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THE JOURNAL

MENTAL SCIENCE

(Published by Authority of the Medico-Psychological Association),

EDITED BY

D. HACK TUKE, M.D.,
GEO. H. SAVAGE, M.D.

“ Nos rero intellectual longius a rebus non absfcrahimua quam ut rerum imagines et
radii (ut in sensu fit) coire possint”

Francis Bacon, Proleg. lnstaurat. Mag .

VOL. XXIX.

LONDON:

J. and A. CHURCHILL,
NEW BURLINGTON STREET.

. MDCCCLXXXIV, V

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“ In adopting our title of the Journal of Mental Science,published by authority
of the Medico'Psychological Association , we profess that we cultivate in our pages
mental science of a particular kind, namely, such mental science as appertains
to medical men who are engaged in the treatment of the insane. But it has
been objected that the term mental science is inapplicable, and that the terms,
mental physiology, or mental pathology, or psychology, or psychiatry (a term
much affected by our German brethren), would have been more correct and ap¬
propriate ; and that, moreover, we do not deal in mental science, which is pro¬
perly the sphere of the aspiring metaphysical intellect. If mental science is
strictly synonymous with metaphysics, these objections are certainly valid, for
although we do not eschew metaphysical discussion, the aim of this Journal is
certainly bent upon more attainable objects than the pursuit of those recondite
inquiries which have occupied the most ambitious intellects from the time of
Plato to the present, with so much labour and so little result. But while we ad¬
mit that metaphysics may be called one department of mental science, we main¬
tain that mental physiology and mental pathology are also mental science under
a different aspect. While metaphysics may be called speculative mental science,
mental physiology and pathology, with their vast range of inquiry into insanity,
education, crime, and all things which tend to preserve mental health, or to pro¬
duce mental disease, are not less questions of mental science in its practical, that
is, in its sociological point of view. If it were not unjust to high mathematics
to compare it in any way with abstruse metaphysics, it would illustrate our
meaning to say that our practical mental science would fairly bear the same rela¬
tion to the mental science of the metaphysicians as applied mathematics bears to -
the pure science. In both instances the aim of the pure science is the attainment
of abstract truth; its utility, however, frequently going no further than to serve
as a gymnasium for the intellect. In both instances the mixed science aims at,
and, to a certain extent, attains immediate practical results of the greatest utility
to the welfare of mankind ; we therefore maintain that our Journal is not in¬
aptly called the Journal of Mental Science , although the science may only at¬
tempt to deal with sociological and medical inquiries, relating either to the pre¬
servation of the health of the mind or to the amelioration or cure of its diseases;
and although not soaring to the height of abstruse metaphysics, we only aim at
such metaphysical.knowledge as may be available to our purposes, as the mecha¬
nician uses the formularies of mathematics. This is our view of the kind of
mental science which physicians engaged in the grave responsibility of caring
for the mental health of their fellow men, may, in all modesty, pretend to culti¬
vate ; and while we cannot doubt that all additions to our certain knowledge in
the speculative department of the science will be great gain, the necessities of
duty and of danger must ever compel us to pursue that knowledge which is to
be obtained in the practical departments of science, with the earnestness of real
workmen. The captain of a ship would be none the worse for being well ac¬
quainted with the higher branches of astronomical science, but it is the practical
part of that science as it is applicable to navigation which he ia compelled to
study.”— J, C. Buchnill , M.D., P.R.S.

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. 125. (New Series, No. 8S.)

THE JOTJBNAL OF MENTAL SCIENCE, APRIL, 1883.

[Published by authority of the Medico-Psychological Association .]

CONTENTS.

PART I.—ORIGINAL ARTICLES.

PAQB

jnry Rayner, M.D.—Relative Cost of Large and Small Asylums. . . 1

A. Chapman, M.D.—On the Recovery and Death Rates of Asylums as in¬
fluenced by Size and some other circumstances. . . .4

illiam W. Ireland, M.D.—On the Character and Hallncinations of Joanof Aro

( concluded ). . . . . ... . .18

W. Plaxton, M.D.— Miliary Sclerosis. . . . . .27

harles Mercler, M.B., F.R.C.S.— The Data of Alienism ( continued ). . . 31

eo. H. Savage, M.D.— Marriage in Neurotic Subjects. . . .49

. Hack Tuke, M.D.— On the Mental Condition in Hypnotism. . . 55

Linical Notes and Cases.— Case of Feigned Insanity; by Alex. Robertson,
M.D.—Case of Acute Loss of Memory ; Mental Symptoms, Pre¬
cursors of an Attack of Apoplexy; by Geo. H. Savage, M.D. . 81 —92

coasional Notes of the Quarter.— The Punishment of the Insane.—County

Boards Bill and Pensions of Medical Officers of Asylums. . 93 —98

PART II.—REVIEWS.

j’H 3 r 6 dite Psychologique. By Th. Ribot. . . . . .98

'emale Education, from a Medical Point of View. By. T. S. Clouston, M.D. 100
1 Practical Treatise on Electro-Diagnosis in Diseases of the Nervous

System. By Hughes Bennett, M.D. . . . . . 106

Dn the Causation of Sleep. By Dr. Cappik. ..... 108

PART III.—PSYCHOLOGICAL RETROSPECT.

1. Retrospect of Mental Philosophy. By B. F. C. Costelloe, B.Sc., M.A. Ill

2. German Retrospect. By William W. Ireland, M.D. . . .117

PART IV.-NOTES AND NEWS.

Quarterly Meeting of the Medico-Psychological Association.—Correspondence
of the Parliamentary and Pensions’ Committee with the First Lord
of the Treasury, the Commissioners in Lunacy, and the President of
the Local Government Board.— Correspondence.-— Obituary.—Index
Medico-Psychologicus.—Appointments, &c. . . * 124—

108956

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The Journal of Mental Science\

Original Papers, Correspondence, &c., to be sent by Book-post direct to Dr.
Hack Tuke, 4, Charlotte Street, Bedford Squar W.C.

English books for review, pamphlets, exchai ;e journals, &c., to be sent
by book-post to the care of the publishers of th j Journal, Messrs. J. and A.
Churchill, New Burlington Street. French, Gei nan, and American publica¬
tions should be forwarded to Messrs. Churchill by foreign book-post, or by
booksellers* parcel to Messrs. Williams and Norgate, Henrietta Street, Covent
Garden, to the care of their German, French, and American agents:—Mr.
Hartmann, Leipzig ; M. Borrari, 9, Rue des St. Peres, Paris ; Messrs. Wester-
mann and Co., Broadway, New York.

Authors of Original Papers receive three extra copies of the Journal by Book-
post. Should they wish for Reprints for private circulation they can have
them on application to the Printer of the Journal, H. W. Wolff, Lewes,
at a fixed charge of 30s. per sheet per 100 copies, including a coloured wrapper
and title page.

The copies of The Journal of Mental Science are regularly sent by Book-post
( prepaid ) to the Ordinary and Honorary Members of the Association, and the
Editors will be glad to be informed of any irregularity in their receipt or
overcharge, in, the Postage.

The foilowing are the EXCHANGE JO URNALS

Zeitschrift fur Psychiatrie; Archiv fiir Psychiatrie und Nervenkrank -
heiten; Centralllatt fiir Nervenheilkunde , Psychiatrie, und gerichtliche
Psychopathologie ; Der Irrenfreund; Jahrbticher fiir Psychiatrie, neue Folge
des psychiatrischen Centra Iblattes ; Neurologisches Centralblatt; Revue des
Sciences Medicates en Ft'ance et a VEtranger ; Annates Medico-Psychologiques ;
Archives de Neurologie ; Le Progres Medical; Annales de Bermatologie et de
Syphilographie; Revue Philosophique de la France et de VEtranger , dirigie
par Th . Ribot; Revue Scientifique de la France et de VEtranger; L'Encephale ;
Annales et Bulletin de la Societe de Medecine de Gand ; Bulletin de la SocittS
de Mtdecine Mentale de Belgique; Archives Medicates Beiges; Archivio
Italianoper leMalattie Nervose eper le Alienazicni Mentali; Archivio dipsichia -
tria, scienzepenali ed antropologia criminale : Birettori , Lombroso et Garofalo;
Rivista Clinica di Bologna, diretta dal Professore Luigi Concato e redatta dal
Bottore Et'cole Galvani; Rivista Sperimentale di Freniatria e di Medicina
Legale , diretta dal Br . A. Tamburini; Archivio Ital. de Biologie;
The American Journal of Insanity; Ihe Journal of Nervous and
Mental Disease; Archives of Medicine; The Quarterly Journal of
Inebriety, Hartford , Conn. ; Index Medicus , N. Y.; The Alienist and
Neurologist, St. Louis, Misso .; The American Journal of Neurology and
Psychiatry ; The Dublin Quarterly Journal; The Edinburgh Medical Journal;
The Lancet; The Practitioner ; The Journal of Physiology , edited by Br.
Michael Foster 1 ; The Asylum Journal (British Guiana); Brain; Mmd;
Canada Medical and Surgical Journal .

