt 
toi tkt cttHUaoa nikia tk« cnaiiiu. 



' im»aait/ also, vfaich is met viUicspedilly in Northen 
fidjr. vaU, toootding to itcsit obwner*, also in ootain paiti of 
Tmee (BaUM, Angen, fte.}, ■pfon to dqiend npoD a ooiutita- 
tional dimue the ipeeul tttiM of irliich is rtill untrnoirn, but vhidt 
is ft""'*''**-* (•rtkatariy by so errthHiiatatn exantheniaj chranie 




b » ftfi iBmnUc to domU the (paciAc utar« of polbgnt bnl I 

it v^ lite tW MRljr pMug view of it whidi I obuioed io lk| 

oC Kqctkaa Batr, t» tbttifa bmn any diaruMieo on tkia lubJMt 

ibMsitr, w c cr j^ to Gkrid (1855), cooMrta eUtfl; in ^"Tigwv 

I ddkiuK, accMifiBiBd bj itepor. lonof nnnorT, wid t^loqaaeiir 

■of h li « gw n i«rTklt«»a—«ii;" tbe ndaookiGa 

br ■ l(»g timo ilnTi ptMM gndnllr into ■ atale 

«f lorpor «f il tte aaAit pcnn, vitii museolu Teakseu wfakfa gntiHj it- 

Ikt ori^ of Bntil 4i«Mden ftom the tpmil inflaeoee of jMif, 
tdHdiC pwAn* om bt lui OUIkwm mppevi to We « ^nart infauoa M 
1fe« dl^M&ia^ ud vt tcw M tiaeB we acsu KfcrH jmii acoomiWDied by 
Tiakat daWMil Vilhoal UJ ecnlinl ditiiga. C^tDCcniuie tb« iaflaeaee of 
t hal— j l aMaa m tba pndactna of cbwie tSMaitj, no dcfintta obaonltOH 
mnnawd. 



f 107. 4. Among the tiro»ie laeaj Jitorien of the tbiiod* 
organs a oprtjtm inflaoKX mnjt alwajB be aUribated to dueafes of 
the bouti alUMMgli tlus dRamstaace doe< not seem to act vitb any 
•pedal froqM&ev. In the older pa^rchologicaJ Itleratare, tbe in- 
Soanw of oardiao disMse b evidenttj very much over-estimated 
(Kuec, 1818, and othcn). Obserration ehovs thnt iii IbeOernui 
asj^ums Ctxst arc uot many incUvidoala with the ordinaij heart 
affections, such ns those, for cxaiupk> which are prodnoed in acnte 
riwunitinii. Certain cxoeptioiu arc, indeed, more apparent than 
real. In the inlerceting reports by Toppd, of the autopsies in the 
BBflom at Colditx,^ for example, heart diieascs appear iti ratlier tti|jh 

' laonasf tfaeae repartv<>f la ixut-iiiorlcm dAmiiutioBa, n oaici (ifi |i[i 



•m OAMBH OP IMANITT. 

popQttioti ; but amongst these tbi-rc nvrc & grcal Dumber of aged 
pitintta vfao had been long resident in the a»;liiTn, unci eren flight 
duges ve there minuteir not«d. It may be tlint manr, eren of 
tlie moeL Mvcrv, of thne licart affuctioits wero of long rtandiiig, mid 
VCR connertol witU tbe production of tbe insanity : for the great 
sajoritT, however, it may certaioly be aMumed ttiat they wtic do> 
rdoped daring tbe existence of the iiuanity. 

Dm Mae rcniiTki apply to tLc atatcmcntaof Tjcrmsna, who, ia Cnbcy 
Hmt. Itmui ckKliao OT ndrulur [lia«ase in ) of the female patients. Sliglit 
■Mttonal tnitiWIi^ ii^ it m tnu^ paouliu to mftn? pfnona affected iritli licart 
dBMM t but *e •bonld lot thenTon conclmie that th«« diseuei have a Rreater 
kdatttot oa tbe derctopiMot of inMmtj ihui actual obienrstiou denonstnitea. 
Tbe diagDoaia o( heart diseases in the iniaae during life b rendered more diffl* 
ntl (»mi Uie »talitlica mor* uncerl«iii) hy the faoL liial, w. sUtM of exaltation, 
cardiac BiiBuai capccUIlj of the aortic ralroa, are vcr; frcquout vitliout auy 
TmlrulardeSeiMUyCff loner liericlit,' 1838, p. 58). Con M nun g I lie frequency 
I J iliiiiiiriii T\l the beart, ato alto Ihe alatittiot Riveo in Ibo Fourth Book. 

Diseases of the arteries in the form of the *o-(ftl!ed artmtit ekroniea 
(fitty degcoeiHtion, athcronia, calcareoua deposit, &c. kc.) exert a 
nndi grcaier influcooe ; ami put of the bcHod, too, which i» attri- 
batH) to faeart diansa ovgbt to be referred to tbe arterial dcgenc- 
mtion which bo freqnenUj accompanies them. This degeneration 
GMues ditorden of the drcoUtiou of tbe most various kinda— local 
uuetnU from incrtanng diminntion of tbe calibre of the utcri», 
enoplulitic inflammation, and, a.i it appears, various changes of 
outritioD of tbe cerebral substance, not yet knowa iu dttail. Pinally, 
pocnl maiBSuiU!!, nnd the early old ngc which oflcn rcsutte from a 
bigb dfgree of alheromn of all the arteries uf thu body, may ood- 
tribate in a high degree to the development of mental disordcn. 
Alberoma i* &cc]uciitly met vritb in the cerebral ailerica of the 
bume; and even when the larger venels pre-srnt no marlced altera- 
ttoo, tbe uinate branchea may be profoundly degenerate. Therefore, 
■UtHtiea of the dtMaats of Uie arteries of the brain cannot be 
girw. 

AiDODgst {mlmonary aSectiotis, ■ certMU pathogeuetio influrace 
Duj perhaps be attributed to catpiy$tma. It has seemed to me in 

^^■|pL)i IB auotbor ('Zeittdirift (iir Pajdiwtrie,' 1855, Tii, p. 393). tliKht af. 
^^Bjooa of Uh yalfa oecured ia ]. nuricd cardiac discuc in ^ of tlie cam [ 
^^Bbd rapDrl (Guntburs. ' Zellscbcitlt' tii.1866, p. 179) showed alto a ooa< 
HKmUe nnU-r. 



were coB- 

of Ac fc'<«gf nd lit 

the ■■uHiuiu frequi^ 

ilidf, eumot 

tktf the coqihjrmi 

whu^ WIS raUf 




beditpated tbl 
iOftheoldff 
in the po*1^ 
fc-^ — gateraBj tffn- 
iotttttdLmmin, We m^ 
■ to pMfd ■(■iiir kill ■'■(. vitha«^ cane^ bom modente diaoi- 
ia* at S^aAoa ml ol the bwdi^ bom the — trtinnt prodnced bv 
the iil iiH i 1 oHtati icMong tog laeia theeokn^the ifaik 
eohm «rihe faea, &c., th* entaee of palUogiee] Btirtc, oT whvh 
» poMtiR pitholo{7 ban nethn^. Ve da sot den; thai diacHe* 
flf the Gtk MLf iHpede the anub/aou, nd that elso those di^ 
dsrageBents oi ogerfMn mbj aoHM^Bea iDnn the "itdni br wluch 
especially the mjorioDs inftuDces oC the monl causes met secood- 
ardj ■{too the bain ; and we c»B adiatt with Broosnis, as well as the 
Oemn ioDowm of the ioEucius theoiT^ that duorden of the boweb,' 
eepeekD; catanfa, nuv be, in ceztain eaaes, the oiigiaatuig rm mm of 
ecRbnl disease, and tberefoTe the ofajects of treatment. Only it is 
neoeHvy, on the oog band, to vmA upon a Qunate sepantiott of 
those intestinal disorders which appear as cooanjucnccs of an alreadv 
exirting oerdml disease, and tfaose which are really canst*, on the 
otiier hud, and princtpaU; to tirge a precipe aDotoinical knowl^lge and 
diagnoais of these chronic diaeuaa. All thevaiiooa orgniuc diseases of 
thelirer^^leaij pancreas. Ingeaadnnalliiitestiiie, oogfatnotptonis- 
enonslj to be raahed amongst bilious diseases ; «c most remember 
that as loDf; as a ainatc aiuttoniical dia^osis ia not made in ttcfa 
indiriiliul aia^, we have no certain basts on which to foand ottr 

1 WjlJii ninatM the murfcablo case of a joang ladjr wliow hrallk had bees 
iiadermined bj prutoogedaad Mven griaC After liaTingparUkca of sonie kit 
iadigeitiUa paatr;, slie wu tDddnl? acixed willi a burning seaHUioaiDtie 
canHaa ngbn ; bIic lbou|^t tlial tlie upper pott of l>rr 1»!t wm in dame*, md 
ran bio the street. Sbc had the idea llmt »Eie won very wicked, himI would bt 
dragged intu bell. Theae ideas atwajs returned when the Ml Ibc scaMtioii of 
bvrniofr. Jacobl, loe. eit,| p. Mj. 



THK CAUSKB OV INSANITY. 



lor 



I 



opinion ob to (^liolo^y or tn-atmcnt, and wc must not attribulc luo 
much signifinance lo lilt! inure palpable but slight disorders of tin* 
iateetiad canal (hfcmorrhoids, for cuiinplc), which onljr cause thv 
ot]»er more imporinnl circainst«ncc to be overlooked. In r^ard to 
the thcon- of cast's wliere chaufjes iii the abdomiml orgniis have lipcn 
found in the ini^ancaftcr death, wc musl refer to llm abuiidaal, et|>c- 
ci&[\f tlic older literature on this subject (for example, tlic work of 
Buzorini, and the serip-s of dissertstions ccimpoaf d nt Bona by Xasse's 
pufnla) ; again calling to niiiiil tlie fact tbat the siiapte coincidence 
of these distosex, wilhont itny knowledge of the ratioaaU of their 
reciprocal action, ia not sufficient to enable iliein to b« considered m 
cauKa of the inaanity. 

Cop/o-pvftkiatrie [(he loeretioiis of the laMiie], wliicli hns been der(!op«I as 
n pecwlinr bud ftoni llic stem of tlic " Soriotic Scliool,'' '""• — p"'''?. iniiwtl, 
Ibrougli the first ediliouor Ibis book— gone out of fusliion : it imj. ncvDrtlielon, 
periup)*till bavc BOnieadniirenainaiigst lliBstro^glcrtof ttie(tlignotIJc«7»t«m. 

Tlic accounts of caxt in which mental disenacs were caused b/ 
iittetliKal worwa (cfijkcciall j ta;o itt], and cured oil tbi-ir removal, would 
be very interesting and prnctirally useful, if tlicy could only benr a 
doaer inTestigatioo. Many of these cases appear very doubtful, 
others s(H>m rather lo riTer to n ultvuus excitement maintained by 
aniP-inia than to actual insanity : in these cnjirs, after remtival of the 
parasites, the nutrilion was improved and the functions of the nervous 
system rwtorvd. 

Tlie CISC comrnuiiicated b; Morel, 'Rtudei cliniqiici,' J, p, 193, ma; b« 
viewed in lliu light. — Eiqutrol luia cbicrvcd Ivucase*. Otiier ease* bavob<'CH 
CoinuiUDicntcd bj Oiritdiu, f crriu (' AcudLJcic de Mvducine,' Sciitcinbcr i^id, 
1834). Wor-J(' L(iiicct,'Ja"unry, iHr,i,iiiidolbi:rs). — Evcu coiigcniUI dementia 
i» Hiud li> bnvc been curvil l>j tbe cxpuUian of wumu ! 

^iaeesti tj' Iht l-idiifift and the anomalies with which wc are as 

I yet acquainted of the urinary sccrclioii do not appear to be of {frcnl 

iiDportance in the eliolog}' of mental diseases. Some enseal may be 

mentioned^ in which the insanity probably had some connection with 

an affection of the kidneys; but these cuse^ must be very rare, and 

Lit ia impossible to ^vc any particulars regarding them. No one 

Jd nnli the rpri-bral svniptoins in Briglit's disease amongst thu 

itui diseiucs : UrightV dii<cn5p, (o which any etiological relation 

' IU;«r, 'M&lod. du Iteins,' i. 1839. p. 53,1; Kriodreicb. 'Ailgemetne ?a. 

tkologip/ftK, p. .|0>. 



19S 



THE CACSK8 OP INSANITT. 



to inMoity coold be attributed, is very rare in the mstne, skliou^ 
the Blighter fomis of renal discuc, bd often present ia tboae BoOStnii 
&am mxriumiui, fee., are u freqooit in a^lams (in general pBnljn^ 
wuting dLecat^s, &c.) as elwrhere. 

Kaimuiui luia icUlcd a cue ol imwiilj wbidt oripnated ttoBg vHh diaktM 
Cf^ehktri^* p. i6j). la JtUuM'tdUtam then mgemnMygmt depreiiiia 
of eenllawfil, but lo aue of »ctul nnUl disMn la knoini to me. 

It u, ftt oil erentfl, rerj ^blcmatic vhotber iii» dutata hwe 
any pathogenetic influcnco on mental disordcrv. We have oot-i- 
days become very sceptical about tlie older re)K>rts of iuHUiity orip- 
natiiig from tbu rapid licating' of cxantbi-tos or ulcers of the Jta, 
General paralyas sometiDies cooimenecs wiLb erysipelas of the Malp, 
but it is very doubtful whcllior the cxantlieiD has any conoectioD 
with llie cen-bral disease wlticli succeeds it. 

§ 108, 5. Oo.\\w c*mlTar;j,ctTtatn dueateto/ the je»UalorgaK», 
and the patholopical influences generally which arise froBn tlieoi, Imve 
in both sexes an important inlluencc. During the period of geioal 
i]ovc1opincal> particulnrly ivlicrc there are morbid states of them 
orgiuis, insanity frrcjui'iil-ly arises uhicli stiU prracnta tho principal 
clianicters of the mental disorders of childhood. There fte- 
queotly occur in Ihtsr cases complications with epilepsy, or chorea, 
or states of anmnatnliulisiii — ciipricious mi-laiiclioly, or attacks of 
iDimia with suspicion. 

Cbscs occur, but only cxcqilionally. whrrc non*satiabc1ion of t)u> 
sexual functions and continence ought lo hm consiJeied as the chief 
causes of the insanity, k certain co<opcmtioD of this circiinuUnoe b, 
however, espixially in the female sex, not uiifrequeat, and it may 
be ^8 which gives a certain deKoite colour to dei-dop insanity, in ■ 
ksmuch Its the Iong-rep«!*»e<l desire now readily shows ilaelf ae 
Amorous end sexual deliriuui, sometimes ideal, sometimes nneon. 
eciJo<I. 

In the waU »«.v, all those disorders of the sexual fanctions vhich 
Are designated involuntary seminal emissions, pollnHo diuma, ice., 
arc of great imparlance. These anomalies, in which evidently the 
tow of the seminal fluid is in but few cases the main point, fre- 
quently (loiiend, as Lallcnund has shown, on local ili^afcs of the 
nrviiuul niticous membrane, the seminal vesicles, &c. ; in other cases 
the ili^orHer proceeds rather from the ncn-ous sj-stetn t ordinaiityj 



THE CAUSES UP INSANITT. 



199 



Uvy am preceded for a long time by incrused wxiud irrilability 
(Buesrive pollutions) , vhicti is less a cause than a sj mptou of tt:^ 
dRadf exialing irrtbtioii. Onoe developed, tlic^e anomulits luani- 
fat UicoDselvcB hj considerable decRaao (^ the ses^ual feelings, dimi> 
ution-of ertction, impotence, comliiriRcl with all po^eiblo kioda of 
KUitive and mental perversions, which gometimm represent actual 
^Btcm, sometiiiiej profoand hypachoiidriosi^. 

I, KtMj jnn ftgo, prompted hj tlio writings of Lftllemnnd,' directed m; at- 
Ititioa to Ibi* point in t number of iiinanc male pitii^nts— it ilvlicitte inreittgE- 
IhB, M Um paticnlt an gcncrnll; verj outining in this rnspfiot, and tlieit 
■Mmmta an «wt to be depended on : moicorer. grnt caution ii iicceataT]r, in 
trior ■<it toiliftct tluir Mtcutioa too maoli to tliit subject. lu ciil^ one com 
oosld 1 sKCccd in proving microscopically Ihc fBot of decided poUutio diuraa 
It defrealioa ; bnt Iceiiaiul;eon«itic«din]ruir that, in a mucli^aternnmbcT 
of Caaco tkaa I liad tap{>o»ed, adlminntioa of tlie soxunl scnsntions und de»iret, 
gvaetallr kT appieetable to the pitieat, and BOmetiuiea al&o actual impoteoca, j 
had foe It lang lime preoedad the deTtloptaeat of lija inBoititj. In tiuch ouea I 
jt on TCf7 laceljr be aacatnined iritli certaiul; wbetlier llicae sjinptouit irero 
Dm oOBMqnuieea of tbe aoterior xeiuil nccues uid abuses, or cf tlic deprcM- 
lag MMtMai vbicb had alio acted as caugc-i of the iiuauilj— vbctbcr tlie; were 
aAtull; the first s^mptomi ot tUo Tnclancliolio itage, or depeadod tipou local 
dneaaes of the ge&tul orgsut. In two inatBDoes vbere the latter decidedly 
to be the case, I had tecourse to the treatment recommended by Lallo* 
m. eaulcriMtioo of Ibe prwlatio portion ot ibo arntlirB— in tbe one cau 
ariUoat ao; afipieciabto ioflueiice on the diieuc, in Iho otitcr tbc oporslion 
removed variotu diMgreaable wikaatioDa iu Ihe genital organs tiF wUicb tho 
paliaat conplalocd* (tciuatiou of coustaut ourrcuta, of beat, &c,), but did not 
pfodMa any rapid faTorable tuQuence ou the iuinnily. 

UUe (' Academic de Mid.,' \txTi, iSgt, and in it snbacqiicnt work] hat 
faiUiihed a nanber of obactration in which mental diicue appeared to origi- 
iut« from iiteniutorrbtM. The insaiiitj was spuctaUjr cbuaaterucd bj tbo 
luDowi^appaannoeai—^ll kinds of chronic peculiar and irrcgulail; numifcated 
bodUj tRMble\ meUnebolio perrenion, tendGaoy to suicide ; feebleness of the 
I, aad eapeeiall; of the' emotions aud will; (^rcnt iod^dsion, &o. : 
:, rtaarkablc seuaibililj, dtatiust, teuilcncj to conaidcr liiniMiIf noclicd 



• • Dea Pwtea st^miiiales ;' ate report* of caies, and ' Reram^' iii, p. lay— job. 
mimaod** ■UtcnictiU aad optniom on llicte points have met with luucli op- 
y^tioBt aad in trnlh Iticj presoat mu]; veak points. But tliat viiicli now 
Moeenia aa, *■«. tbe bel tbat uanj bjpocliuiii!riac«l and melaucbolio •lalea' 

lis ooonoclion sitb local disordcta of the nude (tcitilal organs, ho baa well 
I iu proTJng. 

* Cooper, bi bia Lectures, nientiona a case bi wbiob a lar;,-o number of pro* 
■talid cakuii vira reaoved bj mcaas of oftcratioa. Tbciic calcdi did not oqIj ' 
«HN paia, but a goiatuwiaa emotiwal nciteneut bordcnug uq iiiHiall|r. 



200 



THS CAVSB8 OP INSAMTY. 



\fj twetj one llie niorMeope akne cut oonfinn ihe diagnosis, and 4II trcat- 
ncnt is nsdnt M kng u Uia ipeimlorriXBi oontiDuu ; vbim it oohw. Uu 
nieuUl (li»eM» gtoenllj npidljr 4iuiipe«n. 

In liK/emaleaa. meoatraatioti ind all its disorders exercise gie^ 
mfluenoe on the dcvelopinent and coime of incntiJ ctbease*. The 
most simple, bat at the e«mc titno Uie most tart, com* ue tho&s 
vhPTv, in pfrson!! vho have bcrn hitherto hralUiv, there occun, aft^ 
sudden cesaatioa or suppreesioii of the menses, scute violcDt hvpet- 
ictiiifl of the bntiu, aiul imnKdiatcljr therewith tn outbreak of mcntai 
disorder, geneniUy tnnoift wilJi active cerehnl oougestion. Mon 
fn^ucntljir, indeed, the Cfifssatioti of the menses precedes the iosaoitj, 
but does not stand in »o direct a relation to it ; it ia rather to be 
eoimidered aa result of the persistent emotionut dq>KMion, sg a co- 
p)-mptom of an vsifitiiig uuumiuc state, of other chroaic disease or of 
11 geuendlj' depraved atate of the caastttution : all rhich oonditiona 
arc themseWes more important causes than tlic meiaslam. Oa the 
other hand, menorrhagia n-^utting from niifeniis and general lower- 
ing of the nutnlion mny be a cause of insanity as veil *i of anj 
other ncurrais. Frequently, however, irrcgalaritic* of menrtmation 
first appcAT with IhccominenccmcDtof the mental disease, iii tlieaiuoe 
UBQucr ta tlioy cia^ occur in any other ehronic disease ; aad wo taaj 
also frequently observe during rccorerj from insanity that it does 
not follow upon the return uf the menaes, but the reyers c the rettim 
of the menses follows upon, the alieady accomplished core of the 
mcutid disease. When uenstruation cuiitinues during tlie nwnt^ 
disease, nH it often does without the least derangement, it is not 
unusual to observe, with each return of the period, increased excite* 
locnt, general increase of the mental disorder. In tare instances, 
iiiHanity simply {leriodic, lasting during the menstmal period with 
complete lucid lutcrvols of several weeks' duratiiHij has been ob- 
served. 

Tlie periixl of the G»l ujigiFuriuice ot tlic nieiuct often brint^s wttfi it, to* 
gcttier wilb liciulnclie and nil norls af nerrous rITdcIioiu, distuibaaoes cl tbe 
fedlDgi and enintioiiH wliicli mn; iinxccd to delirium and to niania. Still 
nicM frffinptitlj llie Inller occnrt, or other fornii of Inunii; apixar (a* nclaa- 
cholia with atiipor, lulcidc), in cuca wlicrc menstruation is for a long time 
nicjtbtilly retarded, or even bts not appeared ; Mine caws of the kind past in 
iucutablu iuuiuil^f or deineotia. Il ■■ wvll known tliatnoat females an vaiy 
SGDsitiTe, vcrj prcvieli and ncrvoiia, at llic mcuslnial periods, Alt eansea of 
dib^BMf, eapMulIf moral cniisni, ttct men: powcrrullj at Hick times; and lu 
m»nj pcnoui vlio cnjoj perfect IjfoKIi during tlic inlervolt, there may >k ob- 



THK CADSK8 OF IN8ANITT. 



SOI 



! sHfod. dnriiig tlie period*. » pervenioa o( tentuneut boidcnQg on diBOue, 
■JriiM. li}pocltomiri», or opriciou^uns. lu mauj of ihc icitnan, t.bQ inciit&l 
diataM beooma tocnucd in Hick timu. lomcLioies to ninjiiB, uiDGtimcs to 
B^phomauiacaJ foriDi ac«o»pkiuciii b; nrcbral coug«*lioii, aud tuicidnl jiaticcts 
R^uira to be oucfullj Vftlcbol. Tlictc ihould be considctcd as cates of iicr- 
Tau iniUtiOD of the brain procredin^ [lom the genital orgaiu ; if the lou of 
Uoad hubMnprofiiM^UMimUtiou will be tUe more iucrtftiicd. TkocouaccliDn 
bilVMB tta SMBitiuil dtMider tad tlic iiisBuity appcun to be ino*t iiLiiiiinto 
b tiMM ctWM of nippraiioa of tike roauc« wiiicli iru mealioaicd Qrsl of all. 
Hen, too, reooreiT lake* place wJtlt the return or regulaliun of tueiiiitnuitiuD, 
snd ken iJoncu ippteprinle enEneBBgOfcuR IrMtm^nt ii>ilicnl«d nnd neccMnrv : 
to IUb ntcgor^ ftlooe belong kbo Ihose mrv dues in viiich tccoir.iy from llic 
amaatj ocovn immediately afler Ibe return of Liie niniiavs. D;«msnorrhii?a 
M ordiaaril; BOCOBipuiied lij those ncrvouB affections which arc understood by 
the mamc ifttaia; these are often |iriucj]>BiIy cerebral. The period of Uio 
ematioa dI Ut« awtuct oftai eierciaes n v^r^ rnTorublc, even occAsioniillj 
« emtJTe, inflating on the cxlating mental discosc: more frequcntljr, Low- 
t!rtt, it eterti an uafaroniblo influciLcc.so Ibat the liilbcrin mure vuiabla 
•ad irritaUe fomis bccoma fixed, and pass into cbroolo mania aud dementia. 
TboM ouea ibo which mslic liicir finl uppcaraaco at this time of life, often 
nwlanrTinlia, nregtnGnllj ufau. iLnfarorablL' cliaroclor. 

Tlw iaflKeMo of aKutmatiou is IraatcJ of ia two excellent rcoout )>&pcn : 
Brietn, * Annales M&d. P»;clkol.,' iS^i, iii, p. 574, uid Schlager, ' Zeittelirift 
for PBjduatrie,' xt, 1858, p. 457 (tliis pa]>er maj also be found iu the Report 
of the Vienna Aijium, Wien, tt^8. p. 140). 

TTje toeal dUeaaea of the utenu, ovaries, and vagina (ovarian cysts, 
dMBUeGtnents of tlie nleru5j uteriuc catarrh, ulcers of tliB cervix, ^-c] 
KR geoeraUjr followed is the first place by wdUmarked hysteria, 
wUch ibcQ may gradWly pass into iuaaiiity. TliiN iti»nnity oFUmi 
prweaU distinct traces of its origin in ita geueral hysterical cliarac- 
ter, or to certain morbid coiict-ptiotis (for cxomjile, the idea of 
pttgBiiKry). 

TThitlier it be the <aae or not. the possibility of the eatstenoe of such local 
is fmale patirata ou^ht always to be kept in triew, und on th« least 
ainnle ciaoiinattou should be made. Il is oerlaiiily of great de- 
lathe patieata that there esiita at tha present time smongit asyluna 
|l>jaif«Ma a trialy childish delicacy iu i^ard to vagina) esami nations aud lh« 
MC of the ipccaliun. Is GermsBy. Unaat, and England, I hare found tlie 
a^MMiciey; (lieyarem afnid of esdting the patients, of awaken iog of in* 
osHiig certain ddtrioui ideas, just na lon|; nga, for similar rcuons, they wen 
•baiil lo auacmllatc -, such subardiante consideration ought not In be retpudcd 
wtaB It lalcifcna with what it Ibe only lucans of arririn); al ■ correct diAgnora, 
a^ ifcMtfon a proper syitcm of irealmeDl. The light which ve Rain by the 
mm»^i», and which so frequently eluoidatea hyateria, can ahune elenr up mueli 
with Ibst insaoily which isso cloaclyalliedlo hynkrial 1 hnre 



909 TOE CAQSBS OP INSAVrTT. 



KtjtttI ohMmd In printepnotaM flnlrfa fBjMiBMrfri mmk ti raiOftfjr 
fna li;rt«riad Jsvutj bf nens «! loeU tratecal *f Ike gnilal nrgi^ 
■rUr all fitter dwhw hul UM. Brain ('Ued. Oatatantsaii,' 1839^ 77) 
telttn t«o caM* of rteoferj fra* naple MoU B^tniMil bi MMaqMDH (rf 
local tmloMDtof diseuca of tb« gmiW Wfu^ Bwiag (' P i y dwwc^' p. 
194) Mw two euM u whit^ pfoi^wn uteri uagM|HMBl by ta^aaiA haan* 
rb^e* gkrc rb« to ttlAob of rife ind ■nn'tril tuitimimt, vUch MMed «4n 
U*pnbpnairupcnnaiKiitljnluudh]rflMiMofa|MuiT; uaatamtht 
aatinBl^ romonlof tbepcMairwaifoUftved l^sntKiaf Ifcenaitai diaofder. 
Coneeraing' uleriae dMpboeiwab u eawM of tanoUj, Me U* maiki o( 
U Meyfr, Vifehow"« 'Arehir,' ix, p. ia8. 

S 109. Bot of b11 the inflnenees wliich irisp from tbe ftnalt 
Kxual aj»tem,jrreffnanct/, aad still mott the pufrferai slate aod &»• 
Udion, arc the most important. Of tbc«c, j/rtynamof ib most twelj 
fdloved by dereloped insanity ia tbe form of profound meUneholtt 
or mania ; more freqiieDtJj it caauea merdr a state of moderate dtw 
prettJiHlt whicb is loinctiincs cridcntl; llie fint stjtge of aalweqwot 
pnrrjKTiil mAnin. ^e dirvd. moral influeuc^?, especullf tbe 
Tsrioua emotioust whJcb accompany a first pregnane;, maj be of 
great iiDportanoe in those previoLulj disposed to insanily. .Vo in- 
floeocc not less great ought in other cases to be ascribed to tbe 
>tit<-j ot congcslioo and of antcmiii vbJcb are so frequently dereloped 
during pregnancy. 

Slight meota] dliorden, h^tUrical liunoun, inesiitifale iDngingt, foalbh 
Jenloukir. anil kleptoDinain, nrc during prtgoamef more frequfot ihui fuUj 
dnelop^d itmanitf. CivtM oraur in »)iioh tbe jncntal iltioriler appenra loa 
flartain fonn in «aob prefpuno; ; on Ibe oontnry. v»sn — 1 njself kaoir of one, 
and Guiilniu ('Lctoua orulea.' ii, p. 373) msotiona o^ie — ia wltieti u existing 
rtlij;lil or uiroro iiiciiUl alTccliDu di-'aiigicnrcd during eacli prf gniuicy. *a that 
till! indiTidoikli wcm va potseuion c-f lli^eir reuon onlj when Ibey wen pt^- 
nut. tVe niHj u*uiDC tliut in mob ci»ea tbe crrcbnd diwaK a »]nDpallultc^ 
ilepeiidrtiit tj|M)n tixno (>iif;ht) jirobably tuRetionicil ■fl'ccticnof llto seoetatin 
organ*, wliicli— and witU it the evil inflacnce vUcb it cxernaM oo tlie ecRbciJ 
Ainolknii — ilvajrs (Jisappnn irhea ooncsption takes place losaatlf n»j ako 
'eonmieiue dnrinic the firal moatht of prcgnAiic;, aioro rre^uentl? it makti* its 
Int appeamnoe in tlie lattct monlli* i it o<:cuiQBaIlj diupptan wiUi the d^ 
liivry, or il mas tw not till a Utor poriod, till the reiucn of tiie nenici^ but ve 
cnnnnt calculate nit li certainty- «n I Ilia being the coae— it mjabacontiDaoaDd 
ibcKonic incunblei. Wlica oiic vlio is Already inume becomei ptcfcaut, it 11 
only Tory ciceptionally tliatit oierta a favonble iuDuenceon llie iiiaaniiyt a^ 
thit oaa only be otprclcd in rccciil cases, aiid mob as dcpsod oa disoaKa of the 
ITDiimiivo orgaua tlicMstlres. Sometimea tlie exiating iaataity OMuet witb 
conception, but.r«turoa after doLirei^. V»l commonly Ilic mental diacaac ia 



THP. CADSK8 OP IN8ANITV. 



208 



•sty teadtnd wone, ud ineunbility accelerated. 8e« MJhre^ ' Dt U Folic <l«i 
FctBDOM «ii«eiatcs,* Ac., Farii, 1858. 

Etph daring delivery, and from that time during the whole course 
of ihepucqwral sUtc, severe menial disorders may arise, tlic com- 
jiKheiuion of vhich under the term puerperal iusnuitj, according to 
the form of (lie imanit;', dofs o&t Beem to be very correct, as ttiey 
bare in legord to symptocDS both soincUuiigaltogutlicj' diatiact from 
ordtnarr inanity, and amongst tbicmselvcs possess mitny pcculiaritieB 
in common : stiU, in relation to the peculiar circumstances of the 
(M^o. tbet«rm is qait-e justifiable. In a practicul point of view, a 
tDinnte sc))aralioii of thusc cases is ulvrsys ncccsaary . 

During the act ^deiirertf, there occaiionally occor itat«s of great 
rxcitemcTit and mania; indeed, it hna even been observed that «-ith 
eacb paia tliere occiirrwl a violent outbreak of fury. The pain, the 
very great general ncrvoos excitement, and the evident congestive 
iUtea, lie at the foundation of these disorders ; they occasioually 
manifest Ihemftelve* in great enmity towards the child (sometimes 
killing it) , do not continue for longer than a fcv lionrs or a day, and 
air very important in a medico-Icgal jmint of view. 

Amotij^^t ibe mental diaordcrs which appear subsequently to, but 
generally vithin fourteen ilays nftet delivery, the 00c may be con- 
aidcnd aa the lymptonmlie delirium of other serious puerperal diieascs 
— cndometritia, phlebitis and pyemia, consecutive endocarditis 
(? Kiviach), kc.; caws in which the ccrrbrni nfftTetion ought to be 
uctibed jMitly to the injurious effect of the purulent infiltrnlion, 
partly to the evident cerebral congcalioii — in which the mental di»- 
onia abara the (critical) prognusiaof the principal disease, in gene- 
nJ it p(Tsi«ta or ceases with Jt; la certain caien, however, it may 
ronlhiua for a long time after recovery from the puerperal fmer. 

In anothw scries of cases, on the contrary, insanity is dc\'cIopcd 
witboul the eiiatence of any other jserious puerperal disease; a cere- 
hral dtsc««e vhirh, independent from the commencement, is eith^F 
in the fonu of melancholy, especially of raplua mclancholicua, or, 
cupeciaJly if a t^atc of mental deprcHHion has existed during prog- 
nanay, or one of excitement, and frequently of nymphoraajiiocal 
deliritUQ. These are, above all, the cases which aflerwaixls pass into 
ncsHBlcnl insanitr — of, howe^'e^, on the whole, not unfavorable pro- 
gnosis. They appear particularly in individuals already predisposetl 
under the tntlucooc of all kinds of determining cauars, of vludi tli« 



THE CADSES O? ISSaSITT. 



deprMsing emot»n»,' on tb« one hand, and &Bieniia, oTuig to great 
liirniorrbagc cluring ddirerf, opentions, &:c., on the other, iie eri> 
dead; the uoit important. 

Tlio ink tjmflotnt oT tbe meiiUl di§acdet ta cues of tkc tfttter kind appear 
MBietioie* rcr; mod after Um btrlli of tbe ctiUd, or on tbe Ibtnl or Cftli day vi lli 
tbe niillc fcTcr -, mo«t frc<iiicatlj, at iH events, in tbe first, tbca in tbe wcond 
veek— at latest four vccka iftet dcliterj, titctt lou U blood. Lkcviu 
cnotiou, an oftsn tbe euitjng oauM ; bereditaqr pndiipaaltioa, gttU tMitroii) 
itrUabilitj, great enotioiul BOBCeplibili^ duiiag fiKgauej, fotin important 
prtiiupoaiu); circuni»liu)ees (Ueid in Btdlain — tS^ti — tuaaA iu ill caics of 
jiiiLTpcr*! iuiauit]', bcroditaij prediapoaUioa ia 45). Tb« nio«t Etequeat tataa 
are maniacal excitement, then neluuliolia (freftucDtlj attoaita). 

AmongBt 131 case* Iu Be^m (Webstei), lendeocj (o nicide existed in ^1 
(31 percent.); ia nianiA the pro]{nosi» is more livonble ttun ia mclancliolin 
Ob Ibo wtioir, tlic projinosis of puerperal iucuuLj )■ rcr; propeHf eoBMiieml 
as rclatiTcij faTuiablu ; rtiil. lUc curabtlitj ot tbis rorni ia freqwntlj ofer>C3ti- 
maled: io Uedlam, of 181 Oum, 81 TereeuiT(l(4t'8jptrccat.), while during a 
»])acc of twenty jrtan io tlic sAme uvluni llie ptofortioD o( recover iet Troin iu- 
sanity ingeBerHlvfMf,3<i7 percent, (Webtter). Itccover; occurs EncAlfrequeatlj 
witltin Ibe Grtt ihicc montUs ; wmctimc* we *ce, tmder tbe ajmptunii of 
puerperal maaia. an alrcadx etisting tuberculgaia proceed witli great ni|udii; 
after cbildbirtb, and terminate in death. Simpwn (1S53) tbougbt it probable 
tliat tbe uao of cbloroform ia obatctric practice might prove a prophjlaotio 
agtinat puerperal ioBanit;. Not only bu tliii auumption cot beta conSrmed. 
but caKS bare occurred iu wliicb the u»c of clilurofonn appeared to dclcrniine 
tbe outbreak of the niuiilal diiea»e (Welister). 

Sec F-i^uirol, 'Maladit!* Mciitolci,' i, cnp. gj Scbncidcr, '' Ueber Uaoia 
laotca," in Naasc's 'Zeitscbrift fiir AnLiimp.,' 1833. p. 163; Neotaana, 
'Kraakboileu dca Voratellmi^vcroiogena,' i8i3, c«t>. 14; Kiwi«cb t. ItoU 
terau, 'Din Krutklidtcn dcr WoclincrDcrianeu,* ii, 1841, p. 318) Kcim, 
■MonOKT&phte dcrPuErperalkranktidtcD,' 1 840, §§ 18, 46. 53, 75 ; Sinofcowitt, 
'DieOeitlcMtuniugeD,' ■^3.§>j)i Lcubuscber, ' TGrbandl. dtr Gcariu. filr 
(inliurUliuire,' Berlin, iii46.p.94; Macdoualii, 'Ameiicnn Jounial of luunitj,* 
iv,i847,p. 1131 Webster, 'Jourual uf WjicbolugiuJ Medicine,' 1849; IdcUsi 
"Die Vcunia pucrperaliii," 'Cljiritu Auiiolsu,' ii, 1, 1IJ51, p. m; IVciil. 
'Cnniid. tur la Folic pu^rp^rale,' Diu., Strub., 1851 ; UateCj Trailc de la 
PoUe desFeminee enoeintn,' Pari*, i8g8. 

Finally, as to the inllueuce of lactation, it U well known tliat 
weakening of the coiulittilion through prolonged nursinj; is a cause 
of all ]K>s!<ible formii of severe neuroses; and it is especially sercK or 
pcraiatL-ut emotiuns, moral predispoaitioiw, &c., which give rise to 
this form of cerebral affection — piwrpeial insanity. 

From thin cnnm^ration of the cansee of infinity, tlic general doc- 

' Sec R«i)Mirol, i, pp, 141, 143. 



THB CAUSES OF 1N8AKITT. 205 

trine uaj have been deduced that everything which lowers the no- 
trition, all tme states of weakness, and farther that all circnmstancea 
which over-excite the nervons system, which bvoar congestion of the 
nervous centres — ^in short, all which has as a resnlt the development 
and fixing of the nervons constitution, may become causes of insanilj. 
We shall again revert to this subject when we eome to speak of 
the treatment of mental diseases. 



BOOK XHIBU. 

^mas OF BIGNTAL DISEA^JK. 



& 1 lO. A CLiflS[Eici.TiON of mental dueased locordjog to thur 
niUuw — that is, according to the aoatomical ctumgM of the biaiB 
which lie at tliuir fouudatioa — U, at the present time, impoaBUe 
(§ 6). But, as tfafi whold clauificatioD of meatal due«aei u metclr a 
aymptom&tological one, so tliat we recognUe the diffcKatyonu of 
iiUBiutj oaly b}- tbeir preseotiug difTereat groups of s^mptoim, 
uu(eaii of the anatomical principle of dirisioiij we mast adopt the 
functional, the phjaiologtcal ; and this is — as the disorden of the 
undent&udiog and iriU are the principal aud the most strikiag — also 
a payehologioal basia. Iiisanitj is, thcrcforv, to be dirided accordiug 
to the form and nature of the psychical anomalies. But vhiUt it in 
the luni of clinical instrnction to render conspicuous ai>d to aualysv 
the multiplicity of ueatsl disorden iu the concrete, nosology must 
content itself vith establishing fever principal groups of mccta] 
diHunlera, fewer /undamentai abnonnai ttatet, vhich result &om the 
BgrcomuDt of a great number of casea in oertain dtazutcristic signs, 
and to which, therefore, all the varieties of individual casea may he 
referred. It is these fundaiiiental conditioiu and their symptoms 
that we have here priucipally to deacribe ; and although all llie 
varieties which they may present and their reciprocal transformations 
must iudecd be considered, our liinila do not permit us to cuter into 
exbao^tive details. £vcn that fuaioD of normal and abnormal 
mental appearances on which tlie varieties, intermediate states, and 
transitions depeni), constitutes one of the most inicresling objects of 
dinical study. It cannot, howcvcrj be minutely followed in ttie 
< expositions of a text-book. 



i 



rOHHS or MENTAL UISKASE. 



207 



'n* uulj-sH of observations teadi to tbe eoncliuion tlut then are 

ro grud groapa or fnodamenMl tUte* of meatal anomalicR, which 

. the tvo jQoat cft»cnti«l vuietia of iiusnitj, la tlie oiie, 

I tomii^ consists in the morbid |um)oetton, goTeruing, «nd per- 

nxtrDceof CMofiiMM and eiiiotumeitlal4t,uaia tlieioflaence of wbtch 

the whole mental life suffers according to their n«taie uid fonn. In 

tht other, th« insanity conrisU in diaordo* of the intellect and will^ 

which do not (anj longer) proceed from & ruling emotioDal state, 

bat exhibit, without profound emotiotMl totoitcmcDt, an ttut^teiutait, 

tns(]uil, /aU» »oie of iAaugki vdA of vill (nioallj with the predomi- 

buit characterof mentid w^ness). ObMrratioD shows, further, that 

k tbe greet majority of caaet, tho«e oonditiom which form tbe first 

P*»'*™ff group jpmvA tbo» of the Mcond ^oap; that the latter 

gemnlly appear only as oonaequences and teminaiiont of tbe first, 

vliai tbe ocnbnl affection hs5 not been cured. There is, moreover, 

again pmented within the first group, in a great proportion of 

caacf, a certain de6oite warettttni of tbe rarious forms of emotional 

alaUa, whence there reiullA a method of viewing insanity which 

jwogwiae a in the diflercnt^/nu, different »tefts of one morbiil pro- 

faea ; which may, indeed, be modified, interrupted, or transformed 

"Vy the most varied intercurrent pathological circumstance?, but 

which, on tbe whole, punues a constantly progressive course, wbidi 

kiay proceed ercn to complete destruction of the mental life. By 

MMs of thii knowledge, moat distinctly expressed by Zeller,' it is 

^^Pponible, from the uature of tbe symptoms, to approacli much 

KoK dosely to the problem (which onght always to occupy the 

Ibrpgronnd] of an axiatomico*path<dogical knowledge and dingnosis 

of mental diseases. 

Fatliological anatomy shows us, even at preaent, that in the first 
groop, or in the first stages of insanity, it is rare to find important 
organic alterations, or nicb as are not capable of complete removal ; 
fc1li1s< in the second group, or in the terminal stages, very often 
Qhr exist palpable organic changes which are incapable of cure 
— ptftkdarly atrophy of tbe brain more or less cstcnsivc, with 
mltna of the membranes, and chronic hydroccphalns, "Wc may 
■thai, that those cerebral lesions which ^ve rise to the first stages 
□ty — Icaions which arc certainly not always of an identical 
and which we, as yet, cannot generally characteitse ana- 
lly — have this in common, that they terminate fn very many 
" Zdl. Bericlit, fto. ;" * Med. Corretpondcnibl.,' Juli. 1810. 



20S rORHB OF MENTAL UISKA8S. 

cases in those characteristic consecutiTe changes in the brain which 
*e have spoken of as a stage of permanent anatomical Lesion. 

Consequentlj, the simple sjrmptomatological, the psjcfaologico- 
analjtical method, and the anatomical manner of investif^on, come 
all to the same practicallj important concloaion, that iaaanity is a 
curable disease onljr so long as it is confined to the first group of 
primiiive (emotional) mental disorders, and that it becomes incKraile 
with the development of the secondarjr lesions which constitatc the 
second group. That first series includes the forms of melancholy, 
mania, and monomania ; the second, the forms of chronic mania and 
dementia. 



I 



CHAPTEE I. 

8T&TES OF UENTAL DEPEIESSIOK— UELAKCHOLU. 

^ 1 1 1 . Tux f uiiilanmital affectiou in all these forms of disease 
cOMnti in tbe morbid (} 37) influence of a painfnl depressing 
negBtlTe affection — iu a mciit&tlj painful state. Thii state tanj, at 
the outlet, in Ihc limplest uul th« newt primitiTe fonn of mclan- 
eholia, c-ontinue m the fonn of a ngoe kSag of oppresiion, anxiety, 
dejection, and gloom ; geDnally, however, this obKurc vagac feeling 
of ftODOftiice passes into a singlcj concrete, panful perception ; there 
■Hm thoughia and opinions in hnrtnonj- with the acluul diaposition of 
mind, and without cstenuil motive (false idcaa)— a veritable deliriuin, 
irvolving coEutantl^ upoa some tormenting and pninful subjcet, 
vhile ftt the same tine the intellect presents some anomaloos formsj 
b ratraiDcd in the exerciie of its freedom, becomes »lov and slug- 
giili, and the thoughts monotonooa uid vacftnt. The normal re- 
action towards the cxtenuU world is cither weakened and blunted 
(mentai aniestliaia, iodiflerence even to actual stupor), or exaggerated 
ia M^ a manner (hat all tacotal impressiooe arc painful (mental 
hjpenesUusia} ; and verjr often tlie»: two forms are found in the Mine 
pitiBnt iltenutiDg with each other. Many disorderit of the emotion 
tsd of the will are moreover associated v,ilh this. Their vnrietiea 
form B basil for the iliitinction of the several principal forms of 
■lelanchoUa. Sometimes vohtion ia direcUjr diminiahed and 
vcakcoed, ol other times it is convulsirelj restricted (absence of 
efwrgf and of will) ; at others there appear certain desires and im< 
pulsci of will to which material and object are afTorded by the 
norbid mind ; or, lastly, a high degree of monO puiu excites various 
iiB|>oIaM of au aimless convuLnvc character, which manifest tbem- 
■dTcs in utreme restlenneu, the eontiuiiancc and increase of 
which caa»c these forms of melancholia to ftssumo a difToroDt cba' 
ractcr, Bud tu pui into (juite another vurict; of that of mamn. 

In cnpJojuiK tbfl ttm "•(alci of meatiJ (le)>tMaMu," w« do not wisli (9 Im 
unJentood as impljh^ that Uie nature of tWse ilatei or oonilitioni eonsJits ia 
isMtion Bad wwfcBCM, ocia the^n/y/wwtiiof tlienienlnloroertbral plienooicoji 

u 



no STATES OF UEST.Ui DEPEZSBIOK. 

which MOOMpwiy tboo. Wo hare mcfa mora oum to mmbm I^bI reij 
TMnit j/dto y inUaHtm of tlie bntia ud eiciuiJoii In the mental proccna 
■ra Wc *Gt7 oftcB tin cuim ; bttt tit federal ruati ot thtae (neatal ud 
nteteil) pnCMMi k Jifntmm oc a pthral itau; of miMl. It ii lufficicnt lo 
ivmII IIm imIokj to p^^cal pwa'i mi to tkoM oko t»agni« that tW; m«ke 
Obp better bj nUtitutiDg "tertirat lerjM^ nd *'€miriil irriMim" (or 
" (UimHiM^ and " ■xilUtioii,'' it dwj fairlj noagh b« objected Has in melu- 
cbolia there ia abo k •late o/ irritatioa. 

ObeerratJon shows that the immcTiEe majority of mental diseases 
oommeoce wiLh a state of profound emottoDal perrenioD, of a 
Aepttaaag and suroirfal chaiscter. Guiabin wu the first to 
datsdatc this higld; interesting fact, and make ii at aU Mr- 
rioeahle. Of its general correctness there is no doubt, BOd ve 
MD baTc Ito hesitation iii spealiiug of tiic " 4i<uli*m meianciolietai^ 
aa the initiatory period of mental diacaso. Of course there are ex- 
ceptions.' Tliius in senile dementia, ta periodic mania, in menin- 
gitiA, iu the mental di^easea consecutive to tvphiu fercx, pneumonia, 
oholeta, snn-atroke, &c., the outbrealc of mania is gcncraUy obaerved 
viUwat bong preceded by ineluuhoU&; but the oases are much more 
frequent in which this tiadium m^iteAalicum onlj appearB to V 
ahsent because it was less intense, and was not then recognised as s 
stage of mental disease. 

Tie "ttaJiwM mftaMeiolian^' vhicb precedes tnsaiutjr is bj ume \ikj£eiMU 
dcdgnatcd u the period of incubttion, or " prodronul stadivn ;" uid, in theif 
agudoDi ttic ODtbreak of the discsM dates oalj from the time vhca the patieut 
b BO longer able to oonlrol liis actioiu. TKia limitation i> lo a ccrtaia ul«at 
aibitnry, but the ctrcuinituicQ Lbat the stage of inoubatioQ has alont limp 
a deprestire character is isteiestiog aad of great importaaoc 

The melaQcholia vbich precedes inianity sometimes appears ex- 
ternally as the direct contiuualion of eome painful emoUoQ dependeitt 
upon eome objective cause (moral causes of iDsanity), e. g., grief, 
jabusy ; and it is distitigaislied from the mental pain experienced 
by healthy persons by its excessive degree, by its more than ordi- 
nary protraction, by tts bcoomioj; more niid more indepcodeat of 
external influences, and by the other accessory aSections whidi a»> 
oompnny it (se* further on). In uthcr cases the mrlancholis o^- 
nates without any moral cause, though most frei]Dent]y tliere are 

> GuiaUin liimaolf knew of *ucli exceptiona (' Lcf . oralca,' a. p. itia) ; and h« 
oonqtaiea them to ceics of intermittent fcrcr, vbcrc the cold, hot, aad iweating 
ataftes liiU not follow prcoiMl; tli-c utukl course. 



STATES 07 MENTAL DEPRK8SI0N. 



su 



sod, but it does not originate » their ilirect continuation, but only 
■hoWB itaelf after these affections bare nrought considrmblc disturb- 
in tbe function:* nud iiuirilion of tlie nervous system, or have 
Qcd the entire constitution. 



SitcriOJf l.—Uypcchotidriatit. 

% 112. The bfpochoudnacal state? zepreeetit tbe mildest, most 
tnoidcrBtc form of insanity, uid hxrc mau^r peculiarities which easen- 
liaUy distinguish them froin Ibe other fomui of tnelancholia. While 
tbejj of 0OBC8(^ ebate with the others the generic character of de- 
jection, tattixu, deprcsidon of mind, diminution of the activntf of 
the nill, and of a delirium vhich corresponds to this meutal dispo- 
lition, they yet differ from Ihem in this characterialic manaer — that 
in tbcae states the emotioual depression proceeds from a. strong 
fteUi^ oX fiODiLT iihett vliich coustantly keeps the ettention of 
tbe patient oouoentTBtcd upon iteelf ; that, consequently, the (ahn 
o^nnions rdate almost exclnsivelv to the »faie of health of the snb- 
)k1, and tbe delirium turns constantly upon apprehensions of some 
gnn nuhidy — upon unfouaded and curious idcus rcfratding the iia> 
lure, the form, and the danger of thiit his disease. This feeling of 
bodily illness is sometimes general and vague, sometimes it resolves 
ttaelf into particukr anomaloUB and disi;omircted sensations. It 
often depends on irritation of the ser^'ous centres nrioing from peri- 
pheral di4e««e — oft«n very obscure and eoDce«led — of the viBcera. 
It is also frequently provoked centrally under the direct influence of 
iDonl GUisea — e.g., readbg medic*! books, Sequent contnct iritb 
liypoclioDdriAC*. 

These morbid KoaattoDs ate alirays increased through the directi(m 
oC tbe lUtcution Uillieu; and Khcu the diacasc has atliiiacda certain 
degree of deii-elopmcnt, such may, tlirougb direction of the attention 
to tbis or that o^n, be awakened, displaced, and called forth anew 
in each o^an of the body in succeasion. As to the part which the 
inteUed pUys in this disease, it may be said that, in spite of this 
emotional disorder and of the false conceptions, the astociatioo < 
ideas is usually unimpaired ; the ahnormat Mosationfl aad ideas are 
Iqgtcslly ooDoected throughoulj and justifted by reasons vliich ore 
•tiU within the bounds of possibility. And just beenosc of this 
■baaaice of octnal derangement of the uudentaoding, hypochondria 
lf|tp« to be essentially a /oUe raitommnU m^neioli^f, the anti< 



313 



8TATK8 OP HXKT&L DEPBMSIOM. 



tlicsu of which — the ordintrv lo-calted moAOtoaniaeal folie rmton* 
naitU — ve sb&ll find iu the states of mental exaltatJoa. 

Wo recommend the thinking tnd inUUigcnt rcticr (o ventj for biaueir tlie 
■ndogj nhich remits from ihe coiupuisoo ot ihMc two fonu of tba notWiI 
•t«tM aad fBeling;!. Urjincbandiia rcallj flnds no otlicf auiuble pbea ^i 
nOBolQicj than fttnong mental tliscucs, ttmoag vhicU SuiTigci ■■d CiiUon li^^| 
loug ago r&iiKed it, and tiara tLni J*iiif^I, Georgtl, tod Pilivt It it Im^ 
the ulund c«iuequenc« o( ILo ajFtiptamMalof^j of tiio aScctioa. It h ft pcr- 
TeraiOQ of leatiment which mrj go to the (iigiiteat or tbe iDOst exIreiM dtgim 
vilhftut CMenliailjr elisngiug tbc cbaracter. Ilie lijpochondrtac, it ti ti«e, naf 
rcuon GornictI; — sctliug out frnm falan prciiilKt; but His docs not iaUiD 
leul iiivftlidftte tbe fact ib&t bj^ioobondrii w a meutal affectidn. wi; sore tluut 
Ibat bcoauBt lijpuciioudria ort«ii accQai|)aiiieitor coni|)licKlca vuiogs cJininie 
dJtcaiM leftlcil ill JiirvKiiL or^is, it ouj[l]t on tliat •coouat to Im identified or 
Donfoondcd wilb llicie disease*. 

^ 113. Symptoms. — The diBposition of the patient be^ns to 
diangc nithout an; uKignablo cnuse. He becomes dejected, pon'isb, 
suspicious, exhibiting more extreme smsibiUlj' and n «lisposilion to 
coiincet i-verytbiiig with himself. Kvcrjlliing wearies liim, andbe 
is very cafilj fati^ed. At the comracaccnicat, this state experiences 
Diany retnissioas ; and the paroxysms assuioe the form of an irritable^ 
K«tle»3, and distrustful disposition, or of a mental spathr, which 
m&y go 90 far 09 to produce veoriiietu of life, or nnxicty which 
may proceed to despair and loss of self-control. An un- 
dcfiucd yot vivid feeling of illness torments and annoys the patient 
in an obscure sort of manner. All the parts of the sensory nervous 
•jsteia may be the vent of morbid sermtioiis, oftca very puinfut 
(fonnieation. beat and cold, crawling about of a foreign body — aa if 
hia head would burst — as if he were empty, dead, pierced, torn in 
piccc!, &c.}. And the higher souses also ofteu preacut tin cioggc- 
rated stosibility or great bluntnuss, and actual liallucinat^ons. Alt 
these aiiomidons sensations urge themselves vividly into the con- 
BciousncEs, awabcn »ud maintiuu an idea which r^tca to the diseaec 
in all it« various possible fontis and means of cure. All »vitsntioDs 
MC watched, and seriously commented upoD and flualysed in tlie 
waaax of the ruling gloomy aiid ansioua frame of mind. }^m 
those tbe paticut concludes that be ia tbe subject of very serious 
,and dangerous diseases ; and often be expreMes his fears with an 
atioD of which be himself is tialf aware, and in tbe moat 
graphic nnd ludicrous hinguagr. The pntieiil who cxiubiU only tlic 
nwMfc in»iguiljcant symptom! of disease, speaks of apoplexy — asserts 



RTATIS OP XRNTAL DF.PRESB10N. 



SIS 



I 



I 



tint he is half (lend, that hb be*rt i» dried np or {ictrilW, fais ncrret 
are buroicg coals, hii blood U boiling oil, &c. He wilUi^ljr allon 
that be it the subject of serious diaorder^ or of entire new discaaes 
which liave never before eiistcd, hecauM the gnrit; and danger of 
the disease ia in proportion to the intenntf of tlie feeling whieh 
wanaj* him. ^VheiMrer tlie morbid seiuatioiu change Ibeir sitoa- 
ticm and lutart^, the idms rt-^mrdiiig llie scat and mlarc of the 
fiaeue aU>> ebange, and the patient bdic\i'es himself to be success 
rirclT ntiockcd with aJI tlie diseasca whose pathology he knows. So 
Kmch do theae Hmt constitute a true delirium, »o ral»e and purely 
imaginary are ther, and so little do the sensations which serve aa 
tbnr buta Kern to be connected with them, that they may be re- 
garded caacDtially ea mere aH&mpt* at &rpliination. 

Wc tli«rcforc Gnd bcre eiacllj tbe Mme orttia — tlie Mine objecltre groucl- 
Jbhmh aad tut^eetive founditioD of the delirioua conecpliou uiulh«DtItep 
IpCBa of ■alandiolik uil more iilrMieed insanilj. Take from tlie brjiochon- 
driae bu morbid unMlion^t, auii he viH no loni^tr be aflltcted witb bia imiginarj 
UttWt . taute lb« reclingt v\m\\ af^iUte and tonnent the meluieboliae ia 
another way Iq diuppcar, and no longer ^ill b« betievc bimatir to bo punued 
by \m eneaues, £o. lu nulancliolia tlia abiionnal recliogt vliich precede lite 
dclinnna an as real, aod, at leut at the coniniencetnent, the laine unatableneii, 
tba MOW abrupt change in tbe delirious perceptiooa pieraiU u in hjpo> 
cbofldrii. 

% 1 14. The hypocbondrisc, constantly preoccupied with his afflic> 
lioas, Beds by every posnble meana to penetrate them. He often 
brl* bta jmUe, examines his tongue and hia excretions, and frc. 
qtwBtly diseovcTs in Ibcsc inTMtigBtions causes for fear or hope, 
whkh he sonittimfcs, though the details may be very dJsgusting^, 
takea a soil of pleasure in commonicatiDg to everybody. The great 
dnire to be cored induces him frequently la change hu pliynician 
and his tralment. lie seeks for instruction hy reading medical 
boolu, and often changes his opinion regarding the nnturc of kia 
jBtlady, inasmuch aa he appliea to his ovn esse alt which he r«ads 
of. The mere mention of 1 disease is sufficient to start (lie 

lion that he himself labours under it ; aud, iuQucnced by this idea, 
be now discover* in tbe corresponding organs phenomena which be 
had otver bi-furc niierii-nrcd.* 

I Bntootalwaiais it thcfearsimplyof ordinary bodily di»caMS which 
oaca|Net tbe attention of tli« hy[K)chondriaCj and is the object of his 

* Ooa OMuaol brifi Wiag »lra«lc with tbe remaikable aimikrilj bolwcca Ilia 
and tbe piodudbu of hallucinations io gcaeral. 



814 



STATES OF MENTAL DZPBES8I0N. 



uudetj. Freqavotlj tbe mcntd dement ia Hs maW; does cot 
Gscepe his aotict^, onil the complete change of hia peisoRalit^, ihepot- 
setiioH by morbid sensAtions and itleas, e^iieoiallr, however, a certain 
Boooudy (alroitdy uoticrd S 50), porticuhul/ ia tine mcatol spbrrc, to 
He Bensorial ecnsstionsj whereby tht-sc, although perceived as far* 
merly, no longer produce the same impresiionB, frequenLly fonn the 
great subject of liis complaint. 

Thii lut ud vtrj remarkable ttate, whiali the patienta tiieaiwlTcs have nub 
f ^itteultj in. desoribing, which ve klso hure oiUMlrea obeerred ia aeranl cun 
■■ the predomiDknt knij moit lanliuft lymptom, u tt well as posiibls dewribcd 
in tho rollowing lotl«r of one of Eafjuirol't patientt : 

" I atill coDtinuo to suffer coDstnnlljr ; I hxn sot a momen t of comfarl* ad 
ao liuiuan seng*tioii». Surrounded by ijl that fan tender life bapp; and agraohla 
>tiU to mo tho faculty of cnjOTmcnl and of scnution i* wuttng— boik bn 
beeome phjsicfil impoMibiliti^ In ererything, even in the most tender aareiKi 
I of mj children, I fijid oulj liiitoraMs. I corar them with kiaaea, bat there b 
•omelhing bctirtca tlicir lipi and mine; and this horrid Mttictiiinx a betvcen 
me nnd all the cnjojmtnb of life. Mj nialenw ia tncotnptete. The faacttoni 
Bodtctsof ordintuylife, it Is true, EtiUTeniala tomo; bat id eTcr; one ol then 
thtrait lomHliingwitnting^ta wit, the sensulton vhic)i is proper to then, and 
iLo pleuurc which foUotrs them. . , . JkKiof my te»»a,tueAptrt ^^ myprtfrt 
ttl/i Uiuii Ktrt teparaffdJ^OM m Auf ws m iMfftf iffiM m* anf tmmtim 1 
tliia Impoioibilit^ teems to depend upon tf cdk/ which \ /t^ im tke ficat ^ wKf 
iead, awd ta lie dma lo Iha tUntiMalion of the KntiiilUy tmr tic tehate atrpiet qT 
1^ Mf./vr it tafmi to me that I newf aetwUjF reaei tie tljfee/t whiel I tvMk. 

/ /tet «<il enough the ehtugee of Ifmpentwtr m mg tkin^ but I 00 

longer experience the internal feetiiif; of Ibe air when 1 brealhe mg 

tgft»tti aad myepifitptrceitH, htU /ie »emMtio» of tiat wUetl »ee it Mmptettfy 
WtmHajf." ftc. 

The psychicnl chftngo, too, which occur in the aphcrc of th« will, 
arpj in the majority of iuaUinccs, very striking. The patieota be- 
come dejected, llioughtful, indc<^isivi> ; in the higher grades volition 
is altogetlier abaent. " I nisti tlmt I could be more determined, 
that 1 could peraevere longer ; ^ut io Ao this depends tio longer upoo 
tnyself. I feel thfit. if I could will, I might rescue myself from Uiis 
desperate Hiluutiou, but I am obliged to yield to my painful tcasa- 
tiotia, I feci inywlf incapable of cvcrytliing, and the smallest ob- 
stacle nj)i>ears to me insurmounfnble," fee. Tlie*e are exprcaaiom 
wliich may frequejitly be lieard in the higher degiws of hypochon- 
dria, as wcU as in all other forms of mciaiichoha,^ In Iho more 

' Bee n cnpital extuuple of absoncu of Tolilion in bypochondria by Lcurvt, 
' FragBiCB>,' p. 3S3. 



STATES OP MENTAL DRPRBSSION. 



316 



I 



> 



I 



adra&bMl ttnge of this ducAse, tlie inldinet aUo euffen not only ia 
tbe mumer of which ve hare been speaking, but the canstaat direc- 
lioa of the tbouglils to the Epcciul slatv, ondtbtt means which might 
poaublj ud him impart likewise to the prrception a certain mo- 
noUinjr, vtA in conseqnenoc of this ruling preoccupation of the 
cotuciootQUr, erezytliing that <lo«it not fall withiu this circl« of ideas 
it itithoat the shghtc«t iutciY-st, of pcHrct indiU'LTcncc, nnd is verjr 
specdilv fifaccd from the memory. Hencf! it is that sucli patients 
are often in the highest degree absent and forgetful. They are very 
loqoarioDs iipon the one mbject of tht-ir nfTi-ction, but are httic in- 
cUaed to speak on any other theme ; and thcwe aro ncTer severe caeca 
of hypochondria whrrr tho patient is etiU amiable and can he an 
infansting compaitmii. But the intelligence tttul ncumen which the 
patient often displays in fine combinationi upon hia favorite theme 
may rtill remain intact as also in regard to objective relations. 
It if oolr in tho most extreme grades of hypochondria that nny 
Mtml diminution in the intelligence 'a obserrcd Ins form of dull and 
taoroK timientia vhieh renders the safferer almost incapxblc of any 
JBtcOectual exerti<>u. 

In Uh aggrfgitc of tlicM inentkl (llsordera nhicli coUcoUvdj bave tbe clu- 
ractcr of dcfvtMioD, lijrpoolioailda *haw« itacif u a fonn of nieUnotiolia. 
Aitbaugb in gencnJ, on MMUnt of tbe |ieculiar nature of Llieac iJclirioui oou- 
Dcpiiona, Bad of the much |tml«r oommud wbioli llio pnlitnt liu over liimKlf, 
bjpeehMilm my lie nguded as to a eerUiii eitent upccific. j«t thnt rolias 
teMteney vUck the iMttunt ha* to oonncct and lo compnre OTcrjthing irith iiim- 
•elT.tba limitation of (ke pcrcepliou lo llic special /—this morbid cgolistn is an 
BMrntiai dMncUiiitic corro ponding lo the co-ncciitration in irlf of llic melaii* 
ebolic tuio in ponal, and oetMi«iull;, iLt tbe commcDCcmcat o( the mclan- 
chalie pcnenioB, it is nore by ebancc ih&t the body itnd not rxleraal objocta 
WMMDca tbo «bjcM of ihc norlMd mode of th'^nglit. Tlio liiglicr drgrcr* of 
kypoidiondiia. too, ladnally juas, psrilj tlurouglt incrcsse of llto feeling of 
muet;, putly lliTOUgk llw Cuiig of cnlalu attempt* at ciplmiation, not only 
lata Uw wf>t'Tf4i'*'iPi but ereii caui]tlicAltd with dcliuions (idcoa of bciitf; lur- 
naadid by u invisible sgeney. at bting the liotin of evil mnchinntinnn, influ- 
owcd byu^cnetliin, Ac). Tfast ooiuideniblv degree of self-control alio vlucb 
bypeebwdriKa itill poatan, often disap|«sn duiiog ncli exacerbation. Could 
tbe pkysiaiiBS only obtcrvo Ibwe paroxysnu es fmly as tlicy one st any tine 
in eevm osca in layhiips, all doubts ooaoeming Ihs nwDlaPj luotbid nature of 
hyyothondriwii would veiy sooa disappear. 

$ 11^. Besides these mental disorders and anomalies of the son- 
aiaatta vhich we have mentioned, tln-re may occur in almoat aJI 
Itrpodiondnacs inouiiKnihlc morbid symptoias iu all the various 



»16 



STATKS OP MENTAL DEPRESSION. 



organs, miA titat old oompamon of hjpochoodm to a ohiODie dt- 
nDgtnunl inroUittg th« whole nervoiu tjtUm with terett u (Ik 
DOot general aeute sUgv of tlie diacaac (Hoffinnnn)j is bj- no mean* a 
bed one. Thn*, for instance, very frequontljr the digestion wattm, 
the tougae ii loaded, the appetite is tminodciate or dimiRished, (he 
bowels an constipated, and diction ts uoompanied bj • consuW- 
able derehjpneBt of gas, whoeby tendon is produced in the hjpo* 
choodrao rrgions, pusHng up of Ibc diaphragm and causing a fcdiag 
of opprcasion. Suoh persons an Erequootl; afflicted with hseraor- 
ifaoidf, abdominal pulsations, palpitations of the faeart, cerebral eon- 
gestioQ, beadacllM, disturbed sleep; very often they have an abon* 
dant maoDQS expectomtioii from the larynx and throat. In mai^ 
€a«a it is impossible to decide vbetber and t^ what degree tboe 
rery ririable symptoms are due to snch primary dtsorders of the 
viscera under the influence of which the hypochondria has arisci« 
or how fnr they arc due to KUnc oentral eaose in the ncrroas sjrstea. 
Tito pbysiciiu has always to oialce a most cajreful examination of 
all the accemblo organs. Not unfrequcntJy we see, during the 
course of the mental disesse, some visceral afTeetion gradually make 
its Hppeanmee whicb, in its obscure commeDCOQentj may be cUolo< 
gically connected to the hTpochondnn. 

It is evident that hypochoudrta may arise in two different way^ 
In the first place, u a secondary cerebro-spinal irritntion, in eonse- 
qucQce of internal, but of course often slight, diseases (of the intesti* 
nal canal, of the lirer, of the gfoital organs, perhaps also of the 
kidneys), which give rise man to a feeling of geneml diseomfort than 
to loi^iscd pains. These are ^xctally, on tlie one hand, the slighter 
neehanical obstnictioiu to the passage of the intestinal ooDteoU, 
flatttltncc, and in particular gastro-intostinal catflrrlu, which very 
oftea give rise to hypochondria in sensitive indi^ndanls, and th:tt loo 
ottea of a most aggravated form ; snd, on the other hand, aiTectionsof 
the sexual and nervous system consequent on onanism, goooTrhua, 
and Tcnereal eicesses ; and, finally, ait dyscrasiit. It is prindpally 
to these three Kiies of ufTcctioos that the physician ought to direct 
bis attention. 

In the second place, however, bypochondriit may undonbtedly also 
arivc from direct moral causes, inasmuch as through external circuui* 
stances the iJeaB may be so constantly directed to the state of the 
general health, or of one particular organ, as to induce morbid sensa- 
tions. This ia particularly obserired in those who read medical books, 



STATES OP MENTAL DEPRE8S10M. 



S17 



*bo are frequentlj' in the companj of hypochoiidrincs, or during the 
tiiao of BD epidemic, as of cholera, &c Such cases are, therefore, 
l«w Kvrre wid raie iu compurUon to Ihosr wliitli are produced by 
indirect moral caus*«, such M dq)re*airg emotifins, eiwsaive mental 
exertion, &c. These generate derangements ot digestion, of the cir- 
enJfltion, of the nutrition, &c., vhich become the soorces of the 
feelisg of illnc«i. 

HypochoDdriacal states are aometimej observed in the yean of 
childbood, and more frequently at tbc age of puberty. Ttiey nrc 
eitraordinarily fretjnent in young people, and more mre in advanced 
agei Tfaey are tnore common tn men than in women ; hovrever, it 
JM by DO means rare to meet with most cliaractcrisltc and complete 
_ — CT in the latter sex. The course is in gmeml very slow, and it 
^^kietiiiies presents remissions. I have seen some cases where the 
^^pocfaoadria ap^Kiarcil like im intermittent mania at almost regular 
periods, with intervals of several years. Another tiiiin I obiterved in 
B cvrere COM (femole sex) an almost complete remission take placA i 
afier severe Kpontaneous diarrbae», combined with laDdnating pains 
in the vertebral coiomn. 

JDoring the very chronic course of hypochondria, the nutrition 
ssd appeirance of the pntient may often continue good for a lung 
time ; but vbtrn an organto affectioti of some of th^ viscera becomca 
developed, the patient enters into a sttge generally prolonged of phy. 
mcbI languor, with cmadation, diacoloration of the skin, great 
wtakneaa, &c., whercwich occasion&lly the hy|>ochondriiical frame of 
loind begins to disappear. Sometimes aUo symptoms of apoplexy, 
of jMiilfiis, develop themselves; or the insauityjmay gradually as- 
na« inollMt ibrm, i>atticulatly that of partial dementia witli dc- 

MMBOIL 

RecovOTT is not nnfrequently obtained by moral treatment, bat 
alsQ by icmoval of all physical causes ; the hypochondriacal symp- ' 
loms bare also been oluened to dJRapp^ar with the accession of s 
lit of gout or of intermittent fever. 

Example* of simple and complicated cases of hypochondria of 
nrioos modm of origin, ap|>e8raaco, and termination : 

KXAims Tn. — Simplal cue ttf iifpoeiatdria, eared 6y moral lrtatmait.-~ 
MadtMsiMUa H~, «t. ai, natundlj of a very stroDg cenktitution. rtptlu in 

r miisliiiil pcrioda, tbongb tli« llov vu soeiewliat sMaty, and pmonting no 

> dwrtstio* fmm pcrbet lnultli than a oontiausi aad babitaal coaslipatioa, 

■■lUeBlj lo*( Iker nauil c^crfutnui and complctelj kccludcd lienelf. In fs 

fflf a wbolo year, was she implored lo cipiain this guddea clisngc. At bst ' 



SIS 



STATES OP MENTAL DEVRESSION. 



patient ulmitt^d ber phjtlctftn ta her oaniJencc. and raved to hist vith gmi 
bub/ulaeai Um ciut* of ber miwr^. 8h« compIainFd tlial «Im felt & cootuued 
fun is her right hip, h feeling of vaeaunesa Iberc. opon which ill ber 
tiioogbla «et« conceutrated. Uarinf; exAinined tlis region, Ui» plijeidan vu 
iiiubt« to diseoTCT uijtiiinx that irould acoouat for IhU seaulion of which die 
jMtient complained ; wlien >!ie oil nl onco bunt into a fit of wM^un^ and it- 
elutd \imt she would tctj eoott die, ud that At fett ooatiiiM^ her bonb 
were about lo esmpe from her halt-open abdotniiul pifietea. The plijiieiu 
was careful not lo impugn Ihii foolish nation slIo^Bther, but iiromed lie 
patient Hat the muscular coreriiig of Hie abdonuoi was aomettmcs ■oouvhit 
weak in thii region, i* in her inuv. and that to mncd; ibis w««kncu it was 
anljr nccuaar; to vcnr n bandage roand Uie p«tt. Ttic }OUDg ladj adopted 
his sdviee. and with (be ose of the girdle all th«ae unmsf feeling oompletelir 
disappcaied ; anil, wliat is a1»o worthj of remark, the oonalipattoo wliieh bad 
w loD|t and so obsttnalcly penistcd also left her. (' Bulletin da Th4rsi>eutiqiii^' 

184J, p. 30I.) 

ExAHfui Vni.— iVimnu Itmperam^; i^tita ; iffoeioiuiria; dtaih.— 
Mr. ^I— nai of a necrooj excitable tcaipcramcut ; good-Baluicd, spr^glitlf, 
uid endowed irith a viiid iiRBgiQstioii, ho dcrolcdbii utmost energies to his 
basiness. He mnrricd at the ftjie of thirtf-one. Up (o this lime, ercrTthliig 
bad goue on pnMperouslj aad happily «iUi liiia. Tliough be eaduieJ anlTefiBg 
wtthlheutmost Gouraitenndinaj^aiiimitjijet tbeanullest tiilUa aanojed hiiu, 
and be could uol rid bii thoughts of tben. 

One jear after lits marriage, he was ollaclcd with a rcrj screre and acute 
hepatitis. The liver projected four fingers' br«Bdth below the false ribs. 
(Eighieeu leeches ad atium.) The inflmnaaition rabtided, but with Ibc nrtuni 
of the liver to its natural siio the irritahilitjr of the patient tacnased ; laen 
nolhing made him impatient, and ever jtliiiig was a perpetual sourca of pain 
and annuj^anct to him. Tbc most gloonij apprcheasioiis as to the nature of 
liis liver ouuplaial were auraleued in bim. He began to tliinl; of obstructsoa 
and caaccr, and looliod forward to a future of pain. In spite of this, his em 
was complete; onl; then remained a ffreatl; increased nervoua sensibility, * 
tendeaoj lo exaggerate evcr^tliin^-, aiid his temper became cxtrcm«t; nnahle. 

Kk one time he was gaj aud oiieerful, as furracr^ ; and at another, cliolorio 
ftud licrj, willmut an;- pirrceptible canae. Changes of tenipcmlnrc had a marked 
influencD on bun. In bin moments of bad humour, ho suffered pain iu all pirta 
of his bodj. according m bis attention wm directnl to tbem. But he ooraplaiued 
atiiioit coulaiitlr uf n pain in his rigiit bjpochondritiiii. wliich he ascribed to 
his liver, nit difieiliun vm often faulty, and ho bad dislinct epigastric pulsa- 
tion. Ho now bebered hicnuelf atlacked bj a fatal gastritis. A tiokliag in the 
throat, with a slight dry cough, or tho cipcctoration of some mnco*, then 
awakened in him tho idea that he -was ooiuumpUve. Ue took to reading 
medical books, and imsgitiod himself lo be the subject of evetj diicaM be read 
of. At tlic snme lime, ha oocasionall; cunic to the ooniiolion tlist nU his sus- 
picious were grouadtess, and he often bad entire months of rtipite from his 
ninintion. 

lu the year 1831, f.lic piitieot was nttackedby ■ very serious fever which 
affected the mwous tissues, accompaiucd by gmt ncrrous imtatioa and violent 



STATES OF MENTAL DEPBB88ION. 



319 



I 



I 



puM IB tii« right Bhoiilder. No soonw wu lie oimd of tliU. tlian hs oom- 
plMoeil of fcmttr p«i», vhieh recurred more freqncnlij tli&ii ever. For this, 
scottrMolmlMtal «>l«r( ntid trarclling vru prtMnb«d. But aaj amelJon- 
lioa mm cmHwatiy brokca ia upoa b; nev suffaings mid new (cant, wliidt 
toy HOtt redandtiim to a perfect skeleton. 

Soae Matt after this, puna in tlie luinbu irfpons, ft barning (onsutioo ia the 
itretJm ind bladder, Mggoled to him the idea of eatjirrh of the bLuidcr, or of 
iImw ; ami, in bcl, he did pus some grafcllj partiolcs. From thi» time for- 
ward, hiipluiitaa; left him DO longer It rat. Incessuit I; occupied vitUhiniur- 
Crrifl^ wkith were much eugRcmted by the attention paid thein, Buci by the 
cwefnl MasBer b which they were analywd, his tetiiper became more and more 
imubic, tod he scsrcely ever had ooe tnoment'i peace. Sometirtici he ftare 
hintelf up to > aort of rage nnd d»pntr, but mote often he sank into a ilnto 
of gioomf drprcwioo, in wbioh be fancied that his end vu nt luiud, niiil that 
l« waa tobacvt off byoneof the Gvc innlii<Iic» W which he «»£ in tiifi>.ifllictcd. 
lliiia h« ImeiiMi. latterly, in the highnt degree eccentric and plmnlulie. 
Nothii^ pieaied bio), evcttthiog wks htileful to liim. Thv mint Bui'IitoitR nl- 
Icntiou were u^rntcrully received by him, nnd he would ncRj> orcr tii« mis- 
Ibttooe tfatt placed him in auch dicumsltmees. Tbca lie wojld ask his vifc's 
pardea (iie aft hia injustice t« her, and sg«in irould take It into his head that 
(fa BO loBftr loTcd him ; and this thouglit bccanic a nmr source of dlstrcu. 

He DOW retired rrom boaineaa. By constantly pondering over his affliction}, 
ba taoreaaid atUI mMc tba lurroiu irritability whieb gnre rise to them. He 
iiiiiIIbI all tbt ph^ians tbat were suesested to him. and the desire to 
bMOiiM wcD n^ed kim to follow llieir prMeriptions matt raecrly. He soon 
dfaeoftrcd the iaefllcienoy of their irmedics, which only iiLflicted u|ion htm rc- 
aevad pain. Hie disappoinlronnt o{ his iiopM tended to incite his delusiTO 
iaiajt<Mtiaa, to nerease bis pcrvous exoitemeat uid undermine his strength. 
In ISM ha was again attacked with a fever, which attachod ilself prindpslly 
to tbo maooas tissoea, during which bia temper was aJiuast unheankbh). Uo, 
bovcTcr, rallied, bat without any aiterintion of his ncrrons sufTcrings. Per- 
pataaOy tonntBlcd with bii peculiar phaiitMi«i, ho took it terioyily into bis 
hnd that ba «M • nattyr to stono in the bladder, sad nothing would par- 
nada bin l« the conirary. He pcnbled in this belief, and set off lo tiait a 
eclehcated UtbotriiUl in Paris. The ex ami nations which he there underwent 
M Irritated Ike aielbnl canal and tbc bladder, thai at the eud of a few daya 
Iba patlanl died. No autopsy wai made. (' Brachet, De I'Hyjioehoiidric,* Paria, 

1844. P- 39-) 
ExivnJt IX. — Wtattaf^ eautiltilidn ajul mftanfi^ia ficm marat eataet .* 

m9ff*y Uftmf* Ktf«/lw'«<" < a jmMm.—iXmiMac', , wl. tC, of great 

and phyahial MBiibility, was tbe mother of three ebildren. Her 
taa good, uatS tbe pereerena^ attentions of a risiting aoquaiDtaaae 
wpi at dy giinei bcr affcctiona. Villtid with idcaa of her duty, tlio raiitad 
tba aaJering ialuoM, aad kept the secret of a violent puaioo baried in hat 
hnrt. TUi coaatniat gndaallj aifeeted Iter health ; she began to tulfer from 
yalpllatios, aaaaatioB of faloesa at lh« cheit, and indeaeribable morbid sjmp> 
laww. tlw apjwtilR tailed, the gnstrie tegioo felt iiatnful, and atStehea were 
Ml ia tbc aide. To these actual Knsaliont were anocnald (he most peculiar 




i 



ud Md iilcu ooBeenuijt her h eai l h. Sbe heliet«d loaietmei tkat «ke infoci 
tnm Mmovfitm, w rti gM fran Moeerof tfcc rtwiffc, M cnrtimci miiI noM En> 
qw»Hy fromconwiplioa. ladcfd. ■ fcelipg of IrnaennMi wwgh lad ifamdMio* 
ptctontion. rc*(ri>luicstudnodani*][)cnfintioiii,luile«iBbliilicdtkeauelTH. 
The doctor >upcclcd phtbi»u, utd »cat tko faiktA to Um SMtb ot Entvpt. 
On her jowej itic eouulted dc I Toaiid hw MMlal oowlitiaa oiveii lAeM, 
■ail her tH^&atioii Mrioaulj imolvcd. tier nttttiagt wm, mfsotdimg U 
ber ovD tcuiaioiij, actutU; (ouful ; ilurp, rcd-bol iron vcrc forced tbmiish her 
Anh, Ibe Sbcsi of viich «era (ora u if faj piaeen. 61m did not, tiovetct, 
floaphm avcfa of (lie imIombuj orfctm. After lix laailhi' rendeacc in Uie 
Soalhof Fnae«,ibe«aiaeilluTbodil;nor nmli^iwicafed. The palmanBi; 
■Aelioa aMMcd sot lo tafe extemded, but W imgiaatioa iru fkr man 
diwrdund ; (be exiiibiud • p«ater tendcBG; to riev eTeiyUiiax in iu vont 
ligfal i and on her rctam ta Pmu her sl«le beeajne itiU worse. Then ua 
■giin M« the otgect of her paujoiti taccnisbedi ahtodoned ber hiubud ud 
bmiij, aad Bed vilh her Mdocrr 

Sii moatka afkmnii 1 »aw her igaia. I could kuwIj recognise ber. 
Bnalj. fmhaeu. and fulness wen in the pUoc of k ccndilion bofderiag in 
nuratmu*. Thue vu no hwgrr coogli, eipeetoMtiMi. palpitatioa, guttia 
■leetiOD, pun. atutj diMUC The gntittcatian ofhcrpuikin had rccatkUiihed 
her heallh aw) ditslpalcd Ike dwk idcia of bjpoobOBikttas. (Itracbet. 'Da 
rfijpochondrie,' p. 69.) 

ExAHFLB X. — Ufpadumdrwii pmiiietd fy a m^rai emit ml mawri*it4 tf 
twptntitKM ! rte«vtiy if mvraiwmnu. — A. M—,ui active tad iahorioos but re^ 
simple woiiiaa,iijiif«dherarDii)inni))^afilL Abonasetter who wueoasiiltcd 
declared "tb» reiiw of tho am wen loo nocb dbordand for hiai to cure ber 
complelclj" She now BOu^fat lbs ud of apAijsiciu 1 but ai the arm rttll i» 
■■ineJ vnenred, the eune lo tbo eondiuioa that a reiu in her ann lai^t ban 
been brafcen, uid tbat, owiqg to wwt of Um itxa^ the would aerer again h» 
able to voifc with IL 

ThU Md idea eonstantlf punued bor ; she, in tb« inoal nnhapfij frwe <f 
Blind, conpJiiuod to ber friends or her Uu. Sumo one adtind ber to laj iha 
leg of a frog on the Rpot wlicte tlte rein was injured, nod Ihrov it arterwaHi 
into the lircr. Wbcn alic had dime thi>, slie fdt from that anaitiit Iha mar 
of [lie n-Hter In her htad. Herud and mplniiciLDlj dinpoiilioD bMl bow reiffced 
the liighe*t degree ; she bdicrcd tlinl nil her kufTering* were a ptinisbiarat 
from God, btcausc ihe had not pnjcd nfficiently wbeo iho wta a child, aad 
leflacltd on her fatlirr for not hiving more ttrictl^ enforced liua dntj. la 
ordeti bowcrer, lo make amcudt for her hult, Uia prajod dajr and nigbL 

Her ton, whrv «u twcut^-lhrM jeafa of igt, a nadar of mligious book* lad 
of irrcproaehablc chuactct, nuncd and huaionrad hi* mother with saoh dS- 
gence, that fait friendt. aaiioiu roRarding the elalo of his heallh. lauglil to 
divert him bj bringing him ialo livelj Mcaetj. Ue wm rcrj beahful ; aad a 
litelj girl liaTinc gnujicd hit Arm with touc force in order to nako liiai lit 
duwri, he Frit iLc arii) p.iinful. When he gat home, the nioibcr'a torrowfal 
com [ilui tits led liim to think lliAt the Mine thing hid happeond to hiaiMlf, and 
timt he *1ho bod had a vein broken. Xcxt niorning Ihe pain was aetually nnik 
more KTcic, and the jovng rakn believed that be waa low able to use Us am. 



STATES OP UKNTAL DKfKESSlUN. 



sal 



I 



H« beouBD ever; dny vone ; be ttaMd to vork, uti felt asnired tbat a tbid 
ni winting ; uid bj-uid-bf it seemed to Lim irnpoMibb io tue the arm in 
L ths UmL Hu vltole enployaent of inotLer and boh eouiated now in 

■ By ooutantlj bnodinfi over kin iit&t«, thfi lultcr commf nwd to tliJiik tbat, 
B owing to tbe coEi(>cclii>n bclweea tlie rdni of bolb nrm*, tUc oilier would oUo 
mffer — ink momoit lie became unable to more Uio other arm, and in the couno 
tfijtu he fell into web e lUteof apallij tbat be hud to bo drcnMdftiid un- 
inmtd, « veil m Ted. In tbe twe t>( Ibe motlier alio, tlio laclauclioliik and 
the triigioul ideas iacteeMd ; ibe tliuugbl, u often nn sbc lighted tlii; Htn, lliat 
■be lighted tbe flames of bell, An., and ber cniMc; btcimi: so gnai that sbo at- 

Ilcnptcd to coBuniL tiiicide. Tlie ton conld unl; be weaned from tbe idea of 
aarnng binueU ibrotigb Die eixlioirliitioiis of a clcrgjintu). 
1 found boUi indiTiduab engaged in Ibcir oulj cmplojiocut, tIz„ prajiu^. 
Tba jouag maa held bolb ami ttrniglit downnards, villi bandA and fnn^ta 
cxteaded. He complaineil tbnl he could rot give me bit baiiil, bccauic tlicto 
WBsatcin nuting ia his krm. He omc DL-aror to sir, and, after a minutg 
ilieili^ilinii. t said to bim Ibal o/ nvru a vriu irns wanliog, giviug bim at 
Iha ■■■• tima ■ pOBitiTO aiaumicc tbat 1 irould belp liim. 

I BOW na tnj dogen np and down tbe arm in ttic direction indicated, and 
■topfaB^awldenlj at tbe long oail of tbe tbunib, burricdlj cut off tbe cod of Ibe 
tool, tegelhcr wllb a piece of tbe llctb, to tbat it bled. 1 then tabbed tbe ana 
itnagtj with both hands, ud nclaiuicd with a bud roico, " WilL God's help it 
hH MKceeded— the vun is tiow there 1" Id order to convince liiin that tbe 
niB nalljr existed, be was ahown Ihe fbwins blood, and he was immcdiatcljr 
■■pcBcd W Bake ceilaia oioremcnte. 

i» the mother remoiuMalcd tliat tbe recover; of ber ton was not yvi 

itiU, beeasse he slLll bore the math of damnatton (namclT, bUck dirl up-oii 

ilic chest), this was immediately nibbed off md his skin eleauscJ. Tbe son 

_ DOW, after some reiigiou* exhortslion, ahoolE liaods with tbe bTstandei*. put oS 

I and oa hia clotbct, and on tbe foUowbg daj' eoniiDeiiced to wock by tbiashijif; 

B loaa eon. Tlie mother, toe, eonvincnl of the actual leooveij of ber sob, 

I apin tciUBied hrr diligent habtti) and both are now bodiljr and mentallj well. 

I ifiKtjt, in NisM, ' Zcitacbr. f. i's; ch. Aerete,' ii, iHig.} 

W KuMfU Jil.—}/eart ditttiu, Ki/fiochondriAtu, uvtral /figtud eptMiioHt 

vUtwl iteiM rtnll ; /ertruA ital*; rcwe*ry, rtttptr.—Lwij M— , rI. 50, 

vUk BO bcnditarj diipoaition to insanitj, was oblorotic at 14, Durried at 31 

(tw«abortIoBaaiid ei|^t ordinal} birtbt). T)umgher second pregDaucj, »ho 

«M Mised with Twknt beadaotie, with Tcrti^ ami dclihun, wUicb tckMcl at 

Wt DOsflaaaMat. Vor tbe last Iwtoljr mouths abe bas not metutruoted. lu 

^JhptaiKr, 1839, the was seized w iih a gtacral feelio; of ill-bciiit, willi puna 

^^Hlki gl^lnc region, beatings in the whole bodj, and eenauB attsoka. During 

^nW TasiJiaee in the hospital, ibe f«lient suddenly rcmcvibetcd of hsTiB); 

y dmic <Ml of a w«U in wbidi tbece were three spiders, from that momcni 

Jm Uik eOBTuiotd that ake bad swallowed them, and ftU into tbe most nolout 

HHttH*! owtig to wbidi dbe waa on the 1 lib Febnurr, 1^40, rtmorcd to the 

l»iial*C asjliuu al Tours. 

Slit covftlaiiKd of torasicaUoii aad tmarttnc over nil (be bod; ; stilcbea aad 



aaa 



STATES OP MENTAL DBPRES8I0N. 



beatin([ at ibe breast, ilomacli, abdomen, and liaba ; ringing of tbo nn, Blety 
lennen, tcrtigo, atiJ p«ciiliardteui)>. TbcooBtMOf her thoHgblswM npiuki 
■od ber uairen oo»e<t ; but w tooa as the rtfened to Ibo avbJKt of hr 
dtliimm, ibe b(«uae agitated, and t^pokc not tyoly of i|)id«n wbicb iavaSij 
punad her, bat oT dcmou, i«q>«iit*, and beaaU of all dcacripliooi wbidb 
gnwtd at ber. Tbere vtu sliglit lijrporlroplij of the hcait. aad a broit viUi 
Uw Bnteoond; tbc poUc waabatd (culming remedies, digiulu). Cvmiut 
iwUemicai, and doubta conccraingthepoaiibiiityof iccoverj (gaioba]^). Uiko 
itwl* exoit«d \ij tliis Kmcdj, tbne apidtn van Mcrelljr plamd. wbioh Ik 
patieDt wa« allowed (o diKovor; bat ahc at once replwd, *'Tb«M an tbe (U 
ooes t thej have left tbtirTOOig bebiiid— I fed Ibem in mj boveb." Hie aut 
eootrivavcc wu twice reptatad; bat the patical fell ocrtaio that the tfUtn 
multiplied trcmendoDsiy, and vcre now in licr bad; ftoin bead ta Toot. Eiuj 
atlempt to GoofUice bee of the enci of her idea vu nuA with tbnftla aid 
■buw. 

It vai now nopoied to ber to bera an opentioo petforaed, IbiMgb wUdI 
all the t]>idera niut cntaiul/ be remoTed. She Tec«iied Ibe prapooal vi^ 
J07, longed for the liour of the opcialion. Bod apolce of ber rtoorerj viLfa born 
and ccofideaoe. Tke opcrntioa vm perfonned vitk great ulenmitTi in primiw 
otievcral plifgicitms, in ordei to make an iiu|)ienioit «o tbc tntagiulita af 
the paticut. It coiiMkled ill a slight incision of the tkinof tbe hack, anj 
aefaral tpidcn wIiicK were held i& teadinea* were alluired to run about Ibc bed, 
ahe betierbg (Itnt Ihe; wtn taken from her bod;. Sbe laid that ahe felt thdr 
icmovHl di»tiDCtl;rt and r^oiccd at tbc rciult. Tlicac aiaall inanoiu were be- 
quCDtl; rcpratcd b all paita of b&r body. At Ilia tiino ilc took iutennilleot 
feter (ituiiiiiiu, aniispatmodtoa), was ainr&jra excited, felt istnpportablepaio ont 
tbc whole bodj, and conitaiillf begged for new operations. Once ake at* 
templed to Ibrow bvtactf from tlie window, but without doiagheraelf an jiquji 
at anotlicr lime alio nllcmptod to atratiglo herself. Finatlj, it was declared to 
ber Ibat now there wcid ud mare apidcrs in her boilj j and to ooDTboe ber ol 
Uiis, two new inoitioiu were made, tbe cuophagnl aound BSod.aBd pufgatitta 
adioioiAtercd. On September i)th, iLo >till attributed certain pbjraiologioil 
phenonieiiB to the preseiice of the apiden— the Tuisg and falling of tbe kiysx. 
tie arterial pulae, &o. Sbe waa, howeTor. aoon connuced tbat llteee appear- 
ancee were proacut in all men. Tiicre now appeared a fercriali atalc, witli 
hcadBche and riuging of the tan j and on the i8tli September, all tbe ajrmptoaa 
bad diMpprared. 

The patieul now became completel; quiet, happy and thanUul, and wm 
e>D|ilojed !u tbo kitciieu. The news of the death uf her liiubauil, wbich was 
nablj told ber, Tcicd licr mtj iuucIj, but in uu waj ditluited hei meulal 
bcaltb. During the nttxt winter, honcter, wbicli wu xttj tcrcrc, liviK in tbe 
most indigent ciroumatauce*, and alruggliog against cold oitd baager, aba anf- 
fered a relaptc, accoiQiiaoicd with violent palpitation, agitalioo, fnaoiii, and 
atl«nipt at taicide. The patient was no longer treated acoordiug to be; faUe 
ideas, but gniduaUy recovered under limplo autrient treatment, affuiiooa, batJu> 
narcolic and aperient tnedicinta. (Cbarcella;) ' Annalea U^d. r*;cbol.,' ii, 
1843, p. 485O 



STATES OF 3IEKTAL DEPRESSION. SS8 



Sbotioh II. ~Melaneioiia in a more Jamiied Sente. 

— lu umo] caM», ■iier % period of tongnor shorter dumtion, & state 
of ¥igoe mental and bodily discomfort, often with hypochondriacal 
fiOTcrsiuii, dtpreasion aod rcstk'ssncsa, somctitaca urilh the dread of 
beoootinj; insane, passet) off, a ^ate of mental pain becomes always 
Don dominuit and penistent, but ia inemsed by erery eitenul 
nental imprewioa. Ibis is the essential meiitat disorder ia melaii- 
diolt«, maAf to Air as tlie patient bimself ii concerned, tlie mental 
pain coBiists in a profound feeling of iil-hein^, of inability to do 
anything, of suppression of tbv physical powers, of depression and 
miaea, and of total abafcmcnt of Eclf-coiucioasnco. So soon as 
tbifl oonditiou of the sensorium attains n certain stage, tlie most im- 
portaat and vide>spread consequences, as regards \ha demeanour of 
tlM patient, itsult. 

Tim difpontioii asnunes an entirely native character (tliot of 
■bhoiRDoe or i^ndBion}^ All iiupresuons, even the ilighttst and 
farmerly most agreeable, excite pain. Tlie patient can no longer 
iqake ia snytbing, not eren the moert ptfiising. Everrtliing afiecti 
hia vncoiofottably, and iu all IhiU fa^iipeus around Lim he Sods 
new aaait«B of pain. Everythiog has become repolsire to him ; he 
baa become irriUbU and angt;. Every trifle pul« him out of temper. 
Tbe Ttsolt is, cither perpetual expressions of discontent, or — and 
this is more common — be eudcaroara to escape from all outward 
neaUl unprcMions, by withdrawing himself from the society of men. 
Hid, cooi[Jetely idle and anempkiyed, seeking solitude. Tbis general 
fceUag of arersioD and iadiflerenoe ia often expressed by a dislike 
towards those by whom be is surrounded, his family, friends, and 
rdatirai, which often merges into absolute hatred— by a complete 
aad Bnhappy change in his character. 

We nay sometimes observe in indiriduals apparently healthy 
(partieulaily among females) a similar though much more chronic 
■Ute of habitual pcr^'crsiou of sentiment, aocompanicd by a capii- 
etaus and uorou disposition, with a tendency to contradiction and 
ffl^wtore. Nererlbekss, it is very rarely that this is regarded as • 
norbid state, even although it differs widely from similar evil dispo- 
rilioiu which we see Mmetimes displayed in those who are perfectly 
Wealthy, — through its frequent origin from palpable diseases. 



9M 



STATKS or UKNTAL UEPRKSSIOK. 



through its freijaent remissions, which are explicable hy no veil- 
groDiidcd mentiil motive, and throagh the (act that at times the 
pMicat feels himself coiutmiiied to jrield W the eril diapoaltloD la 
direct opposition to the dictates of his conscience and his iriil, 
aad aithuugh he is iierfectly aware tliat euch conduct is most unwar- 
xantaUe. 

In simple inekncholia we frequently find a condition of the »ea- 
sorium precisely analogous to that which we have described, under 
thii htad of tlypochoudria, iii which the obj<xts of the outer woild, 
alllioagb they oomo iato cou^ciousQcss through the medium of the 
senaea, and are indeed properly understood and recognised, still Uiey 
produoo sD impression utterly difcrcnt from irhat they were wont 
to do, of which the intelligent and educated sufTereni can aloiM give n 
true description. " It appears to me," says sach a melancholic, " that 
cvcPi'thiDg around mc ia precisely as it used to be, although then 
must hsvc bc«n change*. Kvcrythiug aroirnd mc wears the old 
aspect, ererythiiig appeara as it ytaa, and yet there mart hare been 
great changes," &c. This confounding by the patient of the sub* 
jcctiTc chnnge of exterior things, and then objective chuige, is the 
comneuccmcut of that dreamy state, in whiclij when it has attained 
to a tolerably high degree, it appears to tlic patient as if the leaJ 
world had actually sjid completely vanished, — that it bus sunk, dis- 
appeared, or is de&d, and all tltat now remains to htm is an imagi- 
nary world, in the midst of which be is perpetually tormeated by 
finding that lie lins stiU to Uvc. 

At the beginning of this state tlic patient is perfectly cognisant of 
the change which has taVen place in bis moral nature, in all his 
feelings and affections. Sometiiaea he seeks to hide it, and the 
iuquirics conciTuing the cause of his pccuUiir behaviour weuj 
Bud annoy hiiti. He fi-cls thut his former enjoyment in everything 
that was honorable and estimable is fast pasting into tDdiffisroioe 
and actual repugnance. He even coRiplaini himself that his seiua- 
tious are no longer natural, that they are perverted ; and when hii 
evil genins constrains him to rtgard tJie worst side of the world, i 
new source of jiniu and sorrow is presented to him, viz., that he <afl 
rejoice about nothing, and must oppose everything. The onwonted 
impressions from the outer world excite his astoQi»hment, grief, aad 
fear. He feels himself excluded from his former intercoone witll 
Bociet; ; and this feeling of isolation, this exceptional position 
in which he finds himself, favours, on the one hand, the limitalxni 



nxTis OP uwstTkt. Dimasiox. 



or ill ideH eaaesnBg tk nfalin m «UA W iMii tD Ac nU. 

■ril Thr rrlitinii tif ritriMl nhjri ti In hi^tf OBtkeolteha^ 
tlwn [tfoecnls from tim lec&g of iwhtiM, AAnat, aazMCf, aail 
fc«rof«U|iowfl)teiini wliwtsfcetl^rffcibriiHiwwy 
UnnrdB the vorU, bat Bon cAa a pmdtM, bi^faa viUkml 

from aodcij and eoDcenintiaa is Viw^ 

Hat wbieh wiflm moat hearflf ^oa tte and of Aa ptdeot at 
tae eomaifBi I'BM ct oi hii Ihhiimi. m nit ff*'^iiig s cBiBge Tiiiai 
hai taken place in his on pcrNnalitr, that ngaeaa* »aA oWniitf 
annng froan tlitt WMJefaiJ fetHag of aBBojaaee. ¥«t at thia alige 
he is aanrtiineB perfcctlf mre that Us fan are ahnud, and tliat 
Uioec iueu7 tlMn^ita wlucl force tbemxires opoo Um are uttcH}- 
Cdaej nod be ia crcn oaaaWNia of Ua on actool ttste. But tlmr 
be percma that it is impoaBUe for hun to reel, lo iliinV, to act 
otbenrbe tluD be doea, — ihat be cannoC naisi, and how aadeas 
CTcrr effort at rtmtUjtoe is ; tbeo be icoeirea from this ontcoaaag 
of the ISfo (j 33) the idn of being nled, of being bresistibljr 
abandoDcd to BOiae fordgn inflaccce, to whicfaj aftcrwanU, ideas of 
being govenied bj evil poven, of eccict direction of tbo thoughts, 
of denootaeal poMeMJoo, Ae.> eonvspond. 

tbe Umitation of the iril), which is one of the fbudnmental 
dwofckn of mclaacbolia, ia numfestfd by inactinty, ccsntkm of all 
enploTuent, eonstaot doubt and irresototioo, incapacitj of de- 
daioD aod abMOce of wiU. In the higher d^reea, it shows itself in 
actual torpidity and dul»e» of feelii^, inasmuch as imprcssiona 
are no loager followed b^ a rtaetton of th« will ; io the more 
moderate degree*, as Blowncas, monotony, hesitalion iii moTemcnt 
a»d action, feeling oi incapacity for the slightest mental cxeitiou, 
lyit^ in bed, tc. 

Kreiiaentlr there are scnntions of inteaie anxietyf which often 
Bpprar to apHog bom the epigastric and ranliao regiom, and to 
iDouat upwank. " Here," say many of these patients, poinlitig to 
Ibe tpigajtlriom — " here it renutnt like a stone : would that I could 
get rid of it I" Tbcae fcdinga of anxiety sometimt-ii iucreose to 
ntch an extent a» to be almost unbearable; thus driving tlie jiatieut 
into a state of despair, which generally paasoa into an attack of 
aaiiia. Moreover, these stotes monifest themsrlvcs externally in 
■any tariowi fonns, according to the former diipoiition of the 
patiftit, the moral t-niue^, and aocompanying physical aiiomilira 
Ac : at tinea, with the outwnrd signs of grief and cart, or aa ailent 






BM 



STATES 07 MENTAL UErBSSSlON. 



Diclancbolf, as sdf-DoncciitratioQ, or a hlQ, p&snonlesa, n^emi 
Waring; Eouaeliincx as louil sieir-a»!u»ation, vith weeping, wnngnig 
of tlie hands, a.ml grvat icslU-ssncss ; sometiota as morbid pecu* 
Uarity and intmctablc obBttnacy ; or, QuoUjr, u a kudenc; to hj 
violent luuids ou self. 

TbtTO arc some melancholies who an always digcontcDt«], awl 
wham Qothmg pleases; others to whom trtrjXhmg is alike iudUTcT' 
cnt, bvcaute their attention \a completely absorbed in the coo- 
tempUtion of their ovn misfortune; and others who tDaintain 
that for them "o'errthing is too goodj and they cannot undet< 
aloud how it is thot |)cvple do nob dcipiac euch miserable crcatniu 
Bs they are." 

Ail these Tsrieties in the dlapotitjon of mpJancholic* are at tbt 
commcDcemcnt gcDCially uoaccountablcf and do not depend od 
certain definite delirious coooeptiona; tlwrefore it is that the 
patinit himself is also, at tliia stage, perfectly iticapable of giving 
any staLcoient vhich might account for his present ooodition. " I 
an iSnid/' say* auch a patient ; and if asked vihy, he can only 
reply, " I don't know, bat I am afraid" (Esqnirol). HetMC, we a« 
constrained to come to the oonclosioD — which, indeed, obe«mtion has 
led U8 to, and ecrics only crery day to confirm — that exhortations, 
aoltcitude, and ailment have not the slightest elTect uj)OD this state 
of depreasion, engendered by some cerebral lesion; and thai the 
ideas which conduce to Ihu dcrclopmrnl of this state must have an 
isteroal, stibjectirc origin, and therefore a character of irrefutabili^, 
BO that they render the patient wholly impemotts to anything Uke 
argument, and at best only permit him lo cxobaiige ooo moamfd 
train of ideas for another. 

5 1 1 7. Ammalia of (ie iitfclleet.—T\ie painful conecntntion of 
the initid rcprcsMS the vivacity and the natural courae of the 
tboagbts. A fenr ideas occnpy the mind of the patient, and all that 
lie gives utterance to is a few monotououa complaints r^ardii^ 
himself, and of the sad change which has come over him. Or, he 
continually reverts to ccriiiin events uliich happrrkrd about the ram' 
mcucement of his illness, &c. All desire for intpllix'lual iuteceourve 
with his fricnda is generally ^r.ry much dimiiiLshcd. Tho patient 
often sitd perfectly mute, or at bot «))caks timidly, with hesitation, 
in a low tone, frequently iatorrupting himself. One melancholic 
who was undei my charge picseired an inviolable eilervce for ecvenl 



STATIB or HBHTAL DKFaESSlOK. 



nzr 



^nognomj 



wc learned hia 
^ ivocally iatense 
iiuietjr and sadaeM, while at times he would weep an<I vring Ids 
buuls. Ill oUuT cuea tlie ftttitnl beniuLa liiinadf, Leuvcit liecp siglu, 
and M engaged in pra^cn aiid jupplicatiuui, but always on thfi 
■■me aDbjeot ; ;et, in spite of the extrnardinary mouotony of Ins 
intellectual life, be never becomes a prey to ennui. 

Together with those formal disorders, th«re now appear false idcaa 
and judgments, correiipondtng to the actual disposition of the patient. 
Thm, for example, he feels that he ia in a state of aiixiety of mind 
exactly ftmitar to that wliich a crituitutl is likelj to cxpcricooe nft«r 
the pcfpetntion of some misde«d, and so he believes that he, too, 
has conuoittcd some crime; and from this predomiuating idea he 
CHUoi rid himself. But as iu the review of kis life he is onahlo 
to ncall what this crime i?, he fixes upon some insignificant event, 
when he has committed Bome trivial fault, some petty carelessneM 
(or perhaps he may not ercu bu gudty of that), and this unfortuoato 
oc c B f renae becomes (he subject of his delirium. In it he discovers 
tbe cause of his prescat misfortunes, and his fears for the future. 
SometiiDcs he fceU himMtlf the prei* of some undefined torment, and 
tirp(p"'" liimsetf encompassed with enemies. Soou lie aclually con- 
ndoa himself persecuted, surronnded by foes, tbe subject of mys- 
terious plota, and watched by spies ; and as ho cotiiiccta everything 
with himself, tbe moit iusigoiJicant nutter tends to nourish his 
ileliriom. 

Again, tbe psticnt who formerly cherished religious ideas feels how 
pcofesndljr he has changed in regard to this train of thouglit ; how 
thia etit« of anxiety and uneasiness rendcn him totally iucapublc of 
idkdioD; how, conscqncntly, he is unable any longer to pray, or at 
hil dcTOltoiu be is assailed by unhappy native ideas. Ho feds 
thsi the durcb and all other external objects give rite in him 
mcfclj to painful impreasioDa. Thns be seems, to his exceptionable 
poHtMin, like ■ castaway whom God has given up and abaodoDed 
lo the devil and to etcnul cLunnation. Soon he oomes actually to 
bcUere that he has indeed ooounilted grave faults, innumerable sins, 
and that bo baa entirely n^lected his duties, &c. Ucuce we ace that 
it often doponda upon chance, upon which particular tliuiif^liUt or 
ideas the patient attaches m much importance that they recur to 
bin as ftsod or partially fixed delusions. 

All thcM melancholio iiiMUu ideas have one csseutiol cha< 



S98 



STins Ot HKNTAI. DKFBttUlOH. 



racier, tlut of posove saflering, of being coDtrolledj and vta- 
powcTct). But wti can readitv discern bow very various must he 
the epedal subjects of these trlefls, according to the amount ot 
educalioin and 11k cliamcter of earh individual, tlidt antecedent 
hiithnry, and the impreeswo* which liave been aocidcntallv mide. 
TIm mom feeling of loss of wIf-coDtrol, of being given over to 
foffign and peculiar sensations and idea», which awaken in tAc 
ctedaloo) peasant the idea of bcbg bewitched, mn}- in the bctltf 
cducnicd call forih the idea that aome <me is acting upon him by 
meaus of electttcitv, magnetism, or chemislrr. To the one it acenn 
aa if be has lost all his most cherialicd goods, Im children, hia 
rehitionfl, imd lila fortune. This he finnly bdievt's, and fe«ra thftt 
nothing now Temnins for him nnd his fnmilv bat to die of starration. 
Another iimiginr:i that he has become bankrupt, that hia bomnsa 
hw gone froRi bitn, that he is mixed up in the moat serious aad 
criminal offrace*, and erases uot to bcirail that he has rcdoccd bis 
bmilv to the most object poverty and be(^ar]r. At otber times it 
seems to the patieut, when he fecU the change which baa occamd 
in his vholc mode of aensation, and exi>crience3 the impo^ibilitv of 
maintaining hts ordinary share of worldly duties and eniploj-ments — 
imagines that ho can no longer be a duo — that be ia gradually 
becoming like one of the lower aoimals, or that ho ia even already 
trausformed into a beast. Aj tlie cjiaiige in the t)a>ient'« views 
of life and morals in general usually gives to the insanity a certMu 
colour nnd cxpreMiun, so long u tliu nsluml scn»ntians coolinae (he 
same, and the general relations of love of family, interest, headship 
(cmotiona which in all times most actively bear on tbc haman beart) 
raaain, so also the delirium of the meloncboUc prcscnta varioua 
phase* at different epoebs. The fundamental diaordera of the self- 
suRsatioa are, however, always the same, whether the melandiolic 
bclicvea, as ui the day^ of old, that Alius, becoming fatigued with 
his bunirn, may at niiy momcul let the arch of heaven drop; or 
wbetber be imagiuci!, as in the middle ages, that he is under the 
power of sorcerers, ghustd, and witches ; or, as in oar times, that he 
is sought after by the police, or that he is engaged in tbc most 
disaatrous speculation*, kc. 

As to the manner in which tbb delirium is brought about, we 
liavo already severnl times point4M3 this oat. The ]inlient ex]>c- 
rieiLccs a feeling of sadness. At first these fits of »adiieu arv 
only produced under the influence of vexatious causes; but the 



I 



STATKS OP MENTAL DP.PRE89ION. 

liv of causality cicmuids even here some motive, some cause for 
lids, and before the patient has had tine to inquire into the 
ntioDile of it, there ari»c as answers all sorta of rnournful thoughts, 
(lark pieKDtimeals an<l sppreheDaioiis, over which he broods and 
poDilm milil certain ideas have beconie strong and persistent enough 
to be, at leoat for the timf, fined. Thus ihfsc di-linoua conceptions 
agdn posMSS the eroentisl character of aflemjuU a/, cx^l-anatiou of 
the ^cial state. 

At tbe oontnenoeaiiint. and ia manj cues oven daring the eutire course of 
Um melmcliolla, titcrc mvij be do delirium, jimpcrlj? so ciill«(l. Tlic pnticnts 
■■f be lUo qaitc corrcctlj to realise tbcir oHocotidiliuji mid llic lliitijti or (lie 
txletiul world— to uuljrM thttr Hniations with prceuion, and Bntiousljr 
daire to free tbetntdTet ftom Uiein ; bui to do litis i* ftbsulul dIt bcjrood tlicir 
]X>ver. 

Ancrngst Ibe most marked cud* of meUncholijt, tliereis one most important 
diitiocUoB to be oudu, rii., vheLher llic pAtieola sjipcar [o be as it were ia a 
profooiid iirt«m, or tilittlicr all ihcir Irniissctioiis witli the oulcr vorld aro 
nuricd on M if \hej vcrc quite awake. Canes of Ilia Urst class ordiiiariljr 
aiiBMB a mora acute cluneter, >ad more nearly appToiicli thnl form Icnown as 
" iliBfhnlii irilti stupor," tbo pnignOBis of which is much more f.iTorablc 
Ihaii tbal oT tlnae vbioh fsll under Ibe (wood head; nliicli uiiiallj dRvdnp 
llisiiiailii I alowlj, and are mach more ebronio iu Ibeir course. Tbo llrst class 
of caaca naj (erminate tcij sptedilf, aa if the patient had suddcnlj walconed 
up : the httcr Wfnt do IbiL 

} ti8. Anomatiea in fit muiliilUy an<t movmmtl fre(|uently 
accompany tbesc mental (iistorbanees. Tlicsi; are nt times in(hc»ted 
(at ah^y mentioned, ^ 49] by sensations of emptiness in the head, 
of deadoeaa in (Ik bead, or of ssome other inembttr, or even of Iho 
vhole body; eomelimes by these annoying sensations experiezie«l 
over the whole rarfaoo of the skin, and suggest to the sufferer Uw 
idea ibal Kiinc one is clectii^ing him ; or, finally, by hyperasthosia 
oC Uw Mght and hearing (trembling, stArtinf:; nt the diglilett noise— 
perhaps a fuodaoiental cause of the to-called panphobia). 

The special insanity of Iho ."cnseo, tbe hoUufinatimu and iHuthnSf 
hove, ^nite the cliaractcr and impress of painful emotional perversion. 
Vm pttient sees the preparations for his punishment — he 
bms the iiMasengers of justice vbo have come to mixc him — he 
p «w « *ea hdnueir aurroundcd by the flntnes of hell — pri-cipicea 
appear to 0|)eo ander his very feet — spirits come to annoanco to him 
that bo ia about to be judged — lie is pursued by voicea whicfa 
aiUicaa bim in tbo uoet abusive and mocking language, fte. 



OP nOtTAL 



thtfandor apif s*inc« Wtm iteloofadialo^ minor; nd 
farhigafcr A< iiiilMi 1 la ter; Art Ae kndf M ben 

TBied m OiC wj taiam fatm at mthmAtSa, in wiutk 
tlw pattart rimtm»ny hreodt ow hb avs ■Irfwtini', lad b 
bIhiIj m^A 1^ m il J Ma vaon omc ■ ■ ptrtid M^pmnM of 
temaomatm <rf «te u ffof oa a the iTti¥aJ wwM («e ante 
Ibe Wid *'HtbBcbaEa vitk ft^or-)- ^e oAeu net «iUi 
fc a B a eJMt ioMi of tnte lad mb^ tte finer pntindBrir, vbea tb 
prticB^ perceriBg I mctiSe taite ia ftD be e«b» Ins ilw idea (hu Bog- 
geiCcd to faim tbak nae OBB ii oidcmiaiBg (o p]»n luBi, or Ibil a 
Anm bu beat Wfoo^ afMNi Im feod. The ■n l fiMti»» myle— h> 
odocn tml him to imigine tbst he u samonded bj dead bodie*. or 
that be faiiBBetf ii ia a rtite of pittrdBctioo, Ac 

Willi tbe apfieaanoB and iacrtaN at tbe balbici B a li o itt, Ute 
palictit conuDenrea to act eoHrdj accordiqg to iimpnnrjr rdatkoiv 
md eomeqncatiy btwiea man and raon estrmged bom tbe vofld. 
neae hiHiirinatioiin often Km as the object of nev ezpbautiotuif 
uul the most gtoomj and kWrd ideas of wotlds of spintcj of 
amjihiw below tbe earth, vhicli exert thdr infltiuioc upon tbeK 
nnfoctanatca, &c^ take their origin in these perreniona of the aeoaes 
vbich oftea onlv manLfest themx^ves long after tbe conuaoioemcnt 
of the disease, or wfaieh ma^ erea Dcver gire any oatwatd sign of 
their presence. 

Hi motcatn(4 of (h mtUucMie bear tbe impress of tbe ruling 
IHUofol emotioD. GcncraUj thcr ore languid, ferble, or oooslrained. 
The patient ff^^dly resU in bed, or keqis tbe whole dajr to oae 
fionwr, when- be sit« witbtiut taking the slightest notice of anjtbbg 
Ibai is going on uronnd bint. Often be sits ahsolutcljr motionless, 
as immovnblj fixed ai a statue. In such eases the limbs an 
pcrfcctlj stifff and oBbr considerable resistaiioe to aay attempts to 
gins them another po«iltoa ; or dae, on the other band, thev are 
fli)iu>nimlly flexible and mobile, and often retain tbe position in 
wbicb tbey hare been pluced (caloteptio slates). The muscles of 
tbe face arc Koinc-tlmea the scat of a pcnnanent contraction, the 
features are Rxrd, the ejrebrews wrinlcled, the angles of the month 
dnm ti down. All this, joined to tbe geaeraUT Rreyish livid tiat of 
the (kill, K<vc« to these molnucholies abnoft invariahlr the nppcarancc 
ai great age. The ejres uo always cast doniiwards, or, on the other 



irATm Of H£KTAL DF.PRE8SI0N. 



S31 



I 



id, widely ojkq, tnd Itxed irith Uie eipitssjon of saffering, of 
pvurul Icnaioa^ or of nstonkbinent. 

Ao essrultally dilTcrcut ilffporiment i* preMnted hy movcmentii ia 
that fonn of mdaucbolia nbcrc tlic inner dbquictudc is also 
cxproBod bjr physical restlcasness (lacUncholia i^Uns), in irliich 
there usoallr is n eonfuaetl tumiiH of tliougfai. In ewtentiali), hov- 
fvrr, ]hesc arc certainly very moiiutonous aat) of small Tuieiy ; aud it 
is through this paucity of ideas, tliis viuit of fertility, tliat this stale 
difljcts from mania.' At other times, the patient keeps up a perpetual 
motion, ofl«n broals out into iit4 of ve^ping, and constantly wrings 
hi* haiidi. Nut uufrequently, h« manifesia a great desire to wander 
about at liberty, to make long excureions, and to risit his friends 
and relations (aielancholia tTmhtimla]. Oft<^n vhile walking he 
wrtngs Ilia hands, or, beconung violently agitated, tlirowa bis arms 
iota all uanncr of wild conlortiouf. 'We may quite correctly 
rccogniM in these two dilTerent modes of appearance of the morbid 
BKBtal pain, the analognes to the piunfnl Pinotiom of the healthy; 
on the one hand, to the immobility consequent on shock or fright ; 
on the other hand, to the physical restlessness and aviation (running 
about in tlic opcu air, kc) obserred in these in this frame of 
buikL 

H« devMieiuJivm ike itcrmal almndarJ «/ fHytieal keallk are xalueUss fat 
tka purpoae of diagmui of iosaoitjr ti> ({eaen^ or of auy one fortn of meatat 
iKiMW. iMt are of U» kigbett impartaaDe so far m n>gard* it* tWoUtgj and 
liialiwiil Tkn« ii««itliiciiis are l>j no mMuu Gaut«Qt, and <!a not almija 
imiut tfao tans rtialioD to iiiMiiilj. SometimBs thrj are nierd; Uio tjmp* 
loou of aea»e naW/vhicb maj Lare been in cxiilencc for n oonuJcnbi* 
Uat pnrioulj, but vLtcli at the Hmo time nay liave ooalributed tomevhat 
to Uw pndBclioa of cerebtal dueaae {t.g., utcrial liTectiont). SooiotiiBet 
\kt] an aocidctilal oonplJcalioBi, at oilier timet ihcy form tbo tjmptoms — and 
t^M ialtat are b; far Uie aunt imjiortaBt — of the cerebral diaeue tlsolf. To 
thcae IkUer belong pArtictilarljr— 

itt. Iks ilMeaoB « dimiautioB of sleep, to that tbe parent eitlicr Ttmains 
Vjntt ilatflaa^ or fctll M lUtla refreshed b; hit ilcep tliat he alBnns lliat be 
baa not dqit Qliia bcin|t ia fact, a prolongnl intcnial wakelulncas with drov- 
MBcaa of Uw aetuorial CsMtiou). Ue «[lea liu diugreabie drctttu, anil frc- 
qwU^ batlaciBaLiona occur at tbe atomeat of nwaicDiag. 

and. Paiafnl teautiou ia tbe head; e.g., heal, prcaiari^ weight, vertigo, a 
fluting of EtDplincM, of voter, Ac., in llie stiul] ; a light -licnilcdaets like tliat of 
4na\ena»i uoisea ia (hs aan ; amaalMoa timilar lo Uiat ot an aura ; slight 
coBVnlaiofM of ibe aoacJta t waadenDg pains ia dilfercnl ))att* of the body — 




pWlJ9U0( 

MMpdtoliD,aNdi 

Ma* of Ik friadpil 

tttBMt ■mIiiI <iwiia[iiiiri 
■ JoiV VQMB wtoia g ftoa 

fMi k tk i^ nJe of Uu farther 

IMliKij W Ml m . S««T daj she ted n 

fti n^ i}«i MdlbMtb* 




•■1 omI m hm|^ 



TUi bet B^ lad toocittm 

tt iij|intlrtiMl ilopf gw ariafaretBi, 

■ lov a4|' denBgoBoito m tlie intoti. 

f , «f MBfM^ Mfcirily It tke oovmeow- 
I of a iMtnMBleitiwil iMlntii. 
I lie tatfttb kadad, ad am iliaorml (jiptiile 
or (Hd lUi k Mm eowMn) iiKntKd,ud 
MtoMHMtUw idHOkllka tcBMlinoT MtMlyb 
TW mgfnmg ^ aS km j vt mbb pitiatagftci fonuieagaki 
ipolMqii^lathiirAtoaf intaid MfacM. Thumnuj 
•M 4cB Iwl^ P>q;i>S ^*S< fieem tit ak», md ■! iIh uim tiae lg«d|j 
knmO^ tbeir &■««»•* siu, tad Enerng orcr tke lo« ot their M»b' al«»* 
tfaa, or own tcBponl rnktortonea. Tte leaaalioB rfwci^rt il the cpigutrtBB 
irhkhwelawoht miJ tobewpliiMdofliythipiiMherof wieh patinb^ 
■ppcm lo arise &««> ih» diapfcnga «r th» ■ Mnihi il m i Jw. BejiMidUiIt 
Tc K« ■• jet taUa to (o withonr aphoiliaa. Tha ia to be RfnURk 
beoMW H oftM ■pptMi fa) liiHiB tba foriaga of Mixietj, ud we n^t, ty 
OOBtreltii^ X, Micntiaily MMlIonto th* oooditMa oC the patfeat. Thai in iho 
e»e of a jous voaun rtoa I saw in 1 857. and vho, afiu aercre Urtai- 
eoielie trcatnieBt {tot pajewwona), tuffcrvd for a long tine troai ^rmpton* of 
dmwie ulcua Tcotricvli. The rmjneDl fila of aoale tnejaanholia, wiUi Uta 
Un^f ef anzietj^ aMoaapawcd bjr pMlpkatioD, BuiaUiaed a certain ration (0 
onr-tsbwsa of the it onadi , ecnn ia dkt, indigMtioD, i«, JV« raj^tof to lalt 
Aw/ vliieli is rmiiinittlj ohaerved ia tbecaao ol iMlanchDliea, and whidi, when 
IcMigpcnisicd in, beeonua atnwblnome conplicalion onMOOBot of the forced 
ahmcelaliMi ant) nntrqtieiit dafixtiTc MviihiiieDt, ofUa ariaea frooi (ha fsar 
which thete unfortuBiitts cntcriain of bcinfr pcisoaod. or rran nriooa ahnor- 
nal acuationi <riiicli tbcj cipcrioacc in their alonuoh ; aa if their iotcstinra 
were cloMfi up, or there wtn no roon for note food ; or as if aitpctile hMl com. 
pictclj left them. At other timet thej refuse to eat, beeauae ihtj wiaU (^ die 
of huDKer, or bccantc the? brJiere that It; thus itarting Uieasdres the? em 
eapUlc thicir itn* ; or becatue o( hnllntsuxtvcMt, anch aa tlw hearing of roieci 
wbickcommnnil t lie m not to cat. Ac. Theic idcaa Mcm notnctimcs to be Wig* 
gcatad md kc|>t up b; icriow afltctiooa of Uu iutctliual mucous nenbiaBe, 



STATB8 OF XP.KTAI. DRPRKBSinN. 



288 



I tid puticahrl} bj an ttmXe nUrrti, extending orcr & gmt portion of the 
nUatUkl Iract. fiat Lliti raruMl ot food u aba not uurrequentlj-, tu Guislnin 
bujtidioioiulj obwrred ('Lcfonsonikt,' p. 3<S;j) only &d»11ict form oE Uingilsj- 
tof Ibcir etKliniejr.— juit u Ihtj ntate lo i|»ak. Or, Iiutir, it ma; be th« 
HwiJt MMplj o( imil«lion. Tbe iinni«iJi»lc rceulU of lliis prolonged atMCiitciirc 
■n, rsfad BisuiktioD, di^aeM ot llie ikia. slowncu of mpinlian, iluggbiiaeM 
of lh> bowcb, deScuBcy of arine. 

4th. Tbe nutrilioo of Ibe body frequenlljr luBcn. Tlic patients iiccome tiiin, 
tli« akia toK4 ill noattteu And frtsti ippeannoe ; it beoomcs pile, withers &cd 
drica up. la tlie uormal olaCc ve do at limn obncrrD ui miwlogous coodition 
d Uw tkia u Uh resuJt of lionming nnil norTowful rmotioni : yet it lias been 
ttoat juali^ naulied, Ibkt tbe jwrTcnion «( [lie fr«Lings in melucliolicB never 
imdnon ao pnrfbuiidu efftct upon iLc ranalilution 05 ktctc and protracted 
<molioi» Wrtaillljr d6 in Umim wlio arc la |>trfcct health. This luu beca oc- 
co«nlcd for hj Ibc bc( tkat th« majoritj of melancbolici <at more uid digest 
tbUT food mnob better tbu perMmi iu hndth do vhen under tbe infLarace of 
pnfcuail sorrow. But, an tbe other band, wbcn aucb pntienta muat \k fad by 
Gam, ■■ when tbqr ntaee Ibctr food, they sink rapidly into aculc inaraamus, 
oAu aMOCtat«d witb severe and fatal local maladies, t.^., lobul&r pneumonia, 
gugrac «f tbe lungs, Ac. 

Stk. The rMfuitioa is frequeDlly prolonged, incomplete, and difficult. The 
|liil ii opprataed, and scdia to otrfaio air by meaus of deep tight. Palpita- 
tioM of the beatt are by no Bcana nBConunoiii and often it h from lbi> organ 
tbat tkate aciuatians ot aaaicty proceed. 1Ve hate alicad/ ipokcu of affectioua 
af tbo cuaUatwo, and of Uicic importasDc ao far aa rt^rtis tlio dcTelupmcut 
BMi aeiBtcuBoe of e«rcbnt ditraxo. TIm state of tlie pulso it extremtly 
vaiiablat it is often very snuU and .-dow; tb« feet and bands are oRca too* 
itanlly eoU, porticalaily iu those who ncvtrmore about, wlien they may prvant 
a Gyaastio or kadta bo«. 

6Ul Ocni^Bnails of the nnitraal futwtion. Abacacc aiid irregubrity ate 
ter; rraqatnt. la tomt aaaa, wHb Ibo re-estahliahineiit of the menuM wc tre 
tbe menial aiwtioa cooplelely disappear ; while in otliers it produce* do clTcct 
wbaUFW. and even at tunta tends greatly to agitrarate tbe disHM 

Jib. AKMulies in tbe aiinary Mention may be much more frequent than ia 
inanHy auppoaed. UBfotlusatdy, any reliable rtaearehcn on lliis importoat 
nl^Ml VI ilill waating. Tho tccretioiB of tew», ui spite of the state of meif 
tal aecAW mder vbltb the patient eoDStantly labours, ia Tery rarely in- 
creased. 

Cknulfl affections of the visrcra Tery ofltn develops thenuelfc* during (he 
tomiam ef mrfaiicholia, aa luborales &f the lungs, affections of tbe skin, cb(Oiii« 
JBtf^lw) calorrb, Ac. Tbeie afectioaa sosulimca remain latent for a very 
long titt*. Wbea death results, it it generally to Mosf4|iieD0e of one of tbes« 
tlililim 1 1 is by no nmns rare to ace a faUl issue wfaco ibe paiicnts refuu 
tbctr bod : aad in ncbuuholia witb stupor, death, tndcfieRdenl of tbis circum. 
slaao^ soiniilinws soperrcnew ia tbe nidat of an oeeesa of tbe syniploma by an 
i^mntioa of tbe omfanl torpor wid panlym, and umetimei al the autaptj 
is Msb «Maa eooaidmUo osdcDUk b liHUkl. 



3S4 



«TATKS or MK>fTAI, DP.PRCStlON. 



^ 119. Tke Count ttl tbc simple forms of mtUnchoIis it oftco 
very aculc: thu$, for cximplr, la tliosc casca where a very short 
penoO of (laiiifn] peircrsiou of tlie feelings, accompomed witU pn- 
fbund anxiety, prececUs the dcvclopmeDt of miiiia, particuUrijr of 
intenDitt«nt minis. L'sunlly, however, the coarse of melancholia ii 
chronic, with rcmissiona; more raitiy with complete intermistuiiu, 
of Tnrialile dututioii. I hare once seen, in a woman altickcd witk 
intense mcUudiolia [ideas of complete loss of fortune, of iatceA 
■tarralion, &'c.)i a oomptctc lucid inlcml of scaicdy a quartet of in 
hour's duration supervening without any nsngmble caoae^ u>l 
terminating cjnito m suddenly, ^'fttnnlly, the Kmisiona are of 
more &cqomt ocrurrencc at the commcncctncnt of the mclancUolis, 
and also on the approach of convaleacciicc. 

Transformations into mania, aud the passage from this again iota 
Buliiichcdia, am phenomena by no means rare. Sometimes the 
disease represents a cycle of these two forms, which oft<u rcguLarly 
alternate with each other—" U folie circidaiie," which the Frmch 
alienists have reocutly been discussii^. Otlier obsexrert, including 
myeclfj bave aocn cases where rcf;vlarly at one particular season — for 
example, in winter— a profound melancholia bus aupenened, which 
in »|)ring ]»9scs into mania, which again in autumn gradually gives 
way to ntclaiicholia. 

Tlia DUie " folie ciiculaire" wu employed for Uie first time by Fatnt (1851). 
who hu ttioai coTTcotlj brou{:lit before tlie voiU (be eitreme gmitj of ibis 
faraof menUl alicuatiou. B&ilUr|er ('Aas. Mti. PsyebV ■'^54> vi, p. 369) 
look vnek trouble to explab tbal la " folie eircaUiK" Ibere arc ml two (lif> 
fareat attacks— one of aiebuoliQlai snolber ot mania — but thu both tin mcrelj 
two (liferent ftlagn of one and tlio lame attaclc ; chiefly bccaasc ot tbc fact tbit 
belvecn Ibe melancholia niid tlic miniA there it no comptctf rctniHioe. TMi 
aullior ||;i?ea to tliii nlTeetiou ibe name or " Is Tolie n douUe rorme." In some 
cues ibere ba* bctm obtertcd, anil (bi> too during a contlAOsace of scrantl 
jean, a tegular oltcrunLioD, lasiiog for a doy or (or several days, bclwcca mdao* 
cbolia tfaA mtuun. 

A very moderate degree of melancholia with conxideraUo r- 
, missions may persist for many years. Such patients very rarely 
come into aiylums, or at least only dnriitg an exacerbation or an 
iDtrrcarreiit attack of mania. They may generally bo motatatned to 
tlifir yrdiimrj rclatioiiji, mid are t^rmcnta to those who surroaaJ 
tl)cm, and objects of the mo$L varied mistaken six^nlntiott on the 
part both of physicians and of the laity. 

The persistent form of inekiioholia, when of moderate intensi^ 



BTATB3 OP MENTAL DEPBR68ION. 



985 



B Btu) prop^rl^ treated, luts TisanUjr from nx months to ■ Jtmt. 
J uclging from a consideniblc nuinber of observalions, we may almost 

»re(^ard it as certain thnt nciitc intcrcurrait dificaacfi, na veil as 
newly ilerflopcd chronic onen, fre{|ueiitly exert a fnroraliip iufluenco 
upon the inelancliolia, as it usually deaista vith their ai>pcaniii(r{>, 
_ To tlic former class (acutt') belong', for example, salivatiou, the 
P development of an exaDtbcin, intermittent fever ; and to the latter 
pulmonary tubercle. At n!I erenti, however, we mu«t not look 
_ upon these facts an having llie signi£caiicc of crUfs in the old sense 
H of the term, since certain neurones («uch as spinal nfiV-ction^j violent 
toothache, &c.) certainly do moderate, and sometimM even caiue, 

ttbc disapjieurouoc of tlic cerebral discaac.^ 
But what ia certainty na fretjuent as the disappearance of the 
mekncliolia on the accession of other disease?, is it* persistence, or 
even its increase; or (he insanily may, with tie ccs»ition of the 
nclaticholia, merely assume nnothcr fonn. Thus, for example, we 
have Bcea a younf; man who for years had been afBieled with 

• profound melancholia with only slight remissions, in whom, upon 
the appearance of ti »i»'erc catarrh, uccompauied by hteinopty»is (the 
first syraptoras of pulmonary tubcrculosia, which rapidly progrcsBcd) 
and acute paia along tlie entire length of the spinal column, the 
mdatkcliulia yielded to a gaiety, equally morbid, and a reetless cheer- 
fulness. Such case.1 are far from rare. 

ConTftlescencc genemlly takes plstee gradually, with siiceetnve 
diminution of the ayniptoma, and of always more prolonged 
jieriods of calm ; return of fonnrr desires and peculiarities ; &&• 

■ quciitljr witli simultaneous improvement of the bodily health. 
We have already seen that melancholia not anfrrqurntly passes 
into one of the forms of mania ; but Turther, niniple molanchoiin, or 
ractancholifl with stupor, may also terminate by leaving the patient 
in a state of intellectual weakness, a tnon; or less exaggerated state 

tof veritable dementia. Tliis ia probably owing to the development 
of organic altcralioas within the ciajiium. Although the patient 
may have rained his physical vigour, yet the physiognomy wears 
an eiprewion of heaviness and stupidity. The stKliiess miy have 
gradually* disappeared, but the inttUeetnal facultic'S hare lost their 
■ euergy. Not unfrequenlly, there arc also developed states of more 
Wot less profound partial ilcmvntit, where the patient has some fixed 
K^i^OQS oori(»ptioiis, pnrticulnrly certain hallucinations, through 

^^^K ' Sea Ibe cues o( Srodtc, nlrwd} quotctC itbova. 



936 



STATES OP VESTAL DKrBEBSION. 



vliich he is led to believe that people dcain to poison tiim, that he 
in tlic subject of various plo(^ or that he is constootl; elixtrific^, 
Sec; in which case the patient is olmoat almys incuruble. Sodi 
patients, Inbouring under this jmrtial demeatin, states of mental 
wraknns, with the rvmuiu of meUucbolitt (and inania] and luUad> 
iiulions, generally with oameroiis exacerbations, in the form of ooe 
or other of lh« primilire ttates (a^hy alt^riuting with turbaleoe^ 
n modilied sailiie» villi a gaietjr equally superficial, tec), constitolt 
bj far the major (Kirtion of the chronic cases met with in osylaiv. 
We ftball enter more into detail on this subject nheo we cotae l» 
consider partial dementia and dementia. At first the condiiioa 
frequeutl; coutinues for a long lime slationarjr in the form of 
mcloQclialia, varied only with slight changes for the better, oo^t 
again to relapse. At tliis period it is eitremely difficult to ny 
atijrtluDg with certainty as to the curability of such patients; but 
when this state of melancholic apathy continues for tlirco or font 
yean consecutively without remission, recovery is extrvnu>ly rare. 

BsampIcA of simple fonos of melancholia terminating in recorct^: 

KiAHru XII. — Ilyiaehoniiriii, profoKnd mflawAolia. intermUtiml Jknr : 
itt^my. — N. N — , fe [>arisli nimiitf^r, itt. 43, of strong const tlul ion, vm in 
August. 1R15, received into tlie asjlum at Siexbunc, lie baTingbceii ukcail 
in Marcli ot lliat jcnr. Tlie cliicf xymptom* htul hitherto consittcd ia so ct- 
prtwion of great aiiucty and resUciMaee) 1 amucd, Keptical glaaoe ; palo cou* 
teuuee, iliort rctgiiralion, and inmll atid mpiil pulto. He locuud hinself af 
having apeot a^itgrncr^fullifc, knd of ictiou* tnjidcoitanDani : io aome JMid 
moments, liowcvcr, be could corrcctlj' appreciate bis oonditiiHi (bleeding, biislen. 
aitrBi onietioB, mud use ot fcrrugiiiout water). 

On admiuioii, V\s Klance was timid ud ntuteady, the exprtsska thtl ot 
anxiety and doubl ; llie sbdoiDtn diit«nded, boweti eoDitipit«d, avt skin «r 
am euthj hue. The p«li«at declared tliat lie va* torn, enatied, and liovn to 
piooes (cram of tarlsi wiili tulpliur, light tncntnl rmpi^^menl). 

In S«(itcmber ibe patient became gnuJuolly quieter, nod Aonti less (aclina- 
tion to complua of Uii lorrowful rcclinf^ tknn he complaiiied of vcamea 
aed headaclio, and there now appeared aitacla of intftnniltcnl feter of tbe 
lertiiD t;pe. Oa cacb fcrcri«h da; Iiq conliaueci io tlie belief, until the iweating 
sls^e eame on, that he would ini mediately die. repenting this cotrlinually. with 
the most iiitcnte cxpruiion nf anxicly in faitconnlcnaucc and gtsturts. Wbcn 
it was tepresenied to htm that he had said and believed the same thins "f^ the 
proc«diiig fever-day, be replied, " It ia quite dilferent to-day ; ta>d^ I 
must die." .IClerwards the fcrrriati attacks ocrurred daily, anil the fesr of 
-death became ie»» intenae. At lait Ihcj apODtaneMislj ecaaed ; aad vilb tlitn 
dUappeurcd olro (he occuMtiou), which had nvw become los violent tiian for- 
merlr, but were »till frcquuDtlv rciicatcd, winch Iho patient made sgainat bio- 



STATES OF U&NTAL DBPRKSSION. 



387 



I 



aelF of liftvieg commillei! unpnrdoiiiililc Crimea, axi ttic pxcscclimcnl of Inn* 
poral ind elerml punijlimcnt wliicb tlicrcTon! nwiiiltd llim. Onlj » ferUin 
degree of hjitoohnndiiocnl Acir-lormcnt and cxcrsiivc fioxiDty rrgntding tlie 
*t>U of liis plt;»ical licnlli) remained, k^r a short time, behind. The pultc 
beeane regular i thctcdumaof lItclFgi(w!iicbcamcoBcturins llie Itut attack of 
internal II en t ferer) and tlic cnrllijr hue of the *kia both diMppcnr«i). 

ilo toluntariljand cheerfullj engaged in lome iuteDeotual labour, became 
liapiij «nd lively, nnd in Jhdiuh^, i8it>, left the atjlum cODtpletel; canJi. 