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’HE JOURNAL OF MENTAL SCIENCE.

ishedby Authority of the Medico-Psychological Association]

25. APRIL, 1883. ' Yol. XXIX.

PART 1.—ORIGINAL ARTICLES.

'e Cost of Large and Small Asylums . By Henry Rayner,
Medical Superintendent, Hanwell Asylum, Middlesex.

ipport of the position that small asylums are, even
i economic poini of view, better than very large ones,
ck Tuke, in his recent work on the “ History of the
” cites the opinions of the Lunacy Commissioners, as
i their Report for 1857. He also gives in the appendix
*ures which the Commissioners prepared in regard to
kly cost of patients in large and small asylums, and
r ere adduced by them to support the same view. He
lowever, that on taking an average of the six largest
smallest asylums in the list, the weekly expenses per
the latter appeared to be really greater than in the
-a result different from that for which he had cited
>m the Blue-book.

Names of Asylums.

Average
Weekly
Cost per
Patient.

Average
Number of
Patients
to each
Medical
Officer.

Nottingham, East Riding, Cambridge,
Hereford, Suffolk, Derby, Berks, Bucks,
Denbigh, Northumberland, Cumber¬
land.

s. d.

•9 n

181

Leicester, Dorset, Oxford, Carmarthen,
Salop, North Riding, Burntwood, Corn-
[ wall, Northampton, Glamorgan, Wilts,
Chester, Monmouth .

8 10J

228

Gloucester, Lincoln, Norfolk, Parkside,
Warwick, Stafford, Rainhill, Chartham,
Somerset, Worcester, Sussex, Hants,
Devon .

9 Si

265

Beds, Essex, Durham, Wandsworth,
Brookwood, Lancaster, Wadsley, Prest-
wicb. Banning Heath, Whittingham,
Wakefield, Banstead, Colney Hatch,
TTftnwfill .

9 6f

345

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Relative Cost of Large cmd Small Asylums, [April,

I do not believe the position which Dr. Tuke desired to
establish is invalidated by these statistics, and I think that
it is very important at the present moment to point this out.
My reasons for this opinion are (1) In these returns, Borough
Asylums, which are under a different management from
County Asylums, are included. (2) The asylums chosen for
comparison are as much too small as the contrasted*class are
too large, the average number of patients in the small asylums
being only 211, a number which could not with economy
support the necessarily complex staflF of an asylum.

I have without selection divided the whole of the Comity
Asylums into four classes in the foregoing table, which is
compiled from the Thirty-sixth Report of the Commissioners
in Lunacy; the statistics referring to the year 1881.

A Parliamentary Return for the year 1877, yields the follow¬
ing statistics, which include all asylums of which the returns
were available:—

No. of
Beds.

Names of Asylums.

Total No.
of Beds.

Total cost
of Six
Asylums.

Average
Cost per
Bed. '

Not more
than 450.

Notts, E. Biding, Cambridge,
Hereford, Suffolk, Derby,
Berks, Denbigh, Northumber¬
land, Cumberland, Oxford,
Carmarthen .

4,580

785,570

171*5

450 to
600.

Bucks, Dorset, Salop, Wilts,
N. Biding, Burntwood, Ches¬
ter, Glamorgan, Cornwall,
Monmouth, Stafford.

6,307

963,122

152*7

600 to
800.

Gloucester, Lincoln, Parkside,
Bainhill, Somerset, Hants,
Worcester, Beds, Devon,
Essex .

7,099

1,303,166

183*6

800

upwards.

Durham, Wandsworth, Brook-
wood, Lancaster, Wadsley,
Prestwich, Banning Heath,
Whittingham, Wakefield, Ban-
stead, Hanwell, Colney Hatch

16,428

3,215,717

196*9

Banstead ..

276,422

162*9

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1883.] by Henry Rayner, M.D. 3

A second Parliamentary Return for 1877 shows that—

Asylums of

The Average Cost per Annum of Repairs
of Building per head.

Not more than 450 Beds.

£1*74

450 to 600 Beds.

£1-85

600 to 800 Beds.

£2'48

Upwards of 800 Beds.

£291

From these tables it appears, therefore, that the large
asylums cost £44-2 per bed in construction, and £1*06 per
bed annually in repairs more than the medium asylum of
450 to 600 beds; and that patients maintained in the former
cost 6$d. per week more than in the latter. The medium
sized asylums are even cheaper in construction than the
large asylum at Banstead, built in the simplest manner, and
with a special view to economy.

The medium sized asylums (450 to 600) have also the
advantage, in the same comparisons, over asylums of 600 to
800 beds, in which it might have been expected that an in-
crease of patients with little corresponding increase of staff
would result in cheapness.

The medium sized asylums are chiefly in agricultural dis¬
tricts, and some deduction from these results must be made
on this score; but even allowing for this, they would not be
dearer than the large asylums, while they retain the advan-
tage of supplying one medical officer to every 228 patients
in place of one to 345.

These above facts are of importance at the present time,
when so much additional accommodation is being provided
for the insane.

Every available argument should be used to prevent the
building of large receptacles for dementia, or the enlarge¬
ment of asylums of manageable size, by which there is
danger of diminishing the a individual and responsible treat¬
ment of the insane, 55 on which so much of their welfare
depends.

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[April,

On the Recovery and Death-rates of Asylums as Influenced by
Size and some other Circumstances. By T. A. Chapman,
M.D., Medical Superintendent, City and County Asylum,
Hereford.

I have been incited by Dr. Rayner’s paper in the “ Lancet ”
of Dec. 30, 1882, to look up various old calculations of
mine, bearing on the relation of size of asylums to efficiency
and economy, and think it may be worth while to throw them
together, that any lesson they may contain may be elicited.
I find I have various tables of the relation of cost of main¬
tenance in asylums to their size, and also several relating to
the relative rates of recoveries and deaths in asylums of
different sizes.

The figures as to variations of weekly cost in proportion to
size, give exactly the same results as those which Dr. Rayner
has derived from the figures for 1881, but they show them
with some variations—chiefly in not showing so pronounced
a rise for the large asylums in the earlier years.

1872 shows a rise of 5£d. for the large asylums over the
lowest point; 1873, of 3£d.; 1878 shows a rise of 4d. The
figures also suggest that the size of maximum economy
extends from 400 to 700.

It is worthy of note that the lowest costs are largely de¬
termined by the existence of several asylums where lowness
of cost is a special feature of the management. In Dr.
Rayner’s table, for example, the 450-600 class contains Caer-
marthen, Abergavenny, and Dorset; this does not, of course,
detract from the real meaning of the figures, but rather
illustrates it, as showing that the special detailed supervision
necessary to such low costs can only be efficiently carried on
in asylums of not unwieldy size.

An important question suggests itself as to how far cost
and efficiency are related—as to whether asylums spending
larger sums of money produce better results, and how far a
rigid economy may tend to impair efficiency. If we take the
divisions made by Dr. Rayner, we find the recovery and death-
rates for the last five years as under :—

Table A.

Av. cost.

Asylums

under

Recovery

Rate.

Death Rate.

(Dr. Rayner).
s. d.

450 .

.. 37-0 ....

. 10-1 .

.. 3-66 ..

. 9 7±

450-600 .

.. 33-8 ....

. 9-2 .

.. 3-66 ..

. 8 10i

.... 9 3t

600-800 .

.. 37*6 ....

. 10-9 .

.. 3-45 ..

Over 800 .

.. 37-6 ....

. 10-1 .

.. 3-72 ..

. 9 5 f

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1883.] On the Recovery and Death-rates in Asylums . 5

These figures are taken from the asylum reports, and differ
somewhat from those taken from the Commissioners' Reports
used in Table E.

Now, at first view, the cheapest asylums have much the
lowest recovery rate, and stand condemned, but we see also
on looking further that they have much the lowest death-
rate, and it is obvious that if undue economy checked re¬
coveries it would much more increase deaths, and we must
conclude that some other circumstances than the cost are at
work to produce these ratios. To more clearly indicate this
I have placed in column D what might be called a figure of
merit, obtained by dividing the recovery-rate by the death-
rate. Whilst not suggesting that a figure of merit so obtained
correctly represents either merit or a due weighing of death-
rate against recovery-rate, it will serve to show that efficiency
and expenditure do not in any way rise and fall together.