TIk followinf; Btntcmciiti rc^rdiii); tlm origin of Ins dtseue were irnttdi b; 
Hjo policDt after his rtcovery : " From mj yonlh there etiat*.i in me a lijpo- 
diondmul Uste ; even before I entered the Unwersitj, I believed that 1 liad 
coRmmption, >uil tlie usarances of the plijiicitni to the coiitntr; were fruitiest. 
Mnny disagreeable ereals iiupired me with itislrust towurdi men ; anil in 1 810, 
when 1 wiB oondemned lo ioacLiritj on acconnt af disease of Ibc c;cs, my 
ordiuvjr AocDpation coniiited in thinking, Ihc ideal being often very aad, sod 
tuck as could not fail to exert on me an unfntonblc influence. In the year 
1811 a dn look place, nnd a tbomugb wetting, which I Ibere remiTcd, when 
just conTalescent from an ilbcu of scvernl wcekt' dorntion, made a ino«t un- 
brornUe impression on me. From tlinl line the jIodIb became leas frcqueiil, 
ond difHcullj of bea.rin7 aet in. In 1824 i wns oppressed with work, and very 
low.»pirited i 1 cn«d to lake cicrdso; bouscbold c&rc« wiigiied huaTilj ujwa 
Di^ ud 1 loit a nevi; born child. From that time forth I lost all cheurfnlnMi 
and plraaure iu work. After prencbinj;, I felt ratigucd and eiiiausted ; anxiety 
and ud idea) came orer me; 1117 tlccpWM scsiily and tormenlcd by horrible 
dreamt, after which a nolent sbtTer ran Ihrongh all my mcmbcre . Nevertbelcs« 
I couitlercd myiclf bcallbicr than formerly ; the dulncu of Itcaiinj^, pains in llic 
timfas and flalulrnco, from whioh 1 liod bilbcrto taffercd, beenme less trouble- 
•dum^ and I bad no dinagrec^nblc tcnsations after mesU. It did nut occur to me, 
tbczefore, loseck Iho cause of my sad condition in my own body, hut ratbcriu 
lay entire life, which appeared to nie lo have bcva one great crime. Tiii idtn 
did twl t/ri.jiiia{« gradHatly, bit tnlertd, 1/ I rtmemicr nghUy, my mud ail at 
onee lilt* a drtam. Tint f tjeplain mg entire tlali. This oocutnd la perfect 
clearness of thoaght, oonCdeoce in otbere and iu myself. The entire humau 
race aeemed to rite np a^inst me, to throw nic from Ifacir midst with tbe moat 
•liockbg tormentc, and I myself was my greut(»t eiLemy. I ackuowlodged lo 
Dsy wife that I bad comnniltcd the most fearful crime that bad erer be«n per- 
]telrated, and would be torn in pieces by m; pnrislilonera as toon as tliey becnmc 
aware of it. The pcrrornmiice nf my duties became iinposaihlc to nic, and my 
anxiety oonalatilly iocrcAsed. 'L'liu lending members of my conffregation gave 
me ilie beat uMirnocci and propotiiions, but still I ootitidorcd that all was 
loat ; and one day whca 1 fainted at a mcolin);, 1 believed that I bad done so 
willingly. I lltougbt the noise of tbe stove was the beuling of drums, and 
believed that soldiers were oomjnf; to carry mo c7. Aftciwarvts it sccincd as if 
a icaJTuld stood before me on whicb 1 should be torn in little piefws, and the 
fear of excniliou constantly pursued tiie. Tbe tliiugs around me appeared 
more bcauurul and brilliant thnti usual ; all men sccnied wiser aiid mure clever ; 
I oonaidercd myself in tbe deeprat dejiilis, and no longrr cnpnblc of performing 
■ojrUuug* 1 soinetiiDea, only for a momcut, bolicvcd Ihal 1 acrcrUidcsa might 



■P STATES Of ySNTll. DIPIXMION. 

•till be deli rem! i lad Ilia Heeling «ugtBenltj (ollowid by gnrtMdaoi. 1 
Okimat better dcMiibe aij tttU, Mwirds Um Urmiaatiam ot llic fliiiMr, ll» 
Uut o( one «ho hu imkcacd bom n pcoCovwl dteui, nd ouuuA tanwdiatdj 
oniiMB blmaelf tkit it has been a drmo." 

OlHk ftbciil^ from Jtcofai, vBiobaditMp» Bbcc & Pittolack nl 
Ttanffe itt mit liruetn reriHudcon KnaUuttw,* i, £Uierf«U. iSjh 
p. I^I.) 

ExAMru Xtll— Jr«Eiucid& ; ncMoy mi/A Ot nTart ^ f4« — ifrMt «)• 
titafff*. — A joong woDMD, Kt. 19 (wboac inoUwr had coawitltJ aaioii* dani| 
M itUck o[ profoniul moi&noholi>}, heattli? ud «( jsyftil dinioMtion, lid 
BUmlraiW n^uUrlj nooe the wu CrtM> jwn of ifc. ud from bet aixIcnU 
jMt had nSbrcd rrooi levcontm. Allcrvwdt bcc fcdiaga ven affected kf 
a kwe affair which wu not farorahle i» the oircunulxaon, and by other ertBtt; 
awd alie huJiIcdI/ became i!l ia Augual, idig. She prateal«d « alight dtpta 
of imbccQil; ; frtqacoLl; laughed vitliout occaaioD, made all ktada of men} 
kita, and n-ai incoURenl in bet apeecli and actiobi. Hu ^aace, iinaiaiiia. 
ud notoiDcnli were lirelj uJ baalj ; tlie bcllj diitcaded, the bowcb itnuti 
patcd, mciutniatioii leantf . In tLie eoane of a tev noatW ther« appeared a 
oomplele remiwion of the mental ajmptociM, but in aix weeka tha iaaHtilf 
a))|i<Karcd atiott luider a different lorm. 

Tbe paltcut aeemed a prcj to melaacholio kiai«tf, eitlier ut dumb aad 
motbiduM and loit in thought, or weepoi and aigbod, oocaaMnallj exdi^* 
log, "What a tnisfortuoel vb&t bare I doaef" She nfiued food; htr 
Bf pearanM becaaie allered ; Uer fornu (reUmtM wai otaaged mto an eartli; 
hue i ahe bceauie wrinkled, and lier itrcngitli tufl her. The bell} was bard ai^ 
diatendcd | the stoola neic *inall and drjr ; the incnics diaappaarcd, tbe teucw- 
rbn;* conliniicd. After a time her appetite returned ; she went to a trmigh 
cniilaiiiing hen's meat, or *oiigbt clacvljore raw and dirtj food, nhich ahe 
aaofctl? devoured. She looQ gaiiicd a Utile atrcngtli and bulk, bat had ■ 
Uoatcd tod livid appearaaec. After the mental diaorder bad oootiaged fw 
el^t iiiODlhs withoul medical aid, the giil waa aduitted in Aui^ut, i8j<S, inU 
the ft«;liim at Sief[burg. Excepting a somewhat scrofuloua h^t and tbe 
loiig-otitting Icuoorrheet, no tjiuptom of bodiljp diacoae could be obaemd. 
Unr niuvcmenlit trere wttiiout ewtgj, tier carriaf^ ilcoopiog, and ahe mpt 000- 
tiuaoual; nli dnj loitu, nnd, indeed, dr«w audi deep light tad Mtde aueh lamca* 
lationi. that it iccnicd ai if erti? moccenl ihe mot with iooifltfaiag; territ^. 
She gcDorvU; alctpt quiotlj daring the nigiit ; atic required la be •omawhal 
preawd to take licr food. The mental diaorJcr in the paLieot vaa bov maai* 
iMtcd princijtalljr b; the cxclniivo goTcniog mental dispoaitioo whioh toM 
aU licr IhougliU and paraljiBd her vill, vtthout an; othoc mcEita] ooiifaaion or 
tAj definite morbid dircclicn of tho deair» butu;; eviiiceO. The disocdered 
digntion, tlie disIenBionaod b&rdness of the abdomen, logellier with tho «menor> 
rboB and fluor alhui, appeared to afford tbe most impotlout therapeutic indiet- 
lioni (miid and regulatad diet, bathe, occti|mtbn). A convalescent attended to 
tlie patient with mothorl; care, gvincd her eooGdencc, and was of great benefit 
lohcr. 

Towarda iLc end of Septcinber tbe menses began lo appear, but the abdomen 
oonlUiueil dittcndcd ud herd. The palicst paduaJljr beeame talmei. vept lata, 



STATKS or HEM'AL DEPRESSION. 



33» 



fai tit voliiiittfi]y. In three «e<fc*, the mentt* returned; the bellj lost Ut 

■rdlUWi tte bowda boumc rcgulu- ; tlic wtinklci dbappcarcd fruin lier face, 
hU Itie npreatioa became more cbcerful. After the cuetiiea had again re- 
Ivraed, on ike lolb NoTcmbcr, Icr t07r«ir aod tcm left h«r. Emplujrmeut 
m ber obLj pkuorc; Ibe Auot ilbua gruiuftl]; diuppriucdi bcr health 
NGMM gtadmilj imnn confirmtd, tod in April. 1817, iLo irudiamiiMd cured. 
<J«obi, loc cil., p. 198.) 

ExaKPLB XIV. — Mflaaekelia, leith Unde»ey lo t%ieid« anA iaUueinatieM ; 
ItifttM ■«rimMf pitliUUiu. Hfeotrrf in tcnif<^iiM-t* </ eaiteritalioit 0/ l^ 
trikra. — Emil — , »t. 33, showed rormerly high meuUl ntlaimeatfl, bd(1 tit 
Eh« Bgeof 31 b«e>m« iJi kdvocale. His figure wm b«nt, tlie bod; Wn, the 
kwaelc* ion 1 One tiin oolaurleu, the oountcDtticfl raid of cxprcasion, the 
■jck dull Kod taraed toward* tk« i^nnd ; (he Toice vr«&k, behnriour timid, 
uij the hvei extrcputica in consUat motion. Alihougli be epokc little and 
awkwuiil;. ?ot be made tlie foliowiog clear slatemtnt in vritiog reg&rdins hit 
eoaditioD : — 

AAer tbe patient h^ been addicted to onanlira from hU twelfth year, there 
at tbe age of siuetoeu a oliange in hii etiuincler. At 6nt lb«[e was 
laal mental loatbiax at cTcrythutg, a proround ^oeral ennui. Hitlierto 
teen enl; the bright aide of life, but new eveijthinfc iru riewcd from 
'^brk aide, and toon (he idea of luidde entered hit mind. In a jtar Bftci 
Uiia tbe idea Idt him, and he then ocmaidercd hiintelf Ihc object of icora by 
ether*. He tboo^bt that ererj bod j laughed at hiiappRaranoeand hi* tnaBoerv, 
fad be WTeral tine* heard, aa well in tbe streets as io (lie bouse smonKSt his 
fcktiou tad frieftda. npnaeif^ dirtHed offaiiul iiat. At iul be believed that 
iD Ih* vnrld ioaaUed bin ; ifaRjouccxiuj[bed,inccz<d. Eaughed, put hit hand to 
Ihi aoaUi, or ■ poiAet-liar^frehief before hi* face, it made on him Ihe most 
painfol impraasioD — lomttimc* aogry emotion*, soQiettmcs dc*p depression and 
ka intolunlary flow of lean, lie vaa indifferent to everjlhin);, and always 
cngniated with hiaideaa! bo iou)t:ht aolititde, and Koclely w*a psiurul to him. 
Bt owned that be majr have had ballncLoations. hut felt conTioced that his 
UcM were Ml without foundation ; Ibat his oounlcnnnce was Mmewhat atr«iifi:« ; 
tbat penona could read in it bit feara, and lbs Iboughta whioli tonoentcd 
kin. 

He aow expetienced a wejgbt m bis bead, a sort of prcuure on tbe brain { be 
vcdi, puakwk**, ileepj. and doll. Etotj moronicDt fatigocd him, and jet 
Um eoutant deaire to chaofehia position, lie felt llttt be bad become 
oU 1 fcr tbe Utt few looBtb hit depression had been incrosaioK ; /or lit jmit 
• ti tftK n . KttJUtg k»d maJt Om Km a ehttrfal imprtuici*, etMiyfhnf <W cfpriiud 
mtd mmc j tJ Um ; he wa* anxious, bashful, pcrpleiodi inoapahle of aoliag or of 
■paUif I " The Sfdtitof life baa withdrawn itself from ma." 

Tier the paat ^ue wontlia, the palieut hid comgdetelf renouuwd the praetica 
cf CQtsiia, and jct his condition became crerj daj worse. 

He had inntente eoiutipatioB ; eocnplete abeetiM of ereetiona and sexual 
AMlrMi abevt t-l pollutions in a month. The orine alwuj* eoutained n 
ilDecalt&t tcdiiMnt, liie ■ thick decoction of \>ultj, and decomposed 
\j. After nAi atool, ■ *!aeid (laid, like (hiek gttm. appeared at the oii(!(« 
nrclhra, 'Ibe ariac was rosded fraiucntl; ; there was irrilabiliij uf tbt 



f lao. TW 
that 



itftk 







UipW»t^ iigiiiii nhafewmJTic ikt/irm^Am^ 
bT tfae iterimm, vUefc oftm ipwvtt Ik nort aliat eaHsrf 
the Bmtal rfedioB, the diMifiatao* sf «adi vmetiis is of ails' 
iaipoflaiKg, Aocar^Bg to tUi **«, we faaie to aole ike loUoviif 

laL MttameMU nEfitm im the auBr ^vtm to tlwt fcitm tf 
tw>l«iwT> nH» ig vliiclt the it" Kri^ii uuitiu dueflT Dpati rIkwo 
idewt the paticsf • prmi^ Mqbow btiqg thit be bac cowi^ttd 
friffal Ml, llie terror of hdag fnmAei I9 Ml, and tkot be b 1 

tmUBMtj, kc It is Crtqaently ovtag cBtod^ to e^emt ■wadentJ 
in$wt9um thai the intenttl fadng of •stietf u eihibifad, k wasktj 
on MCODBt of no ; or that tlie paticBt, in his araaniftil pefreisMMi, 
•edu tlx coDaoUtioiu of relig^oo, which liere indeed lure not the 
expeoted infloeace, bvt freqacBt]; onl/ result in iaeresniig tlie 
anxietj. In anch cues ve miut benn of confanikHag the effeet 
with the caaae. If it can Karcdy be dented thai the ooostaat 
ealling forth of aocb ideas of contntion, and fevi of the punisli- 
DOit of bell, asd ptrticaiarir that glooiiiy and ascetic manner of 
Tinring the afliain of this world, do poralvse tbc cnci^ of the soul, 
bvour the asceadeacj of inonrDful tbooghts, and promote in weal 
miiuU B stale of nionl dislmction and nd emotion which majr tbna 
moat ewcatialljr contribute to the development of melancholin, stiU, 
in tbc vast majoritj' of ca$cs, thoK rel^oas delusions of tbc 
melancholic are to be regarded as E}rtnptom5 merely of an already 
existing disease^ and not as the caoaes of the affection. 

Tbia form of nl^iau wuUneholia must be catefuUj daUaguislKd from tiut 
oUicr form of aatxatj, in wkieb llu preilonunaling ileliUNiu arc aIm raligiout, 
bulauumcKgajr, uiilHiou9,HuloMludrora — vbere tbe palicuU loiafiac tlut 
■licj aro citbcT God kimMlT, or are moat iiittoialel;r a-lntcJ to Uod, the u{cel«, 
* beareii. Thla Uata diSera widetj uul cotircl/, in b [ujcbolofpoal poiut of 



STATES or MENTAL DEPRESSION. 



24.1 



I, fran RwlBocboUt. ind ve tluU ipcak of it when me comit to consider tbe 
I of ualtotiod in doUiL 



The 



of 




syraptoma are also similar in that interesting form 
mclMicbolu iu «bicli the ecntinictit of being governed and overcome 
nuiufesls itself in ike idea of demonincal poMension, the so-calli^ 
dftnooo-nwlanclioliii, which is met with in all countrie', (in France, 
ticularlj, it is hj no means rare,*) and of which recentlj, in oui 
country, ignorance and the grosscat supcrstitioD have used to 
wont ends. 
In this fonn, this foicign evil power br which the patient imagiiKS 
elf to be governed assumea different demoniacal ahapcs, ne- 
: to tbe pKnuhng sniicntitions and beliefs of the epoch and 
(derib, witches, &c.), to which, as he inaj prohablj' nt the 
wme time experience some abnonnal tcosations in dificrcnt parts of 
Ua body, s very limited seat is as^gned by the patient, — eometimes 

rbalf of bis body — sometimes his head, his back, or his chest, &c. 
ia Dot nncomaiOD to tee, along with thia, ooovnlnon of tho 
volimtat; muscles, eontractions of the hryax which alter the voice 
in a striking maoner, aiuesthesia of difTereiit important organs^ 
luUacinatiotu of s^t and hearing. This delirium is at times 
aeeOBopanied with intermittent paroxysms of violent conmlsion^, 
rvidentlj analogous to epileptic, or still mom frequently to hysterical 
attacks, which arc separated by intcnals of perfect lucidity. 

lliat fann ot DMlanclioilB in which tlte predominant dtluRion !> that the tuh- 
jeel of it U poMCMcd by *otno Aeatoa, nppenn ohicSj in fcRiklc* (klmoit alwKjra 
l^jMarioil waownl aad in cbildrcii. The moit euj expluiatran of thia phjBio* 
IV^eal pkauxnetinn U fftund in these bj no meoni nre cum wlim the trains 
of ihimghl MC ftloaj* kocompMiied bjr a fc^li^g at m«»ril conlmJiction, vliich 
ipita tnvoIanUrilj allKhei ilscK to Uiem, tlie retnlt of vhielt is a TmIiI din'tioB 
ArMpvition in t^e perscoulily. In the mtrca developed cmm, this circle of 
UaH^ wUth ooaatantly accompaoks and nmfi itacU in opposilion to tlic actual 
Ihnwgtt. asMfti a pttfeelly i&ilependent ciidenec ; it Kts in tnotioii llie me- 
(kMlaB at ^Ncdi, eshibit* ud clolbes itMlf in void*, and appear* to bare no 
e mw liea with the (ordinal?) tffo of the individual. Ot tliis train oT ideas 
wLiefi aet« iDdcpendentl? on tke orgmni of Hpcocli, the itidiridonl givlDft uiter- 
■MB U tbea-luu ao cooscioaaaeai before he bean tbeni ; the tffo doci aot per- 



> iL Uaaavi, ' RiadeaeliaiqMf idr la [MoioaaiMnle^" • Aniul. hUd. Pifdiol.,' 
t, ift4^p.4oo: EMinirol. tnaalatcd by Berabanl, i p. aSo. Sec abooa this 
mbJKl^Cklveil. ' Ut la 7alie,' Pari*, tfttg. •, ^ 85 1 Albcn, * Archiv r. 
FfeyaM. Utilk.,' liii, 1854, p. 334 ; Foetal, ' Hia. tut pluicwa MabdJea,' ii. 
r. iioi UoTMo. • Da Badiidi,' etc pp- 3^. 3G4 : BaiUtrpr, 'AsaaL U6d. 
vi, p. i£a ; SeUtsanbetgtr, ib., viii, p. 36x. 

19 




aTbacni. At Ue^cortkirtT.i 

iftteMoMbi 

of afe,! 

Tm iOadEi aemnri OTOT toeorteM^mal la Oi Btonl the pUU 



lirtkto»iUi:lk» 
artU 




«Mp«rfwtljw«L ttiT Biw wn i H wtt pJi h lU Jmi, toht. wJ 
iri^iiWiia, uttittj, pnt ii fc Mi tlw ; aeaMMflj ^aftoM ei Rfafa* oi 
hiifaacileiwnUaM. flht «■ ahtpJ to b k h«i. faai^ iii,|tn ily y. 

Mk^ oodd M knier conattt har tfcnuhrt. ad tboivn — liriilml. m i 
■atd aaoMlj, •> iatciiMl iiiiiilmmw ■ p**** ha b«b IhoiMhtB aad m- 

J^ COMtaBt iMMdirte oppoiiliM H*inal iD «Ucb ■to UtM^ ai 

m. Aa iwMJ ■TOlBt,'' whhhthB; toi MU .da not hag i» htreT. appwd 
wwyth b g vkkh iho bcfxlf woaU do (for exuiploi na Kguut tfce vn 
IjiaKiD bed. vfaicli ber eaaiStim itailen Kcenn;}, oficcidlf . Iioverer, agrint 
^elenttoootUtaMKlUMBU— fn^Ug^Ae. IliSTCieo U alwsj* wicUi^M 
tbe patient voald do good, ud o oa w ti m w cdb tobe^ bnt vilboBt being bwd 
nUnill;. "Tilu aknUe ud kill joumlf!" The paUmt, «ka U tcbrtr 
woman, mj* on Uu >ub}oct, that *bc almost bcUcota tbrt a stnuige boo^ a 
dsiDoa, ia withia tier, •oecrtaii a the tW it b not kendf vfao don tha. I 
look tk patient mte tb« dmiqac at Tubiaifei^ and thrnm had frequent oppM- 
tunitMa of obMrrioc the attacki. Daiiog tbcn dn Mated naoh boated, ofr 
geit«d.litdM)CbaMKandeoBfnedeiiireaaoit,*M]»treTeriib (lemperilfli 
BOfBwl)- T^ attack bated bom twcalj-fow to fartj-ei^ boors. On <m 
OOMkOb at the oomittciioaaeiit, vhea the head vat miu& ooitg«ited, mmeuliiii 
to a hmU amonnt mu performed, irliieb onl; tenpotsnJ; reUerod bcr. Tkt 
tuemorrboidal alTtclioii wu much iuprarod bj tho vm of an ckctoai? o( pcppci, 
but Iho sttAck* oonlbue williout ctiaDge. (Original obtemlion.) 

Elxiin.E XVI. — CAronk tfnvmcinavM.— C. S — ,aa UDinarricd pcaaa[|l,it 
48, voluntiirilf pmcatid hera«lf at the diaiqoe, btcaose >he vas poocMtd I7 
•plrit*. Her (ktfaer bccane a lilttc kirange a> be adianccd ia /car* ; b«r iialer 
Md aiitni'B aon are inaane. Tlie [jatieut UaJ > child aL (lie a^ of ninatrca : ilw 
uracd it tur llrcc jcai*, and fell into a st4U« lA auaaiU, vitb cxtvBdcd jiaiu ei 



STATES OF MESTAI. DKPKES810W. 



za 



Bw limb*, and lomfdimea WDvuluoni. Pvr ■ luitg time tlie hail eontulntre 
TwwemcnU of lite moulli. Tlirtc Tfws tSlci Iho Erat ipptanncc of tlio 
aiseaM (about llnrtcpn ynn ajjul, " ihe gpeakinft out of hti" Dnmcnenotd. 
*™in tbftt moment, all kind* ot UiourLIs or woitli were cxprMScd iinintcn- 
lioniJiy hr the pati«n'. anii (ompliiniyi mill a voire differcnl from her tieual- 
At Gnl it aermt to h«Ta been not to mucb opposing, u qaito iiidilTercnt aod 
even reasonable rcmarkn, which BocompBuied tiie (tiuughbi and langaage of tbe 
patient: for Mample,"!!" said," Go to the doctor." " Go to the piittt," or"Tlia». 
that jon mutt do it," &c. Gmtiinllj thcae indifferent rcmuki vcr« eiuweoded 
bj oUien more De);ativ«, and at present tbe roice lometimoa limpljr eonAmu 
wkat tt aaid br (be paiieut, a\ othora it derides and niockt it : for example, 
when the patienl nji anytliin^ vhich is right, tb« voice sajs after her, "You, 
that JR a lie; tod, that jou must lieep tOjroorMlf." Tbe tone or the roice in 
this speaking of " the *piril" is altraji somewhat (soroetimes eiitirelT) different 
froin the ordinary voice of tlie patient, and she looks u|)on the fact of her bivioK 
aoolber roice as a leading proof of ibercolitj of the spirit. "The spirit" often 
commences to speak vith a deep hKn roice, tben passu to a pitch lower or 
bi]ther than tlie ordinary tone of the patieat ; oooaaionally it passes into a ahnrp, 
■brill err, which U followed bj a iliorl ironical laugh. 1 have mjitK often 
observed tbii. Besides Ihoic words spoken by " the spirit," tbe patient beard 
inwardlr, and simoit inceuantly, a great cumber of sjiiriU spcukiiig. Some- 
Itacg she had actual halladnntions of hearing, hut ii«ver of ai^lit. Praying 
randeved the slate which no bsvo dcneribed atill worto; it iiicressrd the rest- 
lessness, to cbarcli. howcTcr. she could, Trotti awe of the cungrrgation and 
dergjinan, reatt&in the voioe of ibe spirit ; she could alio read aloud from the 
prayer-book without being disturbed. Sometimes her dlicourM had a sligbt 
taint of nymphornaiiia ; she said thst the spirits caused her to hare obsoene 
tlionglits, sod lo express llieni : aiim had pruritus puiieudi. T)i(< paticnl never 
knows, until il in Apokt^ii, what the spirit would aaf . Someliities the power of 
speccli is altoitf Iher denied her for n certain time. la all tiie phonomtmn wliich 
wo hare dcserilied, thu prcBtest and invarisble uiiifonnitj premiltd, auc! her 
condition, which for a long time had Iwen Aicd and stationary, ooiitiuued tho 

fenlc daring Uie sliort period duriuifwliicliahe was uuder treatment. (Original 
scivitioD.) 

EXAKru XVII. — Confuhie* otiaekt, mIMJMM of pcttmiot and fiiitratitg 
0/ tit pmonalUg, of ihort duralioH, in a cMId} — Margaret B — , nl. iiiOf 
linly dnposition, but a godly, pious child, was ou the iQtb January, 1619, 
wilboui kaviDg hrxn previously ill, sciecd with convnlaivii nttnchs, wlitcli con- 
tinaod with few and short intcnnistiona for two days. The child rcBinincd 
unconioians to long na the roDTnUive atlaeki coTitinued. She rolled her cjei, 
made grintiacct, and performed nil kinils o( curious movemciit« willi hor arma, 
Ou Monday, tiie aist January, she assuuied a deep bass voice, and ke])t repeat' 
ing tlie words, "I ptay earacatly foe you I" Wlion thogirl enme to her seasaa, 
she felt tired and nthanated. Sbo was perfectly unconscious of what had p&sacd, 

^F' Wegire the case as narrated hy llio patient in order to show lie arttess- 
^en of the atory. See al«o what is said furllicr on reenrdiiig tlie psychical 
fionditioa during an epileptic attack. 



iU4 



STATKa OP MENTAt. SEPRIUIOl). 



ud men\y uid thai «li« liid bean dtetmia^ On tha tvaua^ o( lb« iial 
JuMiy, MatfccreomiiMMedtoipMkmAloncdUtweUjdiflerait fracn Um In** 
mealioMd b«u toim. TUm v«sce ipokfrAloMst withovl j&tenniaiiaa ■*)><( 
a* tbe crisii luted, Uiat is, for lialf-koan, boan, and ctcd loogei; mJ ^ 
frnlj ocouiooall; iiitcmipted bj the btm raicc, vliidi ittU rcpcawd IW riN*> 
■lentiOBed wonii. [n > moment tUa toitt «ouU rtpTWtrbt & penoa difoot 
from Dial of the patient, and pcrfeoUj disUnct from her, apwddng of licr alvqa 
otjtdivel; and in tbo Ibirdpcnon. There wu no confuiloii or ucobenaa 
•n tlie wordi o( tht Tom, but great coi ii tewc j vm abofcn in amirarin): ■! 
tlic quMiions log^Ij, or is skilfiin; cvadiRp Iben. Bat that «hidi prian- 
pall; di*LTngnuh«d IheM njiogt irta tbeJr morkl, or ratlwr tkcir imaonl. da* 
taiHfT. Tbej expttaaad prida, arroRanoe, nockcry, or batrtd cT tratb, «if M 
and of Chrttl. Tbc voice would tay, " I un Um Son of Ood, the Savioar of ibi 
world— fod murt ador« mo," and immedUtel; afteroardt rait a^aat •T«ijtliii| 
lioljr— biajphcme against God, agaioit Cbriit, aiid a^ut the Bibk ; ci|naa 
rioleDt dnlik« toward* all who follow wlial is good j gira Tcat to Ilia >**t 
violMt DUlodicttoDB, a thoiuand tinea repealed, and rniovai j ragt on pcrcaTHf 
uy one engiged in pmyn, or merd; folding their haadi. AA thu nn^l* 
eouidered a* sjoiptoms of a foreign fatAuenee, ereo altliouf;b tba votee had mU, 
at it did, bclrajrii llic name of the ipeaker, callins it t ilrvtl. WbenCTCr Om 
demooi wished (o speak, tlie couatenanoe of lhegirlitntn«dialdT and verj altik- 
iniclj dianiced, and eacli time preamted n tnti; demoniacal BifKceeiQO, vhM 
ealM to mind the icene in the ' Meatiade,' of Ibe deril olferinit Jetni a •lone. 
On the forenoon of Ihc i6th Jantiaij, at 1 1 o'doelt, the vei^ bout which, 
according to bee tGitiicoiijr, »)ib had been XM by an aaga) sewii daja befan 
would be the hour of licr dclif crj. tbae allacka oaaaa^ Tfce taal tbiog wkcfc 
wu heard WD3 a Toice from Llic mouth of the patient, which aaid, *'Deput,tki 
UDelcae apiiit. from lliia ehildl — knovett Ikon not thallfati chiU ismjwA 
bdovfdf" ThcQ tbc cainn to conaciouueaa. 

Oq tbe 3i9t JnnuftrT, ttie same condilion returned vith tbe laiM aya ploBi. 
But ([raduall; several new roicea appeired, until the niimber Itad incnaMd 
to six, differing front each Dtltcr psrilj ia their tone, pattljr in tbctt langnp 
and aubjeel ; thereToro each aeemed to be a Toioe of a ipacial ptrMoalit}, lii 
wu considered a> vtA bj tbe voice wblcb hud beeo already so oltun hand. 
At Ihia Fieriod, tha fiolsnoe of the fury, blaipliemy, and corse* reiobed Udr 
higliot degree j and tbo luoid inteiTals, during wLicli Ibe patNut bad no lecol' 
Icclion of wliit iiad occurred in Ibe paroijun, but quicLlj and pioaalj read ud 
prajed, ivcre \tsa freijuttiL and sliDrler in duration. 

On the 91I1 Fcbrujirj, wbiub, like the 31st Jaauaty, had been aanoanoed to 
tierasadsy of delivery, Ihla most I nmontable trouble oame la an end, and, laon 
the furuirr ifate, after tlicre had proceeded frotu tbe niotitti of tbe patient Ihr 
waTds,"Dei»rt,t)iouunde&ii9|)intl" "Ttiia isaatfcuoftbe last lime!" thepH 
awoke, and ainoe then has continued well. {Kemer, ' Oeacbichlen Beacsaeotr,' 
Slultg.. I8a4, p. 104.} 

§ III. a. It 16 not uncominou to meet vilh mcUacholics wbo 
ima^Dc llint Uicy bavc entirely loet thctr personality', and Uiat then' 
fue chacgcil. 




STATtS OP UENTAI. DfiPRESStOS. 



3^ 



MetaueMia melomerpkotii. — AVe have slreadj^ adverted to thou 

rhicli dejicnd upon goieral aad partial dys* or atiKsthcsias ; aa 

tbe pfttient inugincs that h« ia dead, that his Itmbs arc made 

d, fcc.; and aim to those deliriou« ideas, proceeding troin 

lociaatMDS, of being transformed into some unsigblly beast. 

of nucli more intcnrt, ns wdl in a ptjrdiulogicaL ai in n 

point of view, arc tlio»c caMS in which the sufferer 

that he ^ changed his sex, men iniagiuing Uiansdves to 

<inco, and viet nrttl. This delusion, it ia (rue, is by no 

eonfiiMd Bpecilicall^ to DieI»iiclioiii-5, but it taxy be developed 

uring tbe conrae of this dlnease, and appears in many cases to be 

■i with a disease of Ihu gtiiital orguns, in wliicb the aesual 

ions diuppcar. 

nna. l4dien«iicts|)eak*ofa|utientwboiniaL^-ioe<i liitnaetrto be* woman, and 

Iclttn to aa iitiat;iiied lover. Tlie auCopBj diacovcrvd cularxcmciit and 

lioB of tli« prostate ^and, ■bscenes, alio obliterntioa oftlie liuclus cjiieH- 

villi dilaUttoD of llie trcsiculn Bcuiinnles and of tlic tu dcfcrai*. (* Dea 

ai^aales.' i, p. 64.) 

Lcwet tbo rtc»nb Mmc facta ooaoeraiug iadif iduiili wliu iinaginc J tLat 
kad diaogcd tlieir mi. In gtJitral, auch caaat an rare ; it 11 uiore com- 
to Hod in tlw Fieacli aajbms, t.g. l!ie Salpftriere, Uio delasioii ILaI 
Ibe oUicf (uule patient* ue changed into men. 

4 132. 3. Another varietjr of oiclancholia i« that form vtbicb 
is duiaderiifed hj n longing for one's native land, and by the pre- 
lominance of thoM ideas which refer to a return to one's home — 
[luuE-^iCKSBas. An analogous afTcction is eomctimcs drrclopcd in 
rnsoncn fay want of employment, and frequently also by the co- 
:g inflaeoce of bad nourishment, dump cells, and onanism. 
loaUlgic melanchoha is sometiinea accompanied by symptoma of 
ifpslion oftlie liead, and even of eerebml infliuiimatii)ii (Larrey) : 
ttua foiffl, too, the same kind of hallucinatiotu sppmr (visiona of 
scxncs, iic). Not uufrequently, we we iadividuaJs affected 
itb a greater or less degree of nostalgia commit acts of \io1cncc 
fxample, the murder of young children, iiieendimim, &c., by 
U). Thone ads proceed more frequently from evidently 
notirca, as from tlic desire to esca[<e from a forced and 
1 position, than from the impulse, which aUo comes in> 
olontahly in the melancholic, to procure a certain degree of solace 
the perpetration of some frightful deed. 

Nstonlly, hetaiokawa b not alnyi a meatal diseue : this is of imiwrtuee 
I aBcdieo-legal point of view. In itwlf it ia a nowarid ditpoulioa tA ipiril 



24fl 



aTATBS OP UKKTAL DRPBESSIOH. 



»iiinie»lcil bj cxlenul cirenEulMiccs. II beeaaea insanilj w)iea Iku ttfO- 
sitiou v> (ironf^j inpngaaUa all Ihe fKullice of llw nbd u utUilj lo cxdadc 
the nnlnnte of tnj oilier Mtititncnt, uid vben it b ■ecaspuiied b; dc&nnu 
coneqilioo* mid hBllocliUtioai ; a state in aliich plijuoal ienagaaeat^—t-f-, 
loM of ippetilc, emwiiblion, ft«.— «re srldom ibKiiL In short, boiM^ckaeii 
ooglil i»/bM to be trgarded u n mental alTociioa oal; wben it pMMDtetha 
uul sigu cf iDMoil J. Tlio waut of reflccLioo wUch ii Ifae bmI inpvtnl 
point in MaeretA mtu, ongbt not lo be tdmitled vhcn Itic tndividul ii pn- 
fcctlj coDipctent to cagage in bis asual aTontiont and [icrfonn hi* dcuo, u 
it Uie c&so witb muij' of Uiimc joung ioccidiiiriei ifltictcd wiUi booH-uduMti. 

It u of mont inporinDoe to distinguish various Tomu of mcW 
cholJA accordiiig to tho different rtlatio* </ tM emotional b- 
ton; of ttio irill and of tlic actions. TIiiis tlic coudttionf which 
ve liave just been coimidcriug may prractil impotiaat modificotioDi 
in two di^crent nod, in some degree, opposite vnys. On the one 
hiind, Wity maj prccced to a state of still deeper »etf-coTM:«ntntiMi 
vitb complete loss of will, or nioro luiially with oonvulxirc tcnBdoui 
clTort. On the olbcr hand, in thc80 states, nvw dcEires aud new 
inovcni<-i)ts of the vjll taaj appear, corresponding to the gencnl 
argnlive disposition, which citlier manifest themsdves only b ou 
iaolnted act of violence, or in a continual outward re8lle«sn(ss toil 
excitement; wheo the melancholia passes into the form of masia. 

According to this view, we may oon«dorj as the piincipal fonnsof 
tnelanehotia, the foltoving : 

i»t. MeliiHck^iia Khere tie atibjecl i^ U is toii in Kif-conlempia- 
/ioH, Melancholia viti ttapor (uaaally dcKriki-d hj the frcaeli 
writers Gt&tgtl, F.ioc-Jiematy, JktdUitgcr, &c., by the not vcfj 
flppro|)riat« nniiie of "stupidit^," though properly understood by the 
hitter according to its luituri:*). 

2nd, Melancholia viii tiut*i/e4talion qf n^aiii^. Jettmetia 
itKdeKeies, jiarlicuhriy wilA certaia aeli <^ vhlence, sometiiia 
directed against self (the fo-callcd suicidal maniii), soutottwa 
against other perfons mid imuiiniatc objects (homicidal maraaj and 
RioooDianin of destruction so far as these cases are coQoected witb 
TQelaticholia). 

3rd. Mdancholia acconpauicd ijfpenUieitt exatemtni ^ tie mil, 
in the stage of trnnsition into mania. 

I BuIUrsvr. " De I'KUt ii«sign4 tittx let Ali£iifo sous lu oom d« Siupidit^;' 
' Annal Mci). I'sjoliul.,' i, [S43, pp. 76 and 356. A later wucic bj the Mine 
'■Mici»n('Annil. TAid. VtjtM.,' 1853. t. p. 151) bum U16 tiUe, "Deli 
'woholio avcQ Stupenr," GuialuD ioeluiled tliit oondition in pkri nnil«r 

LANE MEDICAL LtBRARV 
STANFORD UHWa^WN 
MEOICM CtmtR 
STAMFORD. C^Uf . ^ViXA 




STATES OF MKSTAL UEPEK9SI0N. 



247 



I 
I 



I 



Saoiuir m.—Hetaneiolia mti Stupor. 

% 133. Tliat form of mclAncholiii in Tt)ath is represented tlie 
highcrt degrre of KlT-absorpUon tmdcr the oatward form of stopor, 
is not onl; of the liigfaest theoretical importance on nceoant of th« 
vdl-marked tncatal sjrmptonu, atid of the lerj cbancteristic 
anatomical le<ioD!i in the brain, vhich exist in some case* ; bnt otx 
account of its being »> oft«n and m rv&dily confounded vith 
d<nicntia, which ma; lead to senoos errors bath as regards prognosis 
and treatment. 

Bttllj the palienta in the higher degree of thc»e tiatvx present 
to ippcsrajice lh« rery picture of dementia. They arc perfectly 
dumb, complct«I; passive, thej only move when compelled bj some 
strong estciiul motive ; their vholebcAring is that of stupidity; the 
expression is that of gmeral profound mental oppression, of a 
Tcrit«blc aooihilatiooi but tho glance of such patients does not 
indicate tlie nullity proper to deniejits — it expresscf a painful 
emotion, sadnws, anxiety, or concentrated astonishment. In the 
laorr adranctd degrees there gcDrrallr exists antestheeia, Bometimcs 
|iarti&l ' uid somctiioea general, of the Hurface of the alcin, and a 
cooditioD of tlte Ligba o^ns of fsensc whereby the impressions of 
eight and of buaiiog are lendeied quite indistinct and confused, and 
freqiMlittj ao pcrwivcd as if tht-y came from a distance ; perhaps la 
•one cases there is an increase of tliat cerebral parens of tciuatioa 
of vfaicb ve have already spoken several timca ($ 50, § 1 14). 

The voluntary moscles appear at times to be [>erf«tly rigid and 
on the strcteh, eometin»s benambed; it is not aneommon to find 
■och pacieats in a cataleptic condition, and many of the ohscrvatioos 
oonoermiig ao-csUcd catalepsy belong iii reality entirely to this 
Ibnu The mobility of the members under the control of the wdl 
is alvays very much diminished, occasionally almost suppressed. 
Tbrre is a condition like that vi restnitit of all the motcry fiuictiona 
of the brain. 

In snch circumstances, the patients hare in the majority of eaaes 
lost all oonsciouiocsa of time and jtlace^ as wdl as the appreciation of 
tfarir bodily necessities : consequently, they arc in the highest degree 
ODcIcan — require to he fed, to he clothed, to be put to bed, &c. 



Be rtndli'Tniti da rslUol. CJitbrak,' I'aris, 1844* P> as*^ 



IT1.1 





BeoTOe mtn iii dui^ 
nliJBd eoteim fitialahn^ 
J, ^na u Ifae HMt Raubble "fa—'™' 6a 
tfc^ iBtil f ij ihi il rcii »MA « fiopg » 
the Hind K ttegMt ■ijiiiily at imaUuBet rChh ii 
iKtmtr- Boitbe pitieil,ovBglotUiateamlaiiifite 
of tk MMociil p nec y ticB , ■iwnnirioni of what goo on vMiJ 
hn,fiTM b ■> iBigaiij votU. So hr u be is "■M-ryJj ■! 
mfitj hai iriufpetd, til uoojmI Iub b eSsced ind tnufomed. 
Aa BtaoM iatenal aBxiMf caMintai the iJBadutcBtal stata wlu^ 
toaoorfs hui iIboiI to nBoeitioo, ud EraM dm pcwccd idtH of 
bog tbndeaed ettt; aMOcat witk ■MfcrtDHs; as^ honni going 
to bfl noQ ^''■'j of the vnld oaanw to u cndj ot total «"■*■■*»- 
tke of CTBTftitBg, 11 well as certain drfaaaoBa of baving ooiBBdlied 
MHie &i^itfi] eriiDF, of depnntj, ftc 

The tdkttx 13 unable to exot bis viQ, and Uiocfore feds tbe 
ia^OMnbilitj of fraetaf bioodf fren tbe tmon viucii tbnaXoi hia 
OB all ndes. Vm frcqumtlT be «imol afterwards (ell wh; be vu 
ineap^e of tbc least cxcrcue of wfllj wb; be ooold not trp\y, wbf 
be ooold oot cTj oat. Eaqnirol* bas, bovever, aoi|naiatcd u vilb 
the iiit4Tt«tmg dedantioii of a patient afiCT hii reeof trj . "Thii 
want of actirilj wu due to the Tact that coy sensatioaB wen too 
feeble to call forth an rxcicisc of 'will/' Bat thi* absence of irill u 
noct eridenllr manifested m the titter pasnreDess, inaetin^, and 
inunoliilitj of the patients ; as vdl alsg bjr tbe ioterconeut fiu of 
iQtciuc actiritj wliich sometiiDcs occur, in the saoae wa/ aa muj 
patients mav have now and then a short moment of ooosdotutieBt, 
and obtain a glimpse of tbe scttial world. 

Terj often this external ineonahQitj, this sappresaioD of tbe 
effort, and the exclusive aad deliriuDi, ar« accompanied b/ haUucin&- 
tioDS and illasioni of the same nalare. The patient hears voices 
which aoem to reproach him, to tmult hica, and to thrtaton him 
vith death ; or a confused noise of beUa, irumpets and cannou*, 
ftc He sees witches, funeral prooessios, tubtemmean vaults, 
volcanio cxaters, which appear to jawu at hta Tccy feet. He scea, 
also, the most cherithed of )us relations tnartjred^ &c. Uc fancies 
hnaseUia a desert, in hell, chained to thegaliej-s; in one word, the 
' ' GsistakraaklieitaiH' tdh JJenihardt, ii, p. ii£. 



J 



STATES OP MEMAI. DSrRESSION. 



249 



nitire mibjcdiTe cltangn which is produced in liis sensorial per- 
ccptioDs, and the cooaequent ttniisroriRtUon ia tU iiupressioiu, 
canses nil ntenuil obJKU vhich he tXill perceives to appear only 
in the fonns ind figures coloured hy the predominating sentiment 
(s«c examples) — a fUUc which is also chaiactcriscd hj a coofidcrablo 
degree of coafuaion of ideas. 

Id masy ways this condition presents the greatest »imiUritjr to a 
state of half-sl«ep or dream. The production of emotions of idcaa 
thoughts of a moamful and [Hiinful description find an exact 
;ue in the appearance of peculiiir uev and disagreeable sen* 
stious (formication, pridting, cold) iu the dcadejicd sensory 
nam ; and ve shall sec that this comparison is onlv the more true 
because in a large proportion of tliese cases we are ahU to prove the 
aristwico of an evident pressure upon the brain. The patients 
tlumdra, «h«i thej' again commence to become more \ivc\y, to 
feed tbeuselres, and to do a little work — in nhort, to oonvale^ce — are 
astouuded as if tbe> were jmt waking up, and often ask where 
ihej arr, and only gradually recover tltciiiselv(»!. They thru com- 
pue their actual state to a dreadful drcatn, and their convalescence 
to ao avakcning thcrcfroiii. 

S 134. Still, there is not always present during the courHe of this 
of melancliolia such a multiplicity of painful scnsntions, ideiSj 
images as have be«n mciilioiicd. In many cases it is rather a 
half.sl<eping stat«, without distinct dre-oins or lively hallucinations — 
a state of sclf'abeor])tion, of estrangement from the outer world, in 
wtticfa little else is pcrocivcd than the feeling of profound internal 
divturfaanen and absence of will ; where the inlelleoloal faculties, it 
ia true, seem to be in a state of ahcyancv, but yet the patient 
retains the oonadousncsn of his condition. Perhapit, indeed, it may 
be because the patient cannot give a good account of his state, or at 
b«rt can only feebly recall it, that psychical onooulics so striking ia 
tlumsdres are so little known. 

Tltts, too, may Mrre to expUin why sereral disiingiiishcd ob- 
(Giquirol, Qcorgel, Ellis') have considered these conditions 
be dementia, and tlic fuel ]>ro)x>undcd by if. lilLoc-Dvuiuy 
(1833), and most erroneously generalised by So. Pincl (1840, 1844), 
that in cotain of these patients a cerebral ctdema, and consequently 
OOOtpnMtoo of the brain, is by no mtwu unfavorable to this view ot 

' £Uis, 'Tnit«. ftc, par Aidiaaibault,' Puis, 1840, p. 199 



STATU OP URFiTAl. DKPRESSIOrt. 



the m»Ucr. But, in the &nt places, tliii oczebnl tcdeica is I17 na 
means conFtsot; and rurthcr, the dcclmtiom made by patuals 
■ftcr their recovery ari> of thcmsclres iuffideul; most DneqaivociDy 
to clear up the difference between this rorm of mehocbotis and 
dementia. There is the same diifference bttwct-n mehiDcholia vith 
stQpor and dfrmcntia, as between t^nporarj diminntion b the 
scDsorj nerrea of sctiaibility to caternal impressions, with pun and 
Dcw obnormnl ttensatioiis on the one band, and complete and ptr* 
sitlent aiuKtheeia on the other. Bat as the tvo conditions ms; 
de|)end on the same cause (compresaioo), and while it is not me to 
ate titcse two states succeed rach otbcr, and rapidlj tranaformcd 
the one into the other, so also this form of mdancbolia, as mflan- 
cholic Ktupiditv, may, when it lasts fc»- a ln)|>tli(nicd period, beomc 
transformedi into actuni persistent weaJtnesa of the iatcUeetial 
faoultica, vith ocssation of the painful emotion*, into dementis, — 
into conditions, therefore, where the intellectual activitj is not merely 
reetnuucd, but aclunlly pcrsistoitly and most profonndlj destiojed. 

That wliich outwardlji distinguishes tbtM two states over and 
above tbe expression of the countenance, and particularly of tbe 
aspect of the patient, is, first, in many coses the primari' iitid rciy 
rapid development of tliis melancholia with stupor, and further^ 
tbo almoat universal emaciatiou, tlw Hallow complexion, the irregu- 
larity of the secrelioue, the want of deep, tbe great oppomtion to 
passive movements, the refusal to tnlce food, and the attempts to 
oomuiit suicide — phenomena which are never met with in dementii. 

When melanc:holia with stupor doca not pass into dementia, it is 
rarely prolonged beyond a few months j many sufferer* from it 
recdver, aud recover generally quickly as if nwakiDg from a dream. 
Drastics and vcaicatorifs sfem in many cases to be of iJic otiaost 
!>ervice. Death sorof^timejt HuperveneK tuf the consccjucoce of an 
augmentation of the appearances of cerebral eonpt«ssion (very alow 
poise, 9iC,) ; sometimes, also, as the termination of a gradually 
increasing maraatnus, depending upon intense inlealiual catarrh ot 
pulmonary phthisis. I onco saw a case of suicide in this form of 
melnDchotia. 

Melancholia with stupor is sometimes developed as a primaiy 
affection, especially in the case of young female patieuta, as the ecn- 
scfiueiicc of 9 profound mental shock ■ sometimes, slio, it nukea itt 
appearance after attacks of epilepsy, of mania, or it my even 

wiiate with the latten 




STATKS or 3IRNTAL DEPRESSION. 



S61 



EmtriB 'KXlLL—MtfiiHcioUs wi/i tf^ftor MuunwCtw to remilUnl ftmtl ' 
nrauMfy.— A. B — , m\. 15, % KorenmicDt official, wm kdmittr'l iulo CLarenloo 
on tk« lath Aagntt, 1833. At tue a^c <A fiflctv he liid kn alUck of bssuitj, 
ud notbar at Umi^ of l«entj-t«o \ the flnt luted for lis seeks, tlie UUer < 
lor fiMrlMn d*ja. B^ had been for six weeks ill with inUrmiltcnt fever, and < 
•nddcitl;. viilioiil aaj >p;»eciiible cauie, the Ijiuailj ippnred after serenl ' 
itij^ MiCeriBg fnun Twleat headache. TU« *vmptotni were tho«e of oecebml 
ialjirortinn ; cobtbIsmu occ«md aeveral limes io Uirtc weeks, and oa nior« 
IfenoDa MSHtoa the pttient ktlenpted suicide. Oa ■dmiuioD. the oount«. 
Maes w« pais; tlia ejes txxA, widely opca, ruiil dircctnl to tli« f^ood ; bis 
fifcjaagaomj wu cipreniautus and dull. B— mnaiii«d tlie wbole da; aittisg 
is the iiMB jJaee^ and appeared quite alranite to all orounil him. To qiiestiona 
vUcA kad la be several timet repeated uud spukrn in a luiid roicx-, be replied 
in BooeajlIablM ilowljr and lortt; pronouiifled. In vnlkins, lie aupported liim- 
telf oa the «>ll, or oa other persons, luil proceeded Terj slowljr : ho offered n>> 
aulioM wUd laLeo to the bath, llemorj appeared to be coinplelelj auspcaded ; 
be fctpiired Io be fed, and wa* verj dirij in his habit*. Tlic cutaneous 
KoaMii; vai dull, tin sleep prolonged, and tUe Bpjielito jcrcat. Esquind 
iweaenbcd « blitter to the nucha. B— eompUbed of the pain, and tmuodLalclj 
Imcw Io improve. Kit replies became longer atiJ mure luudlj apokca ; he 
iiwIiiiliHliil ba rmilil not devalop his idea^ nametlmiK prcreiiled him. Die 
pignleffwailoal exprctaioB end dirt/ ImbiU still cantinucd. Soinetiincrs Im 
favnt bdo knd kugliter when bo cetight a gliDipae of n patient dotiicd in a 
linen bloiue. Ity the i^th of October the improremcnt was very evident 1 ho 
«■■ eieani;, and had bcftun 10 pb; on the piano, lu DecenitKr his tormcr 
Bvdf oprceaion retamed, and his intellect appeared complftelj developed. 
I^^ aaaipared iJie state in wbich be bad be«n for the put tliree month* to a 
pnlmged dream. All around bim seemed chaiqced : he believed in a kind of 
grpiail dranlatinn ; the earth Irembled and moYcd under his feet ; lie srcnod 
cva7 awmcBt ia daiigci' of stcppinK iato an abju. He held by tbuH who 
wna Mtr bint ia order to prerent Ibcin from itrppnif; mtu the chiumt whioh 
affMMvd la bim tiha Ibe moutbsof volcuioa. He imagined that tbe bulh-roem 
wn beJI, and that the balbi were boats. Us blister be bclicrcd wax Mm 
brtad of a gallej-alsTe, and that he tbcrtb/ w«* for crcr diihonorcd. The 
persona who aurrooaded htm be took foi rcsusciliaed dcftd. Ue saw his brolbcf 
io iba midtl of tormeiits : be heard the trj for help of Kis relations, and each 
•ema was to him like (be Ihnist of ■ poignard. Tbe crack of Crc»mii was 
on all sides, and the bullets penetmlod his bodj wftliout doing him uj 

llis uii»il was sll ohao*, cuufusiou, delirium, lie oonld not diallllgaiak 

ri^ (rub daf, aad tbe montbs seemed jcsrs. lie blamed himself for ail bia 
■slateata, and Ihc'eCare eoufht to oommit suicide. The more he snffered, the 
■on eiMtfeated was be. for be beliered that hb trouUea were ilia jmt punuib- 
naat ef Im erisMs. At the eemmeiMement ef hit recover;, a letter which he 
rWBvad fitMn his brolber aasistod Kmll; in bringing him Io a correct view of 
bis pocUioB. (Baillarger, loc. cil.) 

ExAiiru XIX.— /a^mnV/n/ nWiUMiU/^ ii^f^ t^ 'Mmttrm»i fitfiait i etm- 
ffawri ifaaetofia wiA ttmpor. Rmtfrf.—iln. il—. mA. ^4, wu adattud 
btolhaaa^llflihnin Iba utk October, i&4>- During the mculnal period) 



Ii» pttieat made sevoal tUempU at inicide ; ber reuoB npidQj idtDMl, i 
bf IW iMgiBiilag of NoTvnW sh* «M cowfk h lj w«U ; «lio «m fimiiwl, 
hat on tha sgili Nanntbtr tba defiriua wt is nmr, «im1 aha wu bran(fal 
b*cl( lo llie limpilal. Dunng mMuLrattiaa tht maJe ft M* Attenpt il 
WKide. Tb« |iAticDt i* oJb, lutlou, and lad -, I)m eounteauos Mupid, ud 
tli« irluioei laaUaiy. Her nsiren ire short uid alowly pnnoniuel ; ibi 
i* noable lo nJtecl ber tliOii|^U«^ to noMMibar tbe lUya or the noatha; ia 
ahort, to liavQ a dear Jdat taginUng uijIliiiiK. Uer head b beaTj and wwj. 
6li« il Mtd without knowing wbf ; ahe beli«vea (hat aha haa eommitted masj 
siuful (ictdfe, but doe* not know wliat xiitj arc. All annod h<T leou chanfed, 
tta hu ringing of the cars and ballacimilioiu ofhwrtog: wheaibe Tails aiUrp, 
■ha MM ahadowB and figure* ; audtknlj aha avakca from fright. The bowel* 
an oonitipatcd. the ipiii-titc food ; piUae loo. tkin cool. LautiTe%eiiGoe> 
ragament to do tonic irork, fare«d pntatoiAu, aocietj. wd balha, verc pa- 
aoribcd aod followed b; iiD|>roTcraciit> 

On the 97th December the mmiMt retorned. irilhmit atlempta at auieide er 
■ggraratiOB of bee miaditioD. After Uieir cc»»atioa tho inpravrnieiit wax rtrj 
rapid ; alic voluo^ilf engBgcd in houaeboUt work, and heoaiae ooaimunicilin. 

On tbe 6\\i January bee rtuou had wmpletelj rciunied. and she I'^nmm i - 
oa1«i tbe foUowiai; : 

DuritiK the deliriuia it teemed to ba ts if tbe were tunou&ded b; tn, 
whii'li biinie<l htr, but, iibe did not fet^l tbe paiii ; &lie melt aboiniaaUe odoar^ 
and ber food liad 110 taile. Tlic tiix^U appeared twice aa loof a* ordinatj, 
&he beard rolcca around her, but could nal distinguish tbe vonb. At £rat the 
thought Ibat slie: waa in ptuoo, aad took ll>e {wlieati (fcaule) for diiguiacd atea. 
In the RioniinK abo aa« the objects around her mora dislinotJf than in the 
ev4!ning. JdbI at the commcneRincnl, she felt jierauadad tbatahe waa abeal to 
be thrown intn a keiik full of buiiing water, and thought (hat aha baird penona 
|)iittin|; tliic'coal on the fire. Tlie rraaon vh; ahn attrmpttd to oammit aaicide 
wu ttiat cTcrjthiog amund her waa traoarorcncd, and tint she hersatf waa the 
canse of il. She thought tbat ahe waa to blaaao for all the hardakipa and com- 
pUinla of the psLinnls around bar, and tbat th«refore it waa batter that 1 
ahodd die. (Baillarger, loc. oit.) 



SbOTION rV. — Melanciolia wUA Ihsfrueiivt Tendtnciet. 



^^T § 115, In melancholia tliis pjnotional stfite of uncaaintts, 

W muktj^ and especially of mental etLSeriog, gives lise bo cerbtin 

I impultea mid din'ctiotis of the will wbicli arc matiifcstctt In extvrasl 

I Bctiuuti, which always assume n ne-gntivc, gloomj, hostile and Aa. 

I Btructivc cliaractcr. The negative idi-as and fcrlings which here pass 

I into effort, tlie atAa wlilcli arc the result of them, mxy be directed 

I either agaiast the individual himself, agaiiiRt other pnsons, or 

I fiuall^ againat iiuaumate objects; and according to the difference of 

L 




OF MENTAL DRPREBSIQ}!. 



ss« 



» 



the OQtward act, these cues hare been dociibed as different mono- 
miiniu (moaomania of maider, raidde, anon, &c.). 

A. Meiame^lia teUi ruiciJal ttnJetKiet. — Tlie [taUiolDgieal and 
etiologieid history of luicide does not appertain entirety to th« 
province of mental nudicine i in fad, wliatevcr certain scicotilic 
autfaoiities' may assert, we arc not warrsnlcd in coming to the 
coDclnsion that suicide b always a symptom or a result of iR»inity. 
There b no insanity jirtaent where the feeling of disgust with life is 
m exact relation to the actual circumstuices ; wliere evident moral 
QUMCB uiA which »iifficieDlly account for the act (§37); where the 
Fcaolntioi) hns been drlibcrattly made, ond might have been 
abandoned had the circamstanccs changed ; and in which re dia- 
eaver no other symptom of mental derangement. When a man 
of very deltcntc feelings putA an end to hn cxistcoce, that he may 
Dot aunriv); tlic losn of his honour, or of aoiue otiier highly valae^ 
pOMCwion which formi nn intimate part of his intellectoal being — 
when B man prefers death to a miserable, contemptible life, full of 
mental and physical lUs, — monlity, indeed, may call him to accoant 
for the dctxl, bat there exists no ground on which we can consider 
him insane; the abburrence of life and tlic idea of self-annihilntion 
cotrespoud to the intensity of the painful impressiona which brai 
apou the individoal, and it is after dclibcnte nflection that the 
act is raolred opon and perpetrated. Bat the cases which come 
vada this eatery are the rarest; more frequently the tendency 
to oonmit suicide drpcuds either upon Fully developed melancholia, 
with all its nsnal symptoms, or (sod this is more frequent) on a 
slate dosrly bordering open utdandioUa — of modenK- but, at the 
same time, general painful perversion of the fcdiugs. The appa- 
rently dolibemte snd cold.blooded set of suicide can, when oon- 
■ideRd per sc, no more prove the non-csiitcncc of insanity than 
any other deliberate act couiinitted in mental disease. The dia> 

■ Es4]airal (ton. dt. p. tSj). " I believe tiist I have proved that an ifidi- 
I will onty pat an cod to bis liAi wbtn be 1* detinoo*, snd Ibtt suicitle* are 
cd." Filret, 'Dcl'lljpocb, ttdu Suicide,' 1813, p. I J7. Es> 
, swrsav T . cxprcues liiiasrlf )cm abtolutclj in olbcr puit of kia work. 
CBiU. dekSocllid. PrsL de farit,' 1845. No. 41. P- aS) baa 
1 ia aa nlahwilw tswy to prove IW iHmit tbat cverj sniejda b a 
Brierr* Itn K««iitJy oppOM^ tha qJnlov of lb* nnivurMllj 
I satuR of luicidn, Ac., by tlie inlcmtinf; ooUeUioo o( the iait writin)^ 
rf fwy naay wiadM, ami eailed attention to tbc oidiiiatT clcanesi sa4 tlelibe- 
I wUoh tbese writiugs sliowed. 




STATES OF MEN'TAL DKPUBSSION. 



position to originate those stata of mental sufTiTiDi; which most 
gcnrrallj coincide vith cxbsostion, coldnem, and dcadefung 
of t)w reaction of the ffelingn, is predsrJjr the Mme u tbc 
disposition to mmtal diseases. When th«se bare ODoe appeared, 
thej brcomc 6xctl, and rule the individual Uk dorc earilr accoti- 
ing aa s feeble eyo offers only 8lif;ht resistance to tbcm (p. 51); thef 
therefore (Veqoentl; appnr aa essential result of a previoasljr weak 
character. The; arc, however, casentinll; dtstiDgai9becl from tl» 
abborteoce of life vliich is the result of otrtain explicable moial 
caoaeat b; their internal origin (§ $7),'by the vant of snffideiit 
moral caasea to account for the act ; frequciillj hj their evident 
»])pe«nnce in consequence of some pbysiod disease, bjr pre sen ting 
periodic uaoerbatioiu withont any monl uon; and finallr, )ij 
being EOinctimcs undoubtedly hereditary. When the whole 
psychical life is govcmrd hj this perversion of the feelings, there 
ariae no limiting or restricting ideas and impabes to resist tite 
thought,' bo it spontaneous or suggested, of erJf-de&tnictioD ; or 
tlieae ideas and impulses soon become worn out and exbanxted, 
owing to the existence of those which cotuUntly, and with the 
pecscrering obstinacy of all other mQUmrhoUo dispositiaDS of lUa 
kind, urge themselves upon the eyo. Indeed, the more huagniAQant 
the oatward motives to the deed, the OMro likely are ve tia finil ii 
the antecedent history of the individual, cau!e<>, or even ceitaia 
sjrmptoms, of incipient insanity ; and the more bnrbarous and the 
more extraordinary the means emploved for the perpetration of 
the deed,* the more are we warranted in considering it to be a 
tenlt of oome morbid perversion of the faculties. 

Sometimes we see in persons hitherto healthy a snicidal impulse 
suddenly dcii'elu{icdj os a form of raptus melancholkus, with ob- 
scuring of the conscionsncss and all the signs of great exaltaUoo. 
(Example XX.) Thns in the cose recorded by Forbes WinaloWj a 
ladjr in whom no one had ever remarked anything extraordinary, 
suddenly during dinner sprang up and attempted to tlirow KcneU 
over the window ; she was pre^'cnted accomplishing her purpose, 
and forthwith there vraa developed an attack of mania. If the 
suicide hud been successful, it woold have represented a case of 
very problematical raptus occurring in a healthy person. Id manj 

' ImtUliou of suicide. 

* S«e ll>e sliookiug oat oC atamlioa id 

I liovat, wito cruciQcd liin 




STATES or MBNTAI. DEPRKSSIOK. 



SS5 



or those cues in which the isdividtuil suddenly resolve* to put »a 
vod U> his cxistcDcc, and immediately puts his porpoK iato cxeou- 
tioQ, Atul whefc ve have failtd to recogoise the existence of aojr 
dumutteristic deliriam, if ve altentivel; examine the facts, «c sbaU 
probablj fiod tliat for a long time past tbc individual has been 
plunged in the most profooad hrpocboDdria ; that he ha* coo- 
sUntl; been duelling upon the state of his health ; that be has 
frniucntly complained of being unable to command bis thoaghts 
and wiU aa fonnerlr; that he baa been umojred with a geoenl 
wealnieai, lecocnpanied by rague symptoms of bodily discomfort, 
particDhiTly with derangement of the digrstire ftuoctions. The 
weaiincvs of life i» generally more chronic, whidi nhow-i itnlf as 
^Jeen oviog to w(*l:ne«9 of the constitution from hard drinking — 
that general exb&ostion and desolation of mind which ariso from 
vsrioiLS caoses, and among oth<-n from immorality, onaoism, and 
veneieil excesses; sometimei it almost appears bs if utme slight 
deviatjons in the deTctopmcni of the sexual organs might give riit 
imA only to those longing hypochondriac states of mind which we 
often enough M« at the period of paberty, bat might also, in some 
iodifiduals, awaken suicidal impolies. 

Cases of soicidc occur at aQ ages of life, even among mere childieo. 
Wo hare already seen {^ 92) that it is frequently hereditary, and 
Hut it may nttemite with other forms of iosaoity in different 
generations. Il U about three times more frequent among males 
than fcmalca. The most recent and reliable statistics would seem 
to hidicale that it ia incmsing in frequency at a most asloumbng 
aod> 10 to speak, progrtanve rate, iu Berlin, Caspar hai drmoQ- 
•tmted the correctneas of this statement. In France, the stattslica 
of the minister of justice show, during a peiiod of ten yearv, from 
1817 to 1837, the 8stoai»hing incrzaac of about one fomth;' from 
183810 1833, the increase still continued; in 1838 and 1839, there 
oeoured one cisanf suicide in every 12^4^9 inhabitants; and in 
i8ja, onoin ercijr 9340 {lath) : tu 1837 the proportion w» only 
H I to erery 20,660 inhabitants; and in 183$ it stood as 1 (o 
nrcry U>3.l8. It is well known that suicide is often propegated by 
imitation ; examples of this kind nrc numerous, from the case of tlie 
maideiis of Mih^ of whom Plutarch wrote, I0 that of the well- 
ImowB example in the Invilides in Paris, and others of slilL nwre 
date. In all times* too, ciMs have not been wanting where 
* Ihifaa, 'Ttail< d« SUliattiiiu^' Puis, 1840, p. agA. 



l»o individtala of different sex hare together committed inicide, kbA 
tlxne iu whicli llie person pat aa end to his existence sftcr larbg 
oommiUed tome net of violence. 

It n not our intctiUixi to enter into JeUlls ngmUnit tb« cvun tad mcmI 
•tgnilloaaoe of Mieidc, or to ennntnls tiia lUtntia of different oosalrin i> 
wird to it. As to tbe buter, nnd the httndredt of docauenU wUek m 
bfonglit fonnid to pram, what ne hare already adniltod, til tho enwsim 
iBOKMM in the number of omm a( sQiode in oar tine, ihcir ttatkonty ii o( 
prccbelj tlio urns Tslue m tlul of the ■t4tciBeDt ragnrdiDg ttic great tuCTOut 
of insanitj ({ 9s)- Tbi> older sl&tistica «er« botit !MOC«ntl« ud defectiK. 
ud it is jaat [Muible Ihat Ike iatTrtait irhieli il his bMn attempted to csl«UU 
TtiKj onlj be appnrcnl; tbetnter ttitirfjei beiD|{ much norecxiet and oonfdelt 
ThuB, «a I bive incntiooed in tbe Rrat edition of tlu* vork, M. Arcbuabmll 
■nuied u> in 1843. tbat ao far at traat ai France vaa eonocmed, ihu incrcaM 
in tba number of anicidca vu not aa acttul riict('An«. &I£d.P*7ch..' i, p. 147). 
■nd that the dUrercnco tnu entirely due to tbe mach Krcalcr care and csactJ- 
tni» with which Hie statistics were drava up. Tbis it potsiUe, juat as it ti ia 
rcgud lo imuiilj in general ({ 8^), but not at a)l probata ; it moat be ad> 
milled that there ii an acliud inenaac in Ihc nmnbeor of anieidei , but the rate 
of pTOgrtuinn in nut so great at hu been mentioned. 

fiAlomon (' ^Velcbea aind die Urucboa,' tc, Branbeig, i8<tt)!i*a roomTor, 
publitlied aome eitremelj istereating atatiitieal tablea, from which it comt* ont 
tbat tbe Dumber of auicidea in Belffluro from 184^10 1855, in Sweden and etea ia 
Faris, so far from increasiiig in a contUnt uniform progreaaioit, a ■■•jotjiiMJ 
vilbtD nrlain, not verf eiteoiled limit*. In the omtnl Bnrapen eonntrfsi, 
il is reckoned Ibat at tbe prcseul day Ibere occurit 00 ta KTct^e, one auMde 
in every 11 or i$,eoo inhabitants: in the Eut, Miicida vu ai^ atHlMiMc. 
At Icaat one Hflli, iierhupa one founh, of thote who commit snicido tn dnmk* 
ards. Id France, t'te ftrcater part adopt drowning as tbe meau of endiDg 
tbeir eiisteuee-, while in England and Germany, bauginf;!* tbefarorite n»ctbad. 
Ons very mournful fact connected with this aubjecl a the saicide of cbi]drea. 
la England, during tbe space of five year^ from 1853 to i8jj,6, out of^ig 
caset of suicide, 33 wore commillod by ohUdren under tbe age of ten jreon 
(Backis). Dumnd-Fardel (' Anu. MM. Psych.,' 1855) hai eoUected l«eH^ 
six caacs of suicido by persona varying in age from Gie to foiirteea yean. Tbo 
motives wliicli usually lead to this muumfu] end arc. aa a rule, pitigUe u eon- 
pamd with thnnc in adulli ; fear of pun iili merit, &f. Thns, a boy, aged uae 
jean, killed bimielf because be hod lost a bird ; another, aged eleven yean, vfaoae 
ease SolilARer describes, from dliappointcd love : another, aged five, thraw Ims* 
telf into the water because bis molher maltreated bim. It is a fact that death 
does not inspire childrto with the unne feat as it does in the majority of adidtt, 
■nd the weak t^it eosily overcome by tbe idea of the thing. Further, in taob 
children there his often, for a tang time, been obserrcd something anomakm, 
■ oetlain perversion of the feelings; w, for ciample, cruelly to aoimali (for 
example), mo J^nbcs Wintlow, " Obscure Diseaice of tbe Hind ud Bain," 
Iiondon, 1859, p. i8fi). 



tarn 




STATED OF yENTAI. DEFJtESSIOK. 



257 



} 116. We miui carefully dtstingutsk (wiUi Guislab'), among 
' Ibc ictualty insane, tltorc csms in which the sotcidal impulse is the 
I moti es»enU>l xTmptom of tho maUdv, the cliicf diaeaar, front tbo«e 
I in wbieh it ippwo, meniy as an epiphcnomciioii, duritig the counc 
I of some o4l^ form of mcDlui alfeetiua. The majority of innnc 
pa«oDi in whom tliis *uiri*lal impulse manift^sts itself suffer from 
»>ine TelUprononnced form of melancholia. But the p«ychnlc^tral 
motiTc wb>ch gives riae to this impulse is far from being nniform. 
Ofi«o it i« on iiuupportable exceis of a geiicTal uaddincd fcding of 
anxiety nhich le^iis tht patient to s«ck relief in «uicid«; at other 
timu he gives way to Ihia impulse, because he feels that all his 
fecliogs liave become dt»Bgr«eable and frightful, and his mi&d subject 
to dreary ami wielced id«*a; in desperation concerning this pcr- 
petoal yoke, he considers himwlf unworthy longer to live, and 
imagtiKs bis whole life is evil, abaudoned, and impious. Or there 
■rise dismal ideas of general nou-cststence ; the iuffcrer imagines 
tlLSt the whole world is annihilittcd, and that conseiineJitly he loo 
BiDat put an end to his existence. Cut that which is pcrli&pa the 
tno«t frequent occurrence » tlie presence of hallucination!, in which 
the profound imcajiincss of the feelings, and the stilt more dismal 
idcu of iclf-destnictiQn, take a Ecnaiblc form, and are presented to 
tlir mind of the palieut with all tht! force and reality of objective 
perctptiona (voices which «iy, " Slay tbysclf! Slay thyself!" or 
tinUndnations of vision conitying the direct cumnunds of the 
Deity). Such impulses come in melancholies often very suddenly 
and tranxiently (lasting sonic hours or days) ; sometimes thtrc 
a|>pcus with the accomptishmeiit of the deed, even though ua- 
•ncoeMfol, an actaa] ivlief and remission, ju&t as in other eases we 
obaerve, after sotno injury or act of violence has been perpetrated 
OB anotlter person by one of unsound mind, that the feeling of 
profound opprenioD wbkb weighed so heavily on tlm patient is 
thereby removed, and perfect calm is restored. Stony mebuieboties 
artfully mxe au uppuTtunL> moment to put into execution the nso- 
lutiao long ago taken, but till now concealed; at other times they 
o|MDly, one might almost say shameleasly, avow their purpose to 
eonnit miieide, and diligently await for wedcs and months an 
Oipportunily of eati^'fying this impulse by every possible means, and 
>even before the very eyes of their attendants. 