The true relation of the recovery and death-rates to ex¬
penditure appears to me to be illustrated in the following
analysis :—

In 19 asylums in which the recoveries and deaths are both
below an average, the cost is 9s. Id. In five asylums in
which the recovery and death-rates are both above an average,
the cost is 9s. 7d. And in 10 asylums, where the recoveries
are high and the deaths low, the cost averages 9s. 6^d., which
is identical with that in 18 asylums with a low recovery-rate
and a high death-rate—whence we may conclude that an
actively moving population, one affording a larger proportion
of active disease, whether of a curable or fatal character,
adds materially to the costs in asylums. We may tabulate
them thus:—

5 Asylums with high"

Table M.

Aver. Recovery
Rate.

Aver. Death
Bate.

Cost.

s. d.

recovery and death- j
rates. -

10 Asylums with high]

► 44'4

10-7

9 7

recovery rate, low?
death-rate. J

18 Asylums with low]

43-3

8-8

9 64

recovery rate, high ?
death-rate. J

19 Asylums with low]

32-7

12-1

9 6

recovery rate, low
death-rate. -<

j 34-6

8-7

9 1

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6 On the Recovery and Death-rates of Asylum [April,

The effect of size on the recovery and death rates is, how¬
ever, of more importance than the question of its effect on
cost, especially from a medical standpoint. I find that I
have tables of these facts for 1861-1865, 1866-1869, 1870-
1875, and I have now worked them out for 1877-1881.

Now the table for 1861-1865 was beautifully regular, and
read thus:—

Table B.

Recovery and death-rates in asylums of different sizes
based on 219 asylum-years in 1861-1865.

Asylum

years.

Size of
Asylums.

Admissions.

Recoveries.

Average No.
Resident.

Death.

!*.

gqB

C O o

§1

A >43

*5 5 a

c ®

5 °*S

,|«S

O O .

* fe

under 100

205

411

16*40

900

50*0

100-200

1480

140

1,374

136

29*17

9*90

28-6

200-300

2,279

835

6,810

17,599

681

36*64

10*00

800-400

5,444

2,174

1,902

39*93

10*80

400-500

6,896

2,749

20,491

2,224

39*86

10*85

600-600

4,840

1,917

14,913

1,669

39*61

11*19

600-700

2,740

1,088

9,790

1,119

39*71

11*43

219

over 700

8,638

2,879

33,402

3,594

33*33

10*76

Which may be condensed thus:—

under 300

2,964

1,008

8,595

854

33*70

9*93

147

300-700

19,920

7,918

62,793

6,914

39*80

11*01

over 700

8,638

2,879

33,402

3,594

33*33

10*76

219

31,522

11,815

104,790

11,362

This table dealt with 31,522 admissions, and an average
number resident of 104,790, and strongly asserted that the
curative efficiency of asylums was parallel with their econo¬
mical, whilst the death rate gradually increased with the
size of the asylum, the fall in the death rate of the largest
asylums not being sufficient to counterbalance the loss of
curative efficiency. However, J waited for a further set of
figures before saying anything about these. When the table
for 1866-1869 was worked out, it showed that the regularity
of the above table was largely fortuitous. The table for
1866-1869 read thus :—

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1883.]

by T. A. Chapman, M.D.

Table C.

Recovery'and death rates in asylums of different sizes,
based on 170 asylum years, 1866-1869.

Jfi

Size of
Asylums.

Admissions.

8 -

■

Death.

Recoveries
p.c. on ad¬
mission.

Deaths p.c.
on average
No. Resident.

Admissions
p.c. on av. No.
Resident.

170

100-200
200-300
300400
400-500
500-600
600-700
over 700

532

954

3,672

5,434

6,993

3,181

8,461

197

382

1,375

2,068

2,487

1,181

2,926

1,487

3,305

11,279

18,692

18,498

12,163

34,613

150

329

1,281

1,980

2,287

1,311

3,453

37*03

40*04

38*49

38*05

41*49

37*13

34*67

10*87

9*96

11*36

10*59

12*36

10*78

9*97

35*8

28*8

31*6

29*0

32*4

26*1

24*4

Which may be condensed thus :—

5,058

11,427

11,642

1,954

4,555

4,106

16,071

37,190

46,776

1,760

4,267

4,764

38*2

39*9

35*7

10*9

11*4

10*2

31*5

30*7

24*8

170

28,127

10,615

100,037

10,791

And for 1870-1875.

Table D.

Recovery of death-rates in asylums of different sizes, based
on 314 asylum-years in 1870-75.

lit

Size of
Asylums.

No. of
Admissions.

No. of
Recoveries.

Average No.
Restored.

Death.

ill

A . .

*5 O-* 3

ft-I

P.c. of Ad¬
missions of av.
No. Resident.

under 200

891

346

2,095

313

39*06

14*93

200-300

3,215

1,122

10,652

1,150

34*89

10*83

300-400

4,034

1,531

13,053

1,480

37*95

11*32

400-500

8,953

3,319

32,428

3,421

37 07

10*55

500-600

8,008

3,154

26,039

2,918

39*44

11*65

600-700

9,526

3,509

32,314

3,513

36*84

10*87

700-1000

3,652

1,334

12,843

1,306

36*52

10*18

over 1000

15,044

5,599

52,409

6,130

37*22

9*78

314

Digitized by LjOOQle

8 On the Recovery and Death-rates of Asylums , [April,

Which may be condensed thus :—

under 300

4,106

1,470

i 12,748

1,463

35-8

11*4

205

300-700

30,521

11,513

102,834

11,332

87-7

over 700

18,696

6,933

65,252

6,436

37*1

9-8

314

53,323 j

19,916

180,834

32,231

These tables do not run by any means so smoothly as
Table B, but they give, when condensed, substantially the
same results. And it cannot be denied that figures based on
704 asylum-years, and dealing with 112,972 admissions and
385,661 as an average number resident, press any conclusion
they point to with great weight, and that conclusion is
clearly in favour of moderate sized asylums of from 300-700
patients, as showing a much more satisfactory ratio of re¬
coveries than either smaller or larger ones, but that this is
counterbalanced to a decided degree by a higher death rate,
though we shall see that the death rate appears to depend
on other circumstances than the size of the asylum.

When we come to the figures for 1877 to 1881, we find an
entirely different conclusion suggested, and are induced to
suspect that the recovery rates may have very little connec¬
tion with the size of asylums.

Table E.

Recovery and death rates for asylums of different sizes for
the five years 1877-1881.

Asylum Years.

Size of Asylums.

Recoveries.

Deaths.

under 200

36-0

14-0

200-300

35-6

10*2

300-400

35-9

9-9

400-500

39-9

9-9

500-600

85-7

10-0

600-700

38-6

11-0

700-800

86-7

10-8

800-900

88-5

10-3

900-1000

89-9

10-4

over 1000

42-0

9-7

292

I did not take out these figures in the detailed way I had
done with those in the former tables, but simply took the

Digitized by LjOOQle

1883.] by T. A. Chapman, M.D.

recovery and death-rates and treated them as of equal value
and averaged them. I believe this does not affect the accu¬
racy of the recovery rate higher than the first decimal place,
or the death rate above the second decimal place. This table
shows, like the others, a low mortality for the largest and for
small asylums, and a high mortality for the smallest. The
recovery rates range also with the others, viz.: the best ratio
for the moderate sized asylums, and worse rates above and
below, with, however, this all-important exception that
asylums over 900 have the best recovery rates of any.

This high recovery rate for large asylums is at first sight
perplexing, being in direct contradiction to the teaching of
the preceding Tables, and suggests that large asylums have
during the past five years conquered the difficulties that pre¬
viously beset them. But I believe they have no such mean¬
ing’, and that the key to the position will be found in Table
F.b.

I have endeavoured to ascertain what other forces
dominate the recovery and death rates, with a view to inter¬
preting the above tables. The meagreness of the items, in
this direction, that I have been able to elucidate, is due very
much to the paucity of any available material on which to
found statistical inquiry, and to some extent to the
laboriousness of collating the materials that do exist.
There are still in the Table of Asylum Reports some
materials that I hope some day to examine, but I do not yet
see how to bring them to bear satisfactorily, even with much
tedious work upon them.

There is a powerful element governing the recovery rates,
in the different class of cases admitted into different
asylums; indeed this is probably beyond all others the
dominant element, but unfortunately we have hardly any
statistical means of investigating it. We see marked
instances of its influence in the case of Han well, where
statistics wonderfully improve on the opening of Banstead,
whose statistics however are very bad, the reason being that
Hanwell gets a larger share of favourable cases than before,
Banstead the unfavourable. A similar element appears to
exist in the improvement of the Prestwich statistics on the
opening of Whittingham.

It has occurred to me that Table XI. of the Commis¬
sioners’ reports can be used to throw a little light on this
point; by comparing Table XI. for 1878 with that for 1882
we may determine those counties where the increase of the

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10 On the Recovery and Death-rates of Asylums , [April,

proportion (not the number, but the proportion) of patients
in asylums at the expense of home and workhouse cases is
going on most rapidly. These asylums must be receiving
among their admissions a larger proportion of chronic cases
than other asylums are, and in these we should therefore
expect to find a lower recovery rate and probably also a
lower death rate, though these workhouse cases often afford
many non-viable cases of cerebral disease.

Nineteen counties have added to their asylum population
at the expense of the home and workhouse cases more than
4*5 p.c. of their total lunatics during the five years. Of
these counties only one reaches a recovery rate of 39 # 1, and
only two others are above 35.

If, on the other hand, we take the nine counties (not
asylums) with recovery rates above an average, we find that
they have added only 2*2 p.c. The reverse does not hold
good in the twelve counties with the lowest increase of work-
house cases in asylums, but show a recovery rate of only
37*2. But this group contains Staffordshire, which for some
reason has very bad statistics, and also Oxford, Berks, and
Cambs., which belong naturally to the group with large
increase of workhouse cases, so that one suspects here some
error in the returns.

The 19 counties in the first group are chiefly agricultural,
Durham being an exception I cannot explain; Middlesex is
an exception that is explainable by the filling of the Banstead
Asylum during the period covered by the Table.

From the same Table XI. of the Commissioners’ Report,
however, a still stronger light may be thrown on the real
cause of high and low recovery rates. In many counties
workhouses are largely used as receptacles for lunatics, and
if we make a list from this table of those that appear to do
so most, and those that appear to do so least, we find that
the first group contains all, with three exceptions, the
asylum8 with good recovery rates, whilst the other group
only contains asylums with low rates of recovery also with
one exception.

It is therefore obvious that whatever may obtain in the
three exceptional counties, that, in those with high rates of
recovery and large use of workhouses, a selection of
cases for asylum treatment is made, the workhouses getting
the unfavourable cases. In those where workhouses are
sparingly used, the asylums get all the cases.

These figures may be tabulated as in Table F on opposite
page.

Digitized by LjOOQle

1883.]

by T. A. Chapman, M.D.

Table F.

Relation of Recovery Rate to the Increase (per cent.) of
Lunatics in the Asylum, at the Expense of Homes and
Workhouses.

Number or Courties.

Average
Increase
of Per¬
centage in
Asylums.

Average

Recovery

Rate.

Highest
Rate of
Recovery.

Lowest
Rate of
Recovery.

Death

Rate.

19 Counties,

With over 4*5 increase,'
viz., Hereford (13*0),
Northumberland (8*9),
Worcester, Dorset,

Wilts, Durham, North¬
ampton, Middlesex

(Beds, Herts, Hunts),

6 North Welsh Coun¬
ties, Norfolk (5*7),
Hants (4.8), Somerset

(4-6) J

►

6*8

33*7

39*1

27*1

9*7

9 Counties,

With over average Re-'
covery Rate, viz., Sur¬
rey (4*4), Leicester,
North Riding, Chester,
Lancaster, E. Riding
(1*8), Cumberland (1.7),
Essex (1*4), Gloucester
(0.7) j

►

2*2

433

510

40-1

10*8

12 Counties,

With low increase (1*8 to ]
2*5) J

0*2

37*2

51*0

28*4

9*6

No. of
Counties.

Table F.b.

Percentage of Average percentage

Lunatics of Total Lunatics Recovery

in Workhouses. in Workhouses. Rate.

over 30 p.c. 33*1 40;9

20 to 30 p.c. 22*5 36-9

under 15 13*0 31*2

As this table throws more light than any other on the
question as to whether giant asylums have good recovery
rates owing to their size, I give the items of this table in

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12 On the Recovery and Death-rates of Asylums , [April,

full, and have marked those counties that have giant
asylums. It will be seen that these hardly have recovery
rates in due proportion to the use they make of workhouses.

I have only omitted certain Welsh counties, which are too
muddled together for the purposes of this table.

Counties.

Table F.b2.

Percentage of

Cases in

Recovery

Workhouses.

Rate.

Middlesex

86-3*

84-7

Lancaster

86-2*

40-1

Gloucester

32*6

46-7

E. Riding

80-5

41-2

Surrey

30-3*

41-9

Stafford

26-6

28-4

West Riding

26-4*

371

Sussex

23-2

31-5

Salop

22-9

87*6

Montgomery

22-1

Somerset

22-5

37-1

Westmoreland

22-4

51*0

Cumberland

19-2

Southampton

22-2

86-4

Northampton

22*2

28-0

Kent

22-0*

36-8

Chester

21-5

421

Derby

211

39-0

Notts

20-7

85-3

Devon

20-6

38-3

Warwick

20-1

84-5

Three counties with high recovery rates and smaller per¬
centage in Workhouses.

Essex

18-6

40-2

N. Riding

11-8

43-8

Leicester

17-9

42-8

asylums with less than

15 p.c. in

Workhouses.

Bucks

141

34-2

Dorset

141

34-6

Cambridge

13-4

81-2

Beds (Herts, Hunts)

12-8

271

Hereford

12-4

83-8

Glamorgan

26-6

* Have giant asylums.

Digitized by ^.ooQle

1888.]

by T. A. Chapman, M.D.

The three counties that are exceptional in this table
appear, however, by Table F, to receive but a small ratio of
“ workhouse cases.”

The question how far high recovery and death rates
are concomitant or antagonistic is interesting, and I have
worked out the following tables:—

Table G.

Recovery rates corresponding to given death rates. Tears
1877-1881.

No. of Asylum

Recovery

Death Rate.

Years.

Rates.

Under 6 p.c.

40-8

6-7 „

40-9

7-8 „

40-4

8-9 „

39-5

9-10 „

40-4

10-11 „

38-7

11-12 „

38-8

Over 12

Table H.

35-7

Death rates corresponding to given recovery rates. Years
1877-1881.

Number of

Recovery Rates. Asylum Years. Death Rates.

Under 20 p.c. 5 10*1

20-25 „ 10 9-9

25-30 „ 29 10-9

30-35 „ 54 10-6

35-40 „ 74 10*2

40-45 „ 56 10-2*

45-50 „ 36 9*8

Over 50 „ 28 9-1

A certain allowance must be made here for such instances
as that of Hanwell and Banstead, where one asylum has
good statistics at the expense of another. I do not think
that these instances are sufficiently numerous to materially
affect the broad result of these tables.

From these it distinctly appears that low death-rates go
with high recovery rates and vice versa , notwithstanding that
many individual asylums present statistics very much the
other way.

* Omitting a small Borough with 24*2 p.c.

Digitized by ^.ooQle

14 On the Recovery and Death-rates of Asylums , [April,

As the death rates rise from 6 to 12 per cent, the recovery
rate falls from 40*8 to 85*7. This would have been seen
without the intervention of the slight fluctuations shown in
the table, had;the death rates been grouped thus: Under
7 p.c., 7-10 p.c., 10-12 p.c., over 12.

In Table H the lowest recovery rates (under 25 p.c.) have
low death rates, but as these are founded on only 15 asylum
years they may be neglected as not appreciably interfering
with the main indication of the table, that as the recovery
rate rises from 25 to 50, so the death rate falls from 10*9
to 9-1.

I do not think these tables justify any conclusion to the
effect that the ranges of recovery and death rate shown are
a measure of the effect that may be produced on these rates
by differences of efficiency in the several asylums, viz., that
the recovery rate would, cceteris paribus, be found to be, if we
could ascertain the fact, 5*0 p.c. higher, and the death rate
1*8 p.c. lower in the most efficient asylum than in the least
so, though I am inclined to believe that the tables do contain
an element pointing in that direction.

Table K.

Table showing the Relation of the Death Rate to the Per¬
centage which the Admissions bear to the Average
Number Resident. 1877-1881, based on the average
for five years.

Number

Admission
percentage of
Average No.
Resident.

Death Rate.

No. of
Asylums

Percent¬
age of
Asylums

Asylums.

Below
10 p.c.

Below

10 p.c.