■|iapM8ond«,'i, p. >44. 



17 



258 



STATU OF BiENTAL DEPRE88IOK. 



Scblittcr (r»gu, ' VtcitcUklinMlu.,* Bd. 64, 1S59, p. i) ftbtcrtcd Ihal la IMO 
lofiniuuty, 91 who dUer aooiBiiUad nieide, or rudetlie ktlempt todt 
M, alaiost »U >ere flmctoliea. !■ Uieaa Cmm tbe nest inpoctant preft- 
pcwliig eum v«c, cenfanl eoagcitloDs, prafoud eihnnUeit cwntd bf pn- 
vioM iiwMf, diaappoialcd lore:, JrmAauum coojoined witii moatd sxcU*- 
■ml (kn we olteo Me 1 uueUal inpube RiddeBlj deiclop itMlf, aad i( Ik 
flonifliuMoii of tli« deed be prercnted, Ibe patient letaiai do racolleelMa o( 
what bu UlLes place) j is one wtAitary oue fear *» tJte dctcminug ouw- 
Xxhaiution of iJte oosstilntion, knsoiu. a dinikie oetebnl hjpenaut, djt- 
seaonbai^ cUoroei*, Ihe climacteric period, tad di te i e) of tbe beatti were ^ 
otaaamd to bara coimidenble inlanoa ia piodiMMg thii itate ot aia± IW 
■oda ct deatb vbick tbc*c indiridnab cUaSf aaUdail waa banguig. 

Bat it b not only in melancholia that we obtenre this sniddal 
tcodeocj ; we meet with it also ia other forma of tnuitiU discaw. 
Il then depends, Dot so mach on abborrcQM of life, as upoD aD 
kiixh of ddiiious coiioeptions, iii the more restricted kdh of tke 
term; the idea, for example, of martjrdom for the benefit of mio- 
Icind, of being about to enter ]>arudi!>e, which is presented to tbes 
eyes iu aplDodid risiong, &c. further, there ocessioDall; appear, 
in pcraous suBcriiig under paitiol dementia, inlercummt attack* at 
suicidal impulau, from most intense abhorrence of life, as a fona of 
melancholic or inuniaeal raptnii. In the tu^lum at Winneothal, 
there was, for man; yean, a mentalljr weak and partialljr demented 
pntient (ideas of being the Emperor of Chiiui, &c.), who from Use 
to time VA3 guddeuly (with considerable cerebral congeation) soaed 
with the most intense disgust of hfc, and it was only by being con* 
tiuaally kept under reatramt that he was pre^'ented from pUtUof 
into execution his deteraitnation to commit suicide. These attado 
lasted for five or m. days, ani) then completely ditappeued ; on 
each occasion the withdrawal of some blood from the bead sotmod 
essentia.!ly to aid in cutting short aiid dimiutsljiu^ the strength cj 
the fit. Those asen in which the insane kill tbemselrea nmn* 
teotioually and without viahing to die tac to be disiinguisbed froDi 
oases of euicide ; — when, for exiimplc, a maniac in the midst of Iu 
delirium misttikes the vtndow for the door, and insisUi upon makiag 
bis exit by that means, or when he leaps out at the window in 
obediesKC to the command of the iUmighty, whose voice fae han 
eaying, "Go to the window, and thou shalt tly as doth a bird/" 
or when a monomaniac belie^'es that he is commissioned to conral 
niniJdiii], und in Oldex lo coiiviucc people that be U really tciil 

I Leuret, * Fragments,' p. ago. 



STATES OF MKNTAL DEPnES&IOK. 



8fi9 



from God, and therefore iurulncrftblc, throws hiniBcl/ from a bridge 
nd a drovned ;* — thcw are not caaca of suicide, for here the 
palicDU bad uo ilesite (o kill themaelves. Closely aUiod to Riich 
CMC! of morbid »clf-dcstrudton, nod fulling under the ame cat4>gorTj 
are those examplca of selT-mutiUltun, generally the lesult of mrlan* 
cboUa oc dehnmu ideas, in which the p&ticnta cut off their flngcts, 
tear out their eyes, cut off their testicles, &c. At times wc are 
vammted in coming to the oonclasion that there is in thwe parts 
a muidenible diminatioa of the Kmibilitj. 

Omm riiB ceeatia which persoM wtially jimne riwitfafert tempts »t laictdet 
It doM oot, bawerer, foUo« that tit mtnlal diKote is simulate]. Uoid) 
'AwlUU. Pijfliol-,' vi. 1X54, p. S4, meDtioDs a oise of lliis descriptmo. 

BXAItFLa XX. — Sintdea ufpearaim ^ aUtmpU at iiHci^ tfM oltfmnug oj 
tkt nrntiouiMB amt l«u tf oil ntoUeetiam. — A l&d; ttill alire, and now (iSai) 
43 ytmt% of dge, had hithetto lived in comrorinble cttcaaiatkiices, nad, oiccptinfc 
iiiiMiimil h^ilcric bc*d*cbc» ud djamenorrboea, tn tbe coutant oijojineiib of 
good b«aJlb. Up to tbe 7«ar 1804, sbt bad never met vitb a miarorluno. 
tier hD»buidh>red b«T tcudcrlj; her cLildren, whom abe \»tntit bad partly 
■■rwd, w«n ttronft aiid healthy, and her circumtticcea euy. On the 14th 
lalj of this year, bDweier, after tht liad mlTcrtd [or terend di;i bcfora 
fron ber ocd^ur; beadaolie, but nliicli bj thia time bad difoppcarcd, sbe na» 
iiuiae, at halT-paat tbre« o'clock aflcr nooo. ta ber ova Voaie, appuentlj 
vd plewtd and Mig«gcd in kaittin^. Suddenly, and witbout the least proro- 
nUao, Alt ipnag up and oUsd ont, ** J mint drown mjaeU — I tnuit drown 
Kyaetf!" wheteopon ibc ran atraigbt to the moat which aurrouadtd tbe tmnit 
■od lkr«w hendf into it. She was imminliately taken out of the water and 
canted, apparently dead, to htr borne. A doctor wat re^idljr tumnoned, and be 
■pefdil? mtored aaimatioii. Sbe, bowcTcr, rcmsJDcd mute, and atmd 
wilb tnAikj open eje* fliedl; en one tpol. pxjiiis no attenlion to ibt cTcnla I 
wUoh paated anand ber. I aav h«r Tor the firtl time oa tbe evening of tlwj 
rjtb of Jnly. She bad, it is trve, daring (be lime which had interrened ihtea 
the a1t*ck, ralmlj aubcaltt«d to all tliat was done to her, and eTen anBllowtd 
tcmm mtdclae ; bat she bad ncrt spoken, noi partaken of food or driuk— abe bad 
Ml ilepti Bor tbovB inleteat in anything. When I taw ber late at ai^t, At 
vna lying in bed, and liglied coatintiallj. When I spoke to her, ahc ttarled 
ud pnoonnnd my name. A candle was brought, and when the aaw ri« she 
' llj Ood ! vliere am I, and vhal bu hnppened to mo F" and OOtn* 

to weep violmllj. 1 »ood aJmed ber. After slie had recogniaal and 

■pelws to kcr kaaband, and iuioind abonl ber cliildrcD, ibe fell aalccp and rtated 
ndUnrfaed till morning. 

On awaking, abe &l onpe ehe«tfiiU; inqaired sboat all tbat bad bappeasd, 
■^ WIS aatoabbed to h«>ar of lict attempt to drown bcTMV, sad of the duffer 
JBlo wUeh abe had tlieteby [alien. On mj appeanmce nest tooming, abe 



s«o 



STATKS OI* HKSfAL DBPRESSlOK. 



laushinglj vkcd wli&t I uUiaUj IIioukUI and Itul s^d of her, mi vu wuDoa 
to know how the OMtd bate cxiOM to lli«rooliali»dHo( drowning befseirvitkMt 
bcinic oontcioiu of tiie oomrresce or knoving u>j came for it. &ii>oc tka 
bh« liu liad screral cbildren, and naaj tUIoga kare occurred to dUliuh ker 
equuimit;. but alie lias ncrtr hail an; audi eitnrafUt vieaa. With tlie exnp* 
Uoa of oocMioDil lijrsterieal altneki and dritneiioRksa, alM baa dvaja ess- 
thuicd hcilttiT, cbcerful, and gaj. (Mcnd^ in Hctike, * Zeit»chiift fur die 
StUtKinnetkuade.' tSai.) 

jwang muQ of largo fortane had been addiolcd \a oaaniniii b«( ncnrtUcH 
eoiitinaed t« eqjoj pnitt; good Itsaltb, He kad BO Other Qiiaat of iiiBfjMift 
tiiaa the ntmenbreacc of th« Itciolution, llie principle* of Rbtoh be diaappnttd 
of. nnd had trra an Kvtral occaiiona nttempLed to oonmit snJcide faj iliootag 
fcimMlf witii a piaUil, tuul would nae no other meaLiu. lie ranMuwd ht tve 
jean under mj cue, duriag which tiau be did not speak ooe word of Booaeoae ; 
be WM cbMrful, amiiblr, wcll-mrormed, and sometintet said to ne, ** Qlre mt a 
pialol !"—" \Vh; would ;oukill;ouracir?" — " Because all Mcnu tircKMBc'* II 
wst not till after the lapse of two jcart that he infonncd me Uiat for a loog 
lime bo had been aobjcct to ballucinaUona of hearing aad of nght. lie be- 
lietred that ho was followed by polJewnM. whom ha ODotutlj heard and »v. 
even botwcca ihc walls of \m apartoaenL, which he beliaT«d were doubk, and 
conaistcd »{ two moveable pariilioiiit, eo tliat one couU hear and soo all whidi 
Jio aaiJ or did. (Esquirol, ' Jdaladiea Uentaica,' i. p. ^5^) 

SsAMFu: X X II. — Fggite mpube to eommit ineiJf cavKd tjr a vMnrf //yU 
imriMga ttalt 0/ bodily leeainets. — N — , a tailor, kL 31, had fall«a isto a Male 
of gnat exbaustiou in conseijuciicc of onsnism, sad had afterwarda to (ahnit 
lo rci»€atcd courses of treatment br njcrcurj. On the outbreak of cholerabi 
the ]csr iSji, Le was so ttrrificd bj- the report Ibat ihe palicaU were drawn 
from IhtiiT Uwdlioga with tOD|^ and olborwtae roaghlj handled, that htUi 
into a awooit and beiievcd that he vis leisad with cholera. At first he eoold 
not work duHnft the daj nor ilccp at night, and the idea that he also ntnst »Qb- 
ject hifliseir to treatment so firgbtful set Mm quite beside himself. lU even 
spent the night with friends for fear of being carried off to a dioleca hospital. 
When at iro;k. his limb& tremhled from aniict; : this keconaidcTcitobeapiV' 
monition of diolcra, haring beard that fright prcdispos&d to it HIi appttite 
left bun,aD(l besides tie was afraid to eat loo uiuch,as too much food ai»diuiij 
kindi of it acctrivd ImrLlu! to him ; indeed, he weakened hli digettion through 
ah&titiencc. Being p<^rj)ciiiiillj toimcntcd lij' fear*, he alopt liltle, and drcamnl 
a gnat deal or diitihit &uJ funerals. During- Ihc dnj he could not rcnlure out, 
for fenr of the disease and of the police. This torment threw him tolo a stale 
of mind 10 irritable, tlml the sight of cattle going to the aiatigblcr-hoBse i£i- 
turbed him rcry much, bccnuse he rcprescotod to himarirhov the knife would 
hu [iluiiged into ihcir throats. At last, when he )iad aomewhst reoorered from 
tliia iiiixiclj, lie uiie d.if hfnrd a tliot go off; whereupon he became Tctjr much 
ufroiil, bcCButc ho thought that some one had committed snicidc On ihe same 
evening he leaned that a person in the neighbourhood had cut bis thnal. 
His terror wu now to great Ihut lie conid not aloep at night, beeaiiac he kept 
coD»tautl; C0D9idcring how tlio suicide had eommilled tbt deed— what part 9f 



BTAin OP MEXTML DETEtHlOS. XI 



hii body had ke ■o —d eJ 7 !■ nm kc rttrwgnJ u, waak. Aok -— y™ 
wkiefa wm caBtiauDr ■■■ " " ; aao ^ ok ngasai h^bu. ; fcc s^mubb. tv 
«t 11 111 II Byit* i- th. 'R».H|..T"~. naa. nsEBBca JL ill (^ fc aseanei 
iBdiTidmL It a kMife kj hAn ks, s k^kc a ikm u / ut smc nc am 
tfaraat, in ^«le gf hit hsnar of it nd lai ^m ^ Sfe. Wus. ^ iaiuc -wm wt 
into kt> haad, he bmUeJ ^d tkcv h fri^ ioK, ir inc c nwer ah a^ ^ac 
keni^Mt veiL Be eoaahndh ihoapa rf (was mob if kkl £ik 
MT a np(^ the idea «f haafiae tsBcdKcr taatrai la mdai : £ jc n^ef a 
bridge, he Ut aa if be amt jaMp us de vkk — "iiiiiiii i jc ■nwr wiiluic 
Bear the edge^ bnt i^iflj taa aaoa m the tncn if lie iBop, jl moff xe u 
be ispdled to tbrov biaatif onr apart ia vil ; if >e ^auc s a »j ap» ac 
felt iapcQcd to javp thra^b it, nd l aaLAtK w^b-^^:^ j^ lanr Ijikb 
and larfob wtn ptCMated to bm. tiaa he mcac hceoa* ii niBiiawii" u imid» 
then ; tet he eoold ant eoaaaad kawef far fcac A&cr :^ lesK jai jun^ 
puTiaed hiai, and bad rt bat ttUnad ta xi iifies ns^nt. ic >uitiiCKi7 
aoDgbt "*—'**■"■ tato tbe ChHite. Hoc n^ luii stniOcrA jtBM. lie *. 
eonBdenhle lo^tb of tiaK, b«t rt jmi oaa^iir'jf hb^itcj 'muc jaat waa zut 
e»plojaiait ofeoaliaaoa* bofirocKiaaKi: ue tae tf ncja, lEst, *.ai»' 
latcd faj Ide fcr. i,p . 196.) 

ExAKTii XXnL — &MMk oMrf ^ oxH^ M^ ' ' r^i i 

tocBKr aoldier, aL 3^ nested frKsne wt K«i >gi, -vibsl vck — ™*if » 
aspntatel Be bceaae daS, ad ra icaed vA m maa i£ wmm. Sfe 
heHdTaiMa«biebeHliHai&jiaeahediBB,fanae>sadiDaL,nd JunEoet ->v 
thootbiaL Ttee voe Ulovcd h« aaavos viia ic ftanc w a« «»»!* 
Tbe itate of ballaaaatiaaa mi maietj a^sa. far w. »i^i>, a lyfi* tl al 
poaaiUe raatcdiea. Tbe pati^ bceaae *.-wtft aon tMrwc m. n* Jaw klm. 
tiooa ; br fmi^^Mj rrfimdfigd im mJa U «vi*«r mhm^/i* :<«» :v- 
■mte— OrrMHvdlna^/bafiriAHEVofacMrt. Eijac-.v'w Sm 19 'tv.w . 
Iba BBte feeble he b w aw t , tbe ursapr lia rueea loeautc K itKiMMt « mc 
he died fraoi ohaMtioB. (ScLpad, 'PKJiu.Osr^,' I-v. fUft- > 7:2, 

EzAHriB XXIT. — I bate K ;«ckU BiAar uacaae a •«»« |X- •'■4 
bat pnlapan of Ibo alena, cued -j; a rxmS ttiw la '.i>t i* mvh*^ 
Siaee tbe aeeidc^ the aadd^ 1 1 11 n im 1 nr« JMr-ipsxea. aatf aiftrt &',». a 
■oat peealiar pejTei ii aa of idca^ Bd a **?-^— -y M aiutaflt «jmu»«'. Iivm 
aaj eic rtioa, the aeci of the ilena penesU sae^ tf U« vAm %f '.ja *tt>i* 
or paaaca tbroBgh it TCa Tr aa ii i > i r MeaMiT it pitm ai ii t Ay la* tauy^imrt 
of a pcMaiT. (Gaofaia, ■ FbtiaEfaahiei,' i%3^ f. As., 



$ 127. Directly nA imiMdiauIr vMit^fi*-^ v.-ii ti> wj AiA 
impulse, ia tbe morbid XkoAkl*:) to '-.i.^'it*. vA ti^^t^/r 'A<*^ ^tvH^x 
or inanimate objeda. Xct clIv (Jo t?>f*t»?>i<7y.v» ft";V/'./ v^^ 
tc^c-thei — not onlj t»»« t}.trfr atti cf *i»/>i». i',-»i(';« '/wi», ;«,** 
much u they are ofttn j^ry^AnuA ufxyii tiy^M «>>/>< V/>*iil m«< 



SC3 



STATES or MKKTAL DBPftBSSIOK. 



c1irri8h(<(l b; the patacnt, fun^uncnUHir the tame eecntiai cbs- 
ra^tcr as the tcQJenc; (o wlf-injurjr and seU-mutitation — but, ia 
genenl, hotJi depend upon thr name- fundament-il Mate of morbid 
negative onotion, and in both there may be also observed oi:nuD 
dificrenoca iu tlie imtnediatc morbtd cmisc 

Ar to the psjcbical motives vhich girn riw to thrse acts of 
violnice in persona already/ ladoitring xmdtr mtlaneiolia, these im- 
pulses would vcem to be doc, in part at least, to nn >ctuiU deliriam 
of the inteliigenee or of the sensori&l peroejitJou. To this cl&ss 
IxrloRg tlioNe coses in which the patients inutgine that thej aie 
per9C«titcd, or generally injured by others,* —whore they attribute 
to certain perscuiH insulting nnd injuriotu expionions vhicli th^ 
hear iu their buUuciDations of hearing, and coosequenlljr actaally 
commit deeds of rcngcancc upon them. To thno are very elooely 
BMociated those violent deeds which are sti{^;e«teil under the idea, 
eridenttv melancholic, that crerytliing in this world ia bad, that 
cTCrifthing is ahnndoned nnd lost; tlut, for example, the inooccnt 
ebildrvii may be best delivered from the misery of this vorlJ lij- 
nn cnrly (violent) death ; or the patient, withont tlie sl^ite^t 
ground for any such fear, imagines that there is now left to lun no 
po»ii1iIi- means of eii»lence, ukI that men he will perish of hnnger 
and misery, i&c. These ideas, more or less obscure, not nnfrc- 
qncnLly discover thcioeclvcs in hallucinatJon8> iu which tliu patimt 
it directly commanded to Itiil, it may beohildreii or wife; and falling 
under nearly the game category, an* lliosc halliiciDationa of hearing 
which purtakr of religious tomtticism (voice of God or of angcU), 
in which tlie patient hears the command to go and follow the 
example of Abraham, nnd such like. Such acts spring from vague 
ideas of the nece&tity of sacriGcing some person, other than but 
closely coiineoted with the patient, in expiation of some terrible but 
imaginary crime; wliilc in other eases the pntieut, regarding him- 
self ns n fflon sliunncd by all, commits some dreadful deed in 
order to draw down upon himself the wcll-drsfrTcd puiushmeiit of 
death. 

Iji r^ard to % grrat many of these cases, including those which 
belong to the following paragraph, there is a moat important and 

■ Ttiiii, for cun)plc, l!io cases vliicli liavc several Limes occorrcd of patients 
attempting lo mtirder llicir plijstpiari*. See Mure, triuihlalcJ bj Iddcr, it, 
p, 9. We would rrfer gouerallj in llie rioti collctltQn of can eOMtaiucd in 
tliu work to illustretc litis chs|)ler. 



or MtStMJL 

cluncteriitK ljiibwiiii «i^ v! jmt ub^ nsns n s 
speaking of sbddr, ra-, lit iawmr a ae maac in»i e* ■Bam 
emotions ind fauLsfti DcninB t?' 'ae ars iik iie ■eO- xi^ 
mitled has beeooe ot^Msin -.^ mn. : ^ ae ui 3u& ^^iri Tat 
patient gains b; iht BaacBKEiia. ie ii» p^itim xr :iie ;«rsai- 

vhat has beoi tcnaed a axoEik jieii i lr amt- jl k itJomBf "^s* 

mental doAatAimaf; aua m uia i i saur » i rumjdv i^ H- 

mebndiobe awtno. 

neoBaca, and *i»ek ia is aupmc nnet, bc vna x ^ «ia w rr » U 

ImIj, i^ed 4^ U i^a a n^ if leicismi ■eancMu. imi. nMi^ ■Busr 
She dedand Iku vioenr « j^ei :c su a i =me^ ae ex m. B>^k 
doire to eaaait ife ^hc <rai^ hck 3e noe lae am >m. jc & -ss^ 
great tenor 'ol its HeeoqiaBaieDL j: -w jbuohIec iar ^ 'kxbhk a£ 
the tcniUe Aae* vUsa ^^ arai^ IK mm. ix mbl iK: vn^r « 
«^ vklcnee, vkdfccr H wadw 
or Ihow mod hs, : 

The patieat imnuU hbak 'Sur BniB»aeK if £■« warn.. \m\ ai tf' 
ophun, £pi^», idmoK, -i amm^ aaz .ai-aii'JL f^ 'Xaip) "^-itAip 
Aimual BepoitB,* i^ -, 'laL Ko. 9k.= *eK- 3*c:.. 

EzavlbXXVI. — A.jMaacviaxiAnxfavalai^ii'-b^aaEiaH.iwn^^ 
tonboa. with taHdta; eeeeaoL jTayr.ir i pannlr kL ■» ■[— iinii i^ 

*igfat o(u;tMagntkaaar> yuac, « if icaout, aamet urn u immui, ana 
avikeacd ia kia aa aiyue » ijl. Jiaaed ina vu^ k naitf i«r t>K k^^ 
telffajexdtiacTioIcaaiam- IsrfaHme, if acncie^ imem^Mmt -m^ -f ^ 
bodj. He raddj rtpcU ik« Ym. jAsb v ua VifW £t asMMt iria m 
badt bat tett htaadf JcKoitfad.? jayr-lwc 'a vmma. ««i «a« 1*w m «, 
perienead p l ta a m ia tnramrim & .ai? raia m jsntt ««7 awk.. aaa Im» 
■eaag ber «Tcp. (l a r aa nf, 'I»a?g^ Wam aaa - t ^ , 

^ 118. We {nqnaslj *» ix VK:^fXjt -rv,, v.\ -a ',i«-. (wmmu- 
have been in the actoal, v x 'j!a«: noaRte, •m^n^nr '/ ;i>7<id!> 
health, joft as in aone ^ *^jw ;aa» ji -rsuut *.iiw. a i^!*Krr^ » 
snicidal tendencr (Xo. XX , lezjfju -i luM. *iUKir. w.-^.; ri'4 
obseoriog of conaoMUDeM v^'jOo^ k^jw iM3i«m«t^ t^j-^nujawi^jf 
with fr^fatfnl haQodBtta-At, i::-n<r rtcjt tut yt-^nt , a. U^ 
blindoesa of hii furr, teaif V, SMKuixt tatt Mai; til Wa v-hm a 
hii way. TbeM caie^ «hx=, ;i«Sip>S ij *jew i/juyyyiw, t^i^^Mw 




a&i 



8TATK8 OF MBSTAL DBPBKSSIOK. 



nicm, it is true, to tnani&, but which, in their p^ebologiAil 
iditiotu, represent violent Rtd of metancholic anxidy, and opedallj 
morliid negative erooUoru, ixMsesa, in their want of any actual mont 
canae, a great analogy to thorn sutlilen lilt< of proEbuud uixietj and 
serere mmtat suflcring vhicli have somcliines beea vitiMued n 
|)rrciiraors of epUtjitk attacks.' 

Almost M obtcniv, in 50 far as (Iw motiTca wlucJi dictate them 
are couccrned, and yd of the greatest imporlaiKe in a medico-legal 
point of \kvi, arc those caaca where individuals hitherto perfoctlr 
taae, and in the full posacaaion of tbdr inteUcet*, are suddndy, aad 
irithout tiny assignable cause, aeincd with tlic most austoua and 
painful cmotiotu, and with a Ijomicidal impulM as inexplicable to 
iheotitelvea as to otlicrs. In swh ca&cs then: arc two categoriet 
into which thejr miut be carefully nrrtinged and tlutingnicbed. 

UndiT lilt-' lint fall thow- cases in vrhkh Ihoee homicidal impulse!, 
suddenly and without txicnial motive, arise in penona who ba*^^ 
been liitherto of a lively, joyou?, and loving dispoiotioD, and ^^^ 
oeasaotly intrude themseNes upon tht-ir ilioughts. &fo3t general^^ 
tltete orieea a profound and maurnfuJ division of the ooaadounicw, 
an internal struggle and storm of the moat painful nature with these 
new and fenrful ideas, against which the whole fonoer contcnta of 
tlie / rciist with all their powrr, wliiclt of course variea in different 
iDdividuak. Pretjaently, during the combat, the individual is only 
ablo to prevent the total discomfiture and defeat of the / by retiring 
from the struggle and betuking himsdf to a solitary neighbourhood, 
where the impulse which thus bwpts him no longer finds an object. 
Then, nA(7 a certain time, these thoughts may again disappear a* 
quiokly as they sprang into existence, and the individual is again u 
he used to be. He scarcely knows how he full into this painfull 
terrible dream, nnd with a feeliiig of intiMiBc n-lief he breathes 
again with th(> knowledge thnt it has termiiuled «o happily. At 
other times, however — and fortunately this is rarer — the / is com- 
pelled to succumb, and the unforlunale one iierpetratea tlie deed, 
and that too without alTurding him any advantage, with the oertun 
prospect of a life of shauie and misery — indeed, with Uic certain 
expectation of the disgraceful death which the last penalty of the 
law inflicts. This, however, appears to him as a relief, and an 
netual bcnetit, as compared with the ]>erpetiml anxiety and tor- 
menting struggle iu his sout, which he fccU he muat end at any 
GOtll. 

< Sm ilie chapter 0a Eptlcptl. 



■TA 



Ct MMXTU. 



MxiXttM XXTU^-^L B— » 




aM<f Ik 

»>Ui h jamitiM 

iaipldmtfeDlBtrto 

hsacntcoMU 

aaatnloftUi 

Unto tat hii two tb 

tain Uw MloctaMle R— , «W bnna. aried by 1 

t floOtctin ef kttn, a «lNdb W j 

tkif pnwd Ihtt tk« teiK M ka I 

vUfcwtHijnHm «brinv.iBd Itat it ' 

iMWtiif kUen. vbtt 1 U iHi k PHI fart. U ite IW Inii (f Dt. Gtf. 

nd Un BaocbMidf bn iMt. 0>«> lnak«a' W Udv, v ^ !<») 

pinnU, *«• bora ia Om jmt i^Stl bit, k osaM^HM af W aalhw ki>kf 
hau Hktd «stk > raj anas friw, abc wm vcacri «ha safj liz wvAm «U. 
TIw inl qraiiiMB of bv BBtker*! Omm. brfm uy decided ^M Bf hs tiH 
<bMM ikJartrf IhiMiliii. voe itea k Iba *am» to kfll bar cbU. lb 
aooonplMilkk InrU pks. ^ oraad tn Hie aC fcv faskv «b(bW, fa 
Older to pat tW cUi tbarak, «itb tta iiiblB ymciurf iJiBrfii^ mj a* 
tkt iBBr tiaa wwaBig it. Hh HlnliH «M diMnvcJ ii tM Is rnvnt 
UrpnUiagit kl» accntH^aad JHBefiila^ Ibandln ike «aa xcHd willi 
ItaMrtriolMtimriihip^rteHiiTUcbbaedfMaeTenlncii. Adnkr 
wni y, iMa waaan bad aot the ilqcUeat rwollwtioB el «lul bad oeeatni, 
aad drre4ed bendf witb tSi s molbcr'a U«ileme» to the eare «( k«r tluld. Ska 
k aUU liviBK, aoij baa netcr agaia had a umuiu aUack. 

In (|iile 0/ LLc pOT«iT of bar pafw<a, Cathrfint gttv op fwifwUj healtlij, 
llaagb *lie *aa fmfmmlij ImUtd viUi womi. Tbe nouH affcwad Itf* u 
K{KbKl(ufllierUMlhkUHMvaBMimK«Untr. 5b«baeaBtviAakiU,ad 
M Uh 91k tfl Jvntwj, tSst, ab« «m baffitf mad with eaae datitarad of a 
bcallbjr bojr, vboH ibe beraetf begaa tc nuM. Soon after bar Mnwy, the hit 
kto a riolml nge, uid wm atlacbed lbenafl«r vilb a fit of ipUcpi;. Tiiia 
aUacb, bowtru, ww not agab reprated. Wba ber cbild «u >U imks old, 
kbe look a lituatioo u waUaurae ; aad abe conducted liereeU in tkii capacity with 
H«f»ktjr,abpyi^ bcracU of aqiuri, chBcrful diipoailiOB. Slic la* itlied Iba noal 
I—Sh im* vpoa hHcfavga^ «iiOM thriving eoodttioa gaxe evidcoM Mmgll of 
tb« aUrrwliona baatowed oa H b; the onnw. At the cad of othtr lii werta, aba 
«H apun aeoed vilb t TioleDt Bt of angor on hcariog of the death of her ovn 
aUU, Iha loaa of whkh iho atUibulcd to the caralcatiuns of the penoB wbowaa 
raarnc it. Acute h tboe impfnaboa at ftnt wcrr, tbej bcoaeM apccditj 
tihreJ. anl aba aalj lanthad her nalenal oma vitli greaUr BMiilui ty u pon het 
At the cod of the tUrij-aeeond weak aflor ber aeeaurlicinent, tike 
I Ihctf i|)fieannoF, jircceded bjr a tlight illneai ; aiid about the 
tCMnth «r*1c tbcRsfler, Uie uunc thing txcurrcil. From thi> tim<r. Hid nursing 
a( Iba dnUI nai ctidcnllr loo miMli for ber elrtiiglli. Slic bocoDbc |>ctlo Doil 



STATES OP MENTAL DEPItRSSION. 



tmatS^tii Ui« dilld >lw Iwgaa tout, being JlniaeiMd with tntennitUnt (enr, 
and then wilb i nerrou tougti. 

On Friclajr anil SatutiUy, th« 3olb muI atat October, Uie mine vm MneA »ilb 
colic, vliicli, more or lua atrert, l*)t»d utn tW Sunday, tboii|ch oauidenbly 
modhfiMl. At the inmo time the espeKen«cd a eetUia B|;it*lian in Iter tloinM^ 
mkI uucietj I but tiila did uot ImI (at auj tune. On Scnd^ evening, whtn in 
tbB lOon ■loos with Iba two youngnt ehUdien, the thoog^it taddalj flubfd 
•aoaa bar nitsd, onMOmga koifeon the table, thst ike ntut kill the nnnluig, 
wlio vu then l;ins ia her U^bj catting her throat with Itis knife. She atolol 
tbftt at tbii momtat tins Mt a p«oaliar notntent ia her h^ij, like a goiglU^ 
aa the cxprcHcd it, and gnita of heat towards Iba bead ; rod the beard, n it 
vara, a voioo oomnunding her to slsy the child. The rer; thought of thb made 
her abnddor ; ao ihe ()ijlcktj bid tlie ekuli tipon the bed, Kutdicd up thr kaUa. 
mi flew with it to the kitcbcn, where she threw it from her, and entreated Ibe 
eook to go with her, and oal to leavo hift, liecautc the wia beaet with etil 
tfawghts. The cook antweicd her that ahe ooald not then LeaTe her worlc. and 
thoKaftcr ahc required to go oat ; so Catherine ajpun retonKd to the ehildmi. 
Still the thouglit conatanllj pfoeated ili^lf; and in order lodrire it aw*j, she 
fell to aiaging aloud, dancinff with tlic chiklica round and rosad the room until 
bedtime. When Ibc eook hid again rttamcd bomc, the aime begged iter to 
remain with the cliildrcn, and iho would occupy bcr place This rcqacst tfaa 
cook refused, and hnvini; departed, Catherine went to bed, slept bat little, and 
■nddenlj awoke with llie irreaislible desire to murder Iho cbild, vboae crib stood 
boide her bed. Hayipily. at this moment the door opened, and her nistreaa 
amred. This somewliat calmed the pri, beeaose she kaew that the cootlicr of 
the child and licr sistGr-iii-lnw slept la the ucne room. Still she slept but 
little, and wa» very re»llc3i llic wliolc tiifilil ; when, about throe o'clock, tha 
niuiderou impulau vta so strong, that she aptang out of bod and rm to wake 
all thote who wci« prescDt. 8he now complaiocd that she felt very nnwcU, and 
WKs beset with unholj IliougliCf, witliout stalin); the ootiirc of ihcm. At the 
lame time, nht ipoke tohenelf as if she weredelirions; luddemly ibe cried out 
aloud, " U Cod, wluit han-iblo, what ftighiriil ihougbta 1" Soon a^aia, " But 
this ia riiliniluiiB. abomiiiahlr, tcrriHd" Then site asked with aniiely about 
the child, tthellict it nsi teftlly beside its mother, and then tpoke to liim in be 
affectionate nod tender manncri and after she had taken some diamoniile tcs, Uw 
became more r|uiol, sud slept till ftboiil ail o'clock next nonun^. The day follow. 
mg, she vrai quite fatigued and ovoroomc, aud was coitstantlj attacked with ihe 
same ]<arciijt ms. Slie rcmiincd pcrfi'ctly dumb and sdf-abiotboda wiUi u fixed and 
fregufttktly ferocious look, and fnoe of unwonted colour, and, conlrary to hot 
tuual habit, look no aotioe of the child. Finally, about Qrc o'dock in the 
nftcmoou, after hflving three times lnVon tlje prescribed draaf[ht,she expericoMd 
more ealaiuMssud relief. Oulj ouccaflerthisiduriiigtheniglil between Monday 
andTueidaj, did thin mnnletuus limight again obtrude itaetf; wherenpoa iht 
leaped from her bed, snd drnak oR tlic potion from which she had fomietl; 
oliUiucd relief. Sinco tlicu the has remained free from oil similar attackt. On 
Tlmrsdjiy, slie, willi inaoj tears, retstcJ wiiat bad oecttrrcd to her. 

Thu attack did nol come on tynohronously with the return of the BiesM«i 
rind not llii' slightest cause cnu be iusi|;nedforil. Themodicuica6ni|ilo|cdwer« 



I 




I 



STATES OP MEKTAX, DKMAWJOK. 367 

patio BiTeri. eutia hmI nleriM. fa. The cUI dU a MiTMho-, Mi Ah 
■tune beU it in her imi Amrin^ th^ lut aaMMto sf ill Hib *«riiC it (kc 
Mine tiacthe quiet cxpra«)aio(lfccpnlNadcil|ni ad vkMil^^fitd^ 
■Ik Ul into a >Ule of Ifae Kn>t«rt dnpar, wUd^ ho w p n, Hoa p«Nd ni;, 
ndgiTe[ifatM toa more cila scnov. (Mlili.ii TTialr. 'Tiilwtiin Hii fii 
StaMnnankiuult,' 1831.} 

Sbuamx XXDL— Ifcc wifa rftiiiimifar yMituMittAylartfc 
Wrin iboiit B oonf^BiBt co ii e«iw<^ wygfc Ac w ■ fapdr. 8b« |RKitai 
tU Iho sppcaiueo of Knuul bodil; tad bbUI hnilfc, bit A« ■« MHlMtlr 
boMtwitli lliDa^t* t««)|itiDfr he* to kil W bw dUna, «ln% a iU mM, 
ttolorcd belter Uwibcndf. SbeniafnilkildMihMUdonMefildnd; 
•iMWuindcspur.ndreKuKfaarftotlMvbmclfOTn'kvMlMr. IsmcI 
■BWHita Jw Ml Mt ■bnoH iniwililto Ifdw to w ■■> pwfci 
•U« aol, ID J in eoMtqwue af whiife At «m lani witk » gmiij I 
Towd* DlhtT cliiURB kbe felt aa Moh nil dayoMlMB, adj (ra 
■iwt Am ftiid be is perpetaal Tew of iLca, nd anUtj htfc aBi 
wkleb »igtit [mmmUj fill uto her IimJs. St« fapt wfaatlj iWMif «p W 
down ftUin, iu ordtr tkal I17 tbc ra; MoUn nd fatifie ifac ni^ iiirs ttcM 
■otioiu out of htf keftd. Thu hoMBJial IwJwiy hitri fcf Atwl !!■■«■ —I i^ 
nd thowiihUic fcbim oflfce waiiwwliiiilj*Myn— irfilMH. (QMqgel; 
• OiMwnoa BMieo-lcsak mr k Fo&e,' 1896.} 

AboUmt Tstj diancteriitM bmc t»j be tJMad aotiascd ia Ontialtt't 
'AMLA>aittp.ia Syit. Ncrr..' p. s;8 ; ladakok OiiihM'i 'l^pm mlta,' 
t. j, p. a3< md 340 1 EHinger, ' ZdUehrift Bt P^iMiliii/ ^^4, i^ f>. 4«. 

Aj to these sangninat; unpulse*, the pcadneticn of ideM MMid- 

bg to tk; lav of cootrvt ($ 19) w, it ii tfw,' kloMMt tbe oafy 
ptrint of ootuuction between them and the dckhibI phencpnwu of 
mental life; Blthoogh there ciuia a rery groit lUflcnaev between 
the (inple ^t, tbat 'm the fortaiule, ideu bf want aod nitaj naj 
mmI]' ahse— in the lover, ideu of faJilihwDM md in hiin who 
■(■iidi oo the hfink of a precipice, uleat of ■ htmSimg ploiif^e ma/ 
be raggeated, and the actual fulfilnent of thow ideaa which lead to 
actions, lod eoatintiallj md pentatcnll? xiige towardi tbeir outtrvd 
spnauoa. 

Sotnewhat more dutioct to thdr pcjcholofpcal notrrea are tboae 
CMM which come aoAa the aecond cat^oi;, in which stteh tm- 
palas originate in thone who hare been long orerwhelmcd with 
piet, eonceBtnt«d in aelf, and bare hcDome «c4oiil misanthropca. 
The noK an individual gives hinuelf over to habiitul nxo'bid 
braodiog upon bu own eondition, with a negativr disposition of the 
ftdisgs, the moK does he retire u|>on himself, uid witliilnw from 
that Interchange of frimdlj and benevaleot aralimmt* whii^h kiiil 

' fiMMckr'iaatMtothafowthind^lfcNelkMorUin'iwsrit. 



W STATKS OF MK^JTAL O£PBKS6t0N. 

man to num ; and gntdually he anives at that point wUere he fecU 
biimelf excluded from all intercourse witli lit.< fellow!', anc) all llial 
iiit«Kcta mnnkind nt large. In auch ctses ve ofleu sec de\-elope(l a 
frrling of bitter auimo«it}' toirards the irorltl, which becomes to tucb 
iiidividiuda pcrfcctlj^ liiUi-ful, |j;looiajr, and fearful; and. there fie- 
qncntly arise impulses to oammit these indeterminate nets, by which 
the individual thinks to repa,v the world, in some ^pkndid crime, 
for all these gricfft and ima^nar}* evils, as well as all those painfdl 
inprearions, the cnuse of vhich ho is ever sucking, not in liimsdf, 
but in the outer world. At limes, tho persons who arc most fn^ 
queiitly with tlic pnlicat draw u|>on UicmaelTes hia laost intcRM 
lialrrd, snd become the Tictims of lliese impulws which the patient 
Buddeulv discovers. More frL'qucnltj', however, it is neutral pcnoni 
whom he attack), as if the feeling of hostility which animates him 
recognised in them ivpreceutative* of a race which he ddcsta. 
Frrqnentty it is the iiiaocest pby of a child which irritales him, 
or the beauty of a woman which incites in him this morderoua dn- 
position. 

The weU'known case of Henrielta Conticf appeareJ far a long tine la 
hrlaiig tolliii catc^j (MsTo, ii, p, 48. 41). But Boiuiet ('DeU Uonom&iue 
du Meurlrf.' Itotdcjiui, i8f,a) IcIU us tliat the ^il Cornier inforaved bei prixu 
GonipiuiioDS tliat it was to kvcni^ LcnelT on lici lorcr, villi vbom she kad braa 
living in tbc irio«t intiiiiale retntioni, llial the &lcw Ucr cLild. iSlei having Unf 
prcntcditiitrd ilic crime. EMRipleaof tinulRrtcudeucieainoliiUrcnareaotwaaliog 
(Marc, i. p. 66 ; Esquirol, ii, p. 61 ; and in Ulo aotk q{ I^onaad, Ui, p. i8j, 
lt<£). In niMj of tiiete cues we are able to establisli llie exiitcncc of diffcRot 
dialuibuMs of llifi jjcnonl health, to irLicb, fr^m cipcric&ce, we arc booiid to 
attribute a eertain influecGe in the produotion of cerebral diKase, or even tj 
the Bctual synijitoms a( tliis alTectioa, f.^., perBiBte&t or traautoty congcstioA 
of the liesil, tnemUual denttgi-niFiiu, UDAiiisin, diseases of the Bcoilal Ofpns, 
unntioni of anticL; pmcccdiiig from tlic ciiriliiic region, weakness of vision, 
general reeling of illiie«3, wcnkocss, conatipalioii, &e. Wc Lave not licrc to do 
with tlift eonn^cntion of llicsc fact*, !a a uiedico-lesal point of view. W«sre 
avsre Ihst such e»timnUon i> bused purely upon scitatlfio grounds, rasulliiv 
float tlie iiioit aiinule tciesrcli Into tko pajohologieal and oreaiiic eauiei wbieb 
have given tim to these trndencici. It u cootcupliblu to see bow ones 
science is comtraiDcit, as a la^t remedy to have recourse, to the Uitory of tbose 
morbid iuipulscs. to jiulirycriui&t. and seldom (to use sacxprGMtODofldalet's) 
ought medical reports to icseiuUc lliote Ituliaa churches irber« every haadil 
find) s safe asylum : but in such cues inedieino most assert her rights, and 
Btvar ought she, when opposed la popular opinion and pravuting ideas, whidl 
rtat on do »uicr ground lliaii nii iirjirrrtct icrjiininlfince « ilb nieitlHl ditnw, 
to tlirow doYu the smis wtiich acicncc bit* put iulo her bands. But Bctlktr, 



8tATE8 OF UENTAU DEPItESSlO!*. 



«o 



I 



en Uw other htnd, should the, vhn tiuUe ti> giro t dcttrminite npioion on 
MiMiik grOBiuia, aeck to nUUisli one on anj oUm( bnil. 

A pBrfntlf diiUnct gTMp oT cuts, wbicli in a inci)ico-l«gil point of new 
H is estfenwl; dificalt to cluiiff, a ttiat vluch coiuttt* of tboic vho kill their 
own diildraL Uuij of thoK indiiidoAls ut dninkdrds at pcrsoos dcroora- 
W<1 hj oUur cauM»( and C0RM<)aeBtly oRen attacked «ilh inunllj. VaiaMj 
\kej declare tlat tbcj kill tfactr cliildrca to dtlirer Ibcm from the iniMriei <>f 
Iha vorld ; a motiTe vbicJi, in Rifta; caws, is not iu itwLf so vbodf uDroaaoii' 
•Ua. Often, afl«( baring comaiittcd a marder, thne pcrsoni in^a aa attcnipt 
(0 coraait aniddc— or nther llicj ialcDd to do w>. hut arc too funl-hearted to 
earrj ii onL la a good number of cues tbo act partakes rrallf of tbe oha- 
nctcr vf Klf-tnulilal»a, and as it wen of suicide, tlirotigb tbe murder vf 
aaolhrr ; u vh«n tbe iuifoftniu(« father «bo lenderlf lores hit eliild seeks, in 
kiUing kim, to sla; binudf. 

Tha |Hjebolo)pcal problems in tbeie oaiea (wb shall return to tbe m a^u in 
aaolher plac*) aransuU; bat litlle cleared up li; an; declarations whic^h iho ia- 
diridaali lliiawlmi naj aiike, wlio in gcncnl briung to the uneducatRd classt 
and can pre no BMonnt wbaterrr of llwrir state cf mind. In \ryx\ tnpdicinc, 
Wi OUf^il to sdbcrc most itricll* lo llic course of eretits, la the remarkable 
■Anpi wbiifc naj bars taken place antcriorl; in the moral intlivtitiialilj of 
tbe |Mt«0«ii to iaiiuirc if be hai cicr bcm sabjcct to billuciniitions, and into 
Us coadhkm both before and artct the act. In ttic rase to vliich we hare 
ntani abore (Seilc, § 41) thia most iDcrediblo fact came cat, rix^ that the 
ladiTidful, af^ hSTlDg slain hb tbree oUildrcn, vasiied his bands, threw bimaelf 
^on Uw sraas, and went to sleep for two hours. He was pf rfectlj incapable 
tt tsftnnoBg the least remorse for hia conduct. Hence we nitisL come lo tbe 
•ndiuioa ihii in Mch cases tbe aols of the indiridual are, at least, of as muob 
faaporlanc* as hia words in lielping us to arrive at a just npjireciatian of bis 
nental ooaditioo. 

Another clau of euet consiala of those wborc llie iDiJividaal eomnili erimes 
B Ordvr lo die npoe tbe scalMd. Utej' prefer that mode of death to suidde, 
bceune tbej hare not the oounf^ lo kdl tbcmsclves, or because thcj consider 
tKal (MJoidQ i* too gross a ud, and that Ihejr could not conress before dutb, 
fcr. Then b scarcely ono of tboie iudiriiluals in Ibis class whom we could 
maJdInr u Id tbe (nil acjojnieDt ol reason. M. Brierre de Boitmont baa bronftht 
t Bgl it Wt six cases of this dtacriptioD (' Ann. M&i. Psjob.,' iSgi, iii, 

4 129- OoM-l)' rcbtted to tho«c impitlaes wliicli bave jaat been 
euioiiiod, sUai tliosc morbid inelmations which we see also dis- 
CDToed bT indancbolics, which impel theoi to the dcatruotion of 
IBUitnuitr objects, and wh!cti mn; be directed ngainat ■iij'thinf^ or 
cvHjtliiaff tbat surround* the patient. Thus, tlicre ore some 11)10 
luvG s comtjuit (ksint to tear their dotliea and beds, to nuke 
tiarpU ot tbciDj &c. Most interesting, ltowcv<T, are tltOM <iMef in 
wbicb tbe deed «ofiaist« of fire-raiaing, which Itu been enotod iota 



270 



SrA.TK8 OF URNTAI. DEPRKSSIO^t. 



• special moDonuuiaj and dMcribed under the name of I'jrniiuuiii— 
I cUutfication purely artifidtl, but which possesses at Irut tlie U- 
vutoge of prwiou.'l V settling the object of dweosvion.* 

If from the olMcrvatioofl vhieh have been pabluhcd upon thif 
subject wecicludo all tbosa CM« where rgotiitical DiotiTcs' bin 
eridentl; goidcd the hand of the inceodiair, there atiU reminB 
a certain namber in nbich this crime of arson has been eomnittd 
hy potknts UbonriDg tmder a welUmarlctd meUnchoUa (particulidv 
(rf DDsUlgift puoing into mania) — a state which is often accompaateJ 
bj is^itant dera^mtnta ia the general health, and frtt^aentlf in 
the sexual organs. The morbid impulse devdopes itself predsd; in 
the same nuuuier as does the homicidal impolae which we have jiut 
bora sluijing. The fi-cling of muatal aiuietj and the general ili^ 

I tarbBoce which arises from the morbid condition of the faculties do 
not, as has been said (Masiua), inipd the iodiridual to seek to stifle 
this auxielj hj th« sigfat of a great flame, but nereljr to rdie«c by 
an outward act, howevi?r negative and destructive ia character, the 
profound discord and uneasiness which rules within, and thereby to 

' obtain peace and tranquitlit;. The particular direction wliich this 
morbid impulse takes, viz. incendiarisoi, ma; arise Grom the foct 
that to those persons in whom this tendencj has been most icconldj 
observed — namelj, young [leoplc, particularly youog maid-scmat»— 
fire, with which they in the performsnee of their duties hare moch 
to do, is always ready st hand, and presents itself as the rcadicrt 
means by which they can satisfy the morbid craving which tormioits 
them — ft moans which is easily employed, and which requires neither 
great energy of action nor violent determination to make uje of. 

Awsf , tkeu, with the tcmt Pjtroinuiui, uid let there be i earefnl tatatigatira 
I in ever; case iato tbc i&diTidul pajchologicol pcculiAiiliM which lie at tbs 
bottom aad gin Hm to thii impulse. The gnrnd qnesljon im fan, in alt sid 
eanSi mutt ctu be to uxvrtain nhcthtr Lbcnt cii^tcd a slate of discaaa wlwli 
limited, or could Xwie limited, tLe iiliortj of the tudividusJ. S>DketiBes ikt 
Sjmptuma of ondoubtcd mcnto! diicsse CUi bo olcarl; diatinguislicil — a dcnfaasl 
fccliag of snsietji lialbciustioiu, sUtca of hjiterical cxsllaltOD ; in olter oiaest 
Ilia actual eiUtencc o( t ncrraas disuue (epil^pij or tliorea) renders [imfcafclffl 



' See the copious German literature on llus subjcet hj Oumixt, Ucokb 
Mtckd, Muiiu, Ftemniiag, Unjtr. lletticb, fie., and rccsntly mOn- 
Jeucn. 

' Sometimes roicngc, tCTHolimu bojish delight in mischief — nmetimesi saJ 
faidted moftt frcrjucDtly, Itic opiaion thtt by dastnifiiiK tW bouse ihnj mifht 
put an cod lo au im^ieuU; borufl partod of samoa sol rstuni hooie. 



STATES or UENTXL SEPRES8I0X. 



271 



Uc iuaiuu(iUiui \h»t Uie AOeuacd hu bccu lubject Ui mbc iwtMiig Bcatal aba- 
ihUoo. We ilimtlil not htpA that aauU; rtrj littla u wiaici lo M«rfa» 
«ilfc Ike Owrt J efactkM is each pcnoM r$ >1S); tkev w, fotlke MMlpv^ 
}minjr, duUiih or bilf-eUMi^ oAen monll; uul btclltctnatl; tm\. nBj, aad 
iitirrigi'wt iadif iduBlt. Hie leecDdiarj «ct oUcb appcu* to be un m i j eHhi e* 
lay BotiTi^ — Uie fetbh ^ htrltf oppoecd so kkmUdm to tke lkii|,ht ef Ike 
dnd vliich cnMcel; apoag ^ 

Of oouH Uicre arc ibo cmm vboe tbc iasue set fin to WUbp mkt 
llu faepnlia of isotins mj dilGRaf. JoaiUis Hartia. vfco beacd Am 
Celhednlo(Iork,m not n ndnchoiicv bat m •ridi^ Uoni^ i^v 
throak paiikl denenlia. mi it vn in eoMeqMMe of lii MhnMiaai tiat 
be eoaghl * to pwge Uie home of Uie Lori of the eercrthy pdwie * rta iwA 
in it To indiule Utis nae undei tke titk of "Pynmania" {«./, FiM^ 
' P«Uk Cfr^br,' p- ^8} is tke aeeesuty bat evil nudt of > taperfat l daMit 
otioiL 

EXAHTUI XXX.— JMrjwUM n/i e 9MI JftraeOf m f m h i Merie Z-. 
■fed abo«t 90 jeai^ of a c«caitiie dnnctcr, tooiBe anlalj lAetai rftac 
tba oeeunueof aoeie fimuly Maaoyutet. Sba believed hnMlT loat, mi «»■ 
deHaad lo Uw pueialiiiiMita of hell. After tenag alUmfUi la eowait eekil^ 
dHOHHialaou-Mrlum wlUt a falMnaikatiM iieck.ndbariBgikeli>cn 
oftkaoordviUiwIuchilM^M^bttealnif^bctMlt '*-^- ' ' ■ |_ 
•he ■handoDol hendt to tbo BttDSit deipair; froa BOtSBif til hk^ ^ 
leaMtead taaled open W bed, iief Wad eoaeealed ia bar baafc. mJ rtpBiJ to 
qawtimi Miljrn lanmrfllnMn Somelioiei ifae diieMned at le^pk apaa lbs 
frilJicW runiihMat vfaieh was avaitiflc her. Oaa itf tk» bantri fcr a pair 
flf edaMin, ami defibetatdj prooeedad to lUBa a Mtbaaa aad W bed vilfc a 
■M of Uule kilea, aad tUa withoal Ite iGg^Aeal trace o( UHcncM ar ^cr ; 
aod ehe told bm TC17 najrely tbat iba vai aiged to do n fay n imeiitiUB 
iMpilia. Bkooai|)leteiy neoTtndat theeadof Iraytan. (Oanliia, * ni(- 
L aapalUaa.-} 

K^vmox y.—MelameAoIia riU PertiHtnt Eteiiemewt ofOe WiU. 

W In tlic laat two aectwns we liave stodied thoae ncaifflif a ia 
P which the morbid lUtc of the facoltics maoifesta itaelf by« Icadawj 
lo ikatnctiOQ. Now, the more tbe nMtire power of the aoul ■ 
Bxcitect bj mental pain, and tbc more geocral extended aad par- 
Alcnt the manner in vliicb this is done, lad tLe more n^pie lad 
pcrmaafnt the cxcitcntent, tbc teaa art we iacfiaed lo rqpird tbia 
eonditioa as oae of melandiolta, ami the atarcr dcca it approadi l» 
Um form of mania. It is uadeae and iiinMHiililii to daaeribe lawe aO 
UuM« btenaediate forms through which tbii tennliM Iron tadn- 
choUa paaaca into maniaca] exciteaieot; we afaall exhibit ta the 
following aectioD the moat |nwBon n ced font of tUa elate. 
Bat it is of impoiUDoe to know that tbert uc ootaiii '"^htm 



S9t 



STATtS OP UBKTAL DKritESSIOK. 



iu wbicli the nrgalivc dii!]>o«itioii of titc fACultics and pennaneel 
exdlrmeDt of the will are Iccpt within modcrato Imands, aud prtsent 
a verr chrouic cuane ; coodiliOM wliicli pxhibit ihcmwlTw ruthw in 
an hnbitua] eccentricity of clurBcJ^r, Aiid whkli are nearly alb«d to 
those of slight and clironic melancholiit, to which «e have alrtad; 
referred, and of which thcv rcprcwtit tlic active form. Some of 
Ibcsc enaes are described hj authors as cases of mental ioaanitj, 
irntMia tine deHrio, Jolie raimitsKenie, moral insaiuty (Fnchar^. 
Tbcso cfliidiLioiia arc cotigcuilol or acquired; tb^ arc cbaiactcnMd 
bj s firiiiig of diaeoiileDt and bitterness, which is either coDstaitt 
or rQUKd on the slightest proTOcation ; b; a perpetual ncgatin 
demcnnoDr towards the cstenul world, thn impressions of whidi 
ahrajs axe, or very nuitv bMome, [lainful in ihcir nature ; and bjr a 
constant reaction of the nitl, in the sense of lb« oontraiy cboloif 
disposition. Ocncnlly this condition is not recognised as a morbid 
one, or it is only after a long Lime that we come to look upon (hne 
individuals as scluatlj' invalids. They well know how to justify br 
lexical arguments their wayward nud unreasonable beharinur, and 
how to dissiiuulale until tlicrc arrives a moment when this state 
enddcniy passes into an access of mania, which serres to tear the vol 
from Ibe eyes of their friends and reveal them in their true character. 

VxtMtVt yXXX.—UahUiuilfefttniain^tX^/MtUg*, kM imfmlm^jUj ojamgir, 
miiiiott oHjf dtmngoHft of tie inUikct.^-Ka onlj son, broagbL Dp ander the 
tjti «r > weak und tndulgc-nt mollicr, curif acjuircd lite litbit of yieUing to *ll 
hia caprices, and to ntl ihc irnpuUca of a rcstlesi and Brtknt tcmperaiueDL 
Witli jean ibp ini]retuosit; of hit dcuru oolj augmeoted, md the forluoe 
which wk* UTiflil; tupj>Ucd at hli rrqucat tectned to level every obatKle wUeb 
stood in the trnf of liis atiprcme wUL If he net with snv seriout dificnllj, be 
bcctmnc cutpcrated and touch enraged ; he attacked willi boldness, and sought 
lo fdId CTer^tliiDg b^ force, and iru pcrpctQally qiiwrcUing aad fighUag.* U h( 
was »a^ with any beast— i. dog, s sbcep, or a hone, Jt mslteced not whieb— 
he i>niiiedisl«lT made an cud of tl. When in comjiMiy, or a gv«t at moj ftte, 
he usually got into a rage and llien rdl to lijclitiag. On tbe otiicr hud, roll of 
rrosoii nlien lie iru quid, and master ofiLlaTBe estate, he conduotcd bn affain 
with tlic gmtnt g^crd tcnc sod upnghtnc^ia, fitlGllcd liis duties to society, and 
made himself knon-n bj his libenlity to the poor. Hitherto his usfortumU 
propcnsilj for gp'tinp into qaarrcli luul onl; broug^hl him b rubes, actions it 
law. and pcCDDiarj Qnci ; but one notorioQl case put la md to hia sets of 
vlolenee. far one da; he gul into a mge ut a woman wbn w&t abiuiitg liim, and 
threw her into a tpriog. 11ic affair came before tho couit, aud on tlic teitU 
mSBf of a crowd of vitncuo*, who deposed to the iiilcmpetatenesa of ku flla 
of aiiRer, be vb« sentenced to bo confined in tbc asjlum ot Bicf Ire. (PiaeJ, 
'Trait* de I'Alienalion,' p. 153.) 



CHAPTER II. 
STATES OF UENTAL EXALTATIOW. 

Jiunia. 

\ 130. Wbile Uie j>nre and nmple fomti of mcIanc1>olia 
conditions of depression of the eelf-tensation tad wlf. 
Sdeooe, of cooocntntion upon lome painful emotioo, of nortul 
f^fomc^Hlratiott, and, ia th« bigbeit dcgrvet, of ercn iDcaptdty 
or nukitig the slightest extrtion, ve have BC«a that, in tlw fonDS 
Itst coiindered, tbe emotional dispositioa b alvajs Dion and mon 
■Ecoiapatited bv morbid iiiipulsn to tnanifeytattoiu of rolition. Tbo 
pMsibilitj of cxliibitiiig the emotion b; actiona, and of thocb; 
Qg rdief, sliova thnt the afTective apbera of the mind and the 
have hcooEoe more fre«; indeed, the ttrongcr and more per- 
it theac impolsca arcj and the more n(tend«] and independent 
upiratioa to freedom becomes, tbe more there result atatea of 
raiiifMt creilfmtnt and ejaitaihit ^ tc'Ut, with wbici) also there 
CMJIy nnttcd an incrfaae iff the ttlf-tmial'um and 0/ tlf-oon- 
iemn. Such conditions, v\ivi\\ have been appropriately dnjgnsled 
11)1 in opposition (o melancholia, morbid atatc* in vhicb the 
arc oiti of tAetiuehe; are compriaed under the nniiie of 
ud nnder Una head there nre iaclud«l t«o diflcrtnt forms, 
lidi, vhih} thej nre intiroateljr connected aith each other, and not 
%Bfre()Befitljr pau into each other, occur •till more frcqaenU; u 
or forms fnLgmentuilj mixed togetlicTj vit. auard and 
nia (sensn slrictiori). 
llo fundamental alTection in the maaiacal states connsU chitAy 
t der»Jigem«it of iIk* motory »Idc of the ronl-liff, tbe effort, and 
mcb a twtan-, that the latter having become free, unrcAtmined, 
. comidcrabljr iiicrca»cd, the individual conaeqacDlJ;' fn-J> 
to gi*c Bome outward manifertatioii of hia powen. yrom 
teodescj (0 nn exaggerated psychical mo\-cincnt from within 
I, from tbU augmented energy and more extended range of 
I cflbrtj, fram thta cxtravagnnce of the will, vhidi constitute the 



S74 



STATES Ol? MENTAL IWALTATIOS. 



emtre-point of mauuieal derAiigein«Ql, vpringi *s ^m & comma 
■onice, those two rorms whicfa in tbeir nature uid mode of inim- 
IcstfttioD arc Booirtirocs so awDtiallv distinct. On tUe oq« KiuJ, 
Uitfl neccnit^r for tlie mamfestation of the increaaed mental actinti 
may mnifest itsdf dirtetly, being propagsted bj a cootinuoiis id- 
pube to the orgaus of motiooi and there explodiog, as it wnc; 
wlicucr there ciisoes a state of great physical lestleasaess, the palieiit 
keeping his nKU>cIes in oonstant plaj (speech, gestures, movvnunb 
of thfi body geDerall,v), aiid peipettuUy spnldng, slioatuig, wcepo^ 
dancing, leaping, stunning, &c. ; and thos Is oonstitnted the fin 
generall; caUcd manin. 

Or, ou the otUer liand» the direct rcsnll of thb more fito i^ 
Tclopmcnt of volition mar be the develogxnmt of inordinate nni^, 
iDcrrAsed self-scojittion, and consequently a coiutant orcr-cstimatim 
of self ; and u attempts at expUnatiott of tliis dispoxilian, deUnoos 
ooneeptlons sHsc whi4;h now bocome dooiiiiant over the mindj 
take the increased actiirity of the will into their serrioe, 
patient has now no longer to do with mere geneial ntftuifestatioii 
CDci^ ; bat this excitation of the motoiy aide of the soul-lifc > 
transformed into extravagant volUioa in ike form t^ parlxtlc 
itlirmt conception, for the most part with madi greater outaid 
calui. As soon as such a condition, aocompaaied bjr ddiriotu oa^ 
ceptions arising from inordinate aelf-coticeit, has in anr 
become fixed, there is founded a state of mental dcrangei 
finitely more serious than that of simple mania. In short, W: 
the latter fonn the patient is freed from his exaggerated impolM 
by their outward manifestation^ and again, as we slull soon sbor 
in the pure form of mnuia, tlic whole disease is coafined ts i 
relatively exteriinl sphere of the mental life irilhout profoundly* 
volving the indinduality, it is the essential characteristic of lUi 
second form of mania, which we desigmite moHomania, that ddixioa 
coticepiionv^ fal^ie idenr, which itrisc from over^eatiniation of aft 
and therefore relate only to the special self of the patient, sffofi 
which immediately involve the ego itself, and therefore the innwiH 
part of the individuality becomes aUenated and falsified. 

§ 131. But if these two fonus in their extirmc degrees artN 
utterly distinct as mutually to exclude the possibility of mistaloi 
die one for the other, still observation shows that in mania itidi 
such delirious idra.« of »c)f-iuiportaucc are by no means untivqiia^ 




E^ 




'* fragmeoU at 
wbick 

It that, m tkc 
mnacakr 

Ij^n vm to 



bej ar« detdoped vitk 4i 
iver, tbere 
iuii^ whieb 

IB the tniitaU sad pnripil^Ky 
tbaaoaMife; tbc? 

Uc& other w n^7, t^ Aef hne bo tine to huwt bed or to 
Iwell in tlie Htad. On the otter had, vbece Oit npid aacowMoa 
af ides* docs aot cxiit, and where tUi lUe of mlhtini tadtiMM 
SdizioD* coDCCfitMns peaetnte the «f9 M dpcfify nd in lodi t Bnacr 
Im Bctoal!/ to form u waartJtl and <™i*i*™»* put of it, ud to 
bT'^"t* not oolj ■ snbjedire leabty to the patieBl, hot the nliag 
pfioctpk of hit whole pijrEhial Hie, thii stotoMCilled ■noaouiUB. 
rnw dtsdoctioa betmca nuua uid akonamttii^ u v« have oh- 
■erred it id the most maiied and chuaotoriatie cuei^ coBKils 
ictlj in the differait directioo which the oripaal kaoB Ukta, ia 
dilTerrat ttuuuier in which th« istdleci ti mothidl; eluogcd, 
ibe vaj io wbidi thei^if liected. In mania the exaggerated 
ipvlae of the will inuBcdiatdj paaaes oatvards as a tcndotiej to 
:ulu' soTL-ini-tit ; in mooonuiiia it is simply an iatcniol ccvci). 
of will, whereb; the internal feeling of greater llbett; of 
ia tramfonned b; a itactionary proccu into exalted fain 
and where this feeling, when it manifeata itaelf, ts no longer 
led to simple morements and relief through thMC morementa, 
lend) ratlicr tuvards the rraiisation of ccrtxia plans wbicb 
froin tbose &lae ideaa. This error in the iilrna nmiiiiiU in 
deliiioiu oooceptiona in regard to tlte tpoeiol indii-iduality 
from this over>eatimatioD of kU; while in mania, the 
it of the imdlcct consista chiefly in a ddiriou* confiuioD 
ideu ifi cotuequence of the precipitona haste with which all the 
prooesaei arc conducted. 



[ 




trt 



STATKS or HKNTAt EXALTATIOK. 



FinalijT, we sliall hare to conaiil«r a Uiird )tate of nenUl ail* 
Utton, more apparent llian real, whicti is nerer found czccft a 
monomimi*, ftiid which consists in this — tJiat Ihe anomaly of tbt 
psTcbical selF-wnsation, this averweetuDg disposition which li« 
originallj' given origin to all thoM fikl*e ooneeptkms hj vhkli tht 
patient seeks to esplnin his state, ditappean more or kas eom- 
plrtd; ; but the false coiKxpUoDa thonadves, tlic exalted idna vliid 
the individual entertains of his own merits, let loose from the f<na> 
datioo on which th^ wetc erected, persist, end as conrtautly pieasU 
aron of judgment, completely govern the whole iiuellcctnal life if 
llu pttieul. We irhall describe (his tiiird condition under tlic tiUt 
of Partial DfiHentia with Eral/atioa, in the third section of Ihil 
book. 



Ib tnanin, u In melMidhoIia, tltera eitits ss iiaportmit iliffcreDcc betvcntW 
cues, in r«|^rd to whether the p&lico[> are la • sitnpU lupcrariiil or in I fr»- 
(ourni drtftu/ ttftlc, vUcUicr their rehliou witb the outer world >r ckv, m 
are lai;, oonrueed. anil ubtcuro. Upon tliit depends in ipvat part Ike degitt d 
leDolltctioo of their state wblcli Ilia paticnta {waicsi after their recorery. 

§ 132. We have more thnti once had occasion to remark tlut, ■ 
the nutjoritjr of cases, mcl&DchoUc states precede the maniacal, and 
that the latter is engendered hj the former. lu the more cioooie 
cojcs we often have the oi>portunit3r of following the whole oooni 
of the disease, and of seeing in melancholies the mental sa&fia; 
and anxiety incrense from dny to day, at first manifesting iMJj 
merely by cxtrcmi; restlessness, but gradually passing into confl^H 
mania. In such cases it is undoubtedly the state of mental slic- 
ing which induce^ this convulsive eonditioii — a phenomenon whick 
may appropriately enougU he compared on Iho one band to those 
conrulsioDs wliich arc brought on by some particularly severe todiif 
suffering, and at other times to those involuntary mascular sot- 
tractions which take place as a sort of instinctive reaction against 
any acute pain {as setting the tectU, clenching the fist, &c.) 

Wc are not to suppose thiit, Iherefoic, the nature of mania eoa- 
Bists merely in the unrrpulated and uncurbed manifestation of the 
negative disposition found in laelnncbolia. For, thongh oftal 
eDough this diEpoeition breaks through all bnrriers, and displi^ 
itself in certain acta of convulsive fury or of destruction — eonditiOM 
"'hicli we have already described under ibc title of raptut meia»- 
™9iiatt ; and although, often enough, during the whole coarse of 



8TATR8 OP AtRJJTAr, FXAI.TATION. 



377 



t maniacal offcctionj the melaQchoUa appears beldnd it u a shady 
rouDct, nnd there aie even tines wtca it advances to tbe fore- 
ground and may again become dominant j still Ihe mania, when 
once Ihr motory rxaltation liaa bocn sd. free, however short the fit 
ttutj he, bec&mes ciitlreljr indepcudeut of the preceding mclanchohaj 
and hursts forlii without the nccosaiiy of being excited anew hy 

fiJancholic emolious : indeed, the dispositioti frequently andergr** 
total cban^, the patient becoming joyful, merryj md over- 
mranl. 

At the Mime time, tliose deeds of dcstructioUj the savage allernpta 
and ferocioua act» committed by nianifics, arc far from being always 
due to a tnu negative disposition of mind, or to even it ntomeiitary 
hostile intention ; much more frequently the acta of Ihesc patients 
arc the result of a blind iuipubc to action, of n uccessity to change 
the cxt(Tunl world according to their will. la acts of destruction 
this desire finds its simplest fultUment, because this is Fa much 
easier than to create arytliing — for this demands a certain amount 
of rellection nnd of c-are, of which maniacs are nholly incapable. 
The desire longs to be premptly satie&ed, and convulsively hasteoa, 
80 to ^wsk, to manifest itself without heeding the more slow in- 
fluence of more orderly thoughts : as he must give veitt to his desire 
in a visible manner, he )>rocced$ at once to the work of demolition ; 
and tJiat which we might be inclined to regard as the object of the 
^H^i^n fact, merely the termination of his activity. We sco 
miHqf analogous to this in the child wlio destroys his toy in 
the endeavour to satisfy that necessity which ho discovers of raaking 
it to suit his idea, or in aclioolboys who wrestle with each other in 
order to satbfj the longing they experience to exhibit their strength. 
In the same way, maniacs often demolish and destroy things amidst 
ahouta of laughter and in the grentcst good-humour. But there 
exists ft complete nnd marked difference between the actions in 
miuiia and the deeds of the melancholic in the form of monumania, 
an affection which in its iutvmal cnuacs Is to closely connected to 
niania. The monomaniac more frequently desires actually to create 
something, and, indeed, to execute somu prodigious work, and to 
bring it to the light of day j and be may even bring to bear upon 
this some amount of n-tlcction, because, in hia ease, the mental 
procesMS do not proceed with the haste, re^tlcasnesa, and confusion 
present in mnnia : but there is time ofFordcd for the impulse which 
tSt« jaKcnt fccU to expend bis force, to be governed by some fixed 



tn 



BTATB8 OP JSZVTA3. EXALTATION. 



great Koi n^ntatccl, but ttahirnlly fidse ides, according U> vluch b 
is ioijielled to irorfc. 

Whea muia, puUcuiul; tbt fom uoompuiiei] with fnrioni deliriui. in 
ffoeeedol out ct nebneliolift in tliQ ntSMr «c luve klrcMdj indicated. vi 
never drcun of attributing to tite pcr*na w affected aaj prcinc<iitat«d aeOii 
act; in fact, it U onl of llie qoesUoo to think of looking lor as; psyehoigpeil 
fmecn ragulated b; ibe rncullics In as iaditidual lalmariiiff unilcr tocb m 
•ffection. Thnt mental act which he ^i{«reoll7 pecfonna is raUier a istdifca- 
lion ot change In bis morbid dispoaitioiit wbtdk got* on wilbout a^ inlmai- 
tioD on hit pul, and ta cxplio&bl« on the |^uk) Xbtt aomo change haa lata 
place in the nature and form of his cenbnl affection. So long at lUa pncaa 
is confined lo a simple change of dt^ooilkiOi the lenou n liiaited to a tjhat 
relativcl? exterior or peripheral lo tlie tneatal facaltiea. and fntfaentij tk 
patient lias then a oonauousneu oC hit condition, of that menta] anotaalj rincA 
vcigba upon tiim, vhicli oppccsxa iIiq rffn, vliicb svema to exact aonieUiksal 
hiai, and vbich lie cannot rc«iit ; and with Ihit ceoaeioiUBaas he^ at tbe nw 
time, prolcit* againtt the immincnco of the diaeascL 

When mania does break out, it is bjr no tneans alvari detennined bj a p* 
uosata or euotiooal (melancholic) shook. Apart from Ihooe caae* of ■■■* 
oaatad bj acute ntruingilia, we see in other forms of dclinnm — aa. for cxaoffe 
af ty^ni fe*er— the same ontward restlesuKai, the Tcdnatary acts and in^rf* 
An moTcmciits, the result at one ttain of the profound anxietj vhktb twat* 
the palieut, or al another time provoked b; hallucinttions. vbi]e afaia tbtj 
majr cons on williout nnjr appreciable cause, aj if tbia inotorj impulse otft- 
ueaoed apODtancoiislj to show itself with tho more profoand dMttaetiaaaf 
the mental racullici. 

A nmilnr atato of matters proTails in ocrtain cn*cs o[ chioaie maua. Toe 
obssrvstion has distinctlj sliowa that vlton the brain has onoe been Iha saalif 
n lesiou paKiJiiiig of iho nature of mcutal pain, there remains s condition i> tht 
bighul d^n^Q predisposing to manin. Mania succeeds mflnnfiltiilji imh h 
the rule; there are e«ses ereo where long after recover; from oielaiMbcliaa 
■eoond attack o! injauitj has oome on, but thit timo aasuaiing the fbm ol 
t&aniu.' 



Section I. — Mania, 

} 133. At we liBve olreadv' rcinaikod, it ia rare tbst muift ibowi 
itself vi-ithout having been preceded by eertaio B]rmptonu of aone 
other mental affection. In the maJGritj' of cases, for fmme tiae 
[HTCvious, the desire*, the fM^tings, and habits of the patient ban 
become entirely diangcd, and generally n tone of mclancholr seens 
to pernide them. This antecedent itadium melaneiolium, wliiek 

■ Ai, for examptft, tlie niatli ease of Jacobi (' Haupirormen.' ftc). Zdler ul 
mpclf liavu obiervvd similsr mta. 



•cuBflr Mzsmx. nuaxmoL ^9 



«^ bsR OBoe bd n aiMk «f vain fEoieai^f ^w-mw^wg v- 
that tiiCT SR gime to hm * snagae. s&c w iJac 'ac*' nv k 
vslciied nd xaond fros lai^ bsbil iiOQiSDioiiKffi. Tauboh.'^ 
mdi paioni ^lAot a etcA Ansv lir «urj,uuiit !dduxi ; mx. b an* 
ipdd to tbe dene sinDT m sk immaosBSf fi-i^*. x Mess m i 

lUlKf VOnld br die iVTAfJy le J wiiH U K VSVBBtUt mL III9^HC TJBC 

riite of cxcitcBiaK, not^ ■"^i-^—'-^j imr i» fdio. nsnee Jt 
doinfc Wkh the Hoaaed bbkbIv ■ » »-" ' '" r i ^as •"■7™''^ to *y'"™^ 
it ia actitns, nev ideat std bkv iancasn kjk, -«ioa.x fine 
pfamgethe palint ntfo a MMe <tf atfaadBBaa aiafai^inc meol^ 
end b; gaaung the waplwe ■awrf', Ai ize e rmarmwBg n: iit 
oonld eoDOcal tfas atMxtd testis hai ■«■ taoe icv ioaa blj 
■ensatHHia «I^ oat and di^Jsr UKaaeJPCs s t^tw ai^ (««. 

Sunahueoiulr vith tfane pntiaai ^wj^amt, uiat mt muCr 
preaent in this fint it^e «cn« bkis c^ demsneni cf tke 
digestive fonctiaiu, <tf tiw drealMiaa, and cf jacaOKM. As £nc, 
thereiiaCedii^flf iIhKM,giat[««szXan; pa9Xitfeiicsd,tc«tii, 
and ahdcKDen; ileeidciBKi^ ■g"-r*'-ig dRasa, hiUMaetdem U line 
■enaea, Totigo; le^iai, or, dh Ae cacmr, pakani <tf tke eMnd«- 
nuKc, cmadatioD, lad a jdkmib (dI tf tiie Aia; mormon 
appetite, fool tongue, and mMtiftiu a ; pdjawion, faqaeBt piiW:, 
and a generaDj febrile itate ; lappnwam U tbe aesiaea, lud, wA 
nnfieqnnitl;, exa^cntttm of the arsBal daina. Tlie furm 'A tjK 
Tisage beoomes dianged; then ii o&n rifgbt gcneni tmtbliog 'V 
the whok bodr ; the senaatwn of beat and ei4d, sod vf b^r i«Ja, 
ii weakened, ' When the mania is fnUr pnnommd, the ftxiiag 
of illnesa disappttn, and the patient exprcaaca hinaelf at qaito 
well. 



CHO 



tTATBS OF MEHTAl EXALTATtON. 



We shall now prowed to exnmine more minntdj this form if 
tnsuuty in its fuUy developed Btate ; bat before proceeding i^ 
miut rrmiirk in pAMing, Itiut ia conscqui-ncc of the muldplidlj u) 
infinite varicij' of svm|)toin5 of tins form of mental disease, 
be ncocssu^ to divide them into groups of phenomcaa, 
coarse, will not all he found in each iodiridual case. 



plidlj u| 

•se, itwl 

vhicb, d 




§134. I. Antmalieat^UU di$pemtic»,o/the detirea,a»i9f^ 
will. — ^The fandamental diBordcr in lunia, the initation apoa tlj 
motor/ »de of the soul-lifo, exhibits itself, firai of all, in tlus spliedj 
AS A high degree of mental pscitenicnt, with restless, impetaotu, ia| 
violent desires and nrlions. The desire for ceaseless action oi 
nicivcmctit, tho ocot^eitT of immc^diatclv cxliibiting in Action sU 
pss-ies within tho mind, impls him somctiinea merply to 
movements, « in dancing, speaking, singing, nhrit-king, laaghii 
Wftcpiiig, ftc ; sometiittcs to restless, objertlroa eroploir<neiit, 
wonld Attempt, According to tho cuprice of t^monent, mdd«))]r 
iinpaticntly to alter everything aronud, sometimes to destroy en 
thing Animate or inanimate — a twidcncj which inaj incr^sc to 
breaks of the blindest fury and rage. But while this riolent 
onbridled impulse ntlacks aIL objects, ruslieA tgAinst every l 
metit, and, totally rcgardlcM of conscqnenoea, shows itedf iu e 
and aimless actions, wc nevertheless find in many of these p: 
a certain coumnlicc wiien thry are rncrgeticolly and A 
resisted, or, more correctly, a state of anxiety still remaining 
the primnry jienud of the di*es«e, and vhich appenn not only 
hive originated the mania, but Also to maiutaiD it. In siuch 
dividuals we can dii^euver bo rcasonnblr net, no deed deduced 
any rntional train of thonght, no care eitlior for their own or 
family's existenoe, no ptwiijbility of being guided hy any 
principle ; indifTfrcnce lowaids all whidi docs not directly 
iipou the point on which they arc jKculiarly uiwicirc; entire 
of interest in anything going on sround; lossoFuU ectue of d 
modesty, sod propriety. 

The concrete mentnl acts which show themselves with 
Tiolence consist wtber simply in certain rapidly ehAnging 
positions, or in certain sentiments which have become fixed, 
ohscurc groups of ideas which manif<.vt tlirmsclvc« in booh 
tioulnr determinate impnlse. Thus it is, that in consequence of 
morbid CKnggcrniion of the scxnni sensations, frequently 




as: 










in oMwtKBit ~""tf* nuL miiuc buedi^ na 

Uld tUi B nnie m EmnHDL ^ 'Ok 
rndfimloas; oc nnrniL uBiot vrnaias' igw; g'-ja^ avz- «£- 
importaBer iiaudr<« isef n i. Mnm^^ aiaei i ' n t letisr ^ 
lifacztT iBJ ;qba li^SK : 3«« <■: j^-P'w > r J* ■ J rzncQ»9"*nit 
fTCTTtlui^ joi Kc na gi MBt n If* m. awe leau wtsl wmaisM. c 

flowing wf—Tag mc -^ nosr vaic i^ r. atKnate ipopt-a^^ 
H it Td^ «!■■■« ^ «K Jiiamiu !■■ aubbeair tuL wtuuir m» 

cowaidiB^ &QB uAJfiauix ii. niusic xntsoit >t fiauu np, itwH. 
gieedlf CDTCfaMHOi te oncacseac, inm. aisae^ -u, itimc im^ 
deuce and tencfirr ; mA inc -wjt «« a. tsMOM. jHiea «%<:fM^ 
ment nioend ia [gt i JTn^ ?ca. fn- \nc » aoe: 'Untt^ -iw «i^;uta« 
degree of eala aad npuK jl ijoi Kaat i/ ytsyouilf ^imu^n^ 
Tenatflitj. 

Sometima, partioUmr at ue frnnwHiwifBe «f -^ iim»m, Cm 
patient himaelf eosplaixtc of uii UMaB:r t« otmais rfj09t. ^^^^ 
and H tnaj be pniTJe in toA a cmt, \n vtaKm^ wHii ium, w ii/jf 
aome atrtnig bmbuI im^ nm k mf Umyjtmij i/> tfj^nm itm, m4 W 
bring him agaia to a nomaOMrj vuu '/ f*wM; m '/^ «>«<« 4 



983 



STATES OP MBKTAL EXALTATION. 



. u if tb« pfltient, in a Bt8t« of iaiu<«(Hucioiutiesa of ln> e>»> 
dttion, gare himself up to the exallation Then it bu ODoe b^im, 
■ad gave tlie reins to Ibe thoiigfau wUcb boMi biis ; it ■ecnu a H 
be iriflhicd, whca hi* will luu tliu* got loose and is no longer 
Rstraintd, to rtreage bimtdi' Tot lliat paiofal rrstraint to vhicli he 
hu been enbjcctcd iar'mg tbc roclancbdic etjidium of bis discssc. 

Juolii boa jNj properij edled our kUention to tbt vlialljr impvlaivs m u- 
tlinotite cliar&cUf of tfae manWsaett. Tbal wbicb detcrmtiie* tbcM itoo 
tins ut or TOlittooi — Uisi h, tbe tnatroraiition of t donmant idea into 
utioo, witit ■ oeriatiL oonoioiiiDeH cf th* otgtct to be ktUised, Bail «f tbt 
acatu acoutatj to bring it Bboat-«td as little is it k state of piofoiiDd [■iilnn 
vliich $tin the pkliCDt iato nctiaa -, but th« ever-nuuuoe, ni»»j wlu«l of m- 
rcftlnuDCd mcnUl moTcmcDt bnsics itself merclf witb tbe seuktiou, ibe Tspa 
OKulhtioDE of Ihoiigbt to whidi nen lia*e gimi the BSme of foelinics, tbe »|if- 
Reial emblioiu, the numberlesi maoicntuj uni atcidentai Knau&l exalcmeiili— 
IbeK it it wbicb alons hare uij inflacaco upoa bim, kDd to wbtcfa be Kekilo 
give espre«sion. At first (be pklieat nimj be able to contrtil Ibis iatoraal 
tannJt, kad, vital is sufBcitDllj remsrkaDe, we mojsec iadiridual* nha, «b« 
ebided for Ibi^ir iniproprietj of bebaviour, ealmlj rqily, nut wilhoat b ccrtea 
lurofirotij', tlial em^ttuagts allooci) to ibrm siiicetbcj are fooi*. Tberurion 
delirium of tlie maciic tpiiraaclirs in tvrm to tbc pusioa of anger, bit it doo 
not spriiig from th« sune motives rrf^itdccl from k monl point of view ; it aiot 
the result of imprcssious made upoa tbc niud of ideas, of thouirbts; itaajr 
spring Qp <iiii[c EpoaUscotiBlj, or, on tbe other iaxti, it loaj be detenuiwii ^ 
impressions nccidciitillj produced upon ltieor][aus of sease, as bj the bghlot 
tbe noon pecutrsiitig into s looiu tluough a window — bj ■ uoise, aooloar, Ibe 
stgbt of a person or tiling wbieb bu no eajrlbl^ oonnectioa wilb Uic patiaA) 
Buj of tbesc iiiB> be iutSciant to pn}T(Ae it. 

Sanelf is it MCtHatj to remark here, tliat bfcauie an iiuJiridnBl di^Ufi 
oertaiB desires or dis|io«itious tiiuing tbe course of bis tnanist we ara vir- 
tinted iu ooDoladiiin: tliut he nuy exhibit iubis aonnal state Bimiiar pfO[CB- 
'eitlen or meotsl Jiipoulions. For although wc ma; soiDCtiines see certifa 
raoti] peculiarities wbich tbc indiTiduBl habiluRlljr pittents in beaJlh nfso- 
duced b his nanoer of coodooting bimself and in iiis aotions daring bis dlisase 
(«.;., ecoeotricitf, capricioiuncsi, &c.), jcl oortain It ts that this fbera tlw 
becomes eiitirelj cfaansed : the jojous man becomes glootny, the sBnona na 
guj, tbc Tirluous laan obscene, the sober maa a drunkard, &<k SoactiBgi 
it is true, ccrtitiu prujicnsitius display tbeoBElvcs for tbe first time, tbe nrj 
csistracc of which we hud not cTcn before suaiicctrd, and of which we belicnd 
bim totally igooroDt ; as, for rianplc, when an kpparcnllf modest girt vtlen 
obsceiie laiif^ii!^ wliioli she ociuld not possiblji bavo leant for tbe Aiat tiae 
during her in»ui<j. 

Tlier« ue loss intense etMi of nianie, when the paLienl, diipUjit^ etrlaa 
pTopcniilics, gives himself up to Ihcni in a maaaer vhoUj ngu^Ucas of bio- 
prietj.but which still prment vcijr trmBicnt derangGuicot of Ibe iatelleet, afcin 
one is aluKwt iucliucd to believe that the patient volnntarjlr iadulgea las tt3 



STATES or MEST.U, EXAXTATION. 



283 



i (UepUimuiU, Bpnphomuuo, dipMmui*). Uowerer, what ibows tb*t 
tU> u Inlj ft inofbid afcction, u this ioToluaUr; nature of ibese aeU : Uw 
|«timt oftea oompUiiM tbst he ctanot resist the desire ; and furtlicr, tliese acU 
hmw tamtthoig imtiDCtire iu (be Dianiur la wliioh. tbej sliuw tbemMtlru : the; 
ecune m in flts vitfa ludd iuterr^, Ihej are rrtquenll; accompftoicd bj otbcr 
qnnptom of iferaageaait of the geaeral bnltb, and tlicf freqiienU; corns on 
•ft«r« prcecdiic aUfre of deptemioii. Oflen oaough, too, ttiii italc pauca 
lafMBj into oas of coapletA a&d ineqiairocal mania. 

§ 135. z. Atumalie* <^ tit ittMlecf.—Tho fiist and most 
imporUnt change which the int«llect andergoes in mnclii, consists tu 
an uritAbilit; and qoantitative exaltAtioa atialogouu to that of the 
(Ivposition and the will — Ui x more rapid Sow of ideas. In its 
tnott luodcrnte degrees this rclatioa appears as an cxaggemtjon of 
the normal faculty of thought. The increased drn'^lopmrnt and 
rapid soccfuioQ of ideas call forth a crowd of long-forj,'ouoii re- 
membrnncea in new and vivid forms — there is an rxaltation of 
ineinorj which, in >DlDe eases, presents the peculiarity that th« 
tnaniac is Me, daring the dismsv, to recite correctly long picca of 
poetry, whicli heforc he was affected, and after his recovery, hn was 
incapable of doing. At times, also, they giivc utterance to thoughts, 
ooDobitationj of id«as and opinions, to which in a state of health 
liey never oootd lay claim ; frequently, nccordiog to the htuuour of 
the moment, or stimulated by external circunistaticea, thejr draw 
carious comparisons,* exiiibit a spirit of the most biting sarcasm, 
cxprtss thenuelves with eitraordiu^y eloquence, and haitard, with 
great aaaurauce, the most daring upimous formed &om an acute 
obaerTstion of the relative cireutnstniicci. 

Such occurs, bowevcr, in only the minority of CMca. Generally, 
bom tlie comioencnneiil, or at leaat very soon, tlie quantitative )n> 
emso and exaltation of thought ue m great, that there results a 
restless and constant succession of isolated ideas which have no 
tatimatc relation with each other, being merely connected by acci- 
dental external incidenta, and aa tbey pass through the conscious. 
DMi with great npidity, and constantly chatige their comhi nations, 
are tttj transitory and superficial, or of a very fragmentaiy cha- 
racter. TbcM ideas, which, owing to the e:ttrcina rapidity with 
which Ihcy succeed each othrr, are very imperfectly developed, bear 
tbe impress of the emotion wliiuh at ibc tioio governs the putient, 

' Wo liaTe, for esamplo, otucntd a patieal wbo oouil sUikingly dciinoate 
an} alij^lit MMmbUfioc to auimali ia tl>e pliyaiofpt«mi«a of tbo<« around 



SR4 



8TATKB OT MRNTAL KXAITATIOS. 



and an sometimes livdy^ nap^rnilioui, ami cxtravtgant ; it oUien, 
gloom; aud menacing. Tliry are in port proroked aud thdr 
eontcuU dctrrtnincd hj the iniprenions which tlie patient receives 
through th« senses; and thtM imprcwions themadrea utt atm 
faUilied by hallDdnatioDs and illa.iioDS, or, as in many cases of 
delinum, imperfectly and GrroQeoiuly iiercdred, owing to tbe im- 
jHCSsion haag only partly received and considered. On the other 
liatul. there ia preaented to the perception, firom the inward, and in 
details iQcomprobenEiblc, instinctive action of tho association of 
idensj a ooiiiitle95 number of images^ woiAa, figures, phrases, wbieli 
nie often isolated and disconnected, often iooessaoUy and separately 
repeated in cries or aiaging, or at times collected t<^thcr into 
sentences, phrases^ and f j>cecbi.-s wbicli tUc patient attcra with the 
expression of the emotion doiniiiant at the time. In certain ease*, 
the miuical clement of speech appears as a tendency to rhythmio^ 
espTessioas, (o assonance and rliyine : the patient Oien speaks always 
in verses,' which, indeed, conuin very little poetry, being merdy 
nuule up of similarly sounding sentences and words. This has bees 
termed " rhyming dalirlam." 

Tlic principal modilication or anomaly of the iiilelligeoce is eon- 
Srmed maTiit is, tlicn, an ineokertnce of ideas which is the tneritable 
consequence of the precipitation vith whicli all the pfvcliical 
plienomcna arc executed, of the impossibility of the complete 
dcrelopmeut of any siiiglc i)ercrptiDn, of the rapid emotional 
changes, and of Ihe fantastic fonns in which their imagination 
clothes the impretisions derived from the organs of sen*e. Fixed or 
persistent delirious conceptions are not proper to this condition, 
neither arc they the result of a possonate iinnginatioD which the 
patient, white yet in good health, may have exhibited; although 
often enough tliey may seem to warrant us in coming to Ihia con- 
clusion ; as, for example, when a maniac often manifests traces of 

> Tiro euunplea of tbia : 

" Und es ut dttBimmcU Pfllobt. 
Dau mnn Gott in> Herzc sJcht. 

&) komm in den Garten. 
Ei lass mioh niclit wttti. 
Der W«in scliiiiekl mir bitter. 
Solion nulit dat Gevitler," etc. 



BcsgDinin, 



'Niut'i Zciticlir./ 1892, >'• P- 'tis); Jacolii, ' Hauptfomn,' 



BTAtKS OF HBNTAL KXALTATIOIf. 



s» 



ftrBMr mental tmpnssioiis, wc nuif be led to believe tlat hi is 
inwintly ncctipied vitb ocrtAin mental caaset which hare led lo 
\m iDsaoity. Here, also, the pouibility of a rapid change in the 
ideu siul the «upcrticial character of the entire aUesation ffliow that 
ve Itave not to do ¥rilh pcniatenl (lominaiit idea*, hucIi as are 
pccaliar to rtates of profound emotion. 

But this is not to say that temporary delirioas conceptions and 
&lse ideas cannot be piaent in mania. On the contrary, they are 
ray&equoDt. Sometimes they counst in series of false opioiontj 
rc^tfdiag the estcrital world sucli aa miut ueccsaorily reoult from 
the eonfuBcd ideaa which, half derdopcd, urge ibemselvea into cou- 
•doasDos, and, in their rapid course, often reaemble fngmcDts of 
■baodoned ideas and false sensorial impressiom. fiomctimcs, hoir* 
emt, delirious conoeptioiia are present which have a much more 
important significatiou -. here, aIm, thev hnve again essentially the 
Btgaificaocc of attempts at expl-vmtion of tlic morbid disptBilion, and 
tlwrefore relate only to the special eyo. A haughty, aadacious, 
ebeofal, gay, derated frame of mind — the feeling of freedom of 
kctioa and exuberance of thought — call fortli, according to the law 
of cansaUty, ideas of greatoess, possession, riches, gnat moral or 
iaftellectunl {>otrer, kc, to which under such circumstKneea alone. 
Uwm is f^veu. a tike (recdoiu of thought and voUtioo. The ex- 
^[gciatcd tdaa of freedom and power must, howcrcr, have a founda* ' 
tioa j there muai be aomethii^ in the eyo which correiiponds to it ; 
Uk *fo miut for the moment become another; and thu change can 
only be expressed by an image, which any momentary thongbt 
may create. The patient may cJl hiinwlf Napoleon, the Messiabjj 
God ; io abort, any great penon. He may believe that be ia in- 
timately acquainted with all the sciences, or ofler to those arouud 
hitn all the treasarea of the world. Ho may also select chnrncttr* 
which are quite nonaenaical : for ciample, he may any in Ike uime 
breath, "I am Napoleon," "I am lliis chair," "1 am yoa," &c. In such 
a case, be cither feels that lie c-atmot fully express that which be 
actnally desires to do, and triea to make up for this by so accumu- 
lation of mufftt; or be altcmpLa thus vaguely to catabhsh a gnat 
omnipresence, to show that he is in everything, whioli, indeed, ia in 
accordance with his exalted frame of mind. 

Bat— and this ilistiogiiishea these incoherently combined de- 
llory delirioos ideas from those of the following form (monomania) 
of Uiofc nmaiu GieX Every tcmponr}' excitattOQ brings 



286 



STATEB OV MKNTAL BIALTATION. 



vith it Dew iauges a»d ideu which dispd the old ; the duposition 
itBclf is ctuDgoible; and as cacl) Frame of miod ponea off, no ex< 
plonatioii i* rwccwary— -the ddirious oonceptioiu hsve no time to 
dereiopc and fix tbeinaelvea b; aUnctiog crther nmSv idew. Tlie 
pataent> it is true, frequently gives exjueakia to theae ideas ia a 
loud and nois; way, bat never In a tone of dc«[> conviction ; indeed, 
be VMJ evea Uugh at them. Those cases present a certain relation 
to cluldrea plajiog a comedy : they enter entirely into the spirit of 
the play, and actually at the momeBt consider themseWea heroes, 
bat at the aamc time knov that thcf arc not lehooily considered 
such by the spectators. 

It u worthy of *poc!«l oonnJcration, Ibftt in many cue* of nuix, the iitUl- 
leot— txolaaive of the diionjen w« ban juit mmtiooed— wema to tie my 
iHgbtlty inratTcd, uid tbat no utiuil wmJoum or dimiiatian oF it u Mppuent 
FnqncDtl;, in spit« of grnt inoolioieiioe of ideaa, the retaeoibmioe of the pi*t 
ia not odjpcrftclir true, but in nanyoiMaall that bappened during Uia period 
of tlie disvaao h ctcq well rcuMnbercd. Not onfreqneall,*, tho patjcot m^, 
bjr Du epiienl to hia recoUectioo, b& for the tnonieDt vilbdraon from the wliM 
of idf u, and enabled to auwer (jumUoiu oonoening Ua fonn<t life eomdfy, 
and even to immte bygone incidenis. Frequuitlyt lie imderataDds so well tU 
thai pnaea around him, mi baa ao much control over binaelf, that a ^ieedly 
irord, a itircat, or a jokci oi cren aa appeanuoe of oonfidoic* in Um, n^ 
eauic him to become calm Tor the moment. The poiTfniou of tlie jad^eat, 
when thej do not- actually coniint a( the forementioned attcnpt* at cipUnatini 
oftbs dispotition, drpend merely Dpoo nppresrion, ai if from want of line 
sufflcicntly to connect the traailent, SeDting,[nocll«nait idn* : aometimn, aln, 
from tbc predominance of certain aerie* of peneptioaa which appear to Ita 
patiant u definite facts. Thus mania, viewed in th« double light of a morfaid 
aaonwiy of the |>tircf|i(iou and of tlio will, pmenU Uie Mine goners] eh«nci«r 
of an afTection of the mind more nperficial than profoond ; and tkla ia denkoo- 
atntcd, above all. by the posaibillty of the tudden appearance of a lucid iaiertil, 
aad even of rapid aul oomplete recovei7 aflei the diaGaae hu laited for yean 
—of recover? in vhicb the patient, although hi* mind ia mu«b GitJitned, nay 
itill be in tbo complete poiicuioa of the fonnei range tt liia iatclUgenoe, aad 
ia every W.1J llic Mtnc mentally m lie wa» berore. Freqiicatly, alio, he can gin 
an Hutl nccouat of hi» itate during the dixaie ; tuid vrc ftcijueiBtly hear mid 
iadividoab give vent lo cipmsionR like the follow! nj; a late men I made I7 a 
patient of Jaeubi'a : " It ti actually terrible when the (hoaghti ao na into oaa 
another in one's beadi" 

§ 136. 3- Anomaliet of tentorial JunctuM and of m«v*m«Ht.i— 
HflUuciiiatioiis of sight, of bearing, of emcll, and of cutaneoui 
eeiiaibilily, arc sometiincs obwncii iii mania, and not unfreqncntlj 
they caiuc oggmvalion of tlie symptoms. Generally, however, tbey 




SXATta or MUKTAL tUUXTAHOK. 



9»7 



nnof bntlttileimportuioe; therabo ^peedilrtHMppearinthegiddf 
baste of ihe m«nUl proc««HS, And tb« patKol unoot gin them any 
prolonged attention. lUmdotu of Uie aeoses. Use interpretitcions at 
KnNtUl peTccptioofl, an nacfa more frequmt: tlw (Mlicat, for 
example^ lalcea > •tranger for on old aeqttaintaacej or wben be bean 
ftn; ooin tbinks that aoine one is caUing to hiiD. Fibs jodRioeat* 
in this Baft, as ia the deliiium of fever, ordiDitrilj depend opon 
noO'COimderatioD of certain parts of the sensorial impreniotu, aad 
pansg great attcotiou to olhi'r«, and upon supetfictil nnularities. 

TSiav is alM somctitna obiOTcd an cxag|;ented seo^bilit; to 
inpretnons of aigbt and of hearing. Sometimes, also, then ia 
dilatation or eontnctioa of the pupils. 

As to the oryeiu ^ movtmeiU, there gtnenllj cxiste in nutna % 
contiuual impulse to ccntiactioDs of many mnacles. The move- 
nettU of the body, and tspeeiallj than of the orgaxu of spoechj 
participate in the etstcof psychical exaltatioo. "Die; are active, 
rapidf mergetic, inasmuch as the speech, cries, geatieolationsj and 
■cticMu of the pttiesC all t«nd to ootwutd nuiifestattoD ; his ootinte- 
nioCB and expicaaoa are livclv, intense, and peculiar. Much bu 
1>een said of the extraordinarr strength, of the actual increase of 
mMCular power in nunio (E«qairol, I^nel, Idcler, &c.). In the 
vast majority of cases there id no such increase of strength ; the 
patient, BQ la from being stronger than in health, can be easily 
maatcred by a aingle attendant, and the appearance of increased 
hodily power generally arisea merely from the regardlesstusi with 
vhtch the patient executes touscular movements during the maniacal 
attack. On llie oilier huid, it is correct and very nmatkable that 
tbe patients can continue, orten /or a vtr^ Ivng time, to make use of 
ihdr moscular power, and to an eileot which far surpasMS their 
capability during healtli. Such individuals A-equeotly psM whole 
WAi, iiid even mODths, almost without slfcp, a pi«y to the most 
violait fury ; and the possibility of such cnortnous muscular exertion 
appears only explicable by the assamptlon that, owing (o an ab- 
Bormil stale of the muscular sensibility, the patient has uc fetlin^ 
tf/^tigtit. We SCO, in fact, maoiaca in whom the natrilion is vciy 
■uidi lowrrcd, tliiuldng and dcchmog that tkoy arc very strong, and 
befiartng thctnaclres capable of any faligoe, while at the same time 
the great emaciation, and the exiuiustion which succeeds the attack, 
umurtakeably demonstrate that the organism cannot bear those 
auttaona with imponity. 



3A8 



BTATKS or MBNTAL EXALTATION. 



Soinetiiaes, «Iso, actual coiivnkion* are observed in tlie wgu» ef 
movetneDt — grinding of the tMlb, twitches of the coonlcouMXi, « 
more extended oonrolsiona* the bttcr occurring gometimes during 
waking, Bometimcs during tt«i»toi7 fiuiiUng-6t« and ceftatic rtatea. 
Partial paml]r!>c« arc mutih mora rare ia mania [ on the other buid, 
very frcqiienllv the Srst cooimeiioeiDent of general parsljMs ibom 
itsdi' during » moderate attack of mania hv tlic unceitam ■Mfr 
ments of thfi tongoe. 



Atnongit the otber sjinptoiai of mania, trowU$d tUtp ia rtrj comuM*— in 
raanj Cmm peruateut conijileu alteplesuwea. Again, too nvA oatglil not to 
be expected froni a calm Heep Autiag (ke eoune of itie dUeaae, as tko omt 
violeut cx«cc(l)Uions occuionallT ensue afltr tlie quictot night*, and, QB Ik* 
Other tiuid, cTcn coiiTalcscctils fie^ticaU; oooliniu for a loo; tioe to «oisplik 
of sleep icuaeu. 

JmmalUt ^ MtmatioM of {ht nwwt Ttriou* fomi naj present UjBmmJiti h 
rpBuia— IieidscUe, vertigo, bnt, aurm>like senulioni anainK fruin tie Hial> 
■bnonnal c«tuiMU> Mtomtiont, paiui in I lie lirabi it-ti or a|i)i4r«iit (o«ingtt 
adiffercBCc), luseDubiliL; to beat or cnld ; MtoaL aosslLtaia ia nucU ItM tre* 
qnrot lliaa ms rormerl; Buppoted (f so)- 

la many cues tliere b ob»ervod in cuornuus iaertett «f Ik* offittit* i vA 
tiiu ia ftequentl; direated to uiieita1>l<r aad indigestible tlucgs. AbMiioe d 
tl>c fcdiii^ of satielj' kppeikn to be tlic cauM of ihis roraeilj', u il is io aa nj 
rtgululcd b; llie i]c{:n:e of cipemlilurc of miiwuhr force. Ifot mifreqvcnllfi 
howerer, the dcniitnd fnr nuttimont t* QaL at sll bcedtd, (ke palicnt finite Mf- 
Itetiog to cat. Tbat dciin t« cat lliclr own excremtnUi vbich sameUaMi 
exists, seems to indicate proffiand iierrersitj of taste and complete ahw>M •( 
Uie senlimcnl uf ditguit. 

An %Mtfu ^ lAt tmal imiiini forms, in man; cases, tlie ceotre-poent of 
tbe moHud ideas aud elTart*; in oilier curs tt is onl^ nccessorj and nodenU. 
often it it entirely absent. It la maniresled by obKciie lancuage and wnliii|r> 
in maremcnts of the hnndt, csposinK Ibe person, otuuiism, &c. On l^ 
whole, it appears to occur idoic (requcntlf in female |)atieats. Irrtgviaritj ••i 
twpfttMiem </ lit meiatt exist in tlio (treat majoritj of cnscs : their T«-sttaUiak- 
ntent Itss often DO effect upon llic niiMit>l sUtc, often it Las an aggraTattag 
iaflucnco; at other tines it appear* ooiacideatlj iritli recovrr;. 

daiiffm in ih trgiuu ^ eireutsttM *md di^lh* arc aot always pranaL 
Allliuti)cl> il is of grent imporlancr, vlien such derasgemcDls exial, that Otej 
aliould he minuttlf invest iesteil, in order to estahliih the tndicationa of Irt^ 
tiiniit iit indiii-diisl enso, ^ct llir; are of IttUe imporUnoc in l)i* dUgaeats of iht 
nmiii.i itself. Tiien the pulse is sometimes of normal frequencf and falaess; it 
is lalilom sJQwer, more fr«i]ue[it!;f a little faster tliim oaaiJi, and rather 9sall 
and fall. Ncrrous pnlpilntion and llie ordiniiry st)[ns of chronic organic lietrl- 
diaase are licrc, ni in nionlal disease i^iierollj, of onlj Ordliiiuf TrcqaeDej. 
Aoooiding to obscivBtions made in the iu\lurti at Vienna, the heait-aminds art 
iodittinct during great ticitcmcnl, and liecoinc nguiu clear uhen caln aels i(> 



STATES or UKNTAL KXALIATIVK. 



389 



t» not voceiDnMD to see coiuidcnblc, Mmctime* wtry jrot cerebral con- 
ation, redK» of ike ftce antl hettt or llic hctd. U ia onl* csocptionkllj cbkt 
• conBtcniace ii paid; umelimw il [woieuUt oji&otic bue; tlie eyu tra 

iaitt injected. 
Ib Uic tiU majoritj of casei Ibere is do fever present. Tlie temptntaTC of 

k« bod^r, u deUrmiaot bjiliutKcmiontiiUr, i»norvial or aom«wli«l d!iiiiiii*tied; 
b on); daring Ibe maniacil excitement of pro^^reiaiTe f>cDcral pnrikljsii tint 

he tnnpvralon of th>e bod; is said to be iDcre&ied. (L. Upycr, 'CLaritJ- 

kvuUcn,' viii, a.) 
The toogne is often fumd. and the salivary secretion increaaed ; the patient 

•Ucm eompUna of tliint, except wLne it is caiued bj an imn]o<l«nie desire 
r alcoliolic liquon. Frcquentlj ILo bowels an; irregular and coniUpatcii, aa 
VMallj the cue ui cerebral diseasta geoerallj. 
The majont; of in>Dia«» aiipear emaetntod, notwithatandini; tbcir inDreased 

ppeiite. Owing lo lliii and to the leosion of tlie eountenince, the; appear 

ider Ibao lliej aMuilljr are. T!ie dimioutloD of the uuirilion is vtij frequentl; 
Up former »0f1)icl stales— amemia, febrile diseases, or eveu (o the melan- 

bolia. Witbout doubt, however, the emaciation dihj also be oviug to the 

KrCMcd CTolutioQ of force and want of »lcep in ButQii. lu lome oases, alao, 
b the retult of tttbemloais or of (oae other serious disease. Tliere are in- 
mcnble nrielic* of ihete acoeaaor; sjmptome, thercsulr of former or ealstinff 

iaease of other orKan*. and vUioh netd not alvaja tieccsutil; be cloiclj con- 

MCtcd wilh tbe iasaiutj. 

$ 137. As to the iJituuion aud courte of manu, it jb obstrved 
Dmetiinn as a pure aod indcpetidcot form of incutal disease, u vc 

Te liitberto conndered it — as a stage of develop ment in the auccfis- 
■ems of mental disorders; soinetitnes (rnuMent attacks of mania, 

man comaij of furj', occar in iucliYidaaU who are alreadjr subjects 
inofotuid mental diaeuae, especially in all the rarioos fonna of 
untsl veaknesa. These sttscks are freqaontly oving to eitemal 
] for example, to anger : frequently aUo thcj are caused hj 
•UaetBaltoDS.' Here, the cbaractcra of the chronic aOcctioru, in 
•rticalar the weakne«s of the intellect, are always combined with the 
fiDptouu of the acute attacks. TbcK paroxysms are connected 
rilfa tlsose coiivuUiTu utatea which occasioually appear duriug tlie 
aane of {Mtnlysia. 

Tn epileptics, abo, il is not uncommon to observe attacks of mnnia 
liich are often characterised by a high degree of bliad fury uu) 
uoeity. SonKtimea tliey immediately follow the epileptic attack, as 

t yeuintan (' FijchialTiD,* p. 74) remaiks that Ibew attacks of fury tacrtase 
■iiwiim of others, vhiU in simple mania tha patient geocfall; becomaa 
iMtr en the cBlnaoc of the plijsioiaa or attcudut. 



MO 



STATU or MKNTAi. 2XA1.TAT10N. 



if the cscitatioii to tlie tutDultnoos moturjr uuvemeatswiae tii 
InDBfrrrrd to otlier parts of tbr brnin. 

Atucmie staUa a{)p(mr to prcdiF|»(e more to tfae ootbtetk 
maoia tliao slates of |ilrtiiora. Profuse hmuorThage (ns in cli: 
■unorrbagia, frrqumt bImJings). states of exhnustion after t; 
fercTi or after npidlf atlTancing tuberculosa or prolot^ed 
toMj in nian^ ctucs be iccogiUKtl a> proximate or predisposing 
The acute mfimiigitis of adults is frequeutly aocompanied faf 
delihum irkicli reaeinbles nwnia in cvrrjr respect; and 
tlien is aftciwarda developeil frooi this disease a more cfanoic 
of maoia. 

Caring the courae of mania tliere is usiuUj an alienutm 
reminiona aad ciaccrbatioiu, and it it not uaiuual to xe 
complete nmisaions. Thus, cases hare been observed in vfaieh tb 
patienu during entire months were only maniacal on alternate ^mj^ 
vith ooiuplett-ly ta-n iuttriuediatc dojrs — a node of cerebral aA«ctici 
ia every vaj analogoot to other rhjthraical neunaea. Very often M 
exnccrbatiui] occurs duriug the menstraal period, at other timi 
violent panjxrsms and remi^^ioiu occur niibout any appndaUt 
cause, perbftp* \n consequence of changes which take place in othtf 
chronic morbid slates which accompany the maoia; in partictdAr,n 
fometimea see complete free lucid interrnls aet in quite ntddeuly ul 
nnexpectcdly. 

McbmcbuUa often alternates with attacks of mania ; oecaooi 
there ia a re^Ur (for example, at certain seasons of the 
altematiott of exaltation and dq>tes»ion (/olit fflrcuf^ire ot theVreadi 
rritcra). In these cases the melancholic stage is (^eraJly someirhii 
more prolong tbun the mauiacaj, which constste rather iu a state ii 
general excitement and TC«.tleS9nes8 than in actaal roaaia. At other 
times we see attaeks of mnnta occur after regnlor or itrfgnltf 
lucid interrals crcry one, two, throe years, &c, — ■jmiodical aawu^ ■ 
grave (ona, s real ]»rch{cal epilepsy whicAi shares the tiiifai'«r*bte 
prognosis with ordinary epitpfksy vtiich has become faabitnaL 






ai-grew; 
utereidH 



MilJner (' P*Tclii>tr. Corrcs|>.-BI.' 1857, No. 17) cominiitiicttea an iab 
c«e «here an individual of limited iiitchectuil txpmij, vitk ioiulBeiraey std 
inunnur «t llie norlic TtlTiit, in conHquenoe of a violeul »boek CtU into «* 
altirk of niaiiia wliicli Usled for 00); an liciir and a lialf, and rcturatd l«in 
or tliricc ill llie icar. TUe lerj (rai»ilOi7 manianl attacks (iiukaia innaiUM 
of vcrj *liort durntiun, cccUTiDg iu tliocoune of apparently perfect health) nij 
be att the tnofc rradilr ouuipand nilli atlaelu of eptldiuT, m somelisnea s*a 
llic latltr ciid in mania. In a iiiedic<o>legBlpoiiilof vlcv, it ti, o 



firATES OF HENTAL BXALTATION. 



£91 



the ume irlietbtr Ibe sUte of ntinia during irltieh (he erinte vu mmntilted 
vu of lofiR or of Uort dnratioii. It is of grtnl intportuice to koow Ibst 
Badoobtedlj laeh qvUe tmuient ktuckt aetaallf oeeur. 

the tia^ paroxyams of mania last soTnetim» only a few lioura, 
Bometinia eolire inoullif ; frvqiK-llI l,v tK-rr w obHiTval nfter (lie firit 
frv vwks a coiuidcrttble rcaiiMioo. Somttjmcs it appears as if the 
piroxysms of mum constilattd a sort of resolution and compensa- 
tioo for tlie former etat« of menta] pain, is tbe name way as wc 
se in epilepsy &nd hysteria many disagreeable aii<l painful sensations 

f vhicb pnxedc the attack disappear irith it. Maiiiacal attacks wliich 

I are mild uti moderated by remissions may Lut for many years. 
It is a nrell-knoiTQ fact, tbat very o^n during tbe course of mania 

I tba Bjiuploius of other «enous diseases are arrested in a remaikablt 

loMniKr ; in particular, tlic patients seldom or never complain of paiaj 
in phtbiaia theycoDgb very little, and can epeat and cry vociferously. 
This ia not lo be considiered as an actual arrest of such organic 
distaacs ; on tbo contrary, they 'continue their cooise of destruction 
of tlir orfran, as in shovn by tbe objective symptoms ; but an anomalj 
at seosatioa similar to the abMmce of the feeling of fatigue and of 

I ksngtr vbich, combined irith the patient's abaorptioa in his delirium, 
icnden bim little hablc to subjective impressions. 

Uaniacs may rteocer suddenly, or tliis favorable result may be 
ydaiUy arriTtd at after progreasive diminution of the symptoms. 

(The esntement ceases, tbe lucid intervals become more frciiucnt and 
loBger. the behaviour becomes gradually more orderly ; the patient 
■gain inquirts concerning this or that IKTSOD, csjicriciiccs ennui and 
trica to mover himself. Sometimes, al«o, we observe that the ecssation 
of the mania is eoiDcident with the appearance of some other disease ; 
fbr eiampte, intermittent fever, diarrbtea, skin diseases, funuiculi, 
fce. ^^e ooiselvca bare in certain cases obm^ived ^ucb so-called 
enUcalappcarancea; generally, hovover, they aro absent { and the 
■tatrment of T<squirol, that no recovery ia to be considered permanent 
which is not a'^companicd by a wdl>narked crisis, appears to ut to be 
entirely wittiout foundation. The most tnutworthy symptom of 
w e u T iry ta the rctnm of the former desires and pursuits of the 
patjeatt and of his uniuipnsnonod b<linviour and acknowledgment 
that bs is really ill. We have on Kveral occasions seen the ob<«nra- 
ttoo made by Jenra very striliingly confirmed, that a relapse is 

1 -MpMatUy to Ik goatdtd a^inst in c»scs vrkvre the (apparently calm] 
piiieiit fcnU teuarkably well, and speaks «ith exuberant joy of Ids 



20S 



■TATBS or HXHTAL EXALTATtOM. 



complete nxovm. Even those wba are completely cand ut d* 
pTcdi»po8c<l in a high degree to a return of tbc disease. 

Ib uidividua] cues, our opinwu eoneening tAe eura^ilitf ^ Ike A*- 
MM is ngoltted principollv by the symptoms rhich the patient pr 
of more or leas pRaumablc oTf^ic disenw of tlie bmin. Those i 
may be conHidcrcd nb«olulely incunble in whicb symptoms, 
ili^t, of general [unlysis ure preseat (see $ 4) ; oil symptOBi* 
penutent convoluons or pinlrsia in th« extrenuties, of tbe boil 
mm, or of the pupils, ue equally u&fivor&ble. ThcM gyiup taM, 
at least whcu tbey are not quite transitory — occurring, forcxam[dr^i| 
eonaequcDce of temporary bat violent cerebral cougvetion,' — tipoeuC 
indicate a peminnenl extennon of the. morbid process to the 
aitoated at the baae or in the centre of tbe brain. Indeed, 
cerebnd hypetaemia* which are so frcqacnt in mania may oca- 
sion tbe development of cxudAtions and tbeir farther trankoma- 
tioOB. The more (he diMasc is prolonged, tlie less it ia interraptef 
by lucid inten-aU and remissions ; and the more iutenae the bjpcmmi, 
the more thew exudntions are to he feared. The groat majority of 
recoveries from uuuia take place within a year from the commena- 
meat of the discaw : iwerlheleae, cases oc«tii where recovery ute 
place after tbe disease has continued for six or seven yews, geami^ 
with radical constitntiooal changes in tbe organism of tbe patkaL 
Great riolence and fury in the attacks are in no vay tufavac- 
•Ue in r^^d to the curiLhtlify of the di^c&sr, 110 more than violoil 
hysterical atladis an of evil omen in the jirugnosis of hysteria. 
Acc(»^iag to all the obarrvatioiia nltich Iibtc hilheito been made, tbe 
periodic intenuiltcut form of mania most in general be comsidciel 
ineanble. 

The fact that in many cases tbe prognosis depeudi much lessapoB 
the cerebral disease iban upon ibc presence of other local or gencnl 
■ffeetioDS— for example, pbthi&is, grcfil anaMnia, hydrsmic or loor- 
batic states, &c. — rcquirca no farther cxptanatioD. Not unfrcquenllyi 
convalescents from mania fall into a condition of profound bodily aai 
montnl wenkneis, irliich at tlrsl cannot with certainty be distiaguitlieil 
from transition into dementia ; sometimes the diaease terminates witk 
a abort stage of melauchulta. 

When tbe patient does not recover, tbe mania may, with tht 
greatest outward c^m, be transformed into the form of monoDuniii 
or may dt'^nernle into one of the chronic secondary slute9 of moDt^ 

* Sef lite dihguer on '' Patliolo^eal Anatoinj." 



STATES OF UBNTAL EXALTATION. 



293 



reakuc» — into one of the rarions forms of dementia, with or urtthoat 
lervals of agitation. 

Ill oiaiiia, death may result from the cerebral affection itself, in 

IQCDH of violcnl liypenemia of the braiu, or more nuclj of 

[tletio catnvasations. Fr«tjufa(!y ilic patients die in a stetc of 

thauttiOD, iritb tli« symptoms of collapse (as freq^uentljr occurs in 

tj), in consequence of acute or clironic di»cat>c in olhfr organs, 

poeamonia, pkutisj, esrbnncle, violent intestinal cntarrii, j>htlii»is, 

.Occidents, such as leaping from n window, &c., arc, in this form 

>f insamty, not anfrequcutlj- tbc cause of dentli, 



Euvrix XXXII. — Simptt muMia, m'M ttrual fjcilfrnml aad ciepl<Mania; 
Uollfttid Deniuns, ftt. ll, of dolicBle conatitutioii. Daring cliild- 
bc li^d iMca rrtquciitl; affected trjtii erupliuns uf Iba BCat]> : his dia- 
ler ii peeuliir, and liis inulleet wf&k. Hi« niatemrvl irrandinat!i<r likd bun 
lor Mren yt^it, and be, at Ibe a.^K o( nintieen, fell inio a slate o| 
)l]r«*t»cli, onderlliGQieof ren)edie*,dinppeaicdin tlirec moiitlii. At 
^wontj'.oiip, b« lullered for mhub tine from nbktinate conttipatioa and Tamitin^ , 
[a U«j, iSi I, OB readiiif; Ibe sarratire of a trarcller, lie felt himself dccplj 
aSFc1«d bj Ibe liardihips wbicii tbal indiridual had bad to eodurc. Tbe following 
dajf W eOBipluiicd of being ill >t oai:, aad an emetic na« idmiDiitcrcd to him. 
Two dajt aftrr, the paliaat was wIjuhI bj atL altack of persiatcnt fury and inco- 
bcTtnt talk Oa^ga dOM* of tariar cniclic aad purgnlivea). During the fifleen 
dayi whieb foQoval, be bad. at different times, Incid iatciTuls of several liouri' 
dntatiOK. Iwl thej were alirajs su«ee«ded by m attack of furj. Ncvcrlbdeai, 
tbeae altacka gnduallj dimiuiihed in iateu»iiy ) towards Ibe middle of Just 
t^ becBinr man imre, and tbe patient cliatteroJ continually from morning to 
Bteaing. Dariag tbe atglit, bowcver, be «njojcd ecrcral hoan of calm sleep. 
The pnln vas traaqoil ; tho oouatenanM worn : the appetite incicaaed ; tlie 
bowak ooDilitialcd. At timet Mme alight convuliive tnoT«meol* vert ob- 
MTTfld ia tbe Ui^. 

A BOBlk alter tbe eommeDoaiDent of tlic illncM, tbc patient was takes to 
6i^ba>K- Daring the Aral tandaja which followed hU adraii>ioii, he remained 
in a Stale of contant deliritun and iacoberoQcj, and eibibitcd a tendencj to 
•ociMat acta el trioleocc on tbcae who aumuudcd liim. NcTprtbcltM, it vai 
geMially during the daj tbat be had bia altaeks of for?, and during tlic 
sight be had geaaTall; esTenl boars of oalm slumber. Although dohBg Uie 
paiviyam be indolgad cooalantlj ia rioleot inovements, the jiulto Boiar 
net abofa fnwi 70 to 80. The temperature of Uie body wai almoat aormal ; 
ifatangaawaaeleaaaDdiuoiati tli« pMiuDi t{iat oflan ; lliettoolawtro cotliTc. 
Towic^ tit* cad of July, the intcnailj of the maniacal attacks dimiatabed, 
alltei^ Ifae latalid was always s pr»y to a eartain slata of eieiieneiil aad ez- 
llMOlisarj ooafwiiua ; lie talked noaaeoM the wM* d*;, but bia idcu liad not 
Iba kaat comuctton, and 00 trace of a dooiinaat idea oould be fbuad ia hia 
lall. Ha «aa uill dirty, aad aUaoktd his food wilb htutat glnlloiiy, ic. Tbo 
, pi^rts wen gconally calm ; Ibe imlae and tbe temptcature of the body cwi« 



t 



IM VtiTU or SKTTAL tXlLTATtOS. 



P^.. .. ..^ .^- . ^|- • ^ -^/w-i^-.. 1-^^ t..^ CateMt 

I^MMi af Ite iMlw w^ t llw p*l>» U — rtiw lo go. U IW (m ' 
U 9m falB Mi Ban imm Ihn fanwi^. lb* p«iirat had. tnm 
lllMi.iHiJiTjlTi|h' • OilW«tierVMl,ik*i.Uciiol«Knel< 
k M a wAcMil flf tftt fodtri «^M wWA ted Mt ban hdbm I 
Bt attwM il tU ■■yiiii rt i *fa» ha Mv. nd tBdirf(«d n 
vftkMt lAiBiL Oitecwiw, tea « fq^Uad past of view U* 

rcf? lAtKcut01k«tb«atkt<Mlof October he vuKwevbl I 
j^|Mli bat the MBtioail pCftccxicB lad nUlxci 
be ohibitcd a nHifart AfaaliaB to rtcal— ■■ ifllwtiiiii 

lia UawUe fa hnkk PioatiM totiMkrill 
torfwMi i M in j BM •f wBl i nl i n ili w iBl.whki>yh iiii nn iilli n lttti 
rflfctgh»i-jwfa«lofwwm«tw wrttllwf utoof riJmw. 

&I iW cowMictwiHt «f Jnroiaj, tk Me ef thew ?vnalies wa 
Zrerj Ivo dqi Ik yetini nndvtd ■ dnck oT tvcnlr bndeli tit 
rnuUr fO«R<t « Ik Htd ; ud enty wtA Uir«e Iwchn vera apfKed 
BosthL Re Bov iinpnviid i» » ivprituiK «a7> Bj Uw end of Ftfanfli> ' 
k eeaU M*wtr eemetly all >tnple qw»tiew. Tk lUaek af muiiMtf a- 
llluilinl coMpleM/ ^iwpfxemi. H nil m tk db^atition la *Ual urftb 
T— wlt w Jaedw. Ait«r ■ ikrt tuM lit inkflcct vu totomi ; bb coMH 
keaat NgeW. He qaittdd tk a^hun In Jalf, afUr kTug •pcnil a javk 
H. (JKolii. ' Die H*s(>iranMii,' i, iSm, p. 8t.) 

Exjufru XXXIII— JVorw/ (SUM.- bum mA /M^raiy /« JtiruMe. v* 
idtMHfa (pn<«># fmdem^. acewewy.— Otbwiac J—, (tt. 39, wiUmit «; 
liHvdiiar; UadeMf lo iniaaitj, enjoying good btaliJi, ciliibited, mhda ftilai 
josBR girl, dwfil; rcligioa* fealiegt, and al Ik gaier line e retjr aoMtM* 
dbfioulMii. 8be Bunkd oae at lier Dear rthtirct, Jtftcr kving kd a tUd If 
Jiini. Aflcrajtaraed a kir*k bwlhFr bubend. Ue wu ret; ridi, nd W 
odea IsDt nKmefi taJiiag aMiunlwt for ii npoa propertj, nbUk fonliaiib h 
«MMd to k aoM md boufht ie. Be vai, tMordinitlj, enifenally li*i*J 1 ui 
a eacd t» k tail!, aAcr b^ dcetb, ikt on seven) occaaions k bad bem MM 
daring Uie aight. in tk ronn of apbaatom o( fire, paaug over UieludivM 
k kd tbuB kuglit. Citkriae vat grcailj aUmcd hj tUa report, lo wktf 
ak was read; to give crcdeecc. 8k tell at Orel into a slate oT agitatioo oA 
aniidtjr, brooding orer a Ibongbt vbieb liftd Uonbled kr bcrore. namelj, tbal 
bj r«ftMn of her nor rcbliooaUip to kr bnikiid, the mwriag« vlikh >k kl 
ooaliaded with bin «u noUuRg bat a eoncabinaye.tnd Ikl tk pbaDtoei hal 
cone lo repnacb her with tlie oriiM^ aa vrdi aa with the propcrtj- vbkfa bn 
lnuband bad aequircd bf his fotced aalo. 8!ic Ihen awoeired the iitud 
leatoring thfM poi»t*ltO&s to Iheir former ovracn; she oxaoiiaed coaawb- 
lioualjthc titles of Ibe propcrtr, uad Ik iDcens bj wbich her buskidhri 
gained Mli rodune. Slin obtained In that mj the proof Ikl, as far lu sk est 
eonoenml, the properij jiad betra legaJI/ aeqairtd : but tbal care her aol tte 
kaiC lianquillii; ; the apparition o( her hiiabutd aiider Ik fonn of a BfMli* 
«f Ore wat a)<raja prctml to her nind. Sho rcioatned calm, ailenl, ud tM 
kfoie eoinpanjr ; hor eja renaiiicd Iscd on Iho aaoso point. Slug lar till 
ktrd nothing, uve Ihc profound reatfaiaatH wbich tonaeated ber wtlbia. 




STATKS or MENTAL KXAI.TATIO.V. 



2»a 



I Stat* of idinp coaliniKd TorBboul tiro innntb*,wbeo the bccwne MgiUtcd, 
I to rcmnn U liOme, comiiig mi guiog lo niirl fn. Tlicu ^tie let nut to 
■(nraMbkl l{i«^rlii«iin. Wl>cti kiianrrivcd, slirgavc licr»(.'lfij[» toB per* 
■net of polticaeM and of complimcnU, cxpi'e»ini{ tieneU wlili 
dcgAiiCt: llirit, on liie foUowing^ iii};lit, elic btr^-aii la crj out 
ll" CBBie io ill citienie terror, uid turn Ler Eurmculs (UuoJIcltUiff, 
■{■[I'icfllion'. cljuen, &B.). 
I Vka ihenfttlled in. Vlien lenlercdtierrooni w!Lboae«f hcrnciglibaun— a 
\o(dcj gutuKnuidTcrj It) tlo given to compliinent, wtio lud > luognose.^ 
I advuieed lowuila mc in n friewJl; wny, nikcd hov 1 did, luii made uc 
\fn(ovai bow. Thcnihe tamed Kvcrnl timci oobcrleft foot and bunt bto 
hler. Her Dcif;bbour obtnYed to her ttiat it was unbecoming lo behave 
thAl fwbion b<for« (he doctor. "Idiot!" «lio tiuwered, "uk tbc doctoi 
I Up jou lo ooofifehend ; jou might rcecli it wilb jour long noae." She iben 
I to aj oat, aad t« Ckll him u&uies. uiiiJ oinLrd lu biiu lilin. He got out 
I my. She llioii Inapt vitti great ndroilncss on tint caudi, and from tlial 
I foot of Ihc bed, irhere the bcgna lo d&ncc like a rop-c-duiiccr. Slie Mng, 
. aad laaglKd Itjr tarns, 8h« ktct oeoed lotnlk fui^liobljr , HaJtliiug out 
qntle uieolimut and wiilioul coiuivction. nnd oliicb w«ic wiiliuut nieuii- 
f, excc|>l Hut abe was enraged. Site »«omed k Mljr. A( itio door lliore mi 
I opaMog throngk wlikk ^e could boo into ttic atrcct. Upon all wlio paucd 
I boat tie in«do viched, allWaigh pftTlialJjr true, obMrvmlioii*. rcl&iivc lo clie 
I of their cbiirartcr, or to ridiculous iucidcoti in ilicir lirca. At timea 
ifcc m fnm one comer ol the room (o ftnotber, as if filie were seared bf »«me- 
Ikbgi f^A the BoaU maketajiid and viuletiC itiovomtriita uf the rigbt nrm, aa 
' abe alnigiHe*) vtUi a ipecife ; but she ncviM bad a inomont'a rest. The fac« 
< pair, hut wliM the patient waa furious it became red. Hia rein* of Uio 
bmmc avollen like a quill ) tlie ejca injected ; Iho lips red ; tbc counlc- 
ncnaeing; all Ibe ttiniotea (enio. 6lie tore bar dccaai knocked oa 
' wh»dO', ud icmpcd tlio nati*. Slie liad an cnori>'Oui ap'pcttte, and ate 
Aj Iha food ttiat was giton to licr. Siia made water and went tn 
■rhhoBt oontcmiiig heraelf «l)ctiicr anj onct wa* oc>r. 
By mghl iba alcpl for oolj a feir hours ; iui mediately wbeu the rays of tba 
•■■ ap paa wd *Im waa ^aia agiUlcd. Uet mtaatruatioD vm ragular; at th* 
Hbh «( Uf OMiM* tba pwoxysna were most intcou. WhenflTtr idcaa hartng: 
aajr eoniteelion eaine, tbe; were biting Mrc&&Dis. She uanud her guatdJaa 
M— *tt«r Kobwpierra, and aha added, " Id Ormiui, thnt neaaa M. tie valet 
ol thfl uaniltooer." After a ttw coherent lliougliu, then came all at oaoe an 
■■WaRMpted flo« of irorda eonipIet«ljr dci'oid of Nnsoi although looMtiiiHa 
■■M Ibia ooafuaod lOBaowe tboe iwght bo diitinguiaUcd aonu ideaa icIatiDS 
to nttenul lore. 

ShK cootinoiDd in Ifab condition during terera] montha ; then J was agai n 
wtkwA >o rii:i im. I Contd litr ia tlie folkiwug stale :—Kicc(il siyhi and 
f, the »tbtr araaea wer« gone. Site waa ti^i|iliun>uiiac in ■ k^i> dcgroe • 
the genital orfnaa; a seating at ber uinatialed desirea; aakiag for 
r*c. Ae. AU tbii fornicil aa MMioblaj* of lymidOM which could not be 



tba patioDt Ui prolonged valk* along uiifreqnaatcd roadi ; nd 



296 



STATES or MKNTAL EXALTATION, 



wbn tifaeliad kvlalent tUaAot fatf.l Kun h«f 5odreptaf UMdUtiHeJi 
Inller klmonittoMimiirelcd. The tvTjcttxi iioHtdialdf. Tlie paiimti 
3a>ii (IB k mallroia wl>)<-li vm bnido Wr, smI riiMJiird aim. B»t •! iWod 
of l«n hffun tkc/arer afOTaM nUmcd, tfcepilient lirlwiins <Wkkt ■■• 
enr7 b>u au old krnr (ditttUtd «■)«? aF dnoads. 50 ta 150 dn^ i^ 
timv* k (!■;). TVe trwtv ot toucli ftiid of Uaie •KVied tu rctoni ■omdrlm ; ill 
puitHt UUfd a lilllf. allliougb ftrj i«)pu>!j, of ha cbildreit, bat ilw dnp 
Jkoagkt Ae nw ber lotcn aroanJ ber. Tbe allJKk* of nunia IfTW ikritf 
■ad BOR ntt; tke patirnt obuincd > UlUe nan tktpt aai wtindrfa 
in«r« mIiii in b«^. We eould ilrMkdy lafcent to ha tlie wcttotr a( ecrtM 
impoiiant cimiauUiices in bcr life. Wben tbe look to nutierj, tkat g to cw ^ 
batokoMiL lbs dcm ipproMb of rs atlwk of for^ ; ud wlicn bar ndJkr; ^'-~^' 
tedHed ud intoUectnkl, we niighl count do ibe ecrtaia ■pproaeti of mc 
Sht did Mt aaj k»|tef Inr ker dicss. bul, on tlic contrarj, ibc Ukrd : 
ItOfMlf nraJj ; the no longer »poi!cil uUctn exet^ kt rsr« int«r«kl>. _ . . 
Imt nprimuid wu enough to casM bcr to conduct beradf beeoBinglj, A»* 
tbe ckM of ehilditD, it wu oeeettuj 10 rewme k«r educktioii at the lf< 
•iMlWila, ind to lend ber progrentTtlj Id k biglier kli^. Bot tbc ittMb U 
foriooa deliriuo did not 5et altog«Aber oeatc tn the iiilcrni of Ilw oniiM 
Then tke look h«r mediose (water of bitter nlnMnda), and onUnanlf two htm 
ftfter baTiog taken it, »be wi> Mixed hj an ittMlc of forr and an immodcnli 
deum i>[ eoitioa. f ifl«eB dijs kfWr each menitnial pcfiMl, little blMdiagi rf 
tan mnock vcr« Uken ftom her. Trom ifau line tbe atUck> at iMim 
beouu rarer, uid tlie patient hegtii to conplaiii ef iteliiii( %ai bnt ii lit 
gnital orgiiLi. T!i«n gmitunl!;' ibe jiaticot iras toduoed to work. Good 
eumpic and good oouDiel led litr bncic to niigioni oooTictiooa, and ibe «h t: 
length cured after k fWa iUaett. (Vdtea ia NaMe'a ' ZciiMkriri,' i9Mk 

P- 709 ) 

Exiunz XXXIV.— fiKi atliieiu «f tUMu, taei afltf atmy liyrwiMi 4 
tmtH dmriny eer/Saemtnl nmd wuriimf ; a lAird altufk a/irr a prtwuUmv Ai'rtL 
Bttcrtry — R — , »t. 34, va* adtnitted to tbe aijlurn oa the lotb NorrttbO. 
1813, Sh« is of koft tenpcraaieni, but ^ery aprigbtlj ; tail ; bair of chatnnt 
cobur; ejcilargvmd brovs. At aiiteea, nenstruatioa Kt in wUhool diA- 
oultj ; tl tweutj/our, R — «u married. 

In bcT tirraly-siitb jckr.Uirra dijt aficr ber lint co&HnnnesI, a ladj perfumed 
vitb Biiik canK to see brr. Imnediatdj tiM beeme delirious ; acTtrtMoh 
kbe coDtioued to luckle her inrint, vhtch died kt three jean of ^e. Tbi* Sm 
attack wat chsnclcriicd b; mania viUi Wrj. asd kaatcd odIjt two nonths. It 
Mated toddtalj after a tudden frig^ht. Since tbii firet attack, tbia woman haa 
coutiuucd Tcrj luKcpliblc, Etcij apring »he tn* lol^cct to cutllMiM of 
accompanied faj delirium, wlitch trai dbpcUed hj Uie aac of anlispuoiodm 

In liec tUriMtb jear, wLilc It — vcrdmI W iBfaut at Ike af;e of one jeu, 
d» *tnt to the abopofacnan wbere tliere wu paintiog. Tbo aa«l) iaui*- 
dbl^ axcited deliiium, wbidi incrMUed during Btb day, and waa luecetJed \lj 
mania with furjr. On tbc 4th a\ Aufruati 1809, abe «aa admitted to the Sb1> 
pjlridre. Vet; marked atiaiemeut; R— i* cnlm, aad leema in poaseauaoaf 
berrcaaoo. Ucrhuabandaolicitt bcrdi»mi>Ml,kndoblatBaitaoUie iitbOctoUt 
foUowiog. Ftoo Ibe Bccond day after ber dinninal, nlimi of delirium, Df 



STATK8 or HKNTAL KXALTATroS. 



M7 



ttinis : itappige of mdutrutioD ; fthdonien tirolliM). RctunKi to tba ujluttt 
(fat p*Ucnt bceono* quirt on Ihoppronch of nintor. Jit Dccombcr, the counet 
n-aufal»lml, and K — Icivn itie ujlom June, tSti. 
her iturty-lkMirlb yrar, t»l Korrmber, 18(3, prtmaturelirihtt inomoialha ; 
luge. Fnun UoeMOondda;. trrcattBlUlivcDGts. jrd NoTciRbrr, [nania, 
iiu7; llwfMtieat M Ukna to tbe asjlum. On ber arriral, Uet ejuarc hagKordi 
feHpaki look abiubcd^ gcnenl raving; mania, Tury. Xbrce dsjintteri 
■i <alm, nd recogniin Ibe (not that abe is in tlie luylani. 
Oa Ui6 l6tli NoTenib«f, tli« ooarKi ceatc. The patient »f« Iter Ivuabancl 
vUi nidcKt inUrcsl ; sbc i« sad, but Iicr Boawcrs arc nccurnte. On Ibe 
*8lli, Uttt; gutnc oppremioD ; copious pJectioD. Since tliat time her 
idsn art oonKCicil ; R — Is calm, and engaf^ in work ; gradual nturo to 
ftMOO. 

Oa llie ai»l DecemW, R — Inrea (he ujrlum quite aane; altbougli tbe 
vt mn a are not perftctljr re>«3ta)iliabec). (E»r|uiro1, iraiitiUied bj Eleciibarilt, 

i, iSaS. p- 15J) 

BxuirLE SXSV. — Farcirytmt of furg, acfompanifd by altemptt at murder, 
camitj i* tit* fiaei oftfilfptiir altadc.^, — A pMaant, bom nt K rumbftcli in Swabift, 
wboa* {MfrnU did not aiyir Ili« bett healllt, «C. aj', and unnurricii, «u lutijcct 
ftvat biicighlh jtar to cpilepiic allarkt. Tvo Te&n ago, bi* tliMue cluing ita 
rfcwartfr without kb; odo bcia^ ablo to ncnount for it : and in pbco of epileptic 
attacks, Ue Htas found liimMlf iciMd b; an irresiatiblv ilisjinniLion to cominit 
Htudar. De itt\% the approach of the fit several hours, and i&metintea a da^, 
babn it wmn on. luiaicdialcl; when be bas the prototiment, he earnestly 
aika lo bo tied sp and bound with obaioa, leat be comEnit some crime. " When 
U takea a^e," he ga;«, " I inujit kill — 1 must ttnngie, vero il oulj an infant. " 
Hii mMhcr and fattier, «hoin, for all tlmt, be loveadearly, vereUicfiot rictimi 
of tbeae BU: "Itolher." cried he, iu a loud tone, "sare jDurtctf, or I must 
■ClURle 7011." 

Belbra the St, be complaini of beinjt overpowered bj &leep, aud jet without 
bttag able to altep. Ho fccb himself greall; eihauateil, and eipuneuce* dight 
mamlaive BOrciMnta in tbe limba. During the lit, lie rotaini Ibe con»cinuiutaa 
ol bia owo exiatoMf^ and know* pcrfectl; that in comnkilllng murder he i> 
Ipiilt} of a crime. When he baa been placed bejond tbe reach of dufug hann, 
bo mica emlortiOB* and frightfal griinacea, lometimes sin];inft, and aoiuetimes 
apaaking in ntse. Hie fit luta from one lo two day*. Wlicn il ia am, ha 
nin, ** UbIoom me. Alaa! I ImTcauirrred j^rtallj; but I hiTc itot out of it 
wril, linoe I bare killed no Obc" (Eaquirol, *oa Bernhardt, ti, p^ 371.) 