16—20

4*6

9-7

All

100

21—25

9*0

6*5

11*2

26—30

10*6

7*9

13*1

31—35

10*7

14-3

■

Over 35

12-9

8*6

170

This table shows the most unmistakable relation between

Digitized by Google.

-1888.]

by T. A. Chapman, M.D.

the facts exhibited in it of any I am able to give. I showed
some years ago that the recent admissions present much the
largest death rates. I may briefly summarise the facts there
shown thus:—

Table L.

Mortality of Patients during different Tears of Residence in
Asylums, p.c. of Av. No. Resident.

During

2 nd

3rd

4th & 5th

6 th <fc 10th

Over

1 st Year.

Year.

10 Years.

23-93

12-02

10-45

7-69

5-67

4-93

From this evidence we might have been certain without
Table K that asylums whose admission bore a high ratio to
their average number resident would present a correspond¬
ingly higher death rate, as they must have a larger proportion
of patients of shorter periods of residence.

If we return to Tables B, C, and D, in each of which I
have placed a column showing the ratio of admission to
average numbers, and arrange these ratios in order, with the
corresponding death rates thus, we find that the death rates
follow them exactly, with two exceptions: 1st, where the
numbers involved are small, so that a fair average is not
attained; 2nd, in two of the tables in favour of the large
asylums.

Table N.

From Table B.

From Table 0.

From

Table D.

28-6

9-9

24-4

9-97*

10-55

29-

10-85

26-1

10-78

10-18

30-

10-

28-8

9*96 small basis 29

9-78*

31-

11-19

29-0

10-59

10-87

32-

10-80

31-6

11-36

10-83

85-

11-43

32-4

12-36

11-32

39-

10-76*

35-8

10-87 small basis 32

11-65

50-

9*0 small basis

14-93

It is possible to select a group of asylums belonging to
rural and agricultural counties that have a low rate of
mortality. Thirteen such selected counties have an average
death rate of 8*3, whilst a group of seven manufacturing
counties can be selected having a high mortality, viz., 12*3.
The recovery rates in these two groups, 35*9 and 34* 4, do not

* Large asylums.

Digitized by LjOOQle

16 On the Recovery and Death-rates of Asylums, [April,

appear to be specially affected by this line of selection;
whilst there are several notable exceptions that have to be
omitted from both lists, viz., Lincoln 18*8, Norfolk 10*9,
Sussex 11*2, Hants 12*2, and Suffolk 14*3 from the rural
group; and Han well, Prestwich, and one or two others
perhaps are exceptions in the urban and manufacturing
group. Then, of course, such counties as Worcester, Nor¬
thumberland, &c., are too mixed to belong distinctly to either.

There are a few asylums where there are special circum¬
stances that make their statistics unusual, and either remove
the asylum from the group to which it belongs, or if kept
within it destroys the special features of the group. In only
the rarest instances have I any idea what these special cir¬
cumstances are. In Table K Prestwich takes a very
exceptional place, belonging to a group with a 10*7 mortality,
and yet it has a mortality of only 6*6. Prestwich is indeed
a trump card in the hands of any one who advocates large
asylums on the ground of their favourable statistics, and it
must be conceded that the very efficient state and high
organization of that asylum must have their effect in im¬
proving these statistics; but a reference to Table P and
F.b2 will show that the high recovery rate is due most of all
to a selection of cases, the less favourable being remitted to
the workhouses. A reference to Table K would suggest that
it ought to have a high death rate, whereas it has one of the
very lowest. Prestwich, however, presents an unusual figure
in its statistics which probably points to the most potent
element in producing this low death rate, and that is the
very large proportion of cases discharged unrecovered,
including doubtless many cases returned to the workhouses
that would otherwise have swelled the mortality. Suffolk,
in the same group, has, on the other hand, a mortality of
14*3. In this instance we are aware that the sanitary
condition of the asylum has been very defective. Stafford
again has very poor statistics, for which I can only suggest
the exceptional conditions known to affect the industrial
population of that county.

The conclusions at which I arrive after this investiga¬
tion are still unfavourable to large asylums, but I confess
not so strongly as, derived from a more limited view of the
statistics, they were before I commenced it.

I.—As to Cost, Table M. suggests that the cheapness of moderate¬
sized asylums is due not entirely to their size, but also to the circum-

Digitized by LjOOQle

1883.] by T. A. Chapman, M.D.

stance that they happen to contain a smaller proportion of active
disease amongst their patients; if the tables may be implictly trusted,
about one-third of the saving in cost is due to this circumstance.

II. —As to Recoveries . In the earlier periods when large asylums
were neither so numerous nor so gigantic as now, they had a compara¬
tively poor rate of recoveries, and they maintained this position until
the last five or six years, during which they present very much the
most favourable rates. This improvement in recent years is, how¬
ever, fully, I am inclined to think more than fully, discounted on
noting that these large asylums belong to large and populous
districts, with considerable differentiation in the modes of accommo¬
dating lunatics—in Middlesex and Surrey by the Metropolitan
District Asylum, and in the others by large lunatic wards to work-
houses—the asylums receiving selected favourable cases, the work-
houses the unfavourable. In Tables F and Fb, Surrey is the only
county with large asylums that maintains a relatively good position.

III. —As to Death-rates , the proportion which the admissions bear
to the average number resident is much the most powerful element
governing the death rate. Of the large asylums, Hanwell and
Prestwich both take a good position from this aspect. I have already
alluded to the exceptional causes of this in these instances. Wands¬
worth also takes a good position, and throughout the large asylums
appear to advantage from this point of view ; a circumstance that is
probably, however, to be largely explained by the use made by them of
workhouses, either by sending to them in the first instance or trans¬
ferring to them afterwards the least hopeful cases.

IY.—As conclusions reached by the way and more firmly established,
as well, perhaps, as of greater, if not more practical, interest than those
bearing on sizes of asylums, I may note—

(1) That a rapid increase in the proportion in the asylum of the
total lunatics of a district, which is more or less synonymous with the
free admission of chronic cases previously kept in workhouses or at
home, results in a low ratio of recoveries, without any distinct
effect on the death rate, but probably slightly reducing it. (See
Table F.)

(2) That the accommodation of a large proportion of the lunatics
of a district in workhouses results in selected cases being sent to
asylums, and consequently these asylums present higher rates of re¬
covery. (See Table Fb.)

(3) That satisfactory recovery rates tend to go with satisfactory
death rates (Tables G, H), and after allowing for such disturbing
elements as noted above (2), and for certain asylums showing good
rates at the expense of others, there is a probable margin due to
efficiency.

(4) That the proportion of admissions to the average number resi¬
dent determines more than anything else the death rates of asylums.
(Table K.)

xxix. 2

Digitized by LjOOQle

[April,

On the Character and Hallucinations of Joan of Arc . By
William W. Ireland, M.D., Home and School for Imbe¬
ciles, Preston Lodge, Prestonpans.

(Concluded from No. cxxiv., jp. 492.)

Joanns glory reached its highest point when she led the
Dauphin to be crowned at Rheims. Up to this time every
thing had gone on as she desired, and as she had predicted.
The caution of experienced generals had again and again been
overruled by her impetuous call for action. One blow after
another had been struck, and every blow told. Fortifications,
apparently too strong for the force brought against them, had
been stormed; seven cities had been taken ; and at Patay an
English army had been scattered and slaughtered like a herd
of deer. The newly-crowned King was urged unwillingly to
St. Denis, and a furious assault made upon Paris from noon to
sunset.

The martial maid was wounded by an arrow from the wall,
and carried against her will out of the ditch. She wished the
assault to be renewed next day, which the Duke of Alen^on
and others enthusiastically attached to her, were anxious should
be done, but the King seemed to have lost courage, and left.
Joan and the rest were compelled to follow. She had given
out that her voices had revealed that she would lead the King
in triumph into Paris; and this was a check which could not
fail to raise misgivings in the minds of her admirers, and to
strengthen the doubts of those not fully convinced of her
heavenly inspiration. From this date, 13th September, 1429,
Joan ceased to have the forces of France at her disposal, and
was obliged, with Alengon and a few brave knights of France
and Scotland, to engage in smaller enterprises. Three or four
places were taken from the enemy, but she was obliged to raise
the siege of La Charite, because, as we are told, the King did
not arrange to send her provisions or money to maintain her
company. Envy and jealousy play a large part in human affairs.
The simple peasant girl who had done so much for France
was adored by the people, who crowded around her to kiss her
garments, and soldiers were willing to fight under her banner
without pay; but some of the councillors of the French king
did not seem even to have the sense to perceive the wonderful
power she had set in motion, and disliked her because they
thought they were entitled to some of the praise which was

Digitized by LjOOQle

1883.] Character and Hallucinations of Joan of Arc .

lavished upon the holy maid. On the 21st May she threw
herself into Compiegne which was besieged by the Burgun¬
dians, and in a sally was surrounded, pulled off her horse, and
taken prisoner by some soldiers of John of Luxembourg. She
was seen by the Duke of Burgundy, and then sent to Beaulieu,
where she remained above two months, when she was re¬
moved to the Castle of Beaurevoir. During the six months
she was in the hands of the Burgundians she was very strictly
confined, and kept in irons for fear she would escape. The
ladies who visited the prisoner teased her to wear petticoats,
to which she had clearly a strong dislike ,* and one at least of
the gentlemen who saw her acknowledged using indecent
liberties with the maiden. It does not seem that Charles made
any attempt to ransom or rescue her, though he must have
known her extreme danger, for the English had proclaimed
that they would burn her if they took her, and they had even
threatened to burn her herald at Orleans as a messenger from
Satan. At last she was sold to the English by John of Luxem¬
bourg for a thousand livres and a yearly pension of two hundred
more. When she heard of this she threw herself from the
tower of Beaurevoir, and was picked up insensible at the foot.
She herself said that she could neither eat nor drink for two or
three days after. She said that she did this not with the in¬
tention of committing suicide, but with hopes of escaping,
thinking that it was better to risk death than to fall into the
hands of the English. She said that St. Catherine had forbid¬
den her to throw herself from the tower, but had afterwards
comforted her and advised her to confess and ask pardon of
God, on which she took heart and began again to eat, and soon
recovered.

The English took her to Rouen, and the treatment to which
she was subjected might have deranged a strong mind. She
was heavily chained by the ankles, and fastened to a beam, and
watched by a guard of five fellows of the lowest sort, who
teased and mocked the poor girl, and several times tried
to violate her. On one occasion Joan's cries were heard
by the Earl of Warwick, who rescued her, this not being
the kind of revenge which he had in view. The men
of war made little concealment that they had bought her
in order to burn her. The Earl of Warwick, who com¬
manded at Rouen, hearing that she was ill, sent doctors to
attend her, because it would be displeasing to the King if she
should die a natural death. The King held her dear, and had
bought her dear, nor did he wish that she should die, unless by

Digitized by LjOOQle

Character and Hallucinations of Joan of Arc , [April,

the hands of justice, and that she should be burned. The
doctors found her feverish and advised bleeding, and the Earl
was fearful that she might pass away under their hands. Never¬
theless she was bled, and seemed recovering, when one Master
John de Estevet entered, who abused her in the coarse terms
put by Shakspere in the mouths of English noblemen, unfor¬
tunately quite in keeping with historical truth. This made
Joan very angry, and caused the fever to return. We see the
same circumspect Earl of Warwick protecting the captive girl
when the Earl of Stafford half drew his dagger to strike her
because she said that a hundred thousand English could not
win France. There was no reason why she should not be
treated like other prisoners of war. She had never violated
any of the laws of war, and indeed had been more merciful
than most of the combatants of the time. Besides there were
English prisoners in the hands of the French who might become
the subjects of reprisal; or perhaps in the fortune of war
Warwick might some day fall into the hands of the enemy, as
Talbot, and Scales, and Warwick’s own son had done. It was
prudent, therefore, to establish some distinction between Joan
and other prisoners, and to arrive at this it was necessary to
make her go through the form of a trial. The infamy of con¬
ducting these proceedings belongs to Peter Cauchon, Bishop
of Beauvais—a man who bore amongst his friends at least a
fine character—along with a judicious selection of abbots,
doctors of divinity and of canon law, and other learned and
holy personages. The trial was dragged over four months.
This girl, who was no older than twenty, and who could not
read, but had passed a year in camps, and nearly a year in
prison, was subjected to perplexing cross-examinations and in¬
sidious questions for six hours a day. Her answers were put
down, though in a somewhat garbled manner, and then fresh
questions contrived. Nicholas Loiselleur, a creature of the
Bishop of Beauvais, was introduced into her cell, with instruc¬
tions to pass himself off as a prisoner on the same side as her¬
self, and try to lead her into unguarded disclosures, which
were listened to through an aperture in the wall. The same
man was afterwards made to act as her confessor. While they
sometimes questioned and upbraided her, two or three at a
time, no one was allowed to give her counsel, and some mem¬
bers of the court who were thought to favour her had to leave
for fear of their lives. Even the Bishop of Beauvais was accused
of being too slack, which he angrily denied, as endangering his
hopes of preferment under his English masters. Notes of the

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by William W. Ireland, M.D.

process have come down to us, of course much shorter than
the actual proceedings, but helping us to realize the unfairness,
stupidity, and cruelty of these pompous pedants.

Joan boldly defended the truth of her revelations, even when
threatened with torture. She said that she had heard the
voices every day in her prison, and that light accompanied the
voices. Visions, if they appeared at all, were much less fre¬
quent. The angel Gabriel conversed with her on one occasion ;
the voices told her that it was he. But the voices of St.
Catherine and St. Margaret were often in her ears. They told
her to answer boldly. Sometimes they came without her asking;
sometimes their voices awaked her from sleep; and some¬
times the voices were drowned by the noise made by her
guards. They told her what to say, and when she prayed to
God for them they came immediately. Sometimes the saints
would ask God what she should say, and return with the
answer. They promised that she should be freed from prison,
but in what manner she did not know. “ Take everything
cheerfully,” they said. “ Do not distress yourself about your
martyrdom, you will come at last into the Kingdom of Heaven.”

Manchon, the notary, who was present at the trial, and who
took part in translating the proceedings into Latin, examined
afterwards at the jproces de rehabilitation, said that Joan ap¬
peared to him to be very simple, though sometimes she answered
very prudently, and sometimes simply enough. As far as can
now be judged, some of her replies were very skilful. She
generally refused to answer questions which were not to the
point, or to be twice examined on the same matter. Her
woman’s wit showed her that these pretended judges were her
cruel enemies, but she had a deep veneration for the authority
of the Church of which they claimed to be the representatives.

Her judges evidently believed that she was deceived by evil
spirits, who took the form of saints and angels. They had got
hold of a story of her consulting with the fairies under an
ancient beech tree, in a grove near her father’s house. Under
this old tree, where of old the fairies were said to have been
seen, the boys and girls of Domremy used to assemble in the
spring and summer time to sing and dance, after which they
went to drink at a fountain near. Joan acknowledged having
danced with other girls under the tree, but she never saw any
fairies nor knew of any one who had done so.

The Court interrogated Joan about her relations with a woman
called Catherine of Rochelle, who advanced pretentions similar
to her own. This Catherine gave out that a white lady dressed

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Character and Hallucinations of Joan of Arc , [April,

in cloth of gold appeared to her and told her to ask the King
for trumpeters and others to go about collecting money to pay
Joan's soldiers. She also claimed the power to discover hidden
treasures. The maid told this new partisan to go home to her
husband and look after her children; and to make sure, she
consulted St. Catherine and St. Margaret about this new claim,
who told her that it was madness, and would come to nothing.
She slept a night with Catherine to see whether the white lady
would come. Catherine told her that the apparition had come
when she was asleep. Joan therefore slept during the day so
as to be able to remain awake all night. She often asked
Catherine whether the white lady would come, to which Cather¬
ine answered “ She would come soon."

Perhaps it did not then occur to Joan that she was using a
test which might be used against herself; for she could no
more make her voices be heard, or her visions be seen by any
one save herself than this adventuress. In fact it is the cha¬
racter of visions in every age that they are only seen by the
ghost-seers. This Catherine of Rochelle having fallen into the
hands of the English, had denounced Joan as in league with
the devil. Another imitator of Joan, called Peronne, was
also taken by them.

When pressed by the Court that she ought to give a sign,
otherwise she had no reason to claim more credit than Catherine
of Rochelle, Joan was led to make obscure references to a sign
with which she had been favoured, till she was at last drawn
on to make a positive statement, somewhat against her will—for
she used ambiguous expressions, refused to answer several
times, and asked them if they wanted her to commit perjury.
The statement is so strange that it merits consideration as bear¬
ing upon her mental condition.

She said that when she was at Chinon the Archangel
Michael came, with a great multitude of angels, to the house
of a woman where she was living, and taking her by the hand
led her up to the King’s castle, and into the royal chamber,
and gave to the Archbishop of Rheims a rich crown of gold,
which he placed upon the King’s head. She said that this was
done in the presence of Charles of Bourbon, the Lord of Tre-
mouille, the Duke of Alengon, and several others; and that
this crown was still in the royal treasury. Joan herself went
into a small chapel near, where the angel followed and then
disappeared.