4 158. More minntclj- to describe the various forms of muuaj 
rvptctmted by nutliora would be of no apedftl interest. 'Ibej are 
arnngcd, as ire liavc already uidicati?d in 1 former pamgraph, partly 
Kccordtng to tlie various Icndencit-s and dfsircs wbicli BUUiifttti 
thcutKlvec in a protnincnt omnocr (nyinplioiuonia, mania aalUna|i 
furor poeticufl, &e.], partly ocoordJng to the Tariotu cqubcb of tlie 
difMae (muu& pQcrperalis, parturieatiam, potatorum, &c.). Ai 
the latter form, dtiirimm trmetH, in all cmw in wliicb it is 





dm^ f n e eiti bj i short tU^e or meUaebolii, 

Ikm MB wdiMnlyj it Um Mose time, preseot moh 

«f iLtt luabt, pcrsiMcat ole«pUaBMi% 

FnqoMtljr t BUte of mnxietj U pccMOl 

pniad, ind keqa np the exciteraent; 

■bo tallnffi ni ti o m cf ngljt of the moit 

■ the greal aijaritr of casea eoasist of 

io^ iMnt*, fainb, &c. : tbt^ ddirium alio 

id [ihailwiiiiii of B predo 



._^ 



IraMM*. Il MMt 

oviiB (a iu ibort dontion i> nal 

K<*mi1m1m^ tfe tBtttUtMiiu of krge lo«m in 

wkn «OMtdntbk of Ummomij 

.) or j«a Mn« tliwiiii paOfenls adaiUcl 

tte fatal MM aecMnd (MmVjr witUn tlw fitat vmL 

mmtan itaaMhw l(f h spca tsftmlma vt ite 

feifwaltf t^ ■■■■• xBiddw (am. tncii w 

cf cmcwntM nrf « eafteu fiuwliitntj wiU 

w i m ia j Hm dMkc«,Waf<t at pnplc^lo 

f i f*rt»— — kawwIfwpMC (Ss 

•r»jtt*»ii<>*p.. J». TUMtla»Ha6MkalCvaloi«tian. llMJIf. 

a>«iw».>iMfagi»fiHjl»at— iliwddtalh: iatkcMcuatlitnii 
MM tifcMBiliw •! 14m mlrnmi 9ipm U SMcntkn. (L. Ueja, 
TiRtev^ ' AhU*.' is. it^ F «&> 

Hmm vmm wkidt ivrml Tkvadi obsonn {puticduij Bikatj 
hate i a nJbt i tmin thr title of m>«* AAmrai (d&i* aign), *ppw 
to Moit bnag distingautnd n a fpeciid fom of wuaoM, ud tu 
i wu nd hulfatr aum^itiDB. Hmk cases hr dnnctcrixd bj tiu 
M^pidity of tkciroatbrMk ; hy ftsnoa* drlmaiD vith incesawt iaaAf^ 
R«r^ Mmcien dialtfniig, htn wi th tlw doainul npramoa of aaxie^, 
and, firfqnntlT, ideai of bdng poiiMKd; bTTOti^,aTk««rd tnmbfii^ 
Momn^nttf, m if the p*tteat -mcit half iBtaxiealcJ ; ffnjnentlj, «li|^ 
iBiucalu- ooolnetioiis, dee^tmatas, paleow of Uw ooaateoBaae, 
■lr7 ton^t^ rapid exhaastioB. Aoeordioe to Briorte, these bMw; 




MM«i 




■ocorepsnieil by fever ; ihey Wt from ■ penod of from •ereral 
.ja to fix or aght veeks, ihey often ttrminatc fstallf throogb 
ddeii collapM ; aflcr dcalli, liTpcjKmu of the cerebral mnnbruie^ 
' ooLUing At nil, i» found. 

Cnireilluf r and Abercrcwb]- bate ilreadj doKribed meh cue*. Sm Brierrs 
Doioa MJdic^,' 1849, aad ' MJmoim it VXetdiaae dc Mticmc,' Uwi. si' 
nlbsr Bttll,'Ainer. Journal of losuiit;,' 19491 icnscB/Zeibdinft f. njcUitria^* 

$ 1 39. The Ijoqueut »lalea of iiuoMp/etcljr daekped mania ue of 
t practical importance ; in the m^oii^ of cues thcr represent 
le lir»t stage of exaltation shidi pteeedH tlu outbreak uf tnanta as 
monoouinia, or a period of rcmissioti between two maniacal 
tt»cka, or even n stnge of termioation of mania. Occasiooally, 
ercr, thU state coDtinoM for a long time ia the tame maiuirr, 
il inaj then rerj properly be considered ai a special form of 
iy with the cbaractcr of exaltation. We have alrcadj in part 
ade Rvcniion of thu state as a relatiirclr mild mode of exprcssioa ef 
Dertain dcairea aJid imtiocb, while the patient UiU shows do klriVinft 
lisordrr of the intdligmcp. Frcqai-ntly, however, llierc is also 
ibaenred a general iucreaM of voliliim not coDcrentnlcd upon a 
dcfiuite serioa of objecta ; and this is mamfested as an uncommon aiul 
rncooataot activity and nstlesnioi, u m. ardent dcnrc always to begin 
something new, as a nccesaity to alter sod remodel t^e external 
orltl acctmlisg to eccentric projecta. Such patienU ban always 
letliinj; to do — apecalatioQs to enter into, to buy or to sell, to 
Di, to baild^ &c,j all they see or wliicb happens to tbem they 
would have and potscM, and very oflea they thereby tpead lai^ 
mnu in a very short time. Ordinarily, they arc very vain, show a 
desire to be considered grest and to excite admimlion ; their 
demcananr is confident and arrogant : the hamour generally changes 
n|iidly frum joy and frolick to depression, and again to violent out- 
farcaks of anger, the latter eipeeially when their actions ore opposed 
and that pride hart. Some show a tcodeuey to cunning and 
ntrigae — ntbera a desire to steal, tu drunkenness, erotic tendcocies, 
expansive religious ideas. Ttic patients gciicr^y talk a greet deal, 
load and rapidly, but without i'|)ecial delirium; their diacourse 
abowB that they have an cxs^geratcd idea of acU, but without the 
drluKioQ of tiring aooic other illiiatrious jierson ; thry bavo iiierrly a 
(aadency to eAlimatA to the utmost their faenltin nnd powers — t} 
wnltb, their phriical streogtb, health, or ^re. The high eatil 




800 ITATKB O? iniKTAI. RXAI.TATIOII. 

which thp iMilient hu of bitDseU frequontl; extends to iQ lb* 
belongs to him, and t)ie mere fact of fto;tbu)g bdng in his pooMfr 
lioa is fetfccdj sufficient to cndov it with extraordiiiAtY qmljUa. 

In this description, giren from odusl otuervatiou, ud wldtk 
igren with tbit of ie»aen/ there wilt be lecogniMd t itste c( 
■nodente exaltation, which, when tlie (>xplonon of the effort tak» 
place towards the ntterior, becomes mania ; vht-n the increaae u mm 
intemal, and fixed ddirioua oonce{>tioD9 arc dcTcloped, bcxoMi 
DOBomania. Tbc further hia ooodition i> front oqc of these etiiai 
d)anet«nstic form!) — thnt is, the lets the pnticut is delirious, the BMat 
B he in a etatc to justify his morbid tendencies bj reasons whid 
■tiU lie within lh« bound* of possihilil^, and do Dot jet appear to be 
deeidedl; the roult of iDiftnitr — the more en^Uy will the morbid 
Dature of his stale be overlooked and coufoundcd with the reiui'. i ' 
Iho normal tendeociea of a capricious and ongiaal individual. Hf 
then falls under the cstegoiy oi/olu ra'u^nanle, of which this coa- 
ititQtcs the maniacal form. 

Sbonld the affection remain at the stage of derelapnient which it 
have dewribcd, it mav either terminate (after a short duration) ia 
reooveiy, or pass into a state of mental weakness in wliich the donu- 
nant jojrooa self-satisfied and self- contented humour becomes fixed, 
and manifests itself in nWj, foolish acts and desire* — taoclm^ 
dancing, &c. ; in childish ploy, in the collection of trorthlcM thiBgi. 
opon trliict), however, he places an atraordiuarj value, &c. For 
this form of mania it wilt be most convcnicDt to keep hy the aane d 
moria. 

Tbc TolloirinK ckSe tSun a» euBipla of this kind of moderata, 
&Q(lparQX7samlcxiiIUiiioii, uotjirogresslag tofullj derelopcd maaiaorto 
naoia. 

KE«Hri.t XXXVI.— Johaan lUaberg, »l. 37, Tigoroaa, «iilii»i 
tendoBcj to ioBsnilj, UtIds ta (ood citeamilaiicca as aa agrimltarist. At Uie 
tge of twentj, he had for the fint tims an attack of iasanitj' whieh ktlcd to 
■ii weeis i »iii«« that time he had seren daDar kiu«lu, rcturna^ at ialansl* 
of one, two, or lltree jesn. 

On each occwion the dilute fallowed a ooune like tkia :^w was at flrat, (bt 
some lime, dull and downcast ; then there Miccecdcd aa aJwajs iacrcasitif ei- 
eitemoil, but which, cvea in it* matt inteue ptrniyxma, co«iattted of a (iin[la 
tUfgeralioD of the ordinaij dupMitions of tli< individual. Hii lore of hone*) 
dofta. and the cbaie became stmig«r tliao ever, and be displayed exlratwdifiiff 
aciivil/ in BgriouUural opentioas. Ite itu tlien etlreaielj oaterpriaiDg; ooa- 

' Art. "Uoria." 'Serl. EdcjcL mrterbncii.' Bd. uir, p. 197. 





BTATJUi or MKNTAL KXAU'ATION. 



801 



tfpMltjr tvuj, ifid eit^&g«j fran morainfr to nif;lit, vritboat rut, in tlie IiuiImI 
IcU-work. He bad > giMt Ofiiaioa of liimieir, nnd caail^ berjino cnraj^odi < 
Hii jod^nt «u K>iumbst r«ebler on tlicM occuioiii. At the amtne lime, lie 
WIS dttiaat in Banner; »Iitinncil llio meinber* of KisfRmil/,aiidin thrirpregence 
WM odd lod impolite. During tlicao fits ho speot tlie nislit genera]!; without 
tltep, viUioot bis wliril; luScring tn the l«ut from IhnI circuniit»nc« oa the 
tglLomiag daj. The appetite incntied ; and nllhougb wliftn not tulTcriit); from 
Uhw Sl> h4 wu lempernte ai m|iccti tlio t»c of alcoholic Hquon, lie lud (Leu 
■ (nal tadcMj lo drink vithont going the Icnglli of iutoxicaliou. Never, 
dviag tlwH BomcnU, did be. to say the truth, suiTci from an; |ifofouiid intcl- 
iMfattlderaiigeuieat; but tcTcni timci hebetnivcii|)i(uinf;coiicepticmB tMrdennci 
OB bttnitj'. lu all the flla, intitnity did Dot bctrsj itself except hj n geiienu 
exBitemBst of all the meDtal racullies. and bjr tlje instinctive dmracter. w> to 
■pealc, of ikoM acts hj wbicb lie nianifealcd his will and bis doirci. In the 
oeotM of frDin four to Qrc vceks Ibii itatc attained its maximum, and the ex- 
aileoMal ifaen npdij dis«p|ieared ; but the reatuntioa to hi* normal clianetorj 
ma not aStoted tuitil after Ibe inteiTcatioa of a periud of dcjcctiun simiUr 1 
tluU whidi narked tbe commenceineDt of (he attack, and wbicb taated for tcveral 
dajri. 

TIm patiest tumaelf, while tbc attscka lasted, ms conscious of liis state, aud 
whew the; were orer waa alwulieii sud asliameil. Several times he nh-ovcd the 
dcMirt^ if iIm attadu wen reneirod,to place himaelf under medical treatment at 
SirgbnTg. At length, when b« was rioteotl; seized another lime, be was mh- i 
ducted to lb« asflum, in September, tBitf. His attack had \>j that time nearly] 
iwdMditabnglit.aad lOon bewail lo decrease sud logive place to theordiuarr 
pariod of dejection. The patient then returned to bis normal coiulitioD. 

What wen tbooauscswliicb from time to time induced this irritable coodiliu'a 
of Um brain and entire nervona sjnlcm, wliich somctiuies stlained an citrn- 
ordiaafj degree of mIcouI; f h is ditlicult lo txplaio. But it wua fuuatl that 
Un patinit had siaoa bis ehildbood ludidsed ia Itibils of oiianisai, to wliioli he 
^^BhUad kioisclf up icTf frc^uentljr. Cootinuall; tormented by rcuiorae, be 
VEnttd the resolulion of no longer abandoning liimself to bli unliapp; Indina- 
tin i but afUr bsving tlrufigled in vain for tome time, bo tndcd b; jieldiag^l 
Wid toon aAcr, foUoiriiig ttic exiisostion of tbe brain and of the norrous sjatoOa 
tlwre eaac Ibo period of msrjiacsl exnteruent wbicli we havo described. 

Tbe treatment coosistcd io a moderate diet ; tepid baths, wlib eold shower^ 
baUw ; norsl nflueoct and compulsory cipcdieals to rcstraiu bim from oaanitin. ' 
Tbaaawtra svccessrul ia keeping bim for at least several moiLtbs from bis 
aUwtfwl babit. (Jaoobi, 'Bie lUufitfonnea dcr 8oelciuloruagai|' i, 1B441 
Mo. I.) 

§ 1 40. 'Sttort concluding tlie conridcration of tbia subject, H ma)' 
bt well to Mjr a fow worda regarding tlie so-called mania tine fifiirio, 
k |»tbologica] vtrietjf catablisbcd bj Pinel — wc roaj" aaj — to the 
detriment of science ; for so tmc and m serviceable wu the reinark 
which PincI deduced from bia obscrfalioti!!, that the impuUeA and 
violoit Klioni in maBia ore not atwaj/i founded upon (lerveraioii of 



ao« 



»TATU or XUTAL CXALI 




lb* nlcM — «v ur of opinioo aor ^ di yB ti 

ffllwr nnl the om — w viutano^ wtm k t» fpi« d 

UoB to two diHerail moibid mnital iCsiei; B^Bcif, 

le irtiul periodic (ttUcki or far; wiUi vaj fitdc 

llie olhrt band aiu] )mnci[iall]r, lo thoae BodcxMe 

•ulUbuo NfrrrtO lo ia t^ fomiH' pagagtafk, m i 

pwfom foolish aotiooi ind >lictw penavtr of 

■1*Q k a potttion to justify ud to expUia that < 

(if eoluMiit rMKining which itQl lies vitloB tke 

biHty, ».«., ^M rajflosiuji/r. The diidp l e i aC 

W^itd MIm iUtot «Bclv the Mine title ; foe • 

wUm «* htv* tkiailwd u » inodent« degree «£ 

rluleum, ukI. more tban this, ctcd oatbrals of 

MqiMuee of biUnrto cooocaltd fixed idcw : Cor the latter then » 

wt tuna the tppcmoM of maoa. 

V Wfl consider tuon clotel)- to which maaiacil atates the 
tion mtrnU <i*r ^/i/ie no be applied, we rtoogniae the : 
Aw4 thai in Do MBgle nut of tnania la th« eolMcioas tikwgfcf, tbt 
intftUigenoP, perfectly free frotn aDjr ditoider. £Tca ia the vs; 
•Ugttlnt drgnw ol umdm the inldiigence peiticipatM in the gatad 
Buhatioa, though it be onljrto the extant of iacneaed KfdiBeM ai 
npidity of thought ; gaMnlly, however, there ia incobereaee. Ia iSi 
itUoki of furT, dntr, ndtn, beelthj thought is quite impooible. Ii 
is tru« tlutt uiauiibcs cut occewonally, by meana of exbortatioat be 
bnmghl for a ahort time to their lenaea, aiid be enabled login 
ouitivt luiawrrs ; but this only bIioim, w Jcsmu' remuked, the poe» 
boliljr i>f Icinpormry triuintoaR and intcrmiasions; " the |)Atient ia not 
dslirwuj whvn bo apraks aeosibly, and be does not speak feaaHij 
in thoao tnuiunit* in nhicb he is deliricms^" Neither can ve sptak 
lit the absence of delirium in those cases, which we have deecribtd, 
when tltere it a norbkl inipoUe to commit acts of violence. Thei 
thow murdcrouB ideas which are not at all in accordance witk 
extenul iiiornl cAUMrs, but awakened by a morbid di^tOBilioD, an 
already in ttwinult^es delirious ideas, just as in furiotu mania, and 
in all vioiait raiction — for cxamplp, rage — there anm new ideas, 
olHnitiiif, »nd conclusiona, corresponding to the moibid dtapoaitlOB' 

Those states in which there is least confmion of ideas and 
delirious perceptions, in which there is the (pratest amottnt of 
lo^cal coherence in thought, arc the sliglit st«tca of exaltation which 

Wortertiiaoli.' 



•TATKl) Oil' IIEMjLL UXALTATIUN. 



608 



I m bavc described in tli« fun^>ing paragraph, wlticb, liovever, are 
JI7 merely the foremaners of the coBimencenicnt of violent 
For these, for /ol'te rauonnante, ve niglit, a? Pincl in part 
\ diii, u»e the Tism<> tnaxiA iiae tielirio ; bat, &8 iii concrete cnsea it \s 
\ gf Utile practical advontagc to rangi; casM unilcr considi-rution uuder 
I certain names, but of far more to obtaia a pajcbological spprcciatioa 
I of tti« fundimeutal morbid psjcbicnl state, the circumstances which 
llwn caoaed ita dcTctopmeut sad its cotucquences, it is, at sll 
iit«, nore adviitabte to nllow those obscure iinmes which provoktr 
ODlionty of lawyers and ether Uymen to fail completely intu 
FititQse. 

In a court of law the moibiJ nature of tbme it«te* ii most euilj deaioa- 
itnUd in cue* vhere tbe ditorJer lias cotne on teiliiH a tiarl lim*. or rclunu 
at isUrtal*, aod llierefure ailtnit* of cotnpamon villi Ibe state uf lieallb in Ibe 
nnc tadiiidual; alao iii earn whnrr llicrr vo coiiouiniULnL nrrvoua ur Oilier 
bodi]}' ajiaploai*. It ia.on ihc cnnlrari, difficult to prorc that a certain iitatc U 
■orfaid when il bu bceo slow and gisdon] in its dcTclopincnt, vrhcn it bat be- 
|miM liabtlnal and paated into fixed pecultaritj of dianoter. It iliould MD- 
•taallj be bene in mind ibat an individual may tail: " quite ratiooalty," and at 
the lainc time ifaov by hli acts and by liis CDcducl (and even by irliat lie doe» 
■oi do) Ibat be i* ncJitaUy dcraoged. 



SEOnov n. — itoitomaitia, 

§ I4I. Under the t«rm moDOtnania are cotnpreheiided thow 
statu of exaltation which are characterised b; affirmative expannve 
cmotioDs, accompanied by persistent oTer-eslimation of self, and the 
extraragant fixed delirious conceptions which proceed therefrom. 

It i* tba fonu wbicfa Heiarotb baa dcaeribed iu Rreat gurt under Ibe name of 
EeUatit f«ro»9M, Bad wLioh Jeuen baa deaign&tcd SthKamarfi (uid in part 
^Inwtti, DrasiocN). Our form only eorreapouds iu jhltI *Mi iLuae utates de- 
Wfibcd bj Jaoobi at monomania, ai Ibe latter alio iucluded uidaQclioIii TJlii 
drfftaw MMeptioBB.' The majoritj of the Freocli medical pijcliologuU eaQ 
Uhm riataa nemumua (acute) o/amlilhu, ^jiriJe, ((f vamUj; alao (aomrdtng 
to Raab) amatammiu. ThcM ooodiliona arc, il i» true, apecially obaorvod ici 
WMVj of Ibe ctaea «liicb lerminal« in dtmoitiB and lunlytis ; but it would bs 
Tery emmeoat lo aupiiose lUat nmnoiiiaDin it alo'ajt the first ilage of iliSs 
foem — il fre'qnciilly tcrminalel iu tecovrry vIlLout aiij paralytic a|i[)ti*ruie<n, 
and Ibe " motioinaniacal " delinnai of paralytio Itas niurcoirr aoaiclliiiig pcca- 
liar, naiDtl/, tbeeail; iofaiian of ■jmplami of mental weakueas. 

' la leretil porta of liia vmrk n^jn Mania, for I'liamjilc, ia llie 181I1 and ijjtb 
iUaatiaUra I 



304 »TATM or aiBNTAL BXALTATIOIf. 

We refer the mder, kt Ik lint fbta, to aba W bem laid ooneentif Ai 
•Mm nf ex«lUUra {■ gea irJ . nti eUc lopengnpb 135. ud bwj mw fnati 
la ft •bort toaiptjan aad expluBtuai id the Borfaid phcueaMfH is nwenMa, 

AmetiMlutrfSt^-tMuacm»m§m,1i» Dtnre* and tA4 9^.— laths 
Fonn of ioMoit; these are all groapcd together raand a coaunnri 
centre, vis. the exagg^ntvd idea vhicl) the patient hw of btaui^ 
Thu is [xjr^icaUy grounded. InafliDQeh as the paver of to!!- 
tioDt which during the mcluicliolic rtage was weakened or ent: 
■upprtSMil, has not only retumed, bat is actoaUr exalted (extoia^; 
in the form of increaMd activity) — inaininch as, at the nme time, tlw 
freedom of impolae to action is accompanied bj (^reat frpedon of 
tbovglit and an abundant flow of ideas — then results a fceting oT 
great aetf-satisfaction ; the patient rejoices over bis great ineotal (aaJ 
bodiljr) well-being ; lie feds hiniKlf richer and more fiee ; ereri 
i-xerlion has becosw eaaj* to him ; therefore be ooasidcn himaelf tg 
be not only pecjeotljr healtlijr —and rejecta with iodi^natioa n; 
expression to the contrary— but he frequently dedam that he nem 
in bis life felt eo well and >o happy. The exalted •df-conadoiHiKf* 
manifests itself as au derated frame of mind, as a jorfol dtspositioB, 
BCMDetimea with the visionary enjornicnt of sablime seosatioos ; it is 
farther maaifeslcd iu great Ktf-confideooe, in presumplDooa, itidi- 
eioQs, proud, and luperciUous behaviour, in which the pattott 
diiplajt lometimw a super5cial eelf-Mtisfied ifltded beuing, Bone* 
times a more deeply stated haughtincs and pride, aitd a desire I0 
magnify himself in every possible way. TWa affimiBtivp dispodtun 
is persislent, it does not alternate with other dispositions withott 
external motive, as is the case in mania. It may, of ooarae, be 
nome&tarily interrupted by external circumstances. "VWo patient 
beoomes irritable and violent ; and if any one exprenes a doubt u to 
tlie accuracy of his aaeertioiu, or opposes by remousttanoc or force 
the execution of his estiangaut acts, be at once becomes impatient 
and an^ ; he seeks to justify his actions and ideas, and will pennil 
nothing to approach bim which might encroBcb apoD hia 
frame of mind. 

Ttie increased power of volition is madfcsted in the neoearit/^ 
increased eccentric activity, especially, borever, in Qumerona ex- 
tnvagsnl plans and projects, the aecomplialiuient of which appears 
qtntc poMible and essy to the patient, who believei himMlf captble 
of anything. In lliis he preeenta n grcal siiuilatity to — yet with 
iL marked difiertjicc from — the dcmranour of the maniac. For, as iu 



earitrior 




4 



STATES or MBh'TAI. EXALTATION. 



306 



I 

I 



t, BO in monomatiia, the primary aud principal desire is that of 
tnifc^tation of poim; but in mnnia this uecesEity of no emo- 
rxplosjon iaimfdiafe/y proiluctt muscular movements (*oine- 
tumultnous) in whi^ it rvUcvu itself. Huiicc the instinc- 
character, bul onlwordlj' exalted, of tlie^t^ states. The more, 
lire CQatrtry, llint co-ordinated series of morbid ideas and 
niotis BCt u|)ou the cialled nill, the more the current towards the 
ilvrior i* set in motion, not nicrclj by mt obsciirv tuinulttioufi 
sit;, but bjr conscious thoughts — the more, therefore, that some 
of plaii premdea orer the taorbid will> the furthiT is the 
adilion removed from mania and druwii tovnrds mouomania. 

Ika dilbteitee is seea most di*tjnellj irhca, ts is \trj aFtea observed, ocr- 
ifranpsol teoaatiotia nod obicurc idea* Rppc*r villi Gftpectal TivBcitjr «ad 
tliemuhn lotrirds tlic exterior as insIiuclB; for ciatnplc, tlio aCLuol 
aa. Tli« Bsaiu with aimple osUUtion of tho seiu&l instincl ncrlci U) 
l^rattf; hi* desire in ihe most direct manner ; be attscka Gferj female wbn comea 
iuLisvaj; tod IlieDjmpboiiia&iso makes obaceaeadiaDces to ever; visitor, la 
oBoeomuia, on the cantnij, the exalted, sexual insiinct, before it paascs into 
on, is (uided bj new ideas sud opiaioas (oT a morbidl;; eialted kitiii) wUicb 
iip7 tke umd : tbe palient will tbea on); f^atifj hb dcsiru in lli« seese 
over-«stimsle of s«ir aad o( «ertaiu delirious ideas; lie onl^ fiuyi hit 
•' topnDOe>tc*aii(iilliialricuilidi«*; Ihe female palicntshsToinisginury 
: adrcitUrea wUb princ«s and king*, ic. 

:iua theudletneiit of the nionQinanisc docs not pass so tminedialclj towards 
> exterior ; rffort is BOOOvijMuiifd b; clear ccnscious IbouRlits and opiiiiuos, 
tbciehj tiK instinctive diaractcr, and bccomra sctusl morbid volitiou. 
M'ltb far errsler, soaielimea with perfeot outward calm, there is a inoro profound 
Mttcrul h>»i of reason tbsn ta msnio, because coDsequenccseooumuU from the 
gDDenJ eialution which set aside llie esseutiitl cttuditbus of lieoJllij mental 

Anomalita of t^e inUUigence. — Here, tSia, Ihere \« first of all 
obHimblc a parcl; fiimial increase io the macit; and rapidity of 
thoughf, which is manifested in exaberance of ideas — owing to which 
tlip patient inwardly rejoices — in lively coiiver^ulion, luul in frequcut 
rhargc of tfae object towards which ihc morbid vtjlitian is directed. 
fiulj ordinarily, tliis occurs ooly at the commenoement ; afterwards a 
fc* delirious idns exdusiveij predominate, and, without iatercluingc 
with others, drlcnnitut tlie actions. 

Another anomaly of the intelligence consists iti an inward increase, 
an exiggerotion, of the ideu in regard to iheimbject, which shows 
itaeU by ■ tcodcncy always to employ gniud, high-souudlug words, 

' See further tiu a case of (his kind. 





SO 



-JA..i 



■0) LmN^ft^v 



J 



806 



STATKS Uf MENTAL EXALTATION. 



the nML brilluul inuges, the highert possible numben (ibouul^ I 
LiaiDioiui, &o.]; <uid iuMmacb as tho«e overdrawn ideas pui lata 
^ ikcte, Huy cx]ilftin tb« Dimeroiu «ec«ntnc pUns of sacli pidinb. 
TheM Dalaralljr vhtjt very much, according to tiie former ctrcn* 
sbutcea of life, etaplojmcat, ud debtee of educatioa of the paliaL 
mie artizHJi ougnifica liis emplojriuent to the utmost ; tbe *alikt 
dreams of laig« aimief, entm upon campaigns and maket (m* 
quests; nnotlicr seeks to solve impossiUc nKchanical problenUt nA 
OS perpetual motion ; others disoover dcv means of locomotkn l{j 
laud and sea, new milvays, or steamboat eoterprUes to coounud 
all the waa of the world ; or, agaiO} be project« impnrlinriif 
joomi^s, or immense arcbitoctuinl pLuis (castles, towiu, kc.) m- 
tjrel; occupy bis mind. Others busy themselves within tfac ipboe 
of idcM; conceiTB comprchcnsiTe ecientifie thoughts, great haJaM 
and religious siins. See. ; believe themaelrea to be apostles, beocfaetOB 
of tile whole fninily of mimkind, beaiers of univenal bappiiieai ad 
peace, &c. ; all in acoordanoc with the accideDtal extenial infloe«wor 
the former practical teodencics or speculative aims of the psiiaL 
These ideas, bowercr, are inrariably distinguislied, in the first ^Im^ 
bv (he feature of activity (in oppositioo to the ideas in meUndiofiii 
where the patient believes lie is governed and tormented br niiinA 
inflacDces), and, in the second place, by their fantastic exaggen* 
(ion. 

Most Ultimately ctnuiected with these ideas, and, like them, pro- 
ceeding from increased self-conxciouHiieM and ovcr-eaiimatto» of tk 
individual powers, there arise, further, false ideas and opiniam 
rcUtiug to the special tg& and its coonoction with the extcrrul wniii 
In these cases we frequently meet with the idea of being eoni 
distiogoishtd person : a superliuman power of posseesiDg inexhaoatiUi 
resources, uf occupying a high posiiioQ, of aiistocralic descent, Ac. 
To this cUjs beloug those patients, so numerous in asylums, wbo 
beUcTo t)iat they arc generals, ^iapoleons, millionuaiies, reformen of 
Iht World, gods and heroes ; the many female patients who ait 
^beloved bv kings, those who believe that they hold freqaeat and 
intimate eonvcnie with Hie Deity, &c. But all laeh belong to this 
clasa only in so far m, and so long as, these ideas depend tipon iB 
actually existing increased consciousness of self, to which they ana 
stand in the relation of etUmpU at erplanattm. 

Thnthhe. idrubavcorigiaalljnBignificuioaaachaslhe fcJlowinit: tbe ids 
ol being ^opoleou, tas oxfunpl«, futudamsatally mesas thai thspatisntb^Un- 



VtATSS OP UKXTAL EXALTATIOH. 



307 



tbe 



ful. bdincs biniMlf capable of iloing grenl IhiaK*, of MCOin)>li»liiug 

bjr ill* fjnut menial ami phjiiul powers la n degree of viilcli lie lud 

^^sTora CTcn dxuiDcJ, and cxtaU oiilj- lie poMiblc to one of Itie few gnal 

tit hiiUr;. 

|Aft«r«iinU (lu* ■flmuUv* dapoaitioa ortcn beoomcs wCHlicr, ud «vpn 

Btd«Ulj diupp«m. when Ibe delirium alone reniBias. Tbe more the elevated 

>• of mtBd, vbich wai origttull^ attempted to be eipUiued bj ibe delirium, 

I Ue iDOra docs the tlill ciisliag dcLirjuni deiteiiente into iiiero irords, 

\ Ik* pktifiot OA lon^i^r atl&cbea uij real signiGcanee, tni the more does 

I tntOMOtbec emdiliun, tliat of dementia wilb llii; cbaracterof txalU- 

kka^ bowerar, as Ibia eiidted fram e of mind coolinuci to proroke attempts 

on, «e can vilb instruotioEiobicrfc the jtiogtm of this eiagF!'^'- 

1 like ildirioiu idcti. A patient, for cxanipU, wlio Lad formerly been a 

■00 loldier, manircita at Snt mctcl; tlic idea of boiog as officer ; in a Ccv 

it • gcntralt and toon tbe leading warrior of tbe daj: and alioald (hia 

DQldthc«c vordt net Jbc »trong coou^b to npreis tli( powrr, tbe 

i>. ud the dellgiit wbich be feels witliio him, bo becomta Lord of tbe 

B, the UtMioL, tbe Saviour, (Sod ; m thort, bo uaes tba bi^liest and 

■t exprOHioDi of whicli Le is avare to deaotc hia inioginar; grcAtuoss. 

voubl, however, be a yttj fpeti error to suppose that tbe piitiGiit is 

I of Ibis npUnalioii, aa such^tbat be calmij c.'utidcra vbat niajr be 

of lib frime of misd. Thii is not the case : Llie iiieat called forUi 

frame of vomA khk suddenly, as ia a Antm, and wbilc htc, at Ursl 

oretiojed, aboclctd, ttntid, or frightened bj tbrm, maj be able to 

thcoa. jet the; sooq intruilc tbcnisclvcs upon bini m fixedly aod so 

^j, that he cao no loogct doubt tbcii rcaiit;-, foe tlicm be 

aU his fonncrTieT* and ideas, surrcodors bi^ old e^o, and wilt eveu 

■J th« Ustinioiij <ff hit tecBca. 

nrrcqucDth, witcu ibcsc atatea hsTS attaioed to a comidcrabli; 

nenit weakaeaa of tbe rattntal preoeaaea enauea (oonaistiug at iiti 

gaoenllj in loaa of nttaoq and eoofiuioo of ideas). Tbe palmit, bowvter, docs 

•Vt tttt» to imagine things, parlicolarl; in regard to his ciallod (celiiig of 

Mliafacliani but it appeare, ufieii, as if li« were alfectiog arrogance anil 

gnataan iMnljF vitli the viev of doceivinjt himself and otbcn. nilb 

i ilasasi oa to the alRadf percepllUe urgent and ineieaaing weakness of 

dMBiBti*— «f ooBOitiag, bj • kind of morbid pride, « oomnonoing vtJd snd 

MUftiMM — bat of eouTM with no direct intention. While, then, nnddallj lliia 

diMrdir ot the iateUigoiwo becomes o confused nus* of grand words and 

, & am ocean, when the mental proecuM remain aotini, that cerlain nf 

dalilions ooBOeptiooa bceome completely 8icd. Cettain it«dfa«t, con- 

■eeted drdes o( ideas thet inccasanllj urge tbemsdTca into tbe fbregniiud of 

j^o oottsmOttMess, gorera all the tbouKhls, and are oipreaacd tn wofda aitd 

■Hds, From Uu cause it nwj teem a* if tliete were mcrelj a putial de»tmeiioa 

^ the iatelliiRBee. whils in nalit; tbe eaaenlial clonenU of thought— oormal 

acl/'ConacMMMDeas, aad a cornet apprecUtion of the sptoiol i&dividasUly and its 

nlalkni to the wottd— are iiltctl; [icrTCTtcd and dcatrojrcd. 

m thsM txtd Ideas, which to him poaiMa the higbe»t degree uf subjucile* 



ace 



STATES Of MBNTAI. BXALTATIOIT. 



rswy 
urmH 



rwlitT, tli« patient cuiaot be directed eitber bj deaw««tntioii or \>j i 
It is only al Ibe earn men cement tint rniuMioBS oomuodiIIj occur, 
vlitch Ihe patient tnaji Mlmit fmr « sliort line ihe error of lib deiutlon, i 
Tfuons 01 external eridence arc laid before liiin ; wkilc at the hum 
oannol tnvanllf oonTince liimiclf at ihe fslsitj of bii idca«. 

§ 143. AmoimIU^ of fAe Seaaorial PihcImm; tHe MortmeitU 49* 
lAe Cdnttuei. — TlnllticinnUon? and illa»om corrMponding to the 
domiiiaat disposition are frequently pteseut, sad an: much more 
serious in their cousetjiKiiccs than tke^ ore in nwiiu. In tiie latkr 
they are soon forgotten; but here lliey pertist, fostw, and essentiilly 
strcDgtheu the delirious coiiccptions. The patient, for ezimple, 
nee an angd bringiug to him a message from heaven ; bean voioei 
comnumdiDg him to commit certain deeds, or communicating anin 
telligible nonecnse, vhich he believes to be Miae divine mjsi 
wortblem objects np|x.-Br precloasi &c. 

The moveinouU of (he montimaniiic do not, on the whole, p: 
the external occitrment and tumultuouB Tiolcncc whicli appear is 
simple mania ; they are geiiemlly more calm, and any excitement is 
usiuilly the result of some estemal motive. An UDccriuiiiLv in thft 
muscular muvcuicuts is here ubo vt-ry frcquuillv' tke first prrmoni- 
tory symptom of a fatal terminatiou — of the comnu-ucemeat o| 
general paraljsiB. 

The outM'ard ap{)caraiice and conduct of these patienta is il 
accordance with those anomnlie* which ve have described. Om 
di^plnys the gestures of pride and of povrer; another appears at 1 
Lhcalrical hero, full uf lg^|]>suunding nords ; while others arc lof 
polite, alTcctcd, gracious aad affdhli? in their demeanour. Some dms 
fftntftslicftUy ; others, esjieeially femnlea, with extraordinary eleganee; 
others, ngnin^ari: totally ntiglectful of their toilette, forgetting e^tiy' 
thing in the coutemplation of exlravngaiit plan*. Theae patieoti 
delight in giving orders, and are impaticDt to know that theii 
conimiiuds utr promptly executed ; they arc covi-tout, gcneroui, nai 
profligate. According to the n&ture of the dominant delirious ides;^ 
they make various arrangements for the currying out of their desins 
letters, retiuisitionsj nad proclamations are issued ; large purcbM 
are made, and polite niiuounccincnts prepared; tliey 
orders and title* with a liberal hand, they prepare laborious 
tics and complicaicd piaus for the rrargnnisation of the worl 
Some putiunU appear perfectly calm ; their coiivcmtiou and 
adicittcs au exalted (riuiquil joy, n sorl of inward rapturoua 



iing. With this there are generally iiMociated idefts of close 
id mysticaJ connection witli the Ucilv, Mcssiauic idc*8, &c., com. 
lined with balliiciDatioDn — which Ikcv carefully conceal — of the 
i])p«firanc« of Ani^clt, heaTcnlv voices, fee. This is the weak senti- 
icutal form of tnoDomanis, which is obscncd principally in 
lists; bat this vinonary bappiness may also be iutcirupted by 
riolcnt outbreaks of anger wbcu their wishes are opposcil, iiccom* 
inied by threats of Dime di«pieaaure, and aolemii prophecies of 
drvadfu] puuishmcnts which are certain to follow. In wonacn 
stmilar statvs of inward rapture occur, having for their object M-xual 
Mnaatioai and iniaginary love affairs ; they also ore accompanied by 
[immerOBa but well-concealed hallucinatiou!. 

Aooording tu tbo predominance o( certuin Bxed idcu, or effort* deprcdoat 

' Bpon dclirioiu coaoeptioDSi special fonna or rnQnoniKtiin have been dtalinguisliod 

utd exiled bjr such iuudm as Thaoinaiiia, Em to muni a, io. 

Tba olher ijniptflinib aitbough here alio ibc cerebral ditcose pay bo 

B«Mk|MBied by tba most numerous and vaiicd disorder* q( Ibe grnrrBl lieaJlb, 

) pi—iil BotluDg peculisr, and axe very HiDilar to IIkmr observed in cnnnin. At 

Urn comoieiiceoieiil, whea tb« stuck it acute, a fcrcrisli coudition rrequcntly 

■iiU; sftmrBnis. s1c«|>Icudcm, <aasti[)atioa, nod soDietijiics cerebral eoQ' 

(cation, 

^ 143, The rorm of monomania is developed, like mimla, geoe- 
nUy after a stage of mclauclioly baa passed otF. At first the otate 
of Giallation may rest for a long time indeterminate hetveen the 
tvu funns. Wh«D certain deUrions conceptions become fixed, the 
patient raters into aa CNrcDtiiilly dilTcrenl flaU;; nnd tiiin condition, 
that of cotifirmeii monomania, is, for the reasons already slated, to 
be oonaidcicd a much nnor« seiioas atfcction tluiii mania. The moro 
calm t]w external belmviour of the plient gradually becomes — the 
moK the alternation of the fnlso ideas recedes, and only a few 
paiticnbir but fixed ideas remain— the more there existed in the 
fomicr inditiduality of the patient certain peculiarities which favour 
the rapid pendratiou and falsifying of the fyo by these fixed ideas, the 
ioH i> a return to health to be looked fur. 

During the courte of thcac stales there occur rctuisaions which arc 
more apparent thiin real ; lliey have more the nature of an citemal 
qoMting than of an internal ce»wition, and are only a calmer 
oocupatMD of the tnind by the dilirium; complete intcnniniona 
ottly take place when the disease is efill vacillating between mania 
•Dd nonomanin. 




i 



310 



ATATRS OF MF.XTAl. BXAXTATIOX. 



Tlie paLirtit ouijr recover. Then it scenu to hioi as if & nil M 
audtkolf raUeo froin hu tyta ; be >wik« m if from s dram, nl 
ouinol nndcratnnd wbjr »implo nuomng In relation to hi» dclM^ 
whicli if now rjaite clrar t^ hiiQ, coald tnakc na imprcmion vpaolol 
during the discMC. ITo 15 noir arccsnblo to reason ; Mil) itif ota 
neccmij to tid his rompit^bensioii by oxplanatioiut nail pslptt 
evidenoc in order to coiuplf^lt-Ij' count«not the detinous idi:as vkA 
still occasionally arise, although, ujwn the whole, tbey an reci];iiiMi' 
by liim as false. A completely fised exalted dcloaioii, vhea ilkl 
oontinaed for more than half a jtax, is not easily got rid of; ixf» 
UuleM, CBMt Kmetiinps occar vbere the monomaniji gndaflf 
dtnppesn after it has lasted for »erenl years : when this ocan 
Dther morfaid processes a>c generally devdopul. All «yinptoasaf 
conunencins tneotal nakness — loss of memory, rcearrence of iiito> 
herence, &c.— indicate that the patient is bMomiiiL; incurable. 

WIko he don not recover, he never oontinoes during the irhohcf 
his future life in the state of high emotional exaltation whidi a 
proper to thin form of iosanity. Tlic iifilrmati?e dtspositiea, te 
clcvittcd frnnie of mind disappear, and its products, the Bsd 
ddiriom ronceplions, alone remain; external calm retoms, and tin 
general beoltli improres; or the patient, ovinf; to the dcvelopatesl 
of scrioas auatoinical lesions urithin the cranium, gnduallj 6db ioio 
a state of profound dementia. 

§ 144. It is very inleroDtiiig to obserrc the dose analof^dlt 

exists in esecatials bctirvrn the symptoms and modes of termiiatiai 
of the maniacal forms and tliote of alcoholic intoxication. Tia 
analogy is sometimet observed even in the premonitory ttymptow. 
There arc drunkards on whom a-iiie liai, first of all, the cllcci il 
rendering them (|nic1, thoughtful, and sclf-roncenlrntcd, preseattn; 
an analogy to the prclimin.iry mclnncholio period. 

The esiiential action, hoverer, of slcoboKc drinks is cxcitatioii, 
rxj>«ii!iiou of all the mrntn! proceMw, volition especially betouonj 
easier and more free. At first the ideas succeed each other mon 
mpitlly, the itnngiiiation becomes more brilliant, the langu^ 
aboundf in striking and surprising inflexions, tltoughts ariw 39 i! 
spoTitanfou^ly, convcrMtion proceeds more easily, and niutcaltf 
action ix more energetic: to this concsponda usually the jttjfi 
frame of mind, the psychical pleasure and power. Altrrwnnls Ibr 
drunken man tLrons off all rectraiiit ; the objects of th« precipitate 



STATES OP UKKTAL RXALTATION. 



811 



npidljr succeeding ]>prce|itiotis are immetUiilcly, and wiUioat 
ion, Ihrowo outtianlt in words and actions ; thoughts formerly 
Icept concealed cwapc from him iiiTolunUrily,or he takes pleasure in 
spring «xpraeaaoa to ideas of hU onn sdf-iaaportiincc; ht mamfest* 
^■uleMoese, ooungt, a degree of sclf-eonfidcooe frequently ap- 
^n'oachingto insolciiw; hi; is a bm^art; lie a gcncroiu and prodig&l, 
be appears to liimsclf to be riclicr thau he really is. Fre. 
iHy, certain desires and tendencicit appear with especial force 
recUooaDesa ; for example, the desire to apeak ill verse, to cod> 
le in a foreign Unj^nge (e«peciiJly in Latin), to sing, to scream, 
qnaird, be. tie is Toy initabk, and, hke the monomaniac, 
oOcnda liim more than to be told that he is drunk. The 
maj change with or without externfll motive ; occasionally 
ideas inroluntanly arise in his mind, and he begins to weep 
jlNtleriy; MmdJmea be becomes tender and scutinicritaJ; sometimes 
ilbfl impulso to increased evolution of force urgc« liiro to senseless 
|daug«ous acts, to strike all around him, and ho becomea slightly 
ions. While in this state, a strong mental impression has 
times such an effect upon liim, that he imcuediately becomes 
aensibls, and the intoxication is suddenly cut short. 

Afu^rwards, still gteater incoherence ensues. The drunkard lifuhis 

haUuciitacious and illusions; be mechanically rcjKuts what lit.- haa 

jllmdy saidj liis memory fails, and he becomes quite incapable of 

l^sUing forth new scries of ideas ; in short, he falls into a stat« of 

Qtia. ?fov, presenting a striking analogy to the commonceniemt 

oC general paralysis, the *])cucb falters, the laovenientd of the tongue 

j are irKguIar, the voluntary musclea lose their cnerg>', the legs are 

no longiT able to rarri' the body, and the individual falls into a 

[fltate of powcrlessness resembling tite adynamic condition of the 

[wrvons system in typhus fei-cr, or gciicral psialysis with dementia. 

The phenomena in infuiity pursue, on the whole, the same course, 
I but pnioeed more slowly. Prom a preliminary state of exaltation of 
the sensations and emotion?, of the intelligence and of Ibc will, Ibe 
toMUtc man gndnally, as the cervbnil diseow progresses, falls rato a 
cunditioa of tncntul weakness, nith hn of command over the fneulty 
of Mpericfa sud all rolnnlary luovcmeotfl. 

tx*MnM%XWU.—0-rarml timyttiim, ; mtliOeiotf; mwumxSa ftmt- 

M/iijr ta itmntit. — O— , as oOcer, enjuyinit habilnkl good bo«ttt>, nnil a ttroog 

•lilMtian, Ud in liis yoalli induljted in a mnlliluile of axccum, vUhHi lisd 

beea MIoved by uj afiprMtaUe Iwd MMUOjwnce. Uc wu inilable, 




I 




■ to at er AntaJ 
tf afiKx^itfrnd tor !■ ciM 



■IflT NotcBbir, 




» wAlaaUM arutatA 

Mr- Akorir « lk» Uowiiv ■»»« Ikt 

»wyr iilriiMiM^ Brng^mii 

to vW Ik* dMghter of > ■■pcrior o&s. *kM ht w« l»M •fi^tij BoqVMsUl 
wilk, Md Tfaow haad be n iboat to nk. He hMl tlrmjjr boa^kt a iwragt 
mJ Inne Car ike parron «f »MkJi« a loag jomj «>tib lkt» lad; tkrea^ 
bnpi. Ha dedmd UmsV la be «f aoUe blood, ud usanaced lk« Ui 
piomtioit via to k fttj tajod. Hk fcapp ia aM m al Ik lijgb«*i pitcK iad 
he-i>kcdto«hBraitwiLbthawMa*atU. Chacfc«dalNadeBkca,h0fcUiil» 
a Bt of ftenaj. 

TowMditkBtad«f7fo*embfrWeot«ndS)(igfaiitg. The pupiU wwr tomcwlMt 
contracted; tbe heaiotrlKwid tcaelj veresmllen; be b«J t"'°> >i> the)aa>U; 
ll>«r« vu « ilet«raiii«tiaai ofUooi) to Ui« hod ; tW polic «*i rapid. Ue ra 
TCTj irriuble, ami eaiiljr becaae earaiR^ He imag^incd Uiat lie poaaeaacd ■ 
CMiidenbte ferltiBe. aad ir« or \otlj lUtion ; lie bdwrod biBaelf eadowed «ttb 
aiipematanl power, &c. Ererj minute li« rlirlrihiitfi ihn largfmt nwil of mnacij. 
one liuadred aii<l tventj mtlliost of louis^J'or; aJl«nnnb be lajn tbat be It 
Ood Ilia Fallier ; but if uit one asked wbo kit father *ra>, be replied tliat la 
ira* a ju(!f;o inUieoourtof cxchti^ncr: and it vas in Tsio thai ooeUied toaboa 
him titat what ]jc uid *rat nbtiird and impouiblc. At anotberline he aaid Uut 
lio had been in heaven, and that lie ht an eioccdiaftlj bcMiUfal Vcoua; Um 
follcnrinic da; tie Mid that be foiiud lilniself in tlie midst of KTcnl tutadndi of 
VciiuK>. Ue wished tn iiiorease alltliarooiDaor Iheaajlura l^raeaiuof Ku.ud 
to Riro Uicm ooDiidcTablc iiTDponiocis. He wt^ied to iiicmoe men in sue, ui 
U muka tlieiit giants. He wiiliod to rabe tbe dead ; and especiallj lie walwd 
lo lram|)Drl iltoustnda of rogimenti ia Lbo air bj ntilUoDi of baUoOM, ftci. Tct 

■mtlii nflcr lii* adniluioo, tbe atUoks of rerltgo returned, and by 



ajdjj^ 



»TATfW OP MKNTAI. KXALTATION. 



813 



* 



•jrnptMu of gwenl psnljtit vilh incmsiae liemtnlta dcTetoped ihemtelvs 
•pnpleflirorm ktlsck*; ile*th. (Jicobi, 'fieobacliianpeii,' ftc, i, t&^O, p. 372.} 
EXiMFLE SXXVIII.— J/ewjwiiiMtf Itrmiaatitg in drmnUia. — J, U — , ai. 44, 
foranlj N officer, nuuifctteil alie«dj for a lengtbened peiiod ■ccrUm Wti- 
ivns in his wb lod moreniciiU. EIc wis rcslleu ud irriubJe. la ihe wtater 
of 1834. etcn ■krn be still pucctMlly nUeoded to bit bus'tD«3i, be began (o 
MClvde biBMlf men iii bis clwiuber, vriiicli be bad (HJorucd Ju a iumenlial fau- 
tutiB luUDer. tnd rod a bonli df very line type lijr lliu light a{ a Urge Ump, 
•Md wilb a pamcful niBgaifTiug gl>M. In spiring, »jmptoin« of cmtitioiiul ex- 
eilmtat vera almdy nuLiiifeft. InJulj, Ibeicappviircd idtas of liio poueasion 
of an immcnw fortune and of (to derated poaitian. ^tion \ik bclioved liimactfta be 
tlic Piiaca ot Neucbaldi tad attbc tamo lime bo IhougLt biuiftcir b great 
(iMintcr, and ipent tba entire d«j in dtkiitnLng and eoiouriug landMapea, u cbildnn 
«rCivOT«i levsdo, andsbowed tbem tg e^otjbody na chofa-d'oiUTro, 

In a fev days he hu admitted into Siegburfj;. Tbe pnpiU were Dotitraeted. 
TTfl bad, at tbe root of tbe noae, a derp scar, the mult of a vouod «liioli be 
liad rcfcind al Uie age of twentj-flve b; falling from a carriage. Hu speech 
WM btvilMli^ aiid fast. He bad seteral *lo<ils per daj. Tbe pulse was soTl 
betwetn ^^ ud too. Trtmbliiiii la ibe IiihIm; id the crciimij a kind of epi< 
leptte aUadCi (allowed by gmt eidleaicrit ; palpii ation of tbe beart : opprea- 
•MB ; tlMN^iitKoeoua reins were greatly sWlcu (blcKidlettin^]. 

TlwfolknriDgBoruiDg bcwucalm, «crt happy, wnlkini; cunt toualljr from one 
aiile to Ihe other. I^t«r, pvai agilatjon. Tbe putinnt wskbed hi» bead wiltt 
kit nnM, aayinSt by iray of eictiac, that il was the fosbioa of the Uoltcntota, 
Often hit reqiteated Bome OM to get ready bis earriagc and saddle bJa Iiotm, 
■ni bnt kit keeper because he refaacd to oVy liim. Sooicimes be cried «ad 
■liMd«d ■hn hinilered froro indnlRiog in his imane praotioea. The couutenaiioe 
vaa pale; the took bed ; tbe bead hut and lluslied. Uc alcplalittk >t nif^ 
(baths, tutar emetic, hlexdiuf, acrluaioDt moderate dint, tiudure o(digit«Uij 
kirr. leechM ood eafemel]. Sometimca the patient rubbed bis bead witb hit 
oercfiieat. Se collected pehblc*, to wbictt be altacfaed great t*1u«, sayinfc Itiat 
Ibi} vera diam«ada. llesiidtbot be mai goiug to Mexico irithajrealietiiiuei 
hTwnwi be was appMaled ambu^ador, Ac. 

Grvltially be hccaae more calm ; Ihe pulM ilover ; tbe iMnpetatore of llio 
body norvaal. .\ti abittaa formed on Ibc bip^ which 1000 healed. Me uk«d vhj 
hs bad ben brongbt to Siogfatug^ aod cuuld not reooUect any circunulauce 
titbar of Ua joamey at of hit adnbiiou. He said thai his daughter, ciglilren 
ynn o( ^e^ vat to many the aoii of the first l)aukcr in lie couuli^ ; and «lun 
bt wia Budt tOMofeas that hbdaoghlcr vaa only four yean of age, ud hci be< 
(ntbed fivr, he did not tceni grrally surprised at it. He wrote hone that 
hi* wife, bi> brother- in-law, and the relaliotu of Iiis wife. Iiad been cairinl off 
to hell by Uio de«U ; that God bad offered bim a high poulion ia LondoQ 1 that 
W bad (orwirded bis walcli and hi* nBiIorin to Uesioo, &«. 

Altamrda ke bigan to say tliat be wu the Fiinoe of Ntucblttel, and that 
he was about to bate cooferred upon liim the order of the Holy S|ilrii. Wbcn 
I ified to abow hira tbe absurdity of bii rcmaiU. ba look uo bocd and ooa< 
ttniirJ lua tali. He one day secretly wrote tO ht« •oonl. tKfllTtnK ^>>> to U7> 
irft«r«DOtttiu Utalbe was Prince ot NcuchfMI, Md H Ivrtinl to him 



8H 



STAtaS or HB.NTAL EXALTATION. 



tiovt|M[»cr conUiDifiit tlw aocmint of bis nomtnaticn. At Uc mnc tinr, be 
cbirfccd hii friend to buj Tor him > new bonw «1 ^Saoo floras, fto. 

After amny ilt«n»lioiu of aim wd mlienalUj, with neir nsmfMtatwM «( 
monOHUMW, l&e pUicut, «Dil«r tli* cmploynimt oT ili^laU% bl«edii^ it-, R- 
nuined Tof six moatba williout aboiriiig U15 ^tpmuble sjmirtoras of iiuui^. 
But MOD be rd) into a stale or inlcUectaal «hIcb»i and coofaiioii of tbavgld, 
■nd eiglil dajt ifter kia dismiiial be was broogbt back mnn, and the nUf 
aianoted lb« very mbm ob&nettf aa foraerlj. lie waa aftenratda reawtnd la 
an iosiilotioo Tor ohnaie cne«i (Jaoobi, 'Bcobaobtungcii,* ftc.. utijt, 
P- '!)fr) 

tMk ittiirioiu cemctpliau ; vJUrwar^ niMaaMiA—M. A^, ant. 30. of t i^f 
lircl; diipoailion \ <ivy gay • had alm|s had hit own will rrom tJie cadEMt 
jcan. He ia Mnsitiro to an; lack of ntfttX aboira is conpanj, and haitk 
aaUtkn to pan Tor a person of higb importuice. He likes violent exerting 
Mcb ns (he oliaw and rmcin];. He la mcd when be cannot exhibit a gnri 
iliow. Prom bis birth to bit fif teeiitli jcar, be waa aibjeet to cOBTulsHQa. it 
us jean, be hod ■ sbatp inflamnaticu of the brun, wbleb vu eared al tbe ^ 
of tea daja ; at twelre, he bad fnguioal licrnia ; lal«T, bo had inflamnMlwurf 
(be tbroet with delirium. Dumf[ liia iafuiej be was ofUa expoaed It 
ftlarming incidents, living at tbftt time in midit of llie events of !» Vtodie. 
Since ibiltiaie, M. A — BOTcrooased to be tnbjwt la paniesof frar. Arbittay 
aitd violent acts ricrciscd lottkrd* !i!m in lime of trouble, contribated to fbiti^ 
fail tendency to alirm. Ncvcithclc», his conttitution got atrooger at the tine 
of puberty. 

A — , after baviiij; faU);ued bimselt willi rtadinf;, is aeiied by a bve o( 
■tiidy, and is connnccd tbnt an allcmpt Is about to be made apon bii lifr. 
Already be feels tlic terrible cKvcis of poison, fie dreads all vbo appnauh 
bim, except bis pnrcnt*, wlio are oouilemned to siifTer Ihc tame (al« with hiB> 
self. He bclicvts Itc sees and licara people stmcd with poigMnb and air-^nH, 
wbioh hare been diilributed for tbe purpoie of killiug; liim. If be wnlka in tlie 
garden, lie conica back immodialely, a^ing tbat be beaid a bullet vhistJe pa)t 
bisear. Somctimca lie iadulgoa in oioosnro laughter, and vbeu aakcd wliy, he 
aiiiwen that he bears soimds out of wbieh he nakea words that exeile his 
Inuglilcr. lie would fun persuade those around (hat Ibey bear tbo aaaw 
louiirls n* lie does. He is conscioiu that be is reckoned mad ; be bewa wiUf 
iuslaat someone crying near bin, "Uadoisn! msdinan !" He ofles aahs Ins 
parcnta whether liis eyes tire not Gxtd or bags>ri). Often, after b meal, he 
Tares, and feck bim&cJf opprc«ied. While in an ion itt D— , a barber wbi 
came to share him bent down Ig gather something. Without any preriou 
allercntion. A— lircda pitti>lat bim and Frncttirod bis inn, Ercryt bins seemed 
to »l!ow tbnt be mintook the unforluDBleniftn for nn a**Msin. Aficr that St of 
maincis, A— rcmaiiieil Qrc dsys without drinking, eating, or goUig to lied. 
After tbii, lierecovcTfilhia&lMp. A — it more none aod calm 1 lie eata, sdthaagh 
nlwaje posscssKd by fcan. 

lie wat now r>ut under my charge. The coontenanN of ths pAlient is 
eitroiTiply cbangerul and nninmled; hu bearing proud and haughty. Daring 

iBntdajslierefuseaevery kind of food. Ue will not ban his beard triocned, 




STATES OP MGNTAt. EXALTATION. 



815 



I 
I 
I 



tie Joes mot tieep. Tbe bovelft, is tfitt of Upid batlis eflntinued kr Mne 
IcBKtli of thne, renHin conttiptlcd. 

A— pftUndB to be the first m&n of gmiui in tbe woHd, ud attompla ue 
miUe OB hu Ufa lkroii|ti feu that he ma; become Lord of llic nDiTcrx. He is 
ApoUs, Cttnr. InTirtM ef bistVDrold litle. lie cxpcels udrcqitires iJUbe 
WVfMtD ob«7 kim. n«i8Mliaincti ilixt llic loftictt iratoii ihouM be m> con- 
PiaailFd villi hiuuit;. A — writes to tU the men t ho occupy 1 be higbett 
potitiod*, CTca to the king fciRiieir. £ieT^ inotDciit lie oipecUi orden to act 
him al libtit)-. Uo Ibrratcss me witli nil tlio weigbl of Lit authoriU, tbc mo- 
in«Dt be iliall be tt libcrtr. Mcanvbilo bo ukt for in fedi-oeat« lad a therif ■ 
officer. Be alODC u muter, do «dc bat isj antborilj over bin). Hi; kokvcrt 
diidilDfiil]; qoratiou addreaaed to him ; vsry oftea he does not deign to 
ma)rmaili3l. 

It !* qnita inpoulhle to pcreuadc tbis patient that he is the sport of his own 
dbonlend booj, and that lu« oonditiuc demand » medical Ircatmciit. Peojil* 
Tob, be tajt, to turn liu head wiib their reniuJies ; but it ia of uo use, iLoy 
Will oot inccMd. Gentlc«CM and pcnntuion ivre pfiwericii. When it is need- 
fal that he ahould bathe or hnie ■ bliitcr applied, Jl esn only be done by a 
l^ml tkov o( fom. Man; timoa ibo palient is cntm ; he latks well, is nmiafalo, 
plaja at tercnl sports, oad nanifeata no tjrmptomi of iosanilj^ ; tbe funcXiooa 
tif tbe oristniani preaent no lUaordcr. (Bsquirol, * Gcittcaknokhtitco,' roB 
Benlianlt, ii.p.S.) 

EXavi-LE XL. — DtKriftivn ffitvm by a noncmaniae o/Mi tomUHtm. (SrafM 
tmo H tKt </ aifiMii Jrimdi fxalt taiyi»^ idtiu ^ ittialrioui pgrtOKolUifi.) — 
A poor thrfjuua, vbom the too rigwoua obtcrvaaoa of bb rowa hti roudered 
loane, nhted ia Ualot7 is Ibo following mannct : — " tliTliig (pme to a house 
«h«t« I was called on Mine wotfc of be&cralRnor, itt tbe enlraace of llie dtunber 
into whicb I wis introduced, in glnncing towards two women, tbcy nude an 
i«|iretaion npMi mj sight and iniipnatioii so livolj, that the; seemed to me to 
ht«a bera illunbed aa If tbe; bad born cicctiiltcd. tgaorani of tlic ciuie of 
M abfular a pheoomcDon, 1 atlriboted it to ialanic igencj, and left, n'hen 
I bad got oat of tbe boaao and awaj fram Lbe objeota wbioh kid so strongljr 
aA9tt«d mo, I becaaie calm ; but during the day, baring rnoovDleret] other 
woiaca. I bad tbe sane distraction and the ume illaaion. lie following dii;, 
bdBg oa a ioaniej, it stcmed to ne aeToral limca that the carriage in wiucb I 
wu snlcd vaa about to be OTCrtumed, wUicli caused me to a; to the pmple 
la ebar][« of il to bold it up. Bat the false ahums eaoatng llieai to laugh, I 
kwcv loo wcfl what fiat mrant. There was, ncTcrtLelcss, a diaordcr and dft. 
niQinaeDl ; bat m; enor laj in altnbulinj Ibis dcnDg«iMiit (o oilemal objocta, 
■twwi it waa ia tbe organs, and in tbe oonftiaion oftetiK occuiuued b; mj 
Mtar hsTiiiK read, seen, or experienced anf Hnular dnntnUanee. On i{v. 
a little town wbieti Ujr on our route, and biitig aeaai sercral women, 
cauaed me the same trouble and tho Hmo illnatOQa u Unae whom I luul 
In lbe lowB. Arrited at the iaii, I bad dinur. T!ie bread and wiae, u 
wdl as crerjlUng arooaii aeened confased and irimit to be orcrtunicd. Tbcn, 
penoaded that n lalanie power aeoonttuuiled me everywhere, 1 left tlie ina 
harrftiUjr, tetUng the innkeeper at the same time that I thoogbt be bad a baad 
ka it, and I ectered tbe carriage again. Tbtn, filing n; attention, aa far aa 



1)16 



CTjITM or MRV'TAl. RXAI.TATION. 



Um agitatioii of tuMtj tnd ffdiag would dlnw, m aj ■drMliirw of Ihe pmiov 
— cp i ig nd of to-dsT, I wu «0BflrBicd in iha opinion bj tka fabUa of Bila- 
dcMjn, wbicli rrprracDl the bermiU st coalianalij boicfced bj denoD*. Ttie 
woH» of St. Pka), nlkere he uj« IW it >• not 0DI7 a^kiatt Icab and Uood tint 
ire hkte lo fi^l, but ngiiul apinCMl powcn ti vril. ctraUl aot caoB|H ar. 
■nd, arenins from thai, I noepuMd no oihn- eanae of nj troubl« and flbt- 
no» except the po w ewiow of s duM», and I rMolted to oomeqaeooe to nake 
WW aciiuat hJin b; baltuf , pnjer. and eiorciuii. .... 

"M; tciiviljr haring bcsa ehangeJ into vaHike ttuj, Ibe image and rnnaa* 
bnace oT tbow wanion vbOH bitloi; and cbamcler bad moel alrongfj im- 
pKued ma in mj duldkood preientod tbecuelvea to me. Tlieii, 017 imagiat- 
tiok tnuportiag ne into all tlie eombria and nnanlta of wluob I bad nad lb( 
hittOTT, I wiihed lo npresciit tlinc nhova cbirielcn, I tried Ifaose of JUo* 
aoder, of Adiillm, sad of Ueiif^ IV ; and. with tbc fint, to wboaa 1 likened 
wjaclf 10 far u lo believe that 1 powowd bis appearaacct his aame, and lo 
bo biiMClf, I conquered at Aibelo ; I Ui>i sie^ to "Syn, and earned ils rui- 
puta br aauult. IVhilc L nprcacotcd Uk chancter of Akxaodcf, the unagt 
of the Tj^riant wbum Uie ooDqoerar cakied to be iupMded on erout* aloaft 
tbe bank of the t« came to mj imagination. Btiasd vHb iudifnaiion aai 
with horror at lliat iprctaeto. I detcaled Ibc cfaanctet of tlie Macedooian hm, 
and t DO loutprr dv^tred lo be that nouter ; but, flxiag nj attenlion Kpon Ibe 
Mid riolinu of hia ciucllj, 1 cmered into Ibe feeliaga of tbe luforttuiate hm. 
and was as sad beoaiue of tliem as if tlicj bad bees betide ue. Uimoga 
Kooul atldck of warlike fnrj, it look taj faoc^ to awicnc the tAaraotcr vt 
AabiU««. I Cincicd nijtctf hlnding on hu amour; I ttioned hit ?oiee aad 
eonagoi I nddrcucd to the Trnjuna worda of inault nnd deSanoe. Tbtn 
dririDg before mc, ovcnhrowiag end pnltu; to ffigbl tbe batlaliona. u it 
teemed to me, 1 found mjgelf, of a andilen, at tbe gatea of tbe palnoe of Pimsi. 
ThcDi bj the oonfiuion and wandering of an imagination which prodnecd impi 
the Dbsractera of which were dim and badi; defined, pasiing rwpidlj fram D* 
eharaclei of Achlllce to ihat of PjttUuh, or rolher, eoafoniMtttig the pcrvui <£ 
the father with that of the son, aud slronK'j impRiaed b; the pict&re which 
Viigil tnaic* of the lalter, believing mjtclf lo be the bero« I got bold of tbg 
four pillnn of mj Iwd, and I tUicw tticm Tigoroudj againal Ibc door of Bf 
room, which 1 drtgi^^d from ila liinitea and carried to a diatanee of (ov 
paces olT. Traiuparted irith joj, excited hjr lUe sliook nad hj tbe cnah, I 
shouted, ' Trti; h rnllcti I llie lainn: of I'riati) is no more !' 

"Mf pnrciits, vlio knrw nolliing of what ailed mc, followed tlifleonneef 
bludiitg mj bod J aud sluLckimg toy bauda. Good Qod I nkal aaffcriop I en- 
dured ! irhat a rctolutlon wu neoompliahed aJl at onec in a; imagiiMliMl 
Fallen from the high Jcgreo of fortune to which I liad rkiicd nijtelf-^ovt- 
cast, oterwhclmed— I looked U|>oii mj cliaiiiia and mj prison witb bovroraad 
tri'rii tiling', and 1 frit n burden at tlic moit terrible dotpair. Having fJca 
ablcc|i, irtf imagiDBtioD was utailcd bj the most fearful imagca, I tlnnghtl 
■HIT Aiicii-ut Ituiiie riaiug from beneath il« ruitl^ Opening its tomha, and fu- 
sciitmg to lujr e<ie« the ikclctona of the most famous warrior* iareMod ia 
armour, tiio &ba{«, the variei^, tlio Butlquit;, aud Iho rvst of wlijeh ooulilBUi 
a horrible tight. Tliul speoUcle impn'ued uij imagtnatioa so stroo^j, thai I 



STATES OF MKNTAL LXALTATIOM. 



817 



nmuniiil for t ioag lime without betn]i ihle to fix mj itl«ntJoa on uj objte 
«r pine of inn viihoat exlrene bomr, wb!cfc, paMtnf; into mj rerj mom* 
aSMei ni; mdm «r smeJI with a sort of slcncii of iron uid bras* — ■ diagrmblo 
odoar wkie4 troaUed me for tnuiy ddjrt. Aflcr Uiat, mj inwgintttion icot tlie 
belter of mt, ud. nusiag me to travcnc ttie bop* of rain vbicb ^>p«u«l to 
cnmbls aoikr mj reel tnd to thruttn mj lieid, it led me to llie gtUs of tbe 
toaipk of tb« 1^ of wir. I thoogbt I wv ihew i^lca open, and Iward Itieni 
grind ipon tbeir biagn wilb a borrible noite. 1 law the goi in midst of hi* 
tanple, aad, hy ■ end tnck of tmifiaalion, I btjiered mjM'lf • monsiM 
drippfag vitb blood and carnage, and bden witb chains. The >Ulc 1 woa io, 
baud and in iroos. fKonrtd that illuiidin, pMliapi cauaed It tn i.|>niiK (ij>. I 
imputed Ibia fii^tful trealmcDt to lb« ialiamanitj wbid 1 fancied to have 
been nbifaitMl towarilt Ibe penon of Hector. IJererlbelesi. a momtmt nriof 
wards, hj a nlani of that rcAectiTc fovcr of wbich I lecincd w liulc Mpablc, 
wnadiiii! m; feelings and flading Ibem oompletclj oppoMd to ihii feature o 
inbamaiiit*. 1 dinvovcd ai<d ibhorr«d (lie eritfll^ of Atliiiles, aiid ptanng 
!■— Jiatdjr to fcdings of Ihc leiidcrctt pit; and conpuaioih I dopl<nred tha 
fate of lite Trojan ben. I cried, or belirvei) mjidf to erjr, *Oli ! Hector 
dear HkIoiI «)ij m*j I not collect Ibj »ca(t«red lisib*, to b«ili« lliem, to 
warn then witb nij lean, and Iq rtstorc tliem to life!' Am I (poke Ibeie 
wonb, I tkrd. in realitj, a flood of tcun. 

*T1iefcding of tbeac gentle pauiotu broagbt me back lo pence and Iranquillilr, 
vbieh fakdaeed taj parcals lo rcttore me to liborljr. I found noChinft bo deli- 
dotti at tbeac fint nonwntt. It seemed to me that all nature, formerij a 
G^lfte, bad bust its bondi, aad etijojed with me the ehnnnt and sdvantagea 
af Uborijr. I took the dtaraclei of a {icaccful ling; I fuiciod tb»t I fottftrtd 
and eurencd in m; imaginar; ilomiiiion all tbe art*, all tbe •oJencca— painling, 
aealptnTe^ arcbit««tui«, grioineUj, &c. I drew, I made plana of apaitn(nt«t 
wWak greniJj amoicd nc .- 1 had ao correct aii c;e, mi to firm a bud, tbit, 
wilhont an; oUicr iDalrumonts Ihan were at band, 1 traced ima(n on tbs 
gnand or oa tbo partitions of my room with oitniordinBrj accurarj. itj 
paxuita and otber aimple people, lurpriseri at aeeiitg me cipreas in tiicli a bapp; 
waj •airral feature* of talent whkil) Ibejr knew L never before eihibited. ima- 
gra^ tbere waa aometliiiig anprmalural in it. 

**1h diapoailiMi wlileb poMraned me gare to mj sense* a i^nielaeaa, irtd tal 
mj inUlttgcnee a penctmtion, aatl to D17 soul a grsDdear and an elersiioii, whiob* 
■adn »e u extnordtnnr; men. I leemrd to md llm heart of people wbo 
a pproac h ed me; T Bnfddcd tbrir diarsder with aatoniabing nagacitj, and, im> 
Indntttoed hj anj coraidcratkio. I described it vitli jastice and precision. This 
gave ooration lo a prieal, who cane to see me tometiioea in mj illae*a, to tell 
BBj iwrrnta quite scrioiul; that I wai poascued bj (he spirit of Pflho, Ibe 
•anM that St. Paul drore from the spirit of a girl, and menlion of whteb it 
mad* IB the AAaof the Aptndei, 
" It mv< periitpa, snrprite praple Ibat I have been able to rememberao 1 
and eircnmalaiicrs : but mjT imaipoation waa ao actirc, that tttrj 1 

ilaair tliere, or rather eagntod itadf in cfaanottn of fin ; and miqjj 
thfngi wbieh fomeriy oalj touebed it aligbUf when I wh in beallli, have rial 
Ibat tiaM beoea*e noeb more aotosl. [Leuiet, 'fnfftvtt^ Ae., tmm, it 
p.rtj,) 




t 



( I4j. U:(DEU this secHou arc comprehended a serica of morbid 
stales of miud wbicli, altliougfa presenting great differences in their 
drtaib, collectively fonn s natural group. Tbe; all closely resemble 
each oilier io the circum«tuice thnt (u-ith a few exceptions to be aAcr- 
wuds meatiooed) tfacf do not constitute primary, but consecutive 
forma of iossnitj, — that tlwy continue as remnants and residues of 
tbe forms which we have already been considering when tkese are 
not cared. Further tlicy arc Allied in this, tliat the fundjimenta] 
mcDtal affectioD no longer dcjiends in them, as iu ineluachoUa and 
mania, upon ruling emotions which secondarily involve the intellect, 
but tbe disorder of the intelligence constitutes in itself tbe . fundn- 
mentil anomaly, the emotious being suppressed or entirely wanting 
($ 31^). Tbia disorder of the iutclligcncu cither preeeata the decided 
cfaamctcr of weakness, which in dementia proper i* mauiferted iu 
tbe rioggisbness of thought, the want of normal reproduction of 
ideas Qoaa of monory) and their healthy association — it may proceed 
to toUl abolttiou of all the mental faculties, with which there is also 
combined weakncu of the nootions and will, want of energy or com- 
plete looi of rdition, and dulness of the emotions, bluntnosa of tlic 
mond nature arising from (he absence or superflcialily of reactionary 
power, — or the mental woJuKSs is in a mpaaure concealed by the 
predomiuance of certain drlirioos oonceptiuns, wboae obrtlnate per- 
aisteooe is aignificaot of all that remains of mcotsJ powcTj and 
behind which all conaciotisneM is bttt an empty roiil. Out of this 
▼loao^ no ideas can any bnger arise which might coniit«iact and 
oTothrow the delusion ; oltboagli the patient is no longer gorenied 
by a dominant sentiment, still the delirium remains per^steni, owing 
to ncoity of thought, wbicli ordinarily docs not merely affect the 
limited sphere of the fised delirious conceptions, but is only the 
partial appearance of a general diminution and deatnietion «f all the 
■CDlal prooesses. Thus we cunnder i)taijMriiel dementia oi^ht (o 
be eonprehendcd nnder tli« states of mental weakness. 



sao 



ftTATKB Ur MS-NTAL WIlAKMliSS. 



lo these Btatn wc no longer recogiuse the duugeabJIity of the 
foWM wliirii we luve hitUwto been cowiilering, nor Ihal aclirilj of 
the morbid ))rooeH in irkich the pLiy of active, licsUliy mesial 
fuDCtion, mcntiil ulaboratiou bjicI cDtnbinatioii, \» so jiUirilf neog- 
nisable (pnrlicutsrly nrcording to the law of caiualitjr). Um (bt 
Cilse idcB», in so fui aa ibejr are not taken over Uom a forma- perimj, 
dqxnd in great part mthcr on incohrxeiice and veaknes^ of Uwogbl, 
or oil purtial dementis, upon ballucinatioDs iiot de]>cnding od the mo- 
tioiu and ou au eitrasion, constantly inon peuetratingj of foma 
delirious idriu rdkting (o tlie cattro >pberc of perception. A^ 
these morbid states (again with a few exceptions), when not cat dmt 
bv death, arc \eiy chronic in tiieir course, and generally arc ca|MbU 
oidy of one Vind of cliange or modificatioa — iuuii:ly, increase oT tbe 
mental weakness. Pievertbeless, they often remain quite atatioDai}' 
for long Bcrica of years ; tbey uo longer admit of ooinpletc teeoro?. 

Uy hiTing. in tlie Brat edition of tbii n-oik, eluted partiil deauntia witli tk 
■lalM of BtDDtal wcaknon, bu ctuicd % ^nt deal of oontnrcnj. But. is bd. 
it oaa be plnced novbero cUe. In ooniplcta dcoiaatia vo bare, sJoDf vHk 
dcliri«as concepliont wliicli \ivt b«c«iDe aa it wero >terei>t*p»d, a deddcd 
diniinuliou of Hie moral jinvcra, a nieiital decrepitude, a vrcdi after the ub- 
ndcd atomt, Tlitre tii»t*, it is true, l>elice«D lliis tenniiul point tod tic 
primacy staKu, iti man; pnlicnta a lonit period o( traiuitloot in «Uich tberc il^ 
I1U51 uotind ievtral rtouim of dellriom eotieeptioni remainifift over frtm then 
priiuar^r ata^ci, uti aciivf uiciils! procus. Ill lliia lie ddiriuu bceoimea ia put 
muilillrd ((uile kvulunUrilj, in part nlaboratad lad ijilasialiMd (} 44). Wtnn 
till* i» cnini>lotrl; 6niihi-d, l!ic quite staltonar; period ooniseiicr^, in wki^ tlic 
delirium consists odI; iii a rrpctitioa of llic &icd rcsiduar; ideas. Tliose abdta 
orirauailion nliicli alill permit a ccnaio clian^ of tlie morbid neotal pheoo- 
mena, kod nliicli ftre Dumcrouily rcpre»ctitcd in ctcij Mytuni, m;, ia rtf^td to 
clauification, a aouroe of entuFCuameat to tUa beginner. Ue may, vittumt toi- 
tutiou, keep to ibe priuo>|ial cImsm wliicli liart beva here evUblialtcd, b«t ami 
coDiidor that aomclimcs a long period of o)i»;rvation ia nccc»arj to determiae 
ia a ^fW caae liov murb ii ttili activltj and pro|;rca«, and liow unci) it MV^ 
rtaidae. NcucnanD (' Lchrb, d. Pajoliiatric,' )Ss9< P- 7^) 0*^ '*bat WO dea^- 
nito (jeincniia, " recotcr^ wiih dcfoct." How far " rtetc*rf may be ^lokm 
of, or rather cannot be spoken of, i* clear. A» lo tlic "itt/ed,'* it caaMitii^f 
expTCsscalbc aaino view wlUcti pnunptcd mo to dua dcmCDlia amoagal Ibi 
atates of mental ireakntat. 

§ 146. The atfttea of mental weakness comprehend two great 
groups — Chronic Mania and Dementia. In regard to the firal, wff 
refer the reader to the description farther on. In tbe form of de> 
meittia we distiuguiili two dlvi«ioii« — the uuc with incoherenee 
of the ideas, but witli considerable, although merely »uperl)ctal. 




STATES or UBKTAI. n'EAXNESS. 



8SI 



•ctivity of perception, gcnerallj with a sligUt dcgrw of outward 
*gilalion (d^mence agit^) ; tlie other willi extreme sluggishness of 
perception, even to complete abolition of it, and with eiternal apa- 
thetic calm (dffmence apalhjque). U\ this cUvigioa wc onl^ consider 
that form of dementia which isacrjaircd— that, namelj-, which occurs in 
individuaJs who have been foroierlv mrntally healthy. We shall 
devote a special clwiiter to tlint form which is congenital, or 
which nriiiea in the early yean of childhood — the rarioua degren 
of idiocy. 

Tliis acquired demeniliii, coosidcrud as a f>{>ccial form of msanity, 
may of course arise primarily — that is, without having been preceded 
by anotlior form of mental disease, or other cerebral disease of a dif- 
ferent nature, as in the case of the mental weakness of advanced 
life or preniature decrepitude, primary atrophy of the bratn, intra- 
cnmial tumours, kc. Aa to the cases described by many actthoTs m 
acute, curahic, )}riRiary dementia, the great majority of them ccr* 
tainly belong to melancholia with stupor, in the description of wliich 
we have already called attention to the readiness with which it may 
be confounded with actual menial weakness, and (o the distinctive 
signs of both forms. Nevertheless, it cnnoot be doubt«d that there 
efirt intermediate slates between inckucholic stupor and actual 
dotnoDtis, and also decided CSMS of primar)-, acute, and curable dc* 
menlia; in proof of which wc shall cite an ititere»tiiig eiamplo of a 
case in which the dementia was probably owing to a:dema of the 
bnin fioiQ pressure on the cervical veins. 

EsAMFLB Xhll.— Butt <f^ dmfitha o^Hntvt icMt/ dmraiicit, anJ vHMout 
tbat^w^t rtfotUetioM ^it, eauttd by an otlfaplat f{ra»ffiilation.—k prisooer. 
■t. 3$, atrong Md Uulthj, liangcd KImirlf. .Uiiioat immciiintcij after Llie 
cutting down of the body, it sboivcd signs ot life ; coiisciouxnMa returned. Tbe 
pftticat gave, apparenlljr qui[« ealmljr sad senKiblj, tlio history of liLi ]if« ud 
hb inoliTe for Ibe deed (wmriDew of life)- On I be roltotrmg day he wa* (ran- 
quti xdA spoke little ; on the third da; he spoke aone. Tlie cousteaance was 
fis«l, tlie eras rolling Dud injected ; tli« teiD{)<M»l aud msuctcr muscles and 
Ibose of ILe ejcs were eonvnlscd ; Uic face immovable and lifeless, like that of 
a statue. Noteusori&l inipreMions aiji^eiLred to be perceived, but a verj- loud 
■oand caiuod sltgbt coutr^ictious of tlie fixciAl muscles ) l)« vent sbniit nnd sle 
withont expressing desire or seiuatiou. A^ftor three weeti lind eUp«ed, the 
peUent was taken to an atf lum ; sods/'cr nfcw morvweek* hn av-nkcnRd. ITc 
renenberod perfectly weU tlie time and tlic circumslaaoea wliieh Ijod iirtcedcd 
lli« haagiiiif! onti) the onset of l«ss of eonicionsDcts, and described the violent 
allVKgle in tiis mitid between the resolvcstidlhcrulfilmeatof tbede<d, Md the 
KBMlioas in the inouicnl of liaaginK — riaginff of the cart and start in the eyea. 

SI 




ZM 



tiTArKS or HIL^^TAL WSAKKXU. 



From Uiii tim* to tbe ^Mf of liii kvakug in Uic Mflflin, kfl i»coll<«lm of tti 
penoDil euftcaoe vu vtatiug ; «tu tin lauHtiaD ilUr tho liu^ag tad V» 
teafontj pou«nion of eoiuotoiiiiieu vtm qoiU aakitowa ta buo. lb 
(ceond awtking took place •nddenlj : one ^7, to Ite courl) Ui« tde* of be 
huldingB RToaDd vu avikened ia him, and this called Torlb reme»bafu»c( 
oUmt Birailar objecU. Tntn tini bov Ike nraUl fuadioiu and the g«M>l 
ksalUi npidl; beoane n>«slabU»hed. (Medtsc in Siebeubaar, ' M v»>ii i« 
die StaatsuBuifaiiule:,' i, t84J. } 

But far more frcqufutly acquired dcaumtta originates oonwwA'n^, 
that Uf after the sjrmptonu of auotber serere oeceliral iliseaM (epilepqTi 
uQte meningitis, trplioid urebnl affectioiu, kc), imd efpccUU;* vW 
otiicf fomu of insanity hove preceded it. It coastitut«3 then fbf 
nd end of all mental diseases wliicb retnaia tuciuvd — mclancboiii, 
maxm, and monomaiua. What is rciy remarkable, senile demesta 
even is not unfre<iueuUjr preceded bjr a period of exaltation— 4 ibnt 
maniacal stage, characterised by great iwycbic*! irritabilityj a ae»Ij 
awakened tendenej to acti\'it]r, reappearance of the sexual ieuxi 
(wishiBg to marry, &c.), and s craving for alcoholic drinks: tfo v 
then followed either by rapid psyctucal oolbpse, or short periodi d 
exnItntioR alternate sereral times with the increasing mcotal woaknee- 
Duriiig eonvfllesoenoo alao, «spcciiilly from violent mania, tbne nut 
unfreqncntly occnn a condition of profound mental weakness : lki> 
statt: bears the same relation to true dementia that great ukl loi^- 
continued fatigue does to bcIuhI panitysia. 

It is not at all anasoal, although hitherto it has been very liiil' 
attcodcd to, to observe a menial stole chanctcriscd by modendt 
weakness occasionally ensue after Apparent iccovery from oiha 
forms, and to remain persistent. In indiridaals who have reeorscJ 
is this way, the acntimcnts regain their former calm ; they can )1m 
again think and judge in a formally correct manner — the raemor; n 
little or not at all disturbed'— thtir conversation ia qoite coherent tai 
rational. But lliey axe no longer the same penoiu ; it sectna ■* i 
thdr mciital individuality had been deprived of ils bc«b and notl 
vuluable qualities, the more delicate moral and tnthfltio sentioKlitl, 
interest in tho higlier mental dims of life, which fona the btattt 
And the nobleness of human nature. lIuHr thoughts and dTarti 
move henceforth within n limited circk-, in tbe splKtre of the immediMt 
wants oud requirements; and whilo they conduct themselves EitioiallT. 
perliaps witli a degree of activity in this circle, all tbe .ipiritual MJ 
ideal concerns of life, all considcratioii or desne of them, ore foirigB 
to them. ThcM persons might be regarded as perfectly tanc— 



bTATEa or MSNTAL WEAlkNK&t). 



828 



since time arc nunj indiTiduiiIf who tie all along of tliis difipositiou 

^^ vc htd not been ucijuainted wUli their former Ufe, and if, in 

nuajr cues, in the phj^ioguomy and whole ilcincanotir, n maikcd 

dumgQ (o tdiotic, cvva &oiinal-Ukc expressions, was not recognised. 

Ttwf an furtliCT capable of simple mechanical employments, in the 

perfonniuice of vhid) thejr show care aad intelligence ; for themselves 

tbej desire notliijig' more than suffices to mtisfy simple mnterial 

wants. Should nteh iodividuaU be permitted to leave the aajrlum 

ind rttuni to onlinarf life, thcr run n great ri?ilc of new and severe 

Itacls of iiuaoitjTf or of gradually pfUMing into conArmed in«Qla1 

realcncM. In the nsj luni they oft<-n for jears cnjoj n life of relative 

lealtJi, calm, and useful employment. 

Sodi riafcs majr be regarded as the mildest forma of dementia. In 

1 kighfr degree* the patient e«aaea to present any appefirancea of 

DonleMeace, and the increasing mental dulness is not restricted to 

finer and more delicate bullies. Sometuaea the whole mcutnl 

ifo again aisomes the character it had in childhood, in which 

lost strilLingljr tli« capacity of absiiact thought is lost; in 

■any fonnaf again, a u-rtaiu superficial and iucoheicnt activity 

dJ mobility of thought still remains. The Rb»enc« of all 

grions tlioii{^rt — hoeaufc eompanlively few and limited masses of 

leas are preaent — the pleasure in trifles and toys which afford 

taterial for superficial fantasy, and the unmasked and anreslraincd 

MBiiiMtatioa of the dupodtioa ootQAlly present (laughing, jumping, 

rcefdig) obaerred in many of tbeac atat«s, cause tliem cIo»eIy to 

Bsemblo the etat« of childhood. Many of these paiienta also have 

be (rested and gnided like helpless children ; they may, however. 

rt kindnctnotaeveritybc kept at light inecliauicul employ nunta, and 

iiKtbodical regulation aiul care kept from nuuufeating the io- 

i^icnnoe aitd confufion of their ideas, and often for a long time 

ed from more profound nieutal decay. 

These cues of chronic loama and dementia conatitutc the Twt 

MJonty of the tuaane, and tustiliitioos dex'oted to chruuic cases 

e almost exdusirety tuliabited by tbcm. It would be well if our 

ndiologicul kDOwli-dge of these states vac only in a degree soiuc- 

f^Bt «p|)nNicfaing to tlic rich opportunitiua afforded to ns of studying 

I The iudividual vanctiefi ant here Htdl grualur Wvaxi tu the 

>niif ve bare already considered ; they can neither be i-ntuncrated 

described. We must rest satisfied with stating and describing 

principal types. 



834 6TATM or KBNTAL WEAKNESS. 



SlCTiox I. — dnmic MaHta {Die VerrAektiieii ; Lt Poiie 

$147. Under lliis term arc comprehended tho» secondu'jr }Ulo 
of tawiity in vliicli, although the origiaal morbid state of Iht 
smtiincata bu coiuidorably dimiuislwd or eren «atireljr diuppeind, 
tlw indiridiuL dues not recover, bat rtmutos effected in such a mnSKr 
(lut the delirium is now most strikingly exhibited in certain find 
deUriooa conceptions whJeh are clieriabcd with CBpeeial prefetenoe ai 
oonsUatljr repeated — always, therefore, a nccoadafy dueaM derdopd 
out of melandiolia or mania. Wc eonaider the term ataaomtm 
{§ 45) introduced by Esquirol, but employed by him in an«sMntii9f 
difliereut stmc, i-specially adapted to designate tliese states, iirovidel 
it could always be restricted to a special form of mental disease. The 
iitndy of the pfiychical phenomena in these patients seems to ut ■<> 
hare been hitherto much neglected, and the tnie nature of tk 
disease to have be«n observed and falsified by auecdotoi conccptioDt. 
Wc shall attempt to describe what we have learned from actual obso- 
vatiou. 

Jnomaiiei 0/ Sel/'OontmutHe-u, the De4ina unU tie tfiU, — Tbf 
Inmsition of melancholia uitd manin with deliiious conceptions t« 
these states always takes place gradually. Tbo stite of negative 01 
afTirmalive emotiou resulting from these condittona often disappean 
very slowly, OEciUutiog for several years : a chronic state of modlM 
melaucholm or maniacal cxeitoniCDt, however, often remains loi| 
]>ersiatent ; after a time this also disappears, leanng hchind it eotMD 
delirious conceptions. According &a the emotional cxcdtemeat 
becomes weaker, appareici refiectiou gradually returns ; in place of 
iucoherrucc of thought, mental tension or convulsirc shock and 
suppiCMcd volitionj there ngaiu enten a more regular flow o( 
psyctiicaj activity. Gradually then is re.catablished an entire et 
partial external ecjuilibrium, as with the diieippcaraticc of the morldd 
emotions the mind bccometi calm. 

But this is no longer the equilibrium of the former healthy hfe. 
Gi&dunlly a ner intermediate state of the psychical tonicity, new 
emotions and a new character are developed : tbc patients arc aot 
now what they formerly were; with the addition of one or Im 
f rroncoiis o]iinions or a few delirious conrcptiomi, they are thoroughly 
chaugcd. This radical change^ wliich ia naturally most distincth 



ftTATM OF MENTAL WEAKNEftU. 



82E 



:«d wlitrre the gcnanl meknoholift and th? mnninral esiOta- 

lave DOW entinig disppcarr^, consists essentially in duljicss 

md vcakuew of all psvcbical reaction — in an abaeoce of senti- 

ncnt, indiSerence, atid diminiiihed enprgr of the will. Kone of 

lese paticata are any longer cjipable of the same interest in the 

xlemat world, the same love and ibe same hate, as formerly. 

fwnda and rclativef mny dip, thnt which wfi# formerly most dear to 

Win may go to ureck, the most joyful event, may happen iu their 

mdly— thity will Mpericnce at mort only a my snpcHicinl disagree* 

bts or agreeable excitement, or tlicj' will (|uickl,v turn from the 

abject BA from nomc umrclromc distnrbsncfi, or they tony not 

Met at all. Only on one point can the ^isjcliical tone stiU be 

eadily aseertaioed and altered — ean emotions and rcactionii of the will 

rapidly called forth : if we touch upon the tixcd idea, if wc oppose 

in (tatements hy arguments or his projects by force, the patient will 

ifdiatcly become angry and violent ; if we encourage the delation, 

will at once rejoice. 

In «ertain cases wbieb may become the eubJecU of medico-l^al inquity, tlie 
Idabcai flf tcDUmeat and thereby jwrr^r/f^ reaction, forms one ot the inott 
tdBBwats of tbete cDodittons ; tb«j pcpient a specie* of quite chnnic 
mial ioMaitj, wbiob migbt bo dcti^ated em->tional wanity. Tlic 
Iboui^ by no ineani the only eximples or tliis eoaditioa aio to be 
^ntxl RKongst dmnkards "ho bare beoome iiuane (see } 41). 
Tin cmotioiiil duloesi o( th« cbroiife nunra it very cliaracteHttically matii* 
I in hia raUtioB* to the uTlvm. The iixJiridunl) are, almost wilbout ei> 
, qatla oOBtentcd with their lot : Ifaej aeTor form plots (irbicb, owiag to 
fnnbcr tbsy ooutd easily da), a tingle attendant leads then liLe a flod:of 
I i thottld one of them tuffer puuigbment or be remored, tb« circumsUnM- 
I not at ill alToct the otben. 

f 148. Emotional states, therefore, are otill possible, but only 

w group of ideas is able to provoke them. The ruling disposition 

a, indeed, on tlie whole, one which corresponds to the delirioua 

[ides, althoDgh iu » weaker degree; and iu the higher gmdes of par- 

[tial dementia there oflcn prevails so entire an indifference, that, 

rithoQt any trace of emotion, the patient inoeaMDtJy declares 

to be the ruler of the world, the porsesaor of all in hearen 

ad earth, Ood liimself, &c. The psychical reaction on all excitation 

than that which it directly in connection with the delusion 19 

ilj very feeble, becauac, on the one hand, perception, in 

Kd br as it is not related to the delusion, has eonsidemlily lost 

eoBf^ and beoome blunted ; and, on the other hand, because 



I 



8S6 



STATES OP JIENTAI. WEAKXKS8. 



freqaentty 01807 niasses of ideis vbich belong to the fonner life of 
the patient arc now coinpk-t4:lv JidsipaUod, fofgotten, or no lopgv 
NCogniMtl hy him as liis owo. It i$ th« same circuDutuicc vhkhiD 
tbespticre of the intelligence does not pcrinil the pativnttoreot^nae 
llii; foUy of Itis delnsioa. The tdations arc not like those of ordinal; 
life, vhcrcnlni(ling iddi, ati imjwlling tliought, l«iBponri]/ obaeucB 
and suppresses the other ideas. In health there b almjg the po^ 
sibitity of the contnsting idcM, douht and bcsitatioa, arihcg. 
Bat in chronic mania, althongh the patient is no longer in the stoU 
of emotional excitement which fonnerl}' rendered it impossible fat him 
to lecognise the error of his iieaa — ^though he, indeed, eomdiiBa 
reasons with formal corrpctuess upon certain points — ^yct be is do 
loD^ capable of doubting the podinfaUity of his delusion. Thattbe 
litcd ideas cannot meet nny disturbance in their coorse, is owing to 
the otrctimst«nce Ibnt no counterpoise, no inward opposition reciil* 
them: and thisnp|>cars to depend quite ss mneh upon a genenl 
weakening of the former iittclli}!;ence, as upon the disappearance ef 
c«rtaia scries of bcaltliy ideas. Thus, the cause of the impossibilitf of 
reoogaising the delusion ns such, and the gcncnl iudifTcTence sad 
diminished psychical reaction, may both be founded ttpon the ssm 
psychicfti dcTccls. 

It is the same xrith the emotions nnd tlie will. 80 long as slight 
Didaitcholia and emotional escilcnicnt remain, volition preseiiti 
tbe general chnractcr of these stfltcs; and there me then oh< 
sciTcd, fomi'ttmcs, n oue-sidcd persistence in a single ncgatire dieee- 
tion (for exnmplf, n continnni tendency delibMatcly to dntii^ 
inanimalc objecta — to tear tlie clothes, pieces of i»pcr, Ac), 
sometimes » restless enei|^ in the direction of lUi; deliriow 
conceptions, sometimes Imnsient maniacal attack). AFtemtdf, 
howcrcT, there also appears in tbr Toliiion a mediate or hi^iff 
degree of general weakness ; some can continue the mccbaoieil 
employmenls to which they were formerly accustomed, n», for c3iample, 
Professor Titel, who believed himself to be Ibc Emperor of Romr, 
and continued to rend Ills course of lectures in the College ; or thgr 
can pursue easy msnual occupations: but Ihete is do longer IM 
desire for lienltby artivily, and even the acts oorrespondtng to ike 
delirious idea, as the writing of letters, issuing of proclamations, fa., 
gradually become less energetic and more nipcriidal ; while in the 
most confirmed states IherB only remains tho most feeble cmploymeat 
I —the aiausiug tlicmaolvcs with pebbles, rags, pa]>er, &c. 

■ MEDlCftV. CtWW 



STATES OP MENTAL WEAKXR89. 



327 



AJl sorts of capricioas ilmres, such a." arc iiUo observed in the 

»D hare alrentljr durliud, an- particularly frequent in chronic 

tttd become fixed biibits, Scime t'oiislaiillj' speic to work 

igrt vnter, uthcra vroulU ht .-ilwnys pulling off tlicir bnata, 

nonirevt s special prrfercncc for oerlain places nud corners 

ttiey msy alvrays bu foand : some will not spenk ; others 

I, aing, (Itclaim, or conttnanlljr employ themselTes in daubing 

le walls; some rejoice in decorating themselves with strnw, mg», 

triflps ; 01 hers take delight in nllowing (heir nnils to grow long ; 

oUiL-rs again are always perpetrating malicious acts, making 

ir gestures, &c. These desires have often a peculiM, niy*t«n- 

-iignificance to tlie paliont, or Ihpy procred from Cfrtiin frame* 

itnd eoonccted with the d«'lu»ioii ; «t other times tliey are purely 

itotoatic, the patient liimself knows no enuxe for them, and is 

'hen questioned regarding Ihcm, in the same way as healthy 

ins arc irritated ulien asked tlie reason of peculiar ItabiLs, such u 

lewiog tlic nails or making tmncceuary movements with the 

lUdUffte. 

4 149. Amongst tbo auMaalift of tiouffH in chronic mania, we 
nrci, in the first phu*e, with a formal change — namely, a aometimei 
iOileFM«, lometimrs increo-'icd dcgm: of wrnkncs;! of thought, genc- 
■Dy necompniiicd by low (forgetfiilncss) of preat serie« of idea* 
vhicb fonm^ly bctcmgcd to tJte indiridunl in health. For thew rc^yons, 
desri|ipTcheniian, no healthy mental conception ia now possible 
lhs|iatieot> Some may, indeed, cnrry on a pn.-tty rational conversa- 
ioo, boi gDncnlly it consists merely of current phrases ; to soon as 
Hrtinl abstrnrt thought is required, tliey show their incajiacity to 
the aabjcct. Real ncuteocss uever exists in chronic mania, 
micas, indeed, the occasional carious comhioations of thouglit 
'hkli* u ee mrin g abruptly and unexpectedly, and seem now and 
Mmevhat nirpriiing, bo considered as such. Qcncnlly, the 
1 cannot fix in his mind, even in a slight degree, any idea 
bieh n not closely connect«d with the dominant ddusion; he 
from tlic subject, nod generally revetta, ia writiDg ercn more 
tn epeakiug, to that einle of Ideas which to him is alone aetual 
real In the more ad^-anced degrees, this weakne« of pcr- 
bccoincs actual iiicolH-iaicc — a coeoal rising of images and 
;bu without aenM or coherence, only loooely connected tiy the 



&TATB8 or MBKTAL WSAKNE88. 



unify of the fixed ideea: vith this clmHiic mama panek into 
dementia. 

We have alresdy teeo, in a fonner chapter, how the eeponle 
ddiriou couccptioni uik in melancliolia atul mania, aad tluir 
BobjeeUmatter is there iDdicated. They always relate to t3M sperid 
pencmality of the patient, to his position in tlie world or rdalioa (o 
the Deity, although their subject-matter pmenls rssmtial dtfo- 
races. 

Bometiinca they arr CTattcd maniacal idcaa of an actife kind, 
lelating to elevtttiou of the subject and his dcHniiiation over extenut 
thtngt — Qod, one of the Holy Trinity, ftate reformen, kingi, 
learned men, prophets, ambassadors firom God, discoveien of pa- 
petual inotion, ilte mother of natnrc, one who luut penetrated lU 
Mysteries and koowa the elements of all things, &c. 

Ot the delirious conceptioaa relate to some affliction, to domina- 
tioa by external things. 'Hic patients believe that tbey arc persecute^ 
snrrouDdttd by ^iea, tormented by secret enemies who empky 
electricity against, them, tormented by freemasoiu, possessed of a 
devil, eternally damned, robbed of their most valued treasiuest fa. 
Or they cherish fixed delirious conceptions r^arding their own body; 
tbej are dead ; their bones ore made of glass, of bolter ; they hartxiv 
atniDge things iu their body, &c. 

From the different characters of these ideas wo are ennbled lo 
distinguish chronic mania with active, exalted (§ 131] deliDU^ 
from the aame with pasaivc, depressed delirium. 

The more limited the circle of these delirious concepliotu, the 
moie do they appear, on superficial consideration, to be simple aad 
even inoonsidemblc errors of judgment. Bat how much do such cmn^ 
even in the most favorable cose, differ from those mistakes which ia 
the sane proceed from delictent knowledge I A long seriet of psf* 
clddd disorders must precede them ; they are inwardly developed 
from ttatea of emotion. The whole personality of the fotlcot i» 
identified with them ; he can neither cast tJicm ftiora him by an act <l 
will, noi rid himself of them by ailment; and ia order to the 
existence of the dehrium in this mild form, not only must that Ion; 
series of emotional states in which it grew have run their ooims, 
but there must also remain, behind a deficiency of thongtit to ensmt 
its existence. 

Above all, however, the pArtinl delirium of dementia depends not 

much on the circuiastance that the false ideas of the patient are 



rrATBS OF VEn^At WK-MtXaS*. 



339 



lited to one subject, u on thu — that be ti^tjt, bf p t S am a t, 
\*ij>rM$e» one sole and Induig filM idea which coostanlly pcmn 
Hu ntorbid thoogiit it nadi nun extended: tbeUsiiUBwIud 
liKD dcreloped io Uw pnntial tfbext of t^ aficiiTC ttnti- 
inenU cttenda not only to the iie%hboimng sphere of self-om- 
9tsi, vherc it dsitorbs the proper estuoatc of the rpctul 
lalitr tad its Klatton to the world, but it also identifies itttU 
[vith all the tbecpntical ideas of the patieat and gradiullT fabifies all 
hta thougbta. Tlien be inTolantarily ntcrs ererrtfaing to the dc* 
lirium ; in its light everjrthiog i» neved ; haA Iho-" be cannot fail, iu 
ibe moat faTorable caaei (for example, in simple hjpochondiiacal 
delirium), to have false DOtioos and Ti«w» of life vhich verc 
fonnerljr quite fonriga to him. Where, however, there exist more 
•eriona fiUse ideas coDcerning the special personaUty, all the patienf ■ 
ricwi in regard to the rxtemal world are totnlW perverted; he 
jodgcs eFer> thing from a false position and from wrong premtaes; 
and when* th«re is moet form nnd logical order, the iosanitj 
proceeds frrquentlj to a comprrbcnsive and romctimea carefally 
concealed sTetem of drlonoos, in which all tho tclntions of human 
tDfcrcDune, all moral considerntionii — indenl. the whole internal and 
nlemal organisation of the uuivcrfc — are mysteriously expressed. 
Sooietiioes ordinary bognage is not sofficicnt to expre^a lus lhoagbt«, 
nnd he invents, at least to cxpTt-S!i the dcltriou!) ideas, a totally 
diflemtt lanKuagr, which ho declares to be ihc primitive language. 
the tangoage of besren, kc. ; and the rooro the sensorial inipressiona 
are obsonred by liaUncinationg, and the inward views become io- 
diatinct and dispUoed by confasioa and weakness, the more do thwe 
aUtea pass into the form of dementia. 

Tba origin or Ihcao prwuncat ddirfotii coocrptioD* can ilwaji be tnced Io a 
■tJ^ ot Mieltaehotia or manai. and oflea to ipecial oocuneaon daring these 
•tagw. Sbould the Ricsd idea consbt in tbe drlu>ioti of being loino illuatrioaa 
pefam^e, Uwir bchariour when oppoaed bjr tbc argnmniti of reason is very 
watilUfc Oaaeraltj tlie p*lieDls caa tkill give an account of tlieir former 
lif«i KBwIiaiea tbcyerea adnit that tbe; bare twca iattiK (ocilaialy, howerer. 
oaty (mm bearaay, aad they thtn nsdenUnil b; it onl; Ihc fom of metnw 
■b^Ua) I often tbcj nBrrale iKe rior minute drcamatBiiora of (lioir cfaaaga 
(Opeciail; baliuciutioBi), but genfrBll; Ihej do so Tcry indistiaclly. 1%^ 
remark (kit in eonrrnalicn ptnont Qpi>oM Ihtir Sied ideas, aad geatnlly 
Uicy quictiT, ihougli unwilliDgl,T, keep cilrnce on tli« nibjrct. SbouU adwd 
arsaaitaU be brnght to bear sftaintt Iben. tbey beein Io icold and btcwaa 
violnt, and tbe amttcMOr ha« g«iiertll; tort their eoafldeao* for a long tiaie. 
ttt Mosa of tbew palkota their fanner Ime perMsallty appear* dttd ; they 



330 



STATU OF URS'TAL WEAKNE8I. 



ipak or it IS at & tlilrd fieneii, mJ often ouly ngw K«oDieUau ol it p(u> 
trat« tie obscarilj in vliicli tl>e old ego a inrolred. 

From tbe foregoing, it will be seen bov rerj Auwnxu Uw wUllectail dn- 
ordere oroiii ILom patients, orratlier bow nnoiuBretbtt st«tcA ooBMqtcBl 
upon muuMwI ud ncbncliolio conditkwt, uid nuDprchcnded oniler Lba um 
oF okntiio HMmiK. New inraligttiou n^y Iknw fBrther tigfit on tUi si- 

Tlie followini; exitmplce will Uill fnrlber <ud in giTiog » ooirecfc tdat d( I^ 
form. 

^ 150. IlaUvanaliont and iUtuiont of a]l the oi^ans of Mwe 
are in no form of insanity so frequent as in chroiuc muiin, and is 
man^ caws tlwjr tnaiisb and mitiuUin Ihe dcliriom. Preqoait^ 
lite patient coiwrrses or qunrreU mntiniially with tbc roiocs wlticib 
hv liirars, and falb into aogi}- esdlement; frciiiioiUjr be finds las 
whole liappincss in a plensbg illusion of sight, like the AemtxieA 
mother whose darling loiig<loBt c1i3d «'a9 repteseiited to her b; ■ 
bioken jug clothrd with rags, which Mic for manj years diaialicd 
wllli Uic greatest tendtrnees. 

Tbe mowmenU, the appearance, and the conduct of tliMe pttienti 
always manifest, cren in the mildest forms, a Dcrtain pcrversitj and 
distortion. The phyaiognomy generally appears old ami witbctcd, 
Riid has an expresaion of Rtapidity or of the dominant ddiriona ideL 
Nearly all maulfest certain pccuharities in tlidr cooducl: nne 
gcatlculnte coiwtAntly, or move tfacir liands and feet in & moDOl«no» 
mnniier ; others prceerre an ecstatie stillneaa, in order to listen to their 
hallnciimtions ; others walk op and dovQ incessantly in a faTonls 
place, like auiu)a]» m a cage, and »peuk or hum words, rhymes, or 
mc]o<li<». Some olvajra remain io the dnrkc^i comers thc^ can iind, 
turn their bnck to the passer-by and are irrilntMl hy eveiy distnrlK 
anoe; others constantly employ themsclns in collecting trifles nf 
erery description — rags, pebbles, shells, &'c. — Io which they otiribule 
great value; nbile others, again, decorate (hcmwlres fantwticniiy 
with cvC3)ihiiig thry can lay their hands on. 

Generally, u-ith the crssfttion of tbe melancholic or maniacal stale 
there occurs a marked increase in tbe size of the body and a stale of 
robust physical health. Ereiy osyliun oonloina )Mticnts who lirefcr 
many years in moderole liealth and attain a great age. 

Intermissions or rcmisnons never occur in these atatoa, and aQ 
I'xpcrieiico goes to show that complete recovery ia imposaible ; bnt 
by the commnnicatioiiB of Lenret it is pbenl beyoud doubt that, by 
vuergptie uictbodical treatment, some of tJiese patients eati Ixi awk' 



STATES OP MK^TAL WEAKNESS. 



SSI 



sDppr«w Uietr delirian and lay aside tbnr peculiar lubiU to such 
, dfgne lluit they tnay be Tcmtlvrcd capnblc, to a considerable extent^ 
[of punuing niniplv avuuitium. U llicsc palJcnU be left to tiiem- 
tvcsj thcj become more uni more ongrospe<] ia Iheir delicioua coa- 
ina ; ifaeM gradually extend to vider rangi:» of tliou^, and tho 
i finatly fall into complete or spathdic demeiitiii. 

BuLvni XLIII. — Cif«me ««da omJ MMmM«i«. — In 1814 tbere wu t 
mam n Ike luiiatia wud* or tbe Charity it CerlJn who lud bosn Ihers for 
ei^t jt*n. Ue wm toon the abject of alUntJon aoJ care thita of 
ieU ticalinenl ; bo m)kcit iboal Ilio corridora and in tlic rooms, atipeannjt 
t»ke ftn intercAt ia all Lbat went on MOnnd lun, but, lo nfcnk truly, occu- 
bg tunuclf with nothing. He laufbed aii<I mocked at cvct^tLuag with Rrrat 
iDgbUneis 1 >ed if 0117 one bsppcned lo sik him nnjlhing, lie rrplj(<d whh 
•unimacc, uul villi a pcsfecltj Mlf-Batiincd air, tironu^R — nnd Ume 
rmindalion of hii toMpenUe egotiim— be wu all. knew sl\, posjeuccl 
and oonld do kll. No tUtlJon vu biglicr tiikn lii*. no knowledge c<^iia1l(!il 
ha fortnno wu u great m Lis kuoirlcdgo, and proportioned tu llin slalioii 
ha believed hirttMlf to oooupj. Thit auuntico wliicb he h.id of hii 
i, Ina dcTcmc**, asd hit power omo out in nil his act) aiid move- 
JLconstuainate actor vould hare bad dilRcuKy in eiprtssinfi: the mag- 
sad ditdua ManiTeitod by Ibia jouag man. uiuply clad in a blauie and 
on a •oodtn box. TI10 fact ia, tJtat ncrtr trad man profounilcr cniTic- 
of bit on ucfita and {[Teatneu. According to information giran, this 
pj joug ma, after aa aumiaatioii for which ho bid woikcd hard, and 
\ In Ind faded, becama lilont. tad, and fell at lengtli into the itate 
we dad biai. In loalitj, it b often in tliis waj we see fixed ideaa 
ig. The lame llting ii oburrablc in tbe caac of thou who, bjr nnlntppj 
ilalMiu. Iiare ftUeo into the pTofoundeat roiwry, aud who. exiiausted hj 
itcUeclmd work, can no longer cnga|^ in tbcm; tlioJr iulcllii^caco bdiatnrbed. 
"1— ddwtlythey prctcat Ibenuelvea totbair frteoda deelitut« and tpeaking 
rnrnUh. 
tkt side of this tavaUd wboie portrait 1 Iiare rapidly aketcbed, and who 
wtO kaovn to ntc, I bare aet another, lal«lj oomo to tbc Mjlum, and 
impUUag whom I iball ny the little I know of him. 

M. S— , agad about 30, in a good poaittou fa bnstneii which brought him in 
• ipval deal, of agrtcabte temper but cuily excited, addicted during Kvcral 
to u imgnlir life, dialtBClcd \n pleararcs, oilsa eioitcd and entccblnl 
tj aiwbelte UiitMn, becama dcoieatcd. A long and uniiitBrrB[ited aerie* of 
idcmnr of cruy kind arvmi to have indacod tbc csploaian of an old 
Unitttj to nadnMa. To every queilion addreatod to luin lic replied, " I 
Beleoel, idjiiUut-gegcnl ; I am a cnpital plnjor at billiarda, an nlm- 
•tpart bOfMinan ; Ulrly, I ^t on liorMbaok in ttie circut, a>d I dia- 
all olbera bj thv akiil, ftlrmglfa, att, and marTellou* eleganoe wilh which 
tbe most rtatlre hones. I .im very rick ; t inriteyoolocome tomy 
I want to have a lillto aainaenrtat. The man you have |i;tren mc bcre, 
^eall akrqvr, pl/aieiinBi faealaoaawac KCtoahoncboci tn the 



S89 BTATES or MRNTAIi WEAKNESS. 

arena," fte. I ftuawcnd bin, " To-momv I viO tnlrodace joa to k mm vb 
ia \u)n, Tho vill cntunl; Uke tn btcrat m ;««, and who mt^ be udiik 
yotu" U. S — then mi (o ue trrj quirtlj, ^ I iJuJl be reiy (fud ; 1 l^ta 
ktn ■ gn*t iiaaj (ricwU, aad 1 like, too, to be on gDod terais 'witii naj- 
hodj." 

It. B— «aa ktanding ia th* oorrUor, supported on liu wood ca bot, vilbt 
look of Klf-fMliifiiction, wbeo I bnnigU U. 8 — la bin, ujing, " Use in 
g«iitleinui «I)Me Kqnainluee vill peAip tnteml jml" M. B — ippiMdirf 
H. S — t flzcd fan sjM ail bin, uid hkring watched him toma moMMiH. ' 
liiiliMdbickw«nl,npiig, "Whouvjou?" M. 8—: " I em « oolantl . 
r^iierial Majralj of KquIa, ud wtjiil«Bt-ge«icnL'* ii~ 11— : " It h r,r 
^ouant bt ne to aiAkc toot Mcqniatanee. I iball tike e gnel iatrr: 
you out of Kgsrd to jour [foailioo. kadyoanqr be quite eiiTe of m; pttrc ^ 
ior I ftm ft fidd>manb*1, *nd during a^ kamra bonra I wccapj mjKli rail 
the eigfttiiaation of the bitsI and inilitar; forco of KiiniL" M. S— . iri» 
nbhed at tb« uohcArd-of wroguiM of hi* intcrloeutor, looked about bia fiA* 
mQbMTkucd, wbiJo U. U— looked et him with all pomble figniij of latmx, 
end, UW with the eoaociounieu of hii net titpcrMrity, he uid to bim. " H*m 
jou fttUI tone other kooompliahinenti which I sii|^t pat to vac?" "Te^Jtr 
Manhal," repUed M. ^-, ■ppcoMkagU.B— withakiiulof [unilint^i 'I 
«oi oliieTof theouiriden; lam abonenanor great »trcagtb and naUr- 
feble ..." Tbea M.H— (IkrowtngbiniM-trbickand auaming&still gnafa 
air, lAile he ehot at him ai disdainful a look at jMstifale, " Vile Mtinu.' 

Hid liCi " DUHAble , worth? of being in a omUiiHuee t" uk] be wilbdif* 

huigbtily. lie aeiumed his oidtasu-j potitiOD bende the wooden bes, *ilh t 
erashiog look tt M. S — , wLo wat greall? fngbteoed. I Uien led i«*j 
M. &— I njiug to him in a low voice, " How conld job mj such tbiofi to thb 
genUeman^' M. S^ replied, "Inererdidgetonhonebe^ek. u I Midjnstwiv. 
but I oAtn thoogbt how good it wouM be to be able to do il. I wiah I eovU, 
tell this gwitlMMB that 1 did not get on borsebeck with tho groom of Iht 
eireu. Take rae, I praj jou, irameijiBtel; to him." I replied, " YonhM«gol 
jonrscif into a terrible scrape with him. As joa know quite well, jim pfand 
jourtelf in a bid po&ttion bj lajing tucb Ikings. Den't try it again, (or jM 
stelbo contempt which that iU-advised banter hat brought upon jou." 2L3— : 
"But I an colonel and adjutacl^gcnen] sUtheBsmc." "Ttet fa aaotWx mt- 
tcr," Irejtlied, "a&dwediall talkaboDtit &nerwkrdB; bat, atpictentijwibVR 
for erer Ibtfeited the esteem ot tliat man. Taic cart llial tbe ume thing don 
not happen in the cbm of other people." Tlie kcrpcr walked with U. &— y and 
told mo afterwards that he had oontinued to ttilk If iil> bioioCibat affair. Hit mi 
lotni:, tlitlfroni llist moment U. S — oeuedto beliere himself a groom, batht 
still bclicTcd himtDir to be a colunel. Tbe paiivnl, who was in tbat condiuga 
during (he last four montlia, was quite cnred In the ooorae of screnl moBltl 
which followed (bat neetiiig in vbich M. H— bad to rtidelj tUakea hb 
insane nolions, wbich were henceforth arrested in llieir further dct^pnoL 
M. II— alwaji shunned hint, nerer spoke to hiin, and tresttd him with (co- 
fanad contempt. M. S — waa alwijts anbamed in lii* presgoee, as if be rcnto- 
bered tbe ^itdun whifh M. H — had nmifcsted towards him at tbeir Gnt 
MetTiew. It was out; when quite cured Uiat he got rid of the nnilmiia— ent 




STAIKS OF UENTAL STJKAIkSESS. 



838 



I ke expenenood in prcxnce of U. H— . Wken be nu ooaipMelj eared, 
VM thoat lo <)ait tbc ujlum, M. S— exUnJed bii iwiul to M. H— . for 
■i siacc bb mtontion, be sbovctl a real attaicluncot ; bat he received liim 
'vltb tie MiM oootempt u focmerlj. moro Ihu ertr penuided oF hi* inftumee. 
of III* fortMBi^ aai ot tlie urmeiLse diilonce wliich separatnl thrm. M. H-— 
Rcnained ia the ujlvn — be «» inenr^le ; M. S— , oa tbe coDtnrj, owed bia 
J, donbtlcM, to the meeting wbidi he bad tiiUi him after bit nrriiral !□ the 
iul. (Sinofiovits, 'Die Gciatcnionugco,' Ac, 1843. i>- 1>.) 
B^UXfUXLrV. — Cire*i> MiTiu'd ofmatif ytari tla»di»g ,- Aaiil» fapruioiw, 
I imiimateijf eomneeitd »UA lie Uading Jf/anos.— Tlie woman B — wml, when 
I wdcr BIT obKTTaliaD, a,bo»t 115 jtare of ag«. So far u koown, «lie 
1 been u inmate of u^lum* lince alio wm sixteen. In her dcportincnt >lie 
■Uj fhawtJ traces of nipefior Iraining. I oouid iievrr Ituii wlictticr alie 
> fcUtiou »tili ti*in(; nobody riiitcd litf, ftnd I had no otb&r mtUM of 
Bcr ooce fair mod luxariuit boir wna dow ncirty grcj ; ber foit- 
rvnakkd, ber deeplj-tct blue (jet were very moveable, and when excited 
' aelaall; ipvLled ; bet gait wa> icnermlljr dow, anil ihc looTcii witbout 
ite dlnclion— tlvaj) as if looking for something, and in seiDicirclcs. Slic 
r Kre<ltd an; one, nor acknowMged a uluUtion ; it wm oul; ntn^lj that 
Vbea wUlcd bj anj one not known to her, would look up, minutell na- 
i lbs iodiridiul, tkea npidly withdraw her eyes and occaiioaallj mmmtii 
' iniiiiin[iiiihiMiihla woidl. At other times the replied to all commuDica- 
I wbkfa vers addietaed to ber with KTeral wrere words Qf rr[troiieb,wliicb 
' coaclnded b; her witiidrawing from ill furtber commnnicatian, and 
ciaK ibia jndgincDl ; " He *luil bo bumcd." If listcDcd to. there 
sue a viol<-nt scene liigblj disturbing to tboae aniiDd her. Tberefore, tli« 
, iaennbic patient wu left to bctaclf, aiid do atlculiou paid to her bamileM 
When let alanc. ihc offended no odc. carefullj avoided all conljuit. 
Bed occupied only with Tsrjr nif cnt nCfain, uid frooi loug outtoio Joined in 
III* ordinar; hou*cb«ld arrangtmcuts. Slic ofun wiote Icltcn, wliicb con- 
aistMl Mtinlj of oapilal letters ; Ibe; wer« always written on la^ theeU 
of paper, a»d addresacd to the moat powerful nonarcbs ia tho world and their 
wins. She always aooepled a few sbceta of large paper and some pens with 
■Mirks of gratitude, althongb abo oeiei ctpreswcd her thanki, and gencmlly 
rapidly disappeared bom the dooor. TromaDUBibcrof ha lellera, I galbccod, 
■nl without lonse troiible, Uie following regarding her ideas ; — Tbe old woman 
bdiered heiself to be a fjueen, daaghter of the sun, and near rvlalivc and 
ffkad of all inonarehs. Slie boptid lo be drawn in a coach of j^Id, drawn by 
■U bona*. Uoat of tbe letters were directed to tbe ruler of theSoblimc Poete 
■ad Ilia wife. Tbe letters lo the mooirchs, which she wrote almoat regularly 
UifW at four tines a year, (ibc al»o wrote lo tbo jndgcs of the earth and to ibe 
(toetal eaceatwMr of the world,) generally coolaiDcd rcqucita and ipeoial 
denandB tbit Ibose persons might be burned wbo bad on sefcnl OOM* 
■ioasi and periofn intentionally, disturbed bcr ia bcr eaiploynents. If the 
nnw aad designatioo o( such persons were unknown lo bcr, tbe woobl gire a 
ill ar lift inn of tb««. aeeordiog lo Ibeir dothiag and habits, so true that the 
pnMU MMt coild bo easily recognised, ia oidee that tbe high monMcbt 
Dooimit BO mistake. Lf any one wen doomed by her lo bt bontd in 




Kidj BKiitkinod. ta MomDulatot of ancomiMa {icneTeFatiee. (kij tx 
cold awl rain; divs did >tie ctont rrom coileetin;, but wbea tht nn 
ihidng Uic lioun u( nemtiiw is Uw ]r»^a >^ **> i^o*! uUtb. Qaile il^'' 
lotbad in faer work, abe oollseUid UBill eoloered itotiM, dead briQjutt beelk 
Aw», Mftaiu laail Icunit, t«igs, eoloared fcMlben, ng», bqght flMat «f |iH^ 
Ac If abc hid aadc a Urge coUectioB, vkm the rocmtloa boor eukdili 
cut ndint (flaaeca lowuds her pocket, tad npidlj Kwgbt Ler mm ta Oifc 
to wneal Ler tteontt. Wilb « certain ntniunf, ud eren with open tsi* 
*nec if liiodcKi], nke would aU«mpl to vithdraw heradf from tLe oul wtftix 
iwrlf. in order ttinl the ntigiit, wben postibte, be llone in licr ntna. Is lb 
lolitiidi: I found opptxtunit; lo obwrte her nnnotieed, and MBnet tpal 
wilbout emotion of wbnt I ww. Slie opened a windov ob tbo avinj lidt d 
IIh apartment, and looked a fev momenls it Ibe tmt ; Ibes nbe dnv bm it 
bar poekela and from the place* of thctr oonccalnwat ber trcuniM, iftai 
tben befora her on the viadoir, and neired them for a tiaie in prafowd na- 
loBplktiooi she then tied thes« gnndy arttelea, GHtened with gtetfl,;tfl>a; 
la^ ud whila thnsds, betwMu the iron bira ouUiale tho window, to that tbi; 
nnaned nquiuled In tors. Wbca Uw bri^ am; wai finUfatd, dieopMii 
tba doorop^te the window, which emaedadrangbt When, owi^to Ibk 
Uieslig:htlT rulentd Icarc;, fcatben, tagt, fto. eeaiBeiK«d to flutter, ibetM 
woman woeld locih with joy cipresstd in b«r eyes aJicnuloly at tbea and it 
(be nu), and weep Tor }oj ; she uoiwlecslj moved bacl.wards and fonrtrdi lib 
to a child delighted with ill loft. As the lime adraaoed, the wonid bnr & 
adM of the approach of Ler ncigliboan froni th* gardan, aad n|Nd)j aaul cm 
fnlly, dislnibing nothbgi pack np all ; and when those who iharvd ber ipirt- 
ment entered, no traco of tbem would be obatmd. At I, danag n^ refoiM 
obwrvotions, approncbcd («lie wai to cu^roued that ^e did not obattn ■} 
approach) and quietl; stwd beside ber, she bore mjpreicnoe wilhonl aeoUiac 
and obMiTcd mo irith joj cxpre«M(l In ber ejvs. Quietly I withdrew, and m 
afletwuUs teveni times enabled to wEtneu the lame Kcae, altbon^h I bd 
already been doomed to be bomed in her letten. 

I directed tbnt Ibis unfortunate waman should not be anaojed during ie 
hours of rcerentioii ; for no one hu a right, vilhout some good niolir<; In 
brcAk upon ihe li»ppinc!i» of hia ncigbbour. Aooordio^y, UUa old wonu (a- 
joyed in peace her small rocMurc of bappintu until her death, whiob oeeortd 
KfcwyMirsaflcrwftrdv S^lie «M more than Sftyynn la aayUms; h«r iaanilj 
hud never been cured, bat hadonenboeniff^Talodby ber qnatnboae K%b 
boor*.— [SinogOTrilf, ' Die tieiitculorungen,* B«I., 1843, p. 35.) 

i^lKaniig. — One day I «u accosted at the Salp^lri^re by ■ vonafi I ^ 
neiier beforo seen. She had a quiet and timid air j the looked at me vi 
if Ireinlidins, and diil not speak. Ucr dicn waa simple and deetnt. I 
udged her about fort? years of n^r, and aflerwardi diaeortred that (hi* ra 
adced her nge. I atood still ncni her, and die oonliaued to look al or. 
Speedily I mw her rncc umme an expretsion inoeeaiinljr of anxiety »i 
l«iTori ihcn tbc rcmuued ctlui, and I nould liare eaid Ibal abe vaa U»tt 



STATUS UP HKNT.iL WBAKNBSS. 



835 



•oua agun tbe nOTemaiU of her faluret indicated igitatioB of 

iuil< I vklked a hmBdred paces Tilhoul Mjin^; s word, and nillioiit 

.nng to Sx mj fttteotion on ber. S!ic fullowol mt, and conlioued 

qnitt aotioa. I ttopptd ■goio, knd rcgnrdcd licr kttcnlircl;, iritliout 

ig In Ui the IcMt ciuiou*. Sbc did nol dianntintic her qaint courcraa- 

for I Hv thatabu tallitd willinie; and allhouj^ mj impasiibilitj vu ai 

■a poHibk, ahe heard objcctioD* and rcproachca to whicLi ilio LMt«iied 

wmfoai. Wc continued looking nt nch other in this my for ncarh half an 

hciiilie narmxirtd aoma word* wbidi I di>lnatcomprcliciid. 1 gmre bar 

B&t«-bM^, CD wliicbahe wrote u f«U»tr>: "Clcmcuccbrouslit loilieSaipC- 

tfBOfiBt of all that lias paMMl lii^re, for 1 Kuve not dcjorred such m 

ineatfor luvuij cneriiod so litllo ItnppincM. 1 swear tbat 1 liaro not 

Tron any one ; ttet 1 bare not borrowed froin an; one all that is in nj 

I — tbc ieircl*, tbc goblets of silTcr i that I amcomc vitb conftdencei tbkt I 

:rc nercr engaged in Uie loltei;; that I will go everywhere wilh boiiouri 

1 Hw tba otU turn . . . ." 

aba gtTa ae back m; note-book, and continued as before. At Icoglb 
"Sat, air, whj do foa not apeak out (o me ? I do not know— nothing 

air — when aothing is said Never have I been iu a bad pince. I 

know what itu jou would aa; to tnt. Ifanj oiieliw teiit me toalecpb; 
Idoa't kiiow what has p&ss«d. No! sir, 1 bavc cctcr been unfaithful 
bin. If moiMieur want to answer me t" 

■* What diifereiioe do jod find in nj uuwera, acoordiog as I move iny lips 
aa I don't more tbem ?" 
fioilUut jou expreas yoareelf fnukly, and I prefer to bur yon speak. 1 
|ou lbo«gbt, ud 1 don't kuow «!iy . , . . No, air, I neTcr dipped my 
a tdeod ; ncTer did 1 aa»iaiuat«. Ycx, sir, I love bim still." 
iW deea it happen tbat jou heard my thouglita ?" 
* 1 llink that >1 ia by i>bysie that L heard bJni apoak. . . . Even whea 
«• b Botedy, I bear lalkitig," 
" Are nd tliiag* ever said to you f" 

**tnev«r bear ajrrccahlie Uiings Yuu will see it my condoct nrill 

IM>t Always bo tbe une." 
** When wcT« yo« nanicd f 
*■ I eotild not tell jov eueUy/' 

" Do you noiembet what day, what monlL t wbetbet it VM in wialn or ia 
maerf" 

*'Ko, tit, I haro forgotten, by tbe work wbiGli haa bcca laid on me, by ibu 
itte and fHpUog. I belicre 1 aa pregnant ) I have perliitps serpents, bat my 
lafaaml is not a serpent. I felt tnywlf carried oS. Tlie King of Ktoaca ^ 
i I aude a crown, asd I said, ' If I have deserved a crown of tliotns, 1 
t« wiUii^ to wear it.' I don't know how I eatne back to earth, and it 
I it nnderacatb me evctyiliiag was esgulfcd." — (Sinc^owUs, ' Die 
Beriin, 1843. p. 35) 
ru XliYI. — Cironie -matin ; lottefptnomaliieMiilji: inHaniieilioiN 0/ 
lil (Mt wjutr,— An invalid, of tbe dirition of Paritet^iel. 56, cujujing, to nllap. 
igoodkctlll, ItSiilatt, iineeif)]7,1h(>pn<H(iaiianeiaflrher perMUalily. 
1 MkTW bcnelf to be <juit< snother ifoniao ihau she wm foroserly. Tbat 



386 



ITATKS or MlCNtAL 1VKAKX£8S. 



twUef Mou to be united to • chuig« vhkh liu Uk«D plueis hccwijgfteo&it 
■ad e(})Muill]r to ballneuutmn, twwMi ud muifoJil. mA eootinil. !fa 
MW ipcak* o( benelf «xo^ in iW tbird pecMO, aad eujilofiBg thk pkn« 
— " the penon or im.*' 

Provided one doe> >o( cone loo nnr tier, ud doM iMt touch bcr b«d, \m 
ehur, or bcr pumenti, sor ujtbiiie that bdonga to her, one meeetit m^ 
m Manning vitk bat. She npUea kinAf ud polild/, " H«« an j«. 
audamr 

"The penon of nebsotadaiM; can me^ nin, if yo« pleua." 

"I doa't kamr joir iuim; be kind cnou^ to t<U me." 

" do pcnon of me has not a nime ; she denrai 70a uot to wriu it' 

" I wmld like mndi to know jour uanw. or rather what foo w«re once eillad.* 

" I nndcratand what you mrao. It vaa Catberins X. We nnaU't t^ 
(atiitCT fH vhit look place. The peraou o( ne baa leaA W aiMe ; the c«tt * 
up on entering tlie Salpjiribre." 

"Wlitt u jour age?" 

" The penon of roc hax do age." 

" But that Catherine X of wliat of whom 70U apokc, how old «u the !" 

"I don't IcDow. She wu born iu i;;!). of ifar^aod lamea , iiTtDf il 

— ^, and waa captured it Paii*, &c." 

"If yotimiiolthe perMDof wliom 70U tptak.joa we perfaapa tiro panMi 
in one f " 

"No! the person of me does not know that which waa botn in 1779. B h 
perhaps Ibat ladjr jou saw ctowmtaita." 

"Are jour parents still ^iie?" 

"The penon of me is alone, and Bueli alone i oho haa no idaliook loi 
urae bad any." 

"Aad the relations ot the pcnon wltom jou formerlj named F" 

" Polka saj the; arc still alive ; the; caltrd thenselre* mg falhet aad tf 
DOtber. and I bclicrcd it up to the jcar 1837. t fuUUed bj dutj to Ihti 
op to tliat period." 

"You ate tbcrcToro tbcir child f Xou mode of speeoh ahowa Uut jn 
think so." 

" The person of me is no one** child. The origin of the person of me it na- 
known L she has no teooUoctioa ol the past. The woman of whom joo tfcak 
il pcrbspt ahe for whom this dreat lias been made {poiutiag to h«r dreaa) ; shi 
was muiiod and bad BCTeral cluldrcn." (Minutely rcLstct tho dnuuataMM 
of lier rnrmer lire, but alvayt stops at lh« jear 1817.) 

" Wliat hare jou done and wLat liaa liAp[)eiicd to ^ ou ainoe jou becana Ihst 
l>erion ?" 

" Tlie person of mc lives in the asjlam at . Thej ntake, and atiU nifcei 

phjaieal and mctspli^sical cipcriiocntd with her. This work was vnknowa w 
her before 1817. — Here oomu a spirit, and mixes its voice with mine. The 
person of ne will uot liavc lliis, and sends it (juielly back." 

" fPlint like are liie spirits of whom you ipesk ?" 

"Tliey arc smidl, and cannot be laid bold of." 

" How iwL- the? ctwl ?•* 

" In blonses." 



STJLTBB Of UaSTAh WXAKNBM. 



837 



-What Ui«tuffe do Quyspt^r 

*Pr«ael). If Iter spoke b 011; otha limiiigi. the pcnoa of ne Mold im4 
Ibem." 
. it Mtiull; ecrtkin tlut jm tee them ¥" 
'Quite MtUm; tho pcnoa o( m* mm tlini, bat ntlaphTUCklly, in io- 
viiihiUl;, not nMlcriiQ} ; Om tiuj wotld not bs nmible." 
" Do jmi (amctiine* csporicuKv odovn V 
" A rcmtiuix ratnpositioQ. ioToiblc, hks sent bii odmn to ne." 
** Do jon lonKticnis feci tbe ianuhle in jour bod j 7" 
*' Tbe penoD of mc feci* it, uid is vcrj ngrj at it i it bu [«qKtnl«il til 
■oris of immodest dt^ds upon bor." 
■* llatc j«iKgood^>petitc?'' 

"Ttiepcnoaof Hteuta; sboliw bread tnd ■iter. Thebcculu ugoodu 
uj oMMoU witk; A» imintmtiatg men," tb. 
" pg jou pray toawtiaof" 

" TIm pcnoa of ne knew her rdigion prefioos to 1817 ; tht Tatomt It no 
pow.- 

** Wlat do jOQ think of the vomen «bo live vitk yoa in tbb room f" 
*'11iepmobofmetkiiik> tkatther hare lo«t tiuir jodgnMit i *t tUetcal^ 
< DMMl of tbem." — (Leant, * Fngiscu PtjcboL,' p. isi.) 
ZxxufiJiXLYU.—afou'emaKia wilk tk» iktrader efatiltiim.~A WOMB 
■lpmraliiilh«8klp£ln^r« belxicdbeiMtf fat bail Ummbw tine, Ood, 'mh 
, 'ind (he Uolj Virniii. Adomcd witk ribboan. vllh t bnnck of fanlLcn 
paper flowtra upon hct hfA, ibe jorfaH; roaawd abovt Iba gnaaJa of 
he lioapiuL Ihi tiiiltiilil iiiii iilifi liii |niiiit> ■! ii.iiiilnlatnl liniWHlieiiie 
kidiiheluydwitMMtdiBkcrMrtjjeon. We bad tka (idlowiiig eownnaliw 
Bll»«r:— 

- Wban did you beoCRM Oodr 

"Hicae y*n after my sarria^; one da; I iranted t« jnnip out at ike 
%&ulov, bit I fell eomeUuog ratmoinK lu." 
" Fifom vkon ?" 
••F«m Ood." 

** Too an God ; it vai tberetoK jaawH wbs natnioed jott t" 
** Tea, and en aooUter daj I weat to eonftaaloo." 
" Tlien JM kad not yet becoow God V 
" No. [ did n«t Uiea fed tlut I wa^" 
"/earn Chtkt was a naa, ud joa an a mmao. Yo« aaanot tbcrcfore be 

Cbrol*" 
' AJi ! 1117 dear «tr, that >■ a njiter j— I k&OV BOtUof el tbat ; I am tie 
Vintin Uarj - 

" It ateau to ma thai you kaic no cbum to eouider TOUtrMtf GoJ t" 
" 1 oill pimiah all Iboac vbo ibu oSaui mc ; Ood cauaot dcKcad froai Uia 
Ibnme to a*enge ne." 

P'*I>o ao( cMnteTOuntlf; yoeare God, arc|«a"iiolf" 
-r«a.- 
** An jon here of joer ova aeeord t" 
"No; I vaaona pilsrineK^ *hen I vu mjrUid, t&d broa|{ttt islo tkta 





,396 



aUTKS OF UtNTAl. 



I 
I 



' Mfhj, Hum. did ytn cUov H. if tdu w«re God P* 
"IcmildDDt preroiliti tl it not (or nc to gq igMat IhtMlklilin Tu 
sUt« procontor voold not let ma go. ^'t thall bars t gnst w.i '■'-' "* 
1 bire wciltcn to Looii Ftulippe^ *<V^ *^^ ^ *^' ^ ^Bg [oc t«c ; 
I haTe ■ farotber who hu four torn, aid tHuf an Bppnatim Id^i.' 
' FngmBn PtjreHoloj^nM.' t8j4, p. 3x3. 

ExAKfLB XI.Vin.-.V^nM<iM^ AMfiyof oitf inmati¥d i 
Uaig Mi m^4i UJIuiMet. U4U»^*a^«mt a/all Ua »aum^ t^ttUtf 
talmmt MtmUiHg ; fMtiUiUy <^empU/df t m« ml img Ikr Mi 
■■RBle».»hauiiaQwi)tt.'Illiiatiiti(MHi>fMidne8a,'lxndDa, 1810^ 
of a naa. Mtnod UaUliviri, «rii«, ju Uw jraar i jy;, m conM^jomcc ot & 
verdict, wBt rcfleircd into tfaa ImpiUl of BeUilcbem ; in 1 79^ be wu 
to tbc diviiica for tucurablea. Then he remahicd (or 6eTetml ;nn^ 
nosidcniig kinualf tka mlqect o[ capuimcnU nmle bj certain 
tine* the taoftm of tbe vorld. In 1809, hit nlativM, vbo wan 
Ilia nvdawa in BethlaheB, proposed that ho abonld be diamiMad, and 
Dn. ClnlterliQOk and Biikett to iaijaite iiion aunnte}; into his imi 
ditioo. llieM gentlMnm, afUr having linted tkr patient four tuasa, 
m ioid and eooadcnce Ibat MauIicvb was ia ■ 'fo'^ "fpt'fi^ ^add 
A Mv oowmiauoB of ei(tit pk}iieia» was now appoanted. who, aftar a 
examination, gnuted a ocrtiAaate, aUo oa oath, fid/ At* aaffn Nw M « jlyt 
ntuu. 

And Liule«d li« was. He cberiihcd ibe ddwaoo, ia ita deUOs UgUy di»' 
nted aid dranatiMid, that a band of wicked bmb wM ajTHHi kirn ia gfwt 
■My uajft if ma^Mtie entrtnU from an apartneDt in the vioiail}' of the ton- 
wall. Ho hMird aad mw tbne pcnoiu, ud can Ibenfon niaulaljr imeSt 
thein. Tliere are Mven «r (been, four ncn and three vomen. Tbe ^ 
amongst tticm is one named Bitl, alao called the King : he is from aistj-baj H 
nxtj-flre jears of sgc ; his llionghta are constanUj directed towards vidul 
ohjecia ; no ouo ever mw kim laugh. The aeoond is oJled Jack the Sehxi' 
DUtcT, wliQ also cslb hitQKJftbc Rc|tistrar, ahontsixtyTsara old, tall sad Itii 
llie tl)ird penoi: is Sir Irchy, aged Bfly-fire : veats a dirty-eoloued eotf td 
• knce-brMclics ; he cciulanttjr en^iloja aljr suoa»tlc language, and apwkl wi<h < 
provincial accent. The foarth u called the Middle*mso : is fiftf-eerai j«a 
■go ) has n havk-likie expression, wean a blue coat and ■ gloaej vest, wl 
aUntljrsil^KnaDing. The flnt woman is oalled Avgiuta 1 lhirt;*Bix jtui 
oC medium !iclf[iit, sad ehatadterisej hj tbe aharpeeea bf her featnca. 
dresses to black, like a cotiutry shopkeeper') wifc^ and wean her hair aspi)*- 
deied. Tbe aecond ia called Charlotte : ahe ii a radd; brunette, and verf lib 
a Franoh womn. The tliird woman is veij peculiar : she nppeara to haw W 
Christian name, hat the other* call her llie Glove-woaian, beimue she *]<V> 
wears cultaii gloves, and indeed, as & Archj itjXj lemarlu, to keep (CDfJt 
from accing tlmt sbc has the iicli, 

) The iBfluencM which these imsginary iDdividitali exert upon the palsaal. ^ 
mcs-ns of a coioplicaled macliiiie which lie csji minuttlj describe, arc of amj 
various cisture. Th(! patient describes ■ number of Ibete TUtou 
{haUucinations) in bis own terms, thus : 
OhUuatifM <^ tU finds— a, kuotting togethtor of Utt fibrw of the root of Ii 



STAnU OP UEKTAL WKAKNBSS. 



339 



ritcrtbr kpMsli if twooght to ft standstill. Cnlting i>ff ef tht tonljhjm 

*— an cipouiOD of the mtgnttio current from tlie root of II1& noso 

IWilcT *urfM9 of tliQ btaiii, w ir a veil ncre ipirend over it, ao lliat tiic 

I of the beait are disconnected (xoni the uijeratious tyf tlio iiiiiid, Dmgon- 

\»j» ij i pft|Kr draKon, so tfaese ruoU, b; mttaa of their art, 

imaj t^idai id«a vbtdi itrtkes them (0 ariao in tlic mind, i>bicli tlien 

\ i» asd fro for scverti bours ; and abould lio wish to get rid of tlie idea 

upon bun and call (orUi tome otbcr, be cunot do la; he must 

I kia vfaote alttmion lo Iheir idea. He is also, <ttuia(f Ibe nhole time, 

I Uuit ibe i^ca it {ottiga lo liim, tai urged upon bin from viibout. 

fotad diM«— a fettering bf judgment ia rcvicwiug one's thougbta. 