The Court offered to allow her to write to some of the
persons she mentioned, to see if they would confirm this state¬
ment under their seals; to which she answered, “ Give me a

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1883.]

by William W. Ireland, M.D.

messenger, and I shall write to them about this whole trial.”
On another occasion she was asked to refer to the Archbishop
of Rheims about this story of the crown. “ Make him come,”
she replied, “ and then I shall answer about this to you, nor
will he dare to say the contrary of what I have told you.”

As a postscript to the trial, and in the same handwriting,
there were some additional notes made by six of the judges
who had visited Joan in prison during the few days of de¬
pression between her abjuration and her death. These men
stated on oath that Joan acknowledged that she herself was
the angel who brought the crown to the King, and no other,
and that she was the messenger who announced that the King
would be crowned at Rheims. Being interrogated whether
the apparitions were real, she replied, “ Whether they were
good or bad spirits they appeared to me.” She said that
she heard voices, especially when the bells were sounded,
and that the apparitions appeared in great multitude and
small quantity, as a crowd of figures of small size; but
she could not be got to enter into any defined description.*
Three of the witnesses, one of whom was Loiselleur, the spy,
stated their impression that Joan was at that time of sound
mind, a question which seems to have received little con¬
sideration during her trial and imprisonment. They declared
• that, up to her very last moments, she persevered in the reality
of the apparitions. At the stake she was heard to invoke the
angel Michael, though on one occasion, at least, she said she
thought they must be bad spirits since they had deceived her
with promises that she would be delivered from the hands of
her enemies.

Of course she was condemned, and ordered to submit herself
to the authority of the Church, and renounce her errors, or she
would be burnt that very day. The executioner, or torturer,
as he was called, was waiting for her with his cart. Under
terror of such a painful death, Joan consented to make a re¬
cantation, which apparently was different from the one after¬
wards published by the Court. She was then sentenced to
perpetual imprisonment.

The poor maid expected to be put into the custody of the
Church, and to have some of her own sex near, but she was
sent back to her old prison, and the guards treated her as

* Inquirebant ab eantrum verum erat quod ipsas voces et apparitiones habii-
iesset; et ipsa respondebat quod sic. Et in illo proposito continuavit usque ad
finem, et non determinabat proprie (saltern quod audiret loquens), in qua specie
▼eniebant, nisi prout melius recolit, veniebant in magna multitndine et quan¬
titate minima.—Tome i., p. 479.

Apparebant sibi sub specie quarumdam rerum minimarum—p. 480.

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Character and Hallucinations of Joan of Arc , [April,

roughly as before. It had been one of the articles of accusa¬
tion that she wore a male dress, and she had promised not
to resume it. The voices reproached her for her abjuration,
and said that she ought to have resisted to the last. The
English, on their part, were disappointed that she had not been
sentenced to death. In four days it was announced that Joan
had put on the old male dress which had still remained in her
room.* This was seized upon as a relapse, the judges entered
her prison. “ She is caught now/ 5 the Bishop of Beauvais was
heard to say. He was very jocund with the Earl of Warwick.

“ Farewell,” he added, u make good cheer, the thing is done.”
On the 30th of May, 1431, she was delivered over to the secular
arm, and a few hours afterwards led to be burned in the old
market-place of Rouen. Joan was much affected on being
told the cruel death she had to die, and went weeping to the
stake. She maintained the reality of her revelations to the
end, and was heard to invoke Michael and St. Catherine. We
have an account of her last hours from Martin Ladvenu, a
Dominican, who heard her confession, followed her to the stake,
and sat with her till the fire came near, when she told him to
descend and to hold the cross before her till she expired. After
it was seen that she was dead, the faggots were pulled apart,
and her body, still tied to the stake, was shown to the crowd.
The fuel was then again heaped around till her remains were •
reduced to ashes. It was afterwards told that the executioner
was heard to say that her heart would not consume, and that he
feared that he was damned, for he had burned a holy woman. An
Englishman, who had placed a faggot to the pile, cried out that
he repented bitterly, and that he had seen a dove come out of the
flames. It was popularly believed that the holy maid had not
really died, and a few years after a woman pretending to be
Joan of Arc again come to life, went about Germany and
France (from 1436 to 1440), and for a time deceived many,
among others, some people of Orleans and two of Joan’s
brothers. She was married to a knight, Robert des Harmoises.

* Guillelmns Manchon dixit quod time erat indnta indnmento virili, atqne
conquerebatur quod non audebat se exuere, f or mid an s ne de nocte ipsi custodes
sibi inferrent aliquam violentiam atque semel aut bis conquesta fuit dicto
episcopo Belvacensi, Subinquisitori, et magistro Nicolao Loyselleur, quod alter
dictorum custodum voluerat earn violarej quibus Anglicis propterea, a domino
de Warvik juxta relationem ipsorum episoopi, inquisitoris et Loyselleur, min©
magn© illat© sunt, si ulterins id attentare pr©sumerent j et de novo duo alii
custodes commissi.—Tome ii., p. 298. Frater Bardinus de Petra ab eadem
Johanna audivit, fuit per unum magn© auctoritatis tentata de violentia; propter
quod, ut ilia esset agilior ad resistendum, dixit se habitum virilem, qui in carcere
fuerat juxta earn caute dimissus, resumpsisse.—Tome ii., p. 305,

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1883.]

by William W. Ireland, M.D.

The imposture was detected by the King, Charles VII. She
afterwards led an abandoned life, and came to a miserable end.

The cold-hearted councillors of that King, who had done
little or nothing to rescue Joan, soon found the want of the
powerful arm which had been so useful to their cause, and even
tried a substitute. They got hold of a shepherd-lad named
William le Bergier or Pastourel, who, as the Chancellor of
France wrote, “ said neither more nor less than the maid had
done, and who was commanded by God to go with the King’s
people.” In an incursion which the French made into Nor¬
mandy (August, 1431), the shepherd fell into the hands of the
English after a fierce combat, in which the Sire de Saintrailles
was also taken. He was brought before the boy King Henry
VI., tightly tied with cords, and then, it is said, thrown into
the Seine. Like St. Francis he showed five blood-marks on
the feet, hands, and side. It is worthy of notice that the
chroniclers who mention this unfortunate youth, call him
insane, which no one said of Joan of Arc.

Twenty-five years after, when the French had regained
Normandy, the whole proceedings against the heroine formed
the subject of a careful inquiry. Evidence was taken at Dom-
remy, Toul, Vaucouleurs, Poictiers, Orleans, Paris, and Rouen.
The old condemnation was formally annulled by the ecclesi¬
astical courts, with the sanction of the Pope, and Joan’s
memory cleared of the imputation of being a witch, a dreadful
one in those days, which blasted all it touched. It is from
the record of her trial and rehabilitation that we have gathered
so many details.

It seems strange that Joan was never canonized as a saint,
as some French writers have proposed. She appeared in a
just cause to save a great nation from ruin. Her claims to
miraculous aid may well appear credible to those who are will¬
ing to admit the supernatural in history, and her fitness to play
the difficult part assumed by her might rather be deemed the
proof of the selection of a higher wisdom than her own, than
the result of the random excitations of nervous disease. How
could God suffer an innocent girl to be deceived by the form
of the messengers whom He had sent of old ? Nevertheless it
would be easy to show that Joan’s voices several times de¬
ceived her; for example, she said that she was destined to
set free the Duke of Orleans from his English captivity,
and that she would lead Charles 711. in triumph into Paris.
There is reason to believe that she gave out that the fatal
sally at Compiegne would succeed. She also said that the

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Character and Hallucinations of Joan of Arc . [April,

voices told her that she would see the Bang of England,
and that she would be delivered from the hands of her enemies.
It must be kept in mind that she was no older than twenty
when she died, and that her career only lasted about two years,
one-half of which was spent in prison. Had she lived longer
it is likely that the course of events would have indicated more
clearly the character of her delusions. Would her hallucina¬
tions have ceased to follow her, and her mind have subsided
from the state of exaltation ? Or would she have gone on in her
claims of having supernatural communication with Heaven ?