• tj^ iimi-tieUt—oac of tlie mi»l frigbtful inodea of boiug iullueuced. 

ftsid pmeal in tbe btaia mi in the ncrrcs, ttic vapour vbidi risoi 

IdoiTB in tkeUood'TCSt4-ls. the gns in the stomach and bo vela, arc in tbe 

si de{rt« famfltd Hid [rnilcifil combii»itblc, iriikU tbcn cnuscs a very 

^opuMioo of the whole bod;. Duiins ibc aulTcriugs of the unfortunitQ 

UiMO raMak let loose a powerful cbargo of tbc galvanic butter;, wliicU 

a fearful sbock and icudi tbc wUok body, fcurfol cnckiug is foil 

the bead, and it i* ictU; voodcrful bow tbe gitat tbock d«ot uot cauM 

! ds«th, Ac. A«. 

[ etsqt, Msltbewi la loTmcntcd b; drtams. These micali Iiktc man; 
knda of earioQslf foriucd dclla : nheu tliej Lave looked at iheiio for a 
line coatinBotisI;, tbej can ikroir the image of ibcac Qgurct into bis 
[Atriag iloep, ic. 

' stuff wliich tlieie individualg use in itietr viperimenls is, according to 
of a nrj complei ami vnrioiii nnture — the seminal fluid of mea and 
^(Miet>[ the <Bunatiou of copper and'tutphnr; the vapour of ritriol and 

Etortis, of iui;btibade aad hellebore; tbo eicrcnient of dogs, human gas, 
I oil, *spour of oncnic^ fte. [Se« the detailed eommuiucationi of the 
t, ud his descriptioD of tbe maehin'C, in Nuse, ' ZcilAcbriTt fur Ptychia- 
t'A.iS.S.i.] 






n}* casu foand described in original Mii8. or in pamplilets, 
ame of Ibcm pablislicd bj the patients tHcmsclvcs, belong to the 
IBS Cftlegor; as this com : for examptej "Cnr of Distress of one who 
» patMmed hj Magnctumj' Stuttg., 1 853 ; nlso the case described 
J KMSer as " Melancholia damonotDunia occulta" (' Keilachrifl fur 
'qrckistric/ x, 1853. p- 413)1 of extemallj' concealed tocntal dis- 
nier of forty years' iliintion, with the deltuJon of being the 
mtinual object of demoiiiacal npcriiocDta, and with domiiiant 
■UaotoatioDs of hearing. — Anomalies of aenwUou ui the most 
arifi parta of the body, which in theao caact m to fantAstinlJy 
tattorated, occaaionaUr occur in the state of health. Tfaeao cutdj. 
koH an; in geofral far too little studiod ; tliey are generally throvnt 
mI daas of hypochotulriaa, and I think I ahall again 



840 



8TATI8 OF UBNTAL WEAKNK&S. 



refer lo tliun dn;»ti«n:. A patient of this kind, in m;r pracuix,fcri 
about fifty yesTB of age, lias for maoj yean cspcricnccd, tlatai 
uninlcrruptedl;, tltc sensation of a constaot " heaving uid Hfting" 
in liifl vbolc hodj. A yonag oiau, tirciitT<one years of igCi nkM 
father had ifffn 'iiuaHe, tua n aeDsation^ nhi^ has been ooiuUnd)} 
JncRMillg RDoe hti fouHeetith year, as if head nnd face were ewsfd 
with threads, and some one was contiiiually pulling al them, alnn 
prcfvrring the head; InncinatlDg puiiis in tlic knrcs and shin-boDCf, 
&c. Thcise patients do not think of ascnbing tlii-ir nulsd; lo 
otbcDj but tlidr ahiiormal tciisations VDuld, Ehould mcnloi disMt 
act in, immcihatclv afford rich mntcrial for euch imputations. 



Section U. — Bemsa&i. 

{ 151. Under tUc stAtcs of mental veakncf« without the strikiag 
lirodoTiiiiiance of a single delirious idi-a, wf comprehend nnder tfe 
name of dementia — as diMingubhcd from apntJirtic dementia — UaK 
in vhich the patients still manifest s certain degree of estetatl 
vivacity and activity in coovenatioD Mwell as in conduct, indidliag 
that Uiere still exists tome Tuiety md actiTity of thought and (#aL 
Here, also, there arc very many varietiea iu tlie tnimncr in wbidi tlw 
mental nuknc^ \i manifested. Most chanctoitlic are the muiaerMl 
tiiiCi vliich in their i-itcrnal symptoms present an ajiparcnt ami* 
larity to mania : this similarity, howcrer, can only be external vA 
Sujierficial. 

lu all these cases the ftmd3nieilta.l disorder cotisists in a gauRJ 
veolincw of the mental faculties. In the sphere of the cmotiona tluj '» 
manifested iu tlic iiicrciisiug incapacity of the ]iattents for mj 
profonnd emotiuii, nilh irrtgulur diitnge of quite superficial (motioRl 
or persistent, complete inditFcrcncc. Ilatv nnd real love ore alic 
impossible to these patients; privations arc little if at all fell tj 
them, and they cannot rejoice at agreeabla oocunencea. If so 
occaiiioQal turbulent chuUition should also occur, it is ncitlicr tbt 
result of strong thought, tior of an energetic set of emotion or w2l \ 
indifl'erence quiclily rclurji«>, and it is tLi» indilTerence which abon 
the abaormui state of the emotioiiiU reuctioiu towards the a- 
tcniul world {laughiug and amusing themselves in the midst of Uk 
Mddest events, &c.). The dominant disposition of miud prenoU 



STATBft OP MENTAL WEAKNESA. 



3U 



rarieties. Some of IImm {wHcnts constantly maoifnt a liirelj 

ntioB; Hkj iaagh, dance, stag, and riiov, in tbcirgatane md 

tion, pride, sclT^sBttsbctioo, aod the most perfect asnnnce 

I ^ 1 j^) ; othera, on th« cootnir, are in a perpetual >tst« 

' mxirtj — thej sJitd many t«ftr8, and pretont tbe STmptouM of ^rirf 

id can. OUicrs, agnin, have a l£Dd<;ac; to do mtschierom acts, to 

}:» plcMurc in the nUfortonca of others. Bat these dispositions 

neither the Ktolt of an external (as in health) nor of an internal 

in mania or mclanrhob'a) tnotirr; tbej are quite raperfictal^ 

itcmate with each other vithont any cause, and are exprcMcd in a 

MDcr altogether foolish and childtiah. With the complete indif> 

Qcc and absence of all actual dcsina vhicti rharactcrisc the 

nts, we sometines »cc maniftsl«d iliwnlcHjr mrntnl inorcinenta 

id aimleds cxiraragant iiupul»< whose meaning the patient him- 

caaiiot understand, and ihe reaction of the will, where this 

till cxisUj has throughout the character of IraasitoruicM ai>d in> 

>nstaQrjr. 

$ 153. While in the sphere of the emotions all tends towards fecblc- 
impotencT and atonjr, the same trntlencj is also obscnred in 
a still higher degree in the sphere of peree^jtion : this is in 
DOC with whot hat been already said rcgaiding the connection 
tmatioital wcnknexs and vcakivcfs of pcrcvption. This 
I chiefly in the form of ioaa of memory, and the power of rp. 
lactioa of Ifac idcoa is cliirlly affected in tliis manner — that more 
it events, things that occur daring the dmicntia, are aimovt 
ly forgotten, while not unfretiuently former ideas con- 
led with events which happened long ago ore mor« easily 
produced : still, many of these ptienta liave utterly forgotten their 
' life, and even their own name. As all the operatiooa of tht 
proceed eotiiely without energy, no durable impmssion is 
of what is presented to it : beside?, these patients have also 
the power of comparing separate ideas, of deducing a general 
fret from them, of judging 3ud of concluding, and all thought has 
Begenoated Into a disconnected m&fs of ftcetiag iaiagM and vunls. 
Vt ia a nselras and sterile activity of the intelligent, which indulges 
ID aneqoal, isolated, and incomplete ideaa, but is incapable of oom- 
Uoing them into a distinct judgment. Front tlii* there results, on 
it one hand, the impoMibihty c^ all abitraotioD, and, on the other, 
nlrrnal iocobcrcnce in tlie associated imago and ideas which 



MS 



STATES or UBNTAL WEAKNESS. 



proued from aocLdeiitAt impreuwns of Mfite, or ueotdii^ to lit 
merely citenul coanectiM] of »ccid«alal simiUrities (fc»r extmfiK 
eimilirly Emimling wor(l»). Prom this, too, there icsuUa tHenM 
of all logi'^l fonu, the irrc^Iat cbaage of disoonnectMl iita^ 
t]ve onineuiing pirrot-like rcpeUtion of words uid phnses btm 
cuMoin and an^ordin^ to accidental similarity ot sound, incobeni 
and sdifvlpfs replies. VTe often think tluU in such palicnta ■ 
attempt at nicmor;,at judgnieitt, and at utteotioa niajr be disoorm^ 
which, howcTcr, falls pofrcrlcss and inuDicacious ; again, wc a^ 
observe brroks io their sentencea iii which the int^nnediate pitl 
whidi fthould connect tJiem and form the transitiott to new ideu ut 
wutiiig, and we maj often receive the imiire^on that tbe«e [HtiiUe 
creatarea thenuelTca were tacitly and painfully feeling their <m 
inability to direct thesuelvM nright amidst these broken reaaiu of 
psychical life. 

Special fixed idea*, true deririous concepttoiu, are never produod 
anew in dcmeDtia; tboac which formerly oxiated' becone vtUt tb 
increasing weakness less intense, and the patient can an liufc 
implicitly rely on them as be can energetically adhere to aaylhing. 
StOI, the reproduction of the ideas which are developed dorii^ Uif 
period of maniacal excitement oAen continiLCB for a long time, inl 
we again frequently find the extnmgancea of monomania ia Xit 
senseless repetition of great uumhem, in immeoae nod romantic idcM 
of tbedr ovn greAtncss and large posteasioDs (tbonsands of miilioBh 
diamonda, worlds, &c.). Thcs^ bowortr, have all becoott to Al 
patient a mere pUy of words, and are totally Toid of thooght. 

( 155. The organs of tense may perform tlieir functions qiiu 
normally ; the patients soc, hear, &c., correctly ; bat tbc dabonlim 
and transformation of the sensorial iinpreiibioiia into ndequtc Hat 
in the brain no longer jiroceeds properly, or— and, indeed, ordioirily 
— hallucinations exist which, along with tlte ideas, share the d*- 
racter of incoherence, want of method, and abTuptne.<«. 

Tiic mn^cular movements nro in many cases restricted, owing to 
commencing or progressing general paralysis. Where tUb is not tlit 
ca»c, the corporeal movements arc reslleaa and unsteady, yet awknid 
and lillle varied, and the attitude is oflcQ dvnty and belplM. 
Sometimes the putii-ntjs constantly run to and fro as if they wor 
looking for aomelhing, or they rove about dancing, hopping, ges- 
ticulating vith the hand) and making cdil notomatie movcnHiiis. 



WTATm or VOTAL WUKKnS. &43 

bar 6tmtmou nl ■nwnrfi wn dtkr JtogrtW ■■pipwmy ^ 
or ue ix pnamn mit et nsj weak ematiam; lad Iksc d» an 

■bfaali, nmmaaf alvan in h^ ploMna ■ k^ wad 

S o tti M W tky aadfeet i njmid icAtf^ of food, 
othcf ijnBptoai of iJyMiih obiliBcy ; bvc bvquatfy ire 

Ok love of cBtbg— 41mt frcqmrtlX n^knr thp Boet lo^- 

UuB^ Vetf iDtBf of these ptfiaits vfao hive been king 

ia tho ts^inn ue lAdicted to «— J— . "^ «a ouj &«• 

Jt gather fitim Uiar eMmnatioB m d i M li o M of oewklcnbU 

of the Mxual faactiopa ■ mcanaSmon wldcfa ought to 

ire inunediite f^ fnither ioTtstisitioD. 

The pbjnognomj ts gcnenHj oU and shtpid, the aqmnion 

iRt, end the et ma Ua u aux ohMmed b^ nc^leet and dirt, the 

. health nutf be good^ or die most rarioos chronic or acute 

I amy be pnaent; not onfivqaaitlj' ihera is a great Icndcaoj 

become corpulaii. 

Complete intenniaBiouDever oecar dariiig the ootme of deoMatiB. 

ihaaas occai in aadi a manocr that quteter and sonwirbat nors 

inal slates alternate vith the periods of gnater turbaleoce and 

itatioo. The worse of these states u always progrcsnvo; the 

veaknesa coostantlj iaatuw, and is most rapid when the 

itia is ccnnpUcated with general paraljaia: otherwise tlic 

Bujr remain in the mom state for periods of aevcml j-rata, 

oerer lakes place. 

SXiUnxXLCX.— TVawifiM »/«9WiUJ«w iwU tOMpJtUdtnmtui.-^a\i» btil 

ODC iiln, uul tJtai wu a ino*t cstrtvagvit one. Slie tliought ah* wh tli« 

She iadeodipokoiboof olbetthingi ; but bcr ujiDg* were withoal 

aim or eoBBMliw^ and ake tuul almott iwiio ot ttio hkblU ofot^iBar; 

Then is not jot Minptct« lou, but 0017 o»naiilond>la wetkasM of aU 

faeullwa, u nuj bo ktrntd Troin Die followint eODnmtioa : 

"IMsMie, i?k>t i> your aaioe t" 

" I am caUed, at; Bame. You owe ine a Held. I nm tadced Ibc Aliai|bty, 
11/ nnJanUaJtog kai been cuitailtd la onler lo maltft an apraa of It." 
" How old an jron t" 

** I aa bmiUvu jears old" (the was at leait thirty). 
** Bow nanj aj« fortj-flTe and thnx !*' 
"That makn farty-tlglil. How I aono ona lua atoltn liolb Uf fpAi and my 

BWtU." 

- M'ho took UxM from joo T" 

" Aak jonr owa tbovglila i I am not Iko eniranlcr woman— T am (lia 
Aboicbl;." 



3i4 



STATEI OP UEHTAL WF.AKXE98. 



" Since vlien iam joa bem Ite Alnigbtr I" 

"Aiwa;*, alvaji — I kite klirija been tli« Almigltlj." 

" But tlie Almigbl; lua n b«*rtl, wiil jaa hurc cone I"' 

"I b^ jonr pirdon. here it is" (pointing tQ ber hair). 

TblB ptUect Mldom remwkt aajtliing, aad hot ■ItealioB n nerer eratia 
She liu little rcinciiibnuicc of Ibc put, ud nr; little of tbe proent. Sbei 
onlj rapkble of tlic aimpleat act»— makiD; bet bed. putting on bee 
eating licr food. Sbe knows Ibe utiM of nobodj about her, nltiiaagli aha I 
tired with Ibem for MTeral jvan. In mDomait ihe puses from Uo^i^ I 
quatrelilrig:, ic <Leurel, ' Fr^metis Pi^k.,' Far., 1834, p. 34.) 



SBcnoK III. — JjktUeiic Dtmentia. 

} 154. Sometimes, u a mode of tertniiiation of Die forats 
have jast bccu cooaiilcring, sometimes withoul tLc untoccdent occorw 
rence of the more noiay siid ngitnti?(l fanns of di'mentia, there oonil 
still deeper sad iDore complete stAtes of paralyns of the psichical 
fanctioiu, in tbe most extreme decree* of mtMiial Jecaj. 

The imbilitf to eomprebend sereml idew and to compm tlum 
alva^s increases, and instead of tbc Damcroaa abrupt discoiiiiecW 
\AfQA s«cn in the preoedlng forms, there gradually ensues almost 1 
total ab»cucc of images and tbooghtt. The aen&oriai impre»ioiu 
are no longer elaborated, notbing comes out of them ; mciooiy ii 
so complett'ty effaced, that not merely vhat happens in one momoil 
is forgotten in the next, but all reminiscence,* of begone times are 
almost entirely lost. Language eren is to a great extent forgotten, 
» that patients even in the most favorable caks can employ ooly 1 
few current, very limited, and liltlc applicable exprcssiotta ; raofC 
frequently the few vords that remain are only automatically le* 
pcatcd, or the words tbcmsdrca are uot entire, but are ineni; 
fjaculationa of accustomed sounds. Tliis very liigh d^tee of dulnos 
of the imagination and loss of the intdtigcncc is accompanied 
by extreme weuknesa of the will. Tlir: patient can no longer 
actuate himself to do anything, even by the force of former habiU; 
he must rather pawively anhmit to be directed by some extraneoM 
impatse. Uc is frequently unable to aupply his simplest vaats, mi 
requires to be fed; he loses himself every moment in lu« omi 1000^ 
and his ignoronce of danger renders it necessary that othcn sbosU 
protect litm against accidents. Ilia conduct is uniform, and ohnji 
the Rime ; sometimes apparently concentrated in atlf — shy, dvlli 
•ilent, and inert ; sometimes automatic movements are gone thiougb 



ATATE8 OP MSNTA.L WEAKNESS. 



845 



iiig to aad fro of the body, rubbing tlie IiaikIk, murmuring, 
nuking QQineaiiing noises &C. The gc,«tun?s are lifeless — tlic 
countenance is reluxL-d or omazec], or apparently* attentive without 
motive, md the udcant look and bursts of laughtrr bIiow that there 
esist no ideas which tin- {laticiit can exprc-'«». Nevertheless, they 
sometimes express slight symptoms of pleasure or displeasure, and 
traces of emotion ; of preference, from custom or with « motive, for 
puticttlar persom ; of the sen^e of shame, of childish pleasure in 
DUtduef, of nusivCy (Iiiding (bumselvt^ji), Sic. In their better 
inoinent«, there come back t« them rcminiscencca of former hfe, « 
greater pnrtidpation and pleasure in the eicternal world, and a lively 
appreciation of kind treatment ; and there is in these lingering tmcca 
of self-coiisciou!'iios8 and emotion enough to make us respect humcn 
nature, even in this its state of deepest degradation — in these unfor- 
tunates, whose silent, inexplicable geoluri-fi often, uncouscioufly lo 
themselves, reveal a melaiicholy past. 

Serious disorders of the motory and nensitive fnnrtiotis of the 
brain very frequently accompany this sad mental state, in particular 
entire paralysis of movement, and frequently also of vcosation, so 
that the patient ran often endure tlic deepest and most extensive 
bums without any feeling of pain. The nutrition may remain for a 
long time unimpaired ; the patients remaining corpulent, eating vritli 
m vontcious appetite, &c. Sleep, too, is often well maintained, being 
■onncl and prolonged. 

Tlie only mode of termination of these states ia death. The 
patients sometimes succumb to tlio apoplectiform attacks which 
occur during the course of general paralysis, or to serous elusions 
, io the brain, to cerebral atrophy, or to chronic and acute disease 
in other parts — pneumonia, gangrene of the lung, tubeiculosis, 
intestinal catarrh. Some die from wont of proper care, owing to 
retention of urine or of ^cal accumulations, or in consequence 
of accidents, bums, choking by taking too large moutlifuls of food, 

Seiule dementia, loo. tcnninales in tlie vaj we tisve just described, as also 
jotBf analogous conditions aonictiRie* observed in tlie prime of lift, and pro- 
ceeding from itniplij of Ihc liraia villi or witbout artorial degeneration, 
Tlic»« lameataUe esses of prinmrr, slowlj commfnciag. prograsaivo dementia, 
oflen proceeding to eooiplcte fnctit»l Jeitruolioo, occnr in the prime of life 
smODg liigU and low; among [lie former, sonictlmca in distinguisLcd men, 
owing to txccuive mental and bodil; exertion and trrilatiou. It is often vttj 



310 STATSS OP MKNTXL 

(Unmlt to diilingniah Lbe nannBMmBSDL of tbeM oanditioiM fmn nevU a- 
Itfualton and ftpklbf, vklA Mif linninwiil lij itiwplfi i— imii SligU nanhMi 
of the citrccnilio aad ^nptomB of unsenlar caBnlMaas oftj ilaa esiit ktlit 
Utter inntion«il omh. Il Is frAiDenllj iwt until after looft abtemtioo tU ■ 
omaliujon c«a be uiiTcd at ; tlie trMtmcat miut be aitricnt and l«aie, lO 
euuet of imtiUion being, ot course, removed. Hom eawt in whidi a priaair 
•late of mental wcakiMM has fiirftloii^ lime preceded an attack ol apopleaj «t 
of eneepliaUtia, geacnll; depend upon dbcue of the ocrcfanl artcziei. 



SBOaos TV J— Idiocy and CrefmUm, 

tf 155. Bj the t«nn idiocy, ve are to uodrrsiand those 
1ioi» in vliich a state of mental weakness haa existed from bnth 1 
from Cflrljr mfancv, nocl ia vhidi IheptyeOeat diveiepKumt lus bm 
therpbv ipip^dtd cr prevented. Individual* in these oirconutaiiOH 
Kiuain to a greater or Ww ■:xtcnt Wlov the avrnigc tn inteUigcDN ; 
nor can they attain to the decree of education and inslrudion cnr- 
responding to their age and social positioti. 

^Vliilc pycUologists arc gencraltv agreed aa to tliis dcfiaition of 
idiocT, tlicjr art,on the other hand, forrioin being at one aa to the sgni- 
ficnncn which the originally popular expression erttinitm should bnt 
in science. Most fre(|uen(ly, lioHcvcr, the term cretiuitm is apj^edlo 
t porticulnr species of idtoey^ aainely, tltat in irhich the ttihjtrl 
prceentti a hereditary defect ^ pkytieat eor^ormaiio* .' it ia in Ihii 
sense thflt vc shall here employ the won]. Tliis physical dcfcd 
need not of necessity be always the same — it is not specific : oerer- 
thelcN, tliere is one form of it, by far tlie noM frequent and bett 
known, everywhere the mane, and apparently chsrnctcrirtic ; il 
occult in various part* of the world, hut especinlly in mouatauMBi 
distriota, as a widely spread disease depending upon locaJ esaxf. 
Tbn prototype of tliis form is alpine creliaitm, and maj he deng< 
natcd by the term cretinism in the restricted sense of the word. IJ 
will be afterwards dejicribcd. This form is always endeiBic ; oc. 
caaional coses of sjioradic idiocy may, however, bo derelopetl, 
according to the nature of the ])Iiy«ical defect. 

In all possible forms of idiocy we can, considered from the stan j- 

point of the iutdlct-tual development, distinguish sereral degrtta oT 

the malady. It would be uaeteu to c3tabU»tt uaity degrees sod 

grndatiuiui minuloly dintinguished from each other ; it is better la 

tdistingui»h, in the first place, simply, lit, fke more senere eatf ot 



STATES OF UBNTAL WEAKNESS. 



347 



ioMlectiial nullity — dementia, fatnitr; and, 2nd, the ieu tgtere 
eaaet of simple mental weakness — wenkness of mind, imbecility. In 
cretins tlic degree of intellectual disorder (viewed goteraUg) is in 
direct rcUtioii to the phjrsical defect; wcUitreforc generally- meet with 
both rciAtioiu together, and corrcfctly dieliuguiab cretius and semi- 
cretins : the latter states imperceptibly pass through many inter- 
mediate degrees into the state of health witJiout aii^ distinguislung 
ngn. 

Acconling la wbat bu htta said, every CTclin it an idiot, but ererj idiot is 
not ■ ctetifl ; idiocy b the more eoin|)rclietiiiire term, OTetiaisoi ii a ipccial 
kiad of it. Ibis leccftlatioa of the term ii at tlio prnent inj, if not gencnl, 
at all CTcnU tbe most frequently adopUd; some ligoif; lij tlic term crcliutein, 
lh« hii[liut drgree of congmilnl dementia. Opiniun* lucli at arc tsprcsscd in 
IW BtMl Tcccst work or Guggeabuld {' Zcitschr. dcr 1c. k. Gc* . dcr Acritc za 
TCmw' '8(io, p. S7) odIj lead to coBfusiuti. " Wi maj contider as mealailjr 
weak, and tbtnfora oa Uia road to cretinism, (!) nil diildrcn nlioitcithcrat 
booM nor is Uis aobool can be ntde accessible to titc onlimiry mcam of odu- 
Gilian and uolruetion." 

la sporadic idiocy, tba pbjtjcal onnrorinktion maj be perfeolly normal ; wo 
ocEaiioiialtj eren meet with beautiful and welUdeTelope<l cliildren in a liigb 
degree of dementia. Ai anile, bowcver. llus ii not tbe ciue; tbe bodily de- 
rcJopmeat b geacrally inrolrcd, in imrliculnr it is oricn far bebiud tbe age at 
tlie patidU; the rorcni, etpecially of tlie licod ttnd fnec, arc inconiplete nitd fai 
ffBm besutiful ; bat ia iponulic cotot we never find (Iidm ircll-oiail^cii uad pc- 
calitf defect* in the pliytical ooufumiiitiuii wbicli, owing to tlie cKonsiraj 
BBonuUes fooad in tereral orgam (&r ciainplc, in tlic liiyroiil Eland), may b« 
Mmldered u an afTcclion of the whole constitutioii. Tbc nllcnpl lo oomptre 
tm^ qti>liUli*e [locutiftril; of llie endemic and noii-endcmic idiocy appears lo 
nc to be al pioent ptcmalure, allbooKb it foajid iu Zdlncr an onginai and \ 
veO-infiuiDed advocate. 



A. Tiioej in general. 

^ 154S. Tli« e^sentiul chamcter of nil idiotic states is vcahictt <^ 
tii inlelUei, as the fundanteutal focnlt}' of tbc mind ; a veakne 
which in many cases mny be rrcugnised in all the phases oF thfl^ 
BCOUl life oqoally, while in others certain psychical processes — for 
aznmplc, tbe emotioHt — ore still allowed a certnin dcgrco of oelivitf, 
or ercn certain gnat series of td«u ranaiu frev and capable of a 
nodenlr degree of derelopment (special apliluilcs, talcnta dis])Uycd 
bjr oefflain idiots]. From tbc circumstance that tbe wcaknesa of 
ercqitiou is ilaelf ttie rundnmcntn) disorder, idiocy b entirely dis- 



348 



BTAT£a OF UEKTAL WEaKNEU. 



tingnisliecl from the ps^chic&l impafecttoiu dependoit npon de> 
ficioicy of the kdms, such ta deaf-dambnrss. From the dr* 
cnmstanoG llut thi* wmIousi oomes oa at &q earl; period of Liir, 
audi that therefore the p^chieal development is umuUed, or it 
least much retarded, it is diftinguigfaed froia deoKntia derelopel 
daring Ihe subwqacat j'care of Ufe irh<ii, u it iudced verr oftcs 
Ihc cue, tlie state of vcaknesi arOM after an originallr nonnil 
mental slate, or even — which happens more nreljr — was ushered a, 
bj a prctiminar; stage of exaltation. 

It is bcj'ood doubt that the wcakneM of the intellect, and llur^• 
vilh the arrest of the p«yctiical devdopitHnt, depends npon a 
oerebral anonaly. Thia fact is, ia geni^, roach more capable of 
being (lircctljr proved and dcmonstrstrd than iu other mental 
Haeatca. In many esses of idtoc; there may be observed cotmdrr- 
aUe {uithologiuil changes in the brain or its membranes, on an 
average mnch more so than in mental diaewe in the mtnd«l 
MUK (^ r59) ; and ve can, in gcoeml, say, supported by the gmt 
majority of cases, that the deficient mcntol denjopmeut is the dinst 
result of deficient cerebral development in childbood, and that it b m 
proportion to it. Nevertheless, evident and palpable clunges in the 
brain or iL<> membranes arc not always funnd in idiocy, and vc are 
impelled, br numerous facts, to the nnumption that there are bUo 
idiotic Htate5 whf^re t he vcnlne^jt of iwrccption does not depend upoa 
organic changes, but originnllj npon a iiimplc functtoual auorralf 
of the btaiu. To tliis clns* ouglit mnny cases to be referred, wliar 
frequent epileptic atlaekj in very early life, or where onamsoi, ooo- 
menced at a very early period, have induced an early cxhaustioo of 
the cerebral functions ; others, where long general illness in a chiU, 
with impairment of the nutrition of all the oi^altf, indnded th( 
brain, and therefore the due performance of its functions ; farthei, 
eves where the mental development remains stationary from vaot of 
anyext«ninl rneiital iinpiilite — from extreme neglect and iuattentioo, 
associalion vith other dementi, unfavorable outirard relations, fte.; 
Gnatly, certain cases where the mental development does not pro- 
gress, because in wenkly children there exists t\ich an excesnTC 
d<^re« of emotional irritability, of timidity and fear, that a state of 
passionate exdtemcnt is awakened by every attempt at mental 
infiucnce, even by any lively seosorial impression, so that developmait 
of the normal process of perception is rendered impossible. Ah 
though few of the latter coaes originally belong to the idiotic state;, 



ftTATES OF UBNTAL WEAKNESS. 



84e 



still they have the lanic practictlly importanl result — arrest of 
mcnUl dcrclopnurnt. But tbefw catcs of mneljr functiotial ccrGbral 
dipoider, which kt the oomnunceinent constitute a more apparent 
danentia, form « very small minority compared with the ca»a 
wberc the psjchical disorder is the reault of organic changes iu the 
brmin. 

Oa th« otlm lud, thoM COM4 vliicli no* and tbcn occur orgrett dalncnor 
kknnoe oT enolkiD, exiitiog: from earlj iurjiiicy. and wUich ve nvutealcd in a 
praeocious pvrreruty of llie dcMre*. often as luileucM, wickcdiieu, suTBgcncs*, 
Ac. do not brlou;; to idiocj, sllbouRli tbejr are in a ccttain scnu pijrchicd 
defects, anii are tonKtimee spoken of m ca»ea of monl idiocy, ttuntiDg of the 
Matimmt*! &c. Ttieae tUit«« may br usociatcd nitli good a> well si with bail 
Balare] talenls, and are out neccuarilj due to arrcfit of dcTciopmeiit of tlio 
pojekical ruDctioni. 

$ 157. The Cituae» of the vsriotts cerebral diseascn Trliich form the 
organic boaia of idiotic states corrcspoitd in many relations vith Ute 
Csuacs of the other ]jsTchical diseases (sec Dock 11] : nevcrthclcis, 
lh*re ii here much thai is peculiar nnd 9[>ecinl. 

It ii erident that, in iniiny coi^s, powerful causes exist tQ the 
parcnhi which influence the developing germ which afterwards 
becomes an idiot. In f&mitic« where cpilcpsyj mental disease*, 
paralytic affections, deaf^dumbness, are freqaent, idiocy is ahw 
obserred to be common. Frequently it occurs aa a mere partial 
phcnomeooo, aa an individonl manifestation of n general deteriora> 
tion of a race : thus we see in a number of brothen and aiitert, one 
Of two idiots, together with others who are small, incompletely 
dereloped, ogly, and sterile. These dcgniL-mtions are princiiially 
obMfved in families where the blood has not been sufficioDtly 
icoewed ; whcr« the marriages have always been with nenrrelatlveaj 
also where the porenta have been too old or too young, or addicted 
to diunkeDDesf. Sometimes all the children of such marriages bear 
erident marks of idiocy, or of some other form of degencratiou ; 
indmlf in oertaiD ca»c« this may be ircogniwd as incrrasiiig from 
the flnt to the last child, so that, for examplo, the hi»l or the two lost 
mrt t|iutc demented — the others stunted in growth, hystericnt, 
nsvotu, epile])tic, dcaf-and'dumh, &c. At other limes some of the 
diildivn are jicrrcclly lu-allhy ; but thii does not render the statement 
tucoTTect, that idiocy is a mark of degcncntion of race in that 
buily : at the time of conception of the rarlous chililreo, the state 
of htmlth of the parent may sometimes iacrease, sometiiius coAsidei- 



330 



STATES or JIEKTAL WEAKHKSS. 



aUr diminish, itw infiucnoe of btie constant (tending to dtgeoentia 
caoaca. 

Tbc ahitUo w doctrine wiikb lau reccntljr been praaulgftted, tbit meDtal diteur, 
draakoiuesi. Ac, of tkg panatt, doe* aot ao modi nftonee Uw genn u it 
bman tli« dcTclopmnit of tha Uioej — tl«l, aader aack nhtioii^ the cue lal 
education or the cltildren mosl ncccssaifly la BaKleolcii->can euil/ be rrfnlad 
bjt tbe resulu of observation of idiecj in UiB btgVx uhI eveo lUe h%Iicit nub 
oflife. Tbis bTpcrthticalqaatiooinfftbelicnditaiuicssofiiiio^caB, gtmn&j, 
oaly lead fren Ihe waj of troth (tee f | 9a 93), and its bneditariarM aiaj bt 
aee«p(ed in llie utne wide teow u t^ oCoUmt laanUl distiuet ({ 93). la 1 
can vhicb ctine under mj obscrriUion, 11k btber of a liijt^ilr idiotic cliiU «(• 
lend from violent penodic beaiiaebe*, during vbicb be aonctloiea qnit* tal 
fafaaeues: Die brother of tbe fattier vuUkevisediipoied totrcqanitbeBdacIa 
(tM } 99). In kDOliiff ou« which I obsened, Uu fiufaet of an idtoUckj 
Ured in a habiliuJ btate of exoitemnit, u if he irere olirajs iatoxicatod: tbt 
bioUier of tiie ftlber «u an itUol. 

Aaother, but Liltle knovn, neriefl of oansei acb donng the f<xtal 
period. During tbis period vnriooa erton of development and 
diseases of the brain and its membraocs may ocnir, to which &oB» 
times cxtonial injurioi may give Uie impulse, for which, however, 
much mote frcquctitljr, no direct mechanicaJ cause can be disoofcnd. 
Great ansmia of the mother, drunkcnnesH, riolent shook and gnd 
daring pregnane}', appear not to be w^llhout influence. la certain ran 
CUM injury to the head daring childbirth may cxeit an JDJiuionu 
effect. 

Far more freqaeiiilj', hovcTcr, those diicaaes which lead to idiocj 
(also thOM which are hercditaijr} do not commence till aft«r birth, 
from then till vithiu tJie third or fourth j&a ; in exceptional caw^ 
till the fifth or even the Ecvcuth year. Thcj commoioe and nm 
sometimes an acute, somctinkea on insidious chronic conrte; llic^ 
consist in congestive, infl.iniDiatorj', or other derangement of the 
natritient processes, more rarely in sauguiueous cxtiuTasutions in the 
brain and its membrsnct, very frcqucatlv iii afTcctions of the cranial 
bones. Bad care and iU-adapled nourishment to very young 
children ; keeping the head too hot ; the use of corcringa wbicb 
compress the head ; the use of opiates ; injuriea and shocks to 
tlie head, and other injurious influences of a like nature ;^ other 

■ See Koitl, ' Der endemisobc CretiniaiiiDS.' Jte., Wten, 1855. V- 9- " !■ lh« 
Brock ciiciiit, fortj-eiglit notable catcs of cliildrea arc knonn whooc idmrj d 
ascribed to a fall ou the luaii ftoiti n liclgiit." In tbis woik ve Ikd a Bombct 
of ooDlributionii to that part of etiology which ilcp«nda upoo ^nonaoe of ibc 
parent) or giurdiaos, or vpon popular opiuioDS. 



STATES OP HBNTAL WEAKKF.SS. 



asi 



discwK-s of cliildhood — u acute exanlheiData^ veakeniag of the 
iu&ntile constitutioQ l>^ rariouN causes, in vomc casen syiiliiLie^ — 
appear at this period to exM tbo grcsteat influcocc on. Ihc origm of 
Uuw cerebrfti aflV-ctious. Tlic iiiflucnoc of early coumcDcing 
pphfty, or initatioa of the scxaal or^ns at an eoily age aii<l its 
consequencMj and, filially, Uio influeDce of total mentnl neglect 
■nd aasociatjoD vitb other idiotic children, ia likcvijic iiot to be 
Itghtl^' eatiioated. 

f^oolly, there nre a series of powerful local causes, peculiar to 
oertah) locaUties, which wc at prcacnt must consider to be miaaiuatic 
in Ifaeir naiure: with the progress of science, lian'cver, we may bo 
jet able to anaiise tlie iiulividunl circumRtanccs. These caascs tic 
at the foDodatioD of endemic cretioism, oud will be oftcrwurds con- 
aidered more in dctaiL But house and chamber miasms, owing to 
dampoen, vitiated or too seldom tcneiccd air, unclcaulincss, appear 
to be capable of cierling quite on analogous sclton; the loiig-con< 
tinned roidnioe of young children in snch chambers is therefore 
Mpedalljr injurious. The " cretinism of large tovnn," amonirst the 
ialiabttaDtfl of low flying, overcrowded, badly ventilated, cold houaca, 
is eatainly to be in part attributed to miasmatic causes — together 
arilh a number of other co-operatiiig influettces. ^iliaamatic caiuea 
act mine apOQ the origin of diseases of the cranial bones than upon 
affixdoDa of the braia itself or cf ila mi^inbrDnes ; they act partly 
upon the ftctus, partly upon the cliild after birth. 

( 158. We have tttn that the great majority of cases of idiocy 
depend upon palpable snomahes of the brain and its membranes, and 
bavt now to determine te^it these anomalies arc. If these were 
known to os^ it wonld be extremely interesting to compaTC the 
various anatomical cliangcs, according to their nature, their seat, &c., 
with the different kinds of mental defecta^ We might hope in this 
w«y to come nearer to the relations of certain parts of the brain to 
certain fscutties of the mind, and, in a practical point of view, to 
arriTo at tbo eleoiciita of an anatomical diagnosis during life. 

' £rteMDaier hai recently publiibed (he eaie o( in idlotio child, where tbc 
enaiun prtMntcd numerous cxu»tMca, and who recovered under llie influence 
of Midi of potaniun. Tlie cue of Guiilaia (' Le{<. or.* u. p. 93), wbere t 
alU hsgoHia of ■ powuful man wbila undorsoing a eouno of me rcur; (ror 
mhiia), wkoae fonaar and subtequeat eliildnui weto perfectly Iwallliy, wo* 
yk/liOi tkia eua is loluestiac, alibough it hai no direct beiriog upon the 
Unaallnii »f tbo hflueace of ijpluU*. 



952 



STATES or lUNTAL WEAKKKSS. 



rfererthdcss, ve soon become coavmoed that, witli our prescsl 
Bateiul, a-jiain hj do means oninpoitaDt ttsulis in these Unc- 
HanmMf be srrivetl at {tee ^ i6ti), but the pruuHpal ]»rt oF tkt 
work cannot at present be nndertAkcii. Id a great Dumber of tk 
cases noir under coiuidattMn, tbc psvckologicd aiuiljniia is so idee- 
tiTc; the uanirotationa of mental Uf«, especiiUT in iiliotic ehtldra 
who die earlr, src so cxocedins scanty ; tbc cbai^^ foutid in the 
brain arc often so incorrectly describc<l ; especially, however, llieteM 
ffeqaaiUy exi*t Afcvni/ cerebral changes, — that, in a lh(*ori>tical poal 
of viev, ve must at present renouDoe more minute expktutJoiu,' and 
content Qursdvts vith collecting and, in a measun;, nrnuigiog iW 
material. Vor the practical anatomical diaguons, however, ve noit 
depend more on Ibt rcnults afforded b; direct examination of lie 
head, on the etiologi- and on certain motory anomahcs, than on tk 
paHJcnlsr f<^inn of the mental veakness. 

In general, vc do not 6nd the o^nie canw of idiocy to be a 
recent And >till progressing morbid process in tiic brain, bot 
either actnal amtt ^ dMw/qpWM/. or .itntes con^etutive to aid 
remnants of former morbid prooeases : as we bare seen, these Baa; 
hare originated during iolrautcriae life, or aAcr birth from the fint 
to the fifth or sixth year, and in certain eases even later. In oS' 
ticnlar, ve must distinguish between anomalies which origiiully aad 
primarily involve the brain, uid such ta in the first pUce constitute 
an abnormality of the skull, by which, secondarily, tite profsr 
de^-clopment and form of the brain is involved. Wc must, of eovat, 
remain undecided as to many coses vrhich may be presented to ui{ 
bat wem^ exiiect tbat the distinctive signs will become graduiHf 
more distinct and more ceriain : this distinction, u one r^gax^ag t 
fundameulal procesa, is, as far as possible, to be muntained. U 
flic following enumeration of the anomalies which, according to 
experieneo, are presented in idiocy, ve shall endeavour, as far u 
possible, to carry out this distinction. 

i >o9- *^f t^^*c anomalicH, f>onr/j> of Ue iraia, in it« vatiou 

modifications, lakes the lead. Abnormal smaUiieti tjf (A^ cntin 

hraia (generally wdl pronounced in the convolutions), with mloi^ 

oepludu!>, is to be regnrdcil as an nrrest of devdopment, of which tk 

Mourco is souictiiucs in Die brain itself, nud somdiuies in lite crauioa. 

P ' Wa expect la raoctvo iafcrrnialioo on tlicae pcfbts from tlie idtol inslitstia% 
jtut ai cornet idcM rrguding; mecitAl disesAO were Qnt recoived fran Ut 
atjlum*. 



STATES OP MEKTaL WEAKNESS. 



853 



lie latter appwtrs to be tbe more common, and it is principally the 
premature ossification of the colirc cnuiium wltlch couliiics the 
brain antl prevents its normal expamion. Verj carljf occlusion of 
tbo foiilant'iles (which is somttimEs eveu complete at birth), prtma- 
tare ossification of a great umuy of the sutures of the skull, hinder 
the rapi(] growth in tlie early ptrrtods of Ufc which is charactoristic 
uf the human brain (tu nunc of the \fivfei auimuU dci the fuutaaclles 
remain long open) ; and thiH injurious influence on tbc ecn-brul 
(level (ipm eat h greater according as the compcusation which occurs 
through the expansion of other pnrts is less. In the other, lew 
namerous class of microcephalics, all tbe crauial suturca remain, eveo 
to adult life [ffhiTcby the crnuium inaj be either well proportioned 
or unBymmetrical) ; aiid the souwca of the defective duvdopment of 
tlie hram most lie within the organ itaclf, or the cranium remains 
amall with the brain. The brain itself may in both series of cases 
he simply small — a miniature brain, without other Anomaly or 
defect, and properly proportioned m all its parts : more frequently, 
fhcro also exist other changes, particularly scleroses, hylroccphaliut, 
' onequnl size of the hemispheres, or other form of dis-symmetry. 

■ Ll mtnymicrocopliAlica tlie brain UevtAsmnlicr than miglit be presumed trom 
the external Aspect of tbc cnLoiuia, ov'iag to tlic occasional oaorinoui thic^CM 
of tbc bones of the akull, and to Uie ocoasional cxUtenco of & coniiderabie 
amount of li^dfoccpliAlLiB. 

BaiUarger ('iVcad dc M^d.,' 39 Jul., 1S56) hai reported Msei in whioli 
the fontatieUea were, crca at birtli, to a great extent osufled. Cnivcilhier bu 
seen a case rrlicre tlicro iroa sjnntosis of all Uie sutures at tbe age of cixlil«ea 
moiitlii 1 case) ia which nuiny of ttie sutures are already ottilled at the age of 
3 — 4 are byooiueaiis rare. Also Vircbow('Gesainiii, Abband!.,' Fmnkr., 1856, 
p, 905) lint described iiucr(ice[ibiilie skulla lit wlucli all the sulurei existed. I 
myself hate recently r;innimcd tlie iriuiiuai of a girl, ngnl nineteen, vbo died nt 
Muiaborg ; sbc presented the ajipeuraucc u( n child of ten or twclrc jcars of 
ago, liad been epileptic and quite idiotie (xmintcrrnptcd state of profound 
dnamioeaa, eomplttc dambacst, incnpocilj to walk or to stood). Tbc croaium, 
wliicb was very small, very short, and iacliucd to tbo right side and forwards, 
presented all, even the frontal suturo, without trace of oBaifloalian. — Another 
cranium, sent to me from the sajtnin at Wintcrbacb, and wliicli bad Iwlonjjied 
lo aa idiotic woman, tweutj-onejcara of age (weigbt of tbe brain, 36 loth — 
aboat 18 ounces — (bo Ivft bcmispbcrc very abort), woa not bo Iotko as the 
skull of ;in urilinnr; eliild of seven years. It did not, liowevcr, present any 
strikingubnormalityof fomi, being only a lillle unt^ miue triad ; tlie froutalsutun 
waa completely otiliteratcd, the sogilLal suture whj iiicuuipkte anteriorly* pos- 
teriorly quite OMifirJ : tlic other sutures were well preserved. 
Conccniug a remarkable ease of miniatuto brain vtiicb Iftillargcr and Grn- 
ilct exaniiactf, tee 'Acad, dc M^.,' 36 Mai, 1857. Tbe brain wastbatof 

28 



8M 



BIAtM or KKNTAL W]UKi«JiaS. 



% hinde Axtco duU (J iM); ii wu peifectlj well fonud, ud pcocntcdia 
true oT Igidtoccplulu : it wu, bowcTrr, so liUk derttopcd, ihkt it mtiiW 
iLfl brain of a f«lu» is Ui* Mveati or dght riOdUi. 

Under tlic bo«d of gtatnl portrt; «( (be bnia, »aj rIm be napi tboK 
BMM ia which Uu eoDTolntiou n* muikthtf ninpto, •tttam^ the teloMit 
the brain ia Mt muoli b«kivthe Bvags; Umhoum pnBent atleut Aiwlibb 
dimiiutioiL of the ceRbnl surface. 

Ill idioia the bnua U fxcqueotlj dimbished in volume in cctiis 
puts, or it nu; even present cMtftio deCecU. The following m 
the principal rari«ties: — Sometimca the cerebral heroisphem ut 
mpcrfecUj/ decehptd in eerlai» parU, most frequcnllr a lb 
anterior loint (wlien the autero-poslerior diameter of tbc cnniiab- 
u frctiuentlr happens — is diminisbed, the cerebral hemisphefei m 
ixtcctasaily ahort^iiod, but this ii generallr most etnkingljr iDaiii> 
featcd in the anterior lobes], when there te oftoa rcmiirlabtc rtanlug 
of the olfactory bulbs, sometimes nlio of the jicn/griar foiet, whm 
the cerebeUuin is not so completely coTcred as usual or not cchd- 
pletclj covtreJ bjr the cerebram ; those parta which are insaffidectlT 
developed may present fcv but moderately developed convolatiM*, 
or thcv mhj be rer^ small, ns if atrophied, or aa if ihcy remaioed ■( 
an early cUildi«h stage.' Tnequalitjf of the ttto lalttt of ti« irm, 
ptrticukrijr of the eerehral i«Mi^(utffVJ, must not be attribattdu 
hypertrophy of the greater, but to atrophy of the mnaller half; a^ 
this abnorinal snuUnew may be the rcfult of a deformity of ti^ 
cranium (unilateral etvaosis), <» of ui original deficieiK^ in tW 
derelopment of tbc brab, or of arrest and atrophy in cotueqiMDece' 
enccphalitic, apoplectic, or other processes, of whioh palpable traco 
may somHimca subieqncntjy be found (brown or yellow apvbi 
small deficiencies iu the cerebral substanoe, &c.). In this Rspcct 
all degrees exist, from the slightest shortening to the state whet i 
whole hemisphere has olniost totally disnppeiired, and is traDsfortDcJ 
iDto ftue^ihwork filled with senim; even in moderate degreea, the nb- 
•taooe of the U-saer bcmisjihitrcs is often changed, coriaceous, oonpid 
(aoleroKty), the lateral ventricles dilated, the choroid plexus tltick> 
ened, &c. The dissymmetry frequently extends to the cercbd* 

' Tbc latter oondition, the tpiMi of the two posterior lobes tnodenle)/ tol 
■ymmetricoll? dimmiilifd In volume, I r^cGiitly ebeerred in an indindoal, ipt 
twcDtj-tUrcr, wbd Lad ud'tr been idioliei but had, on the cootrai;, <s* 
hibited a iiicderntR ilp^rec of iiitelligence and read a itrett deal. Ue liad mm 
iDPnifi^Lci] Uixj bcxubI dajto ( IliU caido la Ijc inquired iiilOy aa he was Hiahrf'^} 
The cerebral bcuiia|>Iicn;a did not cumpklely cover the cerebellum. 



6TAT£8 or 11II»TAL WXAKNeM. 



860 



i 



torn, fota Varolii, and meJulU oblongata; in pMticaUr, tht 
cercbeilum often ptrtidpBtcs in it when the atrophy r«ults feom 
sborteniDg of the cramium, and, as it appears, this atrophy is some- 
tune* <po th« same eidc as the atrophied cerebral lob«, sometimes on 
tbe opp««it« 8id« ;* there frequently exist atrophy, pareaia, ooDvulsiona 
of tlie opposite half of the body (ilie condilion vhich li»s in recent 
time* been deKribed as " unilateral atrophy," and vliicli is not 
alvays a«»ocialed vith idiocy). Little attention has as yet hecn 
paid to atropijf of (he nuduUa oMofiffata and inequality and afyvt' 
meiry of many parU of the htm of t&e brain in idiot*. Tliesc, how- 
ever, will appear more important in proportion as the osseous basis 
cnoii is, tbrough roceut ijivestt(;alions,^ recognised as the point of 
origin of the disorder in Ti^y many caacs of idiocy. 

Id lb« fortaieobOBeH microecpluJic gtri from Muiabergr, I found the foUotr- 
log abaanMlities la Uic pons Vuolii anil mcciuils oblongoU ;— TKe pyrainidB 
■ue ililie 00 both kidei; tbe left olirarj bodj was somcvtul sliortcr than tbe 
d^t, Mpeeialljr at it* inferior parti ll>c l«ft proccMoi corebclli ad )>ontcin vm 
wnkcr, uniUer, ud oa iti anterior aad lateral border as if beat inwards \ on 
ttfl hft half of tke pom Varolii the oblique band of fibrts (ruban fibwux of 
KmDt, coBUAg fioni tba oorpnt nstiTorinc) was much more ptfonoonccd, Hf)a- 
titMl OB ill lower border (rois tlie noro horitontal fibru of the pons by a deep 
poors; in Uia Ibnrtli ranttide tlie tuber ciucreum al tlie point of tbe calunus 
«u kn derdoped tkan the rigbt ; tlie left titmiipliere of (be cerebclluDi wsi a 
IJIlle inuQer bnt lomewliat bighcr tlion tlie rt^ii. In tlie work of Demmr, 
' Ceticr naglciebe Gtomc bcidcr Bcrabalflcoi' Wurabuig. 1831, tbcrt are many 
w logo u a csasiplei of inequality of the two lialvta of llie pons Varolii, of the 
two iiJaa of iIm ipinal corJ, and of the two olivary bodies. The aacie oondiliaa 
baa been obtcrved by Valentin io an idiotic cliild from Abcodbcrf; : anojnitlies 
Hbo in the pjiaaidal udolirar; bodic» were sren in a caM bj the Sardtsiaa Com- 
■hl(w ea CrcliaJsn {* Rapport,' ic, p. 304}. Tbe tMlin tfiiut cord sppean 
to be abepUsd in waw oretias (caw of Eulcnberg and Marfels ; Niepce, ninth 
wutopaj) ; Ibis fonts an important subject for further invcitlgaliou, eajieciallj 
In fauliiiituals sufleriiiK frooi paraljtis with coonliiooa, Ac. Cases of spina 
biflda tCKetber with hydrocephalus Lave also been obscrrcd. 

Heschl' liaa described, midiT the name ot poKncejiialut, those 
ctrcbial defects in which a large portion of tbe convolutions and 

* 8m Tifchow, ' Entvicilang des Schidelgrnsdei,' Berlin, 185;, p. 1 14. 

■ Ttrdiow bas, in hi* workonthephyiiogaony ofCretiaSipartienhirly oalled 
■ttMUion to tbe tact that liiftht deiialions in lonn of (be pons Varolii, tbe ine> 
daUk aMoHpta, aod Hm raoith Tcatricle, may originate tKroogh spbcnO'baular 
sjnfiitoafa^ 

> Prager, * Viertrljahn^'if'i' Bd, Ixi. l8g<}, p. 59. A self-olMcrvtd and 
tkrce Other Qttca. 




I 



[ecDtriun smniovale is trantiiig, in sucli a manner that a petgou mif 
look tiirougli Ihc BEKrture ^tfuigltt into U» ventricle ; tlib b 81W 
wilb Kram vliicb ii conUincd iit a l>lacl<lcr or inesliworlc of tlic fnt 
mater; sometiinu tho correspOQiliiig put of the cranium ftojaH 
out wank. 

PorcnecfiluJaa doe» not appetr lo bo pcotlnMd bj tdusi umst «( d«Mlsf> 
neat nf Ibo aJTcetcd put o( the bnin, but ratber bj id iuln-ut«riiio dboK 
vhicb at a very url? perbd deitrof > tbe part, la neatly ervrj «as« of tba 
khid Uiero U Idiooj, wilb mom or Uu ponljm ami oontncUon of lli« opfwk 
half of Ibe bodj ; ia cuci preacDting these ajmpUMU, upeciallj U ibera te ■ 
promtineibcc ou one tide of tbe akuU, the exutcara of tliia Ittim najt befi^ 
luined(llachl). lUacd (' Clia. MiUhcaL,' Banbors, i86^p. e5)ba»n«alV 
published u aaalogoiu oaae vbcce Ibe tabject. a man forij-serea jrcan tS ip, 
bad tulTered fVom menUt «eakM«, dementi)^ but bad neatber been ftn^lk 
nor, stricUj ipeakiuit, idiotic 

As farther but mure rare aaotuali«s met irith in idiot*, mav be 
uctitioued numerous, mure locaUsetl, cerebral tkTccts, dcSdeaqr tr 
cxtmordtoary smallncsa of tlic most varied ftmctures of the o^to; 
iiidci»l, there ia »ciirw\j nay portion of the brain whivli haa u(A ben 
fouiui either altogether absent or quite tttdimcntaiv in th«ao<vea> 
tores. Thill, llicTc arc cxampica of abiicucc of the eoLire offr 
bclluin ;' of dcfieicacy of tlie pineal gland ;* of d(;f<cct« of the fomil 
[Nicpco ill several of hia auto]»>ic»] ; of a rudimcntarj ooodititii 
of one or of both olivary bodies, peduncles, corpora mamillan, 
|-thslanius and corpus striatum ; of atrophjr of Uic optic ooaunisssi^ 
delioicQi^ of the auditorjr nerves (Valentin} ; finalljr, of abseooe v 
rudimcntaTy state of llie corpus coUosum : of this anomaly, iboQl a 
doKCQ cases, many of them vcrv interesting, faarc hocn published. 

Some of these cuci of dcflcicnc; of the oorpos aliamai were pnfouilf 
Idiotic ) tliis nppcnrcd lo be tlie cue only in those vbcre otber defccU or laa- 
oulics were pTesealsd bj the brain. To these brlong— ut. the cueof Bisnda 
(1748, quoUd bj Yotg) : child of Mveu ^cnr*. profoundly idiotic; coetpUi 
abicDcc of Ihc corjiua oalloauni, botb bemlspberca and ibc thalami and oorpoa 

tilriBtania leather in one mus; there vai DnpitiiiUrjbodv; tiiere vn aoaMtaa 
of the pons Varolii, but uone of the prninids and olirajy bgdics. and, tfae OBsesf 
' The famoui caw of the idiolie girl, of tlercn yean of Bgt, ■ AnaL lUk,' 
lirr. XT, pL 5. 
' » Scbnepff ("Soo.de Biolt^JR," 'Guclle Jlfid..' 1850, p. 894). Tliabna 
U oLburwiae nonuol ; lUc piluit«rjr glgmd wm nbunt ; iu ii« place won tm 
u^liona, liani like stones. Tiie »ubjFcl bad been veali'iniiided fronbirtb, 
d died at lh« age of twcnly-oiue. 



STATES 07 MBNTAT. WEAKNESS. 



8S7 



lSrg{'DiaB«d(nhiiigi)aiBa1kens.'frc., Uiinclirn. iS;;;;: girl.MVentcen jrMn 
Jafa£«,u tk« h^btstdegreeidiolic, nod badly developed {itijaicnllj 1 iLc inlJttle 
[im> part of the ocrpm cillotiim wnscDlirdj wanting^, likewise Ibc E«ptum, the 
I |Mit of Uic foniii ; of (he Bntciior ind nliilc cammiMurca of iLo ^jrus 
atw, only a rudiment cxatt ; tlie iaknd of Itcil is conaidcrablj aliophic-d ; 
: oisralutioiia arc abaoniuillj f>roupcd, man? of Ibom entirely absent : LIiq 
I of tha otrebclIoTn arc iiniymmctricBl -, hydroccplmlu*. 3rd, llio caae of 
I ('I/Midaa ilcdica) Gucltr,' fol. i, 1845} : ciiild of one year, in whom 
[all InteUeclual mBQifcatAtioiia irnd tenaonnl perception) nppenr to hnvcbcrii 
[■atircly vuiUngi corpiu calloaDin, septum nnd fomiit Kbtnit, ticcpt two small 
beleiigi>0 to tlie corpus enllosuin. Bn<l vliich hin^ in Tront from ench 
•re ; I^droorphnlii*. Pin»IlT, scvrnl of the nine niUnpnies of cnics of 
icnlinism bj NiJpce ('Tnwi^du Goitre.' Scl'ati!, 1851, i. p. 35; ii, 
III) prcMBt Tcry RTOat thiaiirM or iiii[)erfect deTclopment of (ho corpus 
|<il)anun, iloiig vith other deficiencies in the bmin. 

On Ibe other liand, Ihcro it a scries of ta%n nlierc tlirrr h no [troFound 

[ idiooj, bet lacrrJf a moderate degree of mental ircakDCM ; and »ometini«s even 

[ tkit doca wi nitt. Caseof Hcil ('Arcb. f. I'bjsiol,' Bd. ii, 1611, p. 341]: > 

,»gtd tbitly, deaiciited. butitilUbletogQineauge*; tbi; middle free part 

Ite ootptu calluun), tbc corpora gfciculKta, tbe Goavolution of tbo corpus 

Ifltlkmi iBil (b« septum lucidutn irera entirely nbsral : the otbcr parta of tbs 

ilpfeartobwcbeeu oorntal. CtMcof Suit; ('The Human Brain,' Ijundon, 

IB94!, p. 433) : aboj, aited iereiiteen.&lv3;B mcntail/ vciik, but look del ighl 

' In reading religion* book* - na* bcneiolcnt, dorilc, sleepi, inclined to ainmblo 

' nd f«Il : bettdca the want of Ibc corpiia catloaum, a cjit vas foand in tbc 

.hnia. Cmc of Paget ('Med-Cbir. Traanact.,' vol. uii, 1846, p. 33): girl, 

•ged Iwenty-ontt amiable and cliildbli digpotiliou, tUowcd 110 aiiikin^ pocu- 

MmHj, good memory, aelioni nj^id and infiuna I derate, tpccch sharp and abrupt ; 

tbe corpu»callM'nin waa ijiiilc ndimciiUrr, biding tci>re»t'iitMl b; a tliin baitLt 

|sf fcoritoolkl fibres 1 ihc tcpliim and middle [art of llic (oiitiK neia abaent. 

[Cm« of Miidicll Henrj <■ M«d.-Cl.ir. Traiunct.,' vol. Jixi. 184ft. p. 339: n 

bqjt Ifcd HHtxa, gentle, but daw to Icaro, dull, slcepj, mucb di>tur1>cd wbcn 

iMpUlj tpoken to; tlie bmin nonniJ: the eor;iDS cbIImudi repruented by a 

iHVUont^ baad of librc\ i| ineti broad 1 liio septum and middle anlrrior 

fuit of tb« fornix kbtott. Ciue mrtitiored in llic Rcpoil of tbc Virnaa 

AsyUm for iSsJ) : a mta, aged tweaLT-Src, in hli tvenlieth year became fpi- 

tqitjo in coDMqnnca of a frisbt, and linoe ibcn Lna Rtadtially fallen iato 

docKclia: tbo Mfpu oaUosnm absent, Ihu anterior ommiisure incomplelc; 

bydtocrplulns. 

( I ^ To the Anatomical lesions most frcqnfiatlj met with iii tho 
br»in» of idiot* lielouga Mromc hydroctphatu*, congenita] or oom- 
BKiiiniur in early youth, ati<l from tbe most moderntt! to the highest 
t<hgw^; H \* oftcD accompiiiifd by reinarknbte thickening of Iht* 
IHBiag mcmbraDe of tlic ventricle*. In mnny cases, the hjdrocc 
[plialtu arciBS to constitute the pritunry and chief diMUC ; thin mny 
\h» unttaed in thoaa oaw ocpccuilly wbrre ttw ouificatiuii of Uio 



S6S 



fTtKTAL WRAKNr.SS, 



emniiim talcs place »lo*Iv, n)tcTt tlie bonei of the head Koaaa 
thin, vlicTP tliere it coiuickrablc or even moderate increase of goe 
of the aaniuiD (macrooephalns). In tnan; other caaes, igBui, Ik 
moreased amount of sernm in the cranium of idiots is often MeonJ- 
B17 ; a result of limilttion of dcrelopment, of atrophy of eeitaa 
parts — in short, of cm-bral dcfideudes (hj'drope ex vacuo), or ft is 
even n more occidcatal complicntlon of vnrioiu inaUonnations of fle 
bruD. A. convincJng example of this is afforded hy the unilatenl 
bjdrooeplulus iu atrophy of one side of the brain. Id all thee 
Mccs the craninm msj \k of the ordinarjr drcamference, or cnn 
(and very often), as ire have alicady reea, coosiderablr less. TW 
Tolufoe of the brain may in enrjr case of cotiaidtnhlc htdrocephila 
be ooiuidcred to be dinODisbed, nnd very frequently tbat porttaa 
whicli remains is less capable of pnrforming its function. 

Ran but nrj ia\emiiag mftlforaations 6f tlie head arc eaned lij prtid 
hydrocephidns, by grcnt dilatation of the lateral Ttatricln m mly oac jMrt (Itr 
nample, tlic inferior coniu}. .Slioiili) ibfs occur al n period wtiett Uie Ml 
rtiti coiitials in part of Ibo ainnbranouii rUmenU of tlie rnnial bonea, ij«M- 
tries] protnuioRi are fonned,ln const>iaeDoe oflheeccculria pressura aiotM 
OB lie •orrapomjinf; portion ot the bnin. sac-like jironurxoccs 00 tin JtA 
Bto WiHigk, Prapjr, ■Yicrteljahrsclir./Bd. 1, 185s. p. 3« 1 I^smbl. see | t(f. 
A. terr rcmarltable and xery nn ful whidi has been obserwd hy Vaksdii 
and Ni^pcv is the presence of n fiflb Tcnlricle villtio Uie olirn of Ibe a(*^ 
bellum (voitric ciliaris, itormil in ibe bnin of birds). In ifao fini ew 
(from Abendbcrg) tbo TciiLiicle v*i fnm ■ to i| lock Ion ^. Tbosc ifi^ 
with considerable lijdiooeplulic enlargement of ibo craaium genec^y t^ 
mail) Mnnll, tod ttif!r entire dcreloptnent i« relrograde, so tliat, for esaaifl^ 
St fistccn jcars of igt tbej appear like 6tc or six. Siill, this ia not ihifi 
and necetsaTilylhncue. I myscU icnorofcasn where aoonsidersble amoui 
of hjdroeepbalui cociiilcd tn'th a ircll-dcnlopcd body nad pleasant fealona 
Tbe causes of these dilTercnccs vould form an iii(creatiti]{ subject of slady. 

. Saerpialitie precetxt of vnriabtc extcat^ sMnetimes localised, WDf- 
timea more diffused and tcrminnting iu difTcfent vays, but espedallf 
in aderosis nnd atrophy of the affected jKirts, constitute in aua 
cases of idiocy, the principal aiutomical legion?. These may oocor 
even dorinf; the enihryooic stage, daring the first montha of life, at 
the period of tbe fini dentition, nnd sometimes later, up to tbe fointh 
or (Uth yean. In those cases vbere dcatb docs not occur till long 
Br the disease has run its course-, it frequnilly hnppms that the 
laina of these processes are diflicult to distinguish, and it is prit- 
fapslly through cicatrices or other thickenings, Ihrotigh pigu ■' ■ 
on, &e., that (be ntrophied parts (sometimes a whole bemiephnt} 



■TATKfl OP UBNTAL WBAKN288. 



859 



be dirtinguished from structures cimply arrestcil in thdr dcvelop- 

icnt. lo these cases the idioc/ is very frcqucotly acconi^atiicd bj 

nnihitcral niotory aiF(>ctioii {parwis, eontradion), and sometimes by 

'Jepyy. The dilTujed kgpertTOphie o/* (Ii« connective lissue of the 

I vbich mny, gctteiatljr speaking, be rcfcrm) to chroiiin rjicc- 

■htb, and which is often found in paralytic dementio, has l>c«n 

»ved by certain well<nuirlced exninplc<i to occur in idiocy. 

Isialxrl bu eoumiinicatnl ("Soe. At Bblogie," 'Compt. tend, et M£m.,' ii. l, 

856, [»■ 9) an iDt«rt9t(Dg case of tliia kiad vliicli was cukmiucd mioroacogucd]; 

r Bofau;itoociitTed in aa idiotic c)ii!il. two jaan of age : the veatricuUr walla, 

I great gsnglii, ibe pons xai pcduni^lps were toUil Biid bard ; tLeir tiaaur waa 

iltc like CMntdiouc, llic nervt-tiibes in Ihe wliilc iiubitancc were almost 

J5 dnlrajed, aud an amnrphoiu f;ra.iiular aul»tauce oO'Cupied thcii 

^t llicn abo ciiited uevlj formed Hbrouii councclivo tissue. 

FtbOM eamnaa otMs in vhich wc nretoM thai n hitherto beatthjrand 

fclI-je*«lop«d child, tixiwt tlin ^rioi of dcnLitbti, or durlii|; llie aeooiid or 

Wd 5caf, tuddcnl; bcoimc fcTtriah ; was attuckrd !>]! conrubioiiA (" &Ls"), 

iirinm 1 fcU ialo a alight (oporiilc sUlc, and loon nftcrwnrda appnreullj n- 

cred, but tbe inlcltcctual dcrclopmeat remained at a ttandstill ; apealusg 

waUdug:, whieb it had rte«i!tl,T comoi«Dced. become difficull, but tbe " fita" 

I aad ipulually pus into «piiepsj ; — in tlicac common cnars there arc l«o 

. whieh w« h«TO principal); lo eonaidcr. Tbeae ate Beoerally cillicr 

atlresUte* and alight iiiflntnmatnnr proRcaies in Uic met»braiM--t,«hidintitj 

vilk ouification (inBaiiiiiifltor5) of the »uturea of the craaiiim or 

. Uio gGam«l deTclopmeut of till) infantile brBiD, and tctt frtquouti; Icatra 

I MTOiu dTusioDs, or a dispotition to the {^radoal dcTclapmcnt of hjdroce- 

Of the; are »tnt«a o( encephalitia, which, alter tbe pusiog oS of ths 

lat^R (with strclliag of the brain, fto.}, iuTolTC or aoapcad fiirtbcr d«Tc- 

IB the allected parla, and may ofleD be recogniaed long aflrr in their 

I at tbo a«tap7. Tbeac proccves maj be aaaamed, abore all, in caaos 

iben ona aide of lb« body is a littlo less derelc^ than tbe other, where con- 

ubioDs, paralywa, eoolraelions, tc exist, limited to one aide of the body. As 

leuunple of (lie roost MTero form of this kind, I quote the following case 

I Calinetl (' Matad. iiilluninat. du Orvcau.' Par., 1B59, ii, p. 41 1) : " Abealthj 

y, duiiig OOQTalctceDM from measles, fell into a tiol«ot conTulaiTe sttaek, 

rhich «u (bUowed bj prolonged oocna : he came out of tliis state deaf, dumb, 

. bliad ; is fonrteen da;s tho a«nie of bearing returned ; after the lapse of a 

' be learned to (peak a few words, but he oootiaucd bUad, became epileptic 

I on tbn right side. At tho a^e of thirteen be was ia a ataU of 

1 deaatutia ; »1 nJDcteni he Miidd ^rliculaU a few aoundi, but eould not 

tinaelfi hii right kg was weak, his arm contrKlcJ. Ucdird in liialweatj- 

I year. Tbe tight lialf of tho bod; wiu liiirm«r and tmallrr Uian tlio 

>tliB ersiiiuB ftinaU, wdl formrd, tc tj tbkk ; ncdcma of the pi> ; the left 

plMfC tanwdenbljr analler than tlie right. Tho left poaterior lobe was 

tly small i ita cod rolut ions as thin aa the blado of a knife, *crj Atm, of ■ 

I ydbw colonr eilemally. inlrniall; of a dull wbU* ookur ; the left 1 



S60 



STATSS 07 UENTAL WEAKNESS. 



and utnior lobn vera aIm maUer thu otiiauj ; the rigU poBteriv Mi 
wuliltewbo AlitUeiliiniKub6d4lldlU||^tljBCjiCrotia; the optSci <rere buliuilej. 
Tbc Klenuu uid ulroplt; q( the bc^ vere eridniUjr tbe rmilu ot n or- 
ptuJitle proceu cooBCcutivc to mmlM. 

Ujrp«rtrophjr of tli« Imin occurs mudi le« frequcatlj in i£oU 
tliui da th« various alterations vhidi v« have Fmimcratcd ; it is ia- 
|iosnble to distin^isb it during life bota hydroccphaliu distendins 
tlie oraniam, an in both cases tbe be«d is large and llic onificfttk* 
imp«>rfect, nnd— vhich is interesting in many vajrs — the base itf\ht 
cniniuD) is not exteodcd, but ratlief shortened, or il preacota onlj 
nornul proportions. (Vircliow.) 

BaillBifcr ('Aud. do UH^' 19 Jnl., 18^ mentiMS Uie ctM of a dfil 
of four jean, in wboin the brain weigbed 1305 gmnnua (or mm tkmlht 
adult amagft) ; ud uotlier eua of a child (' Qu. hcfadOBadura^' tSgf, 
Ko. 6, p. 9j) in wbom tha body weighed (Jurtj>ux poandi, and the bnia 1160 
gnmnw. Bricqiictt Delaiuun bare reomtlj reported aaalogoos < 



A remarkable appHmnce, and one which hu hitherto netmi 
Tcry little attention, is the uuosual abundance of grev sabstance (a 
the ordinary' localities) nbich has been remarked by rarioai 0^ 
Kcrvom (Stiilil, ll/iscli, Xii-pce — seventh and ninth uuiopsie») m the 
braiDB of certain idiots, the amount of the grejr substance bang 
greater thau thiit of ttic white. OccasioDallf, new fomtatioBS of 
grey 9ab>t