Brierre de Boismont has shown that hallucinations are quite
compatible with sanity, and even speaks about physiological
hallucinations; but though men may have hallucinations with¬
out their reason being overset, we hold with Dr. Hagen* that
a hallucination is always something pathological. By deranging
our sensations, the channel of all our knowledge of the outer
world and of our intercourse with other minds, hallucina¬
tions must ever place the reason in danger of being overthrown.
Joan wrote a letter to the Hussites threatening to give up even
the war against the English, to visit these heretics with an
avenging arm. It is clear any one making such pretensions
at the present time would get her case considered by doctors
of medicine instead of doctors of divinity ; nor need it be
said what would be their decision. But she lived in credulous
times, when no one doubted that men frequently communicated
with spirits. The only question was whether they were good
or bad spirits. Joan believed they were good spirits, because
they never tempted her to evil, and urged her to free her
country, which she and those around her believed to be a good
work. It was seriously discussed by a learned doctor of
Germany whether Joan was really a woman at all, and not a
python, who would disappear or turn into a serpent, like the
lady in Keats’ poem of Lamia. When the whole age was thus
deluded, there is little wonder that Joan herself went with the
current. The great difficulty, of course, is to give a rational
explanation of her early delusions, which seem to be connected
with hallucinations of hearing and sight. I cannot say that I
have any clear explanation to give, and would not like to pro¬
long this paper beyond the limits of your patience. I shall
therefore defer any further statement of my own surmises
thinking it better to have presented to you the facts in the
career of Joan of Arc, which it is of importance that you, as
psychologists, should know in order to form an opinion.

X Studien auf dem Gebiefce der Aerztlichen Seelenknnde, von Dr. Friedrich
Wilhelm Hagen. Erlangen, 1870. Die Jungfrau von Orleans, p. 107.

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1883.]

Miliary Sclerosis . By J. W. Plaxton, M.D., Medical Superin¬
tendent of the Asylum for the Insane, Colombo, Ceylon.

Is Miliary Sclerosis a fore-death change ? Most of us
have believed it so : many of us doubt, myself amongst the
many. As to the grounds of my unbelief, they are briefly
these:—

1st. The rarity of its absence in brains examined by me since
I entered the tropics.

2nd. No one has ventured to say he could link this change
with phenomena seen in the living.

It was a relief to one in this doubting state to hear that in
the Pathological Room of the West Riding Asylum the same
doubts had entered.

Not only so, but one of the men best able to guide us, we of
the ruck, was to investigate the matter. (See Dr. McDowall’s
paper in the “ Journal of Mental Science/’ January, 1880.)

Time passed, and no sign was made—we know with good
reason.

With scepticism strengthened, and with inquisitiveness
whetted by delay, in April last, a season of comparative
leisure, I overhauled my bottles.

I found I had pieces of 22 brains.

Brains of insane dying in the lunatic asylum ... 20
Presumed normal brain ... ... ... ... 1

Brain of bat (Pteropus) ... ... ... ... 1

I submitted them all to the microscope, with this result:—

Miliary Sclerosis absent ... ... ... ... 1

Miliary Sclerosis present ... ... ... ... 21

It was present in the normal brain, and present in the bat’s
brain.

Casting about for a reason for its absence in the one brain,
the note I had made that no spirit was used in hardening in
this single instance seemed a clue worth following. My usual
custom was to take a bottle of spirit with me to the post¬
mortem room, and then and there place the desired piece of
brain in it as soon as removed from the body. In this case
my custom had not been followed, and I had made a note of it.

As to the other 21 brains, I have written a note of its use in
eight human brains, and I know it was used with the bat’s

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Miliary Sclerosis , [April,

brain, making nine brains with which its use was certain. The
hardening was in all cases completed by some chrome fluid.

It remained for me to test the hypothesis that the use of
spirit influenced the production of Miliary Sclerosis.

To this end, brains of four patients dying here were used.

Two portions were taken of each brain ; one portion placed
at once in a solution of bichromate of potass, one portion, placed
at once in spirit.

I have just completed the examination of these brains, the
result being:—

Spirit portions—Present in
Spirit portions—Absent in...
Other portions—Present in
Other portions—Absent in

3
1
0

I have also examined an additional two brains which had
passed through spirit. Miliary Sclerosis was present in both.
The outcome of my inquiry stands thus:—

Individual brains examined .28

Brain passed through spirit—

SotbtII} T ° tal . 27

No spirit used in . 5

Where no spirit was used—Miliary Sclerosis absent in all.
Where spirit was used—Miliary Sclerosis absent once, present
26 times.

The number of cases is too small, and the conditioning of the
cases too imperfect, to warrant any certainty, but, to say the
least, they are suggestive of this, that spirit determines the
appearance of Miliary Sclerosis.

In the “Journal of Mental Science,” July, 1882, mention is
made of Dr. Savage’s paper on this same subject of spirit-made
changes in nervous matter. His experience would seem to
march with my own, but unfortunately I have not seen his
paper, nor one by Spitzka previously advocating the same view.

Dr. Batty Tuke, in reply, as it were, shows that this is no
new thing, having had to lay aside as valueless a large number
of slides in which, working with spirit, deceitful appearances
were present. These appearances were not found when his
method was changed.

The changed method is, if I mistake not, to limit immersion
in spirit to 24 hours, and then harden it in some chrome fluid.

Dr. Mitchell strengthens Dr. Batty Tuke’s case by the

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1883.]

by J. W. Plaxton, M.D.

observation that Miliary Sclerosis is less recognisable after the
prolonged action of spirit.

The inferences from these observations just quoted are:—

First. Prolonged immersion in spirit causes the appearance
of, at least, a pseudo-Miliary Sclerosis in nervous tissue.

Secondly. It veils true Miliary Sclerosis.

Thirdly. Twenty-four hours is not a “ prolonged” immersion.

How do my cases tell for or against these propositions ?
Conclusively as to none, for all but one of my brains were in
spirit 48 hours or more.

The exception was in spirit three hours only. In this case
the sectio cadaveris was made five hours after death; the part
to be preserved was placed in spirit six hours after death, was
in spirit three hours, was hardened in bichromate of potass
and chromic acid for ten weeks, and was nine months in
spirit before examined for the above purpose.

Unless it be argued that the Miliary Sclerotic change unde¬
niably present was the product of the second immersion in
spirit, I, in the light of my other cases, am driven to conclude—

Either (1) a shorter immersion than 24 hours will give rise to
the change, miliary or deceptive, whichever it may be.

Or (2) the change is due not to spirit alone, but to spirit
with some influencing accessory.

The accessory which at once puts itself forward is heat, my
work-room the year round, night or day, rarely rising above
85° F., and as rarely sinking below 75° F.

If the argument from microscopic examination is uncon¬
vincing as to its origin in point of time, what is the argument
from the living ? It has been seen oftenest in cases in which
during life the nervous system has suffered. True, but these
are also the cases in which the brain has oftenest been
examined.

Is it recognisable as (during life) being connected with any
train of symptoms ?

Is it the unvarying accompaniment of nervous disease ?

I think not. Dr. Long Fox, quoting Dr. Kesteven, gives
a list of 21 diseases, all diseases in which grave disturbance of
nerve function was present, but some, certainly, in which it
must have been present as a bye product.

It can scarce be said to have been the cause of idiocy,
yet, in the case quoted, Dr. Kesteven counted 25,000 granules
of Miliary Sclerosis in the square inch.

If not the cause of idiocy, we must either suppose it did or
did not cause recognisable disturbance of function during life.

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Miliary Sclerosis.

[April,

It can hardly be doubted that such a dislocation, to say
nothing of destruction, of nerve elements as the intrusion of
25,000 foci of Miliary Sclerosis per square inch of surface
would cause, could exist without some manifestation other than
idiocy to mark its presence; yet no note is made of such.

Again, quoting Dr. Fox :—“ It can be seen to exist in a
large number of cases in which the mental faculties have
scarcely suffered at all—in spinal diseases not at all.”

Yet, again, I find it present in the brain of a man dying
without trace of brain defect, and I find it present in the brain
of a bat shot by myself, whose brain was lodged in spirit two
hours after death. True in these cases the brains lay long in
spirit—the man's 49 hours, the bat's some weeks—but then
the same change is present in a brain three hours only in
spirit, and which is safe in chrome fluid nine hours after death.
This brain, though, was that of an insane patient.

To conclude. From clinical observation we have little or no
reason to believe this change due to disease.

From the microscopic examination of brain and the observed
effect of spirit, we are certain that deceptive changes are brought
about by the use of spirit.

I myself would go farther, and say there is strong reason
for doubting the reality of Miliary Sclerosis as anything but
the effect of post-mortem change , however it may be induced .

I have assumed that the changes I have seen are really what
I believe them to be, the Miliary Sclerosis of Dr. Batty Tuke,
or, as others prefer to say, Miliary Degeneration; but even if
they be but the simulacrum of the disease, I shall not have
ventured on unaccustomed ground in vain, if he will quieten
our mental unrest by showing us the simulacrum side by side
with the true.

Forewarned, we shall then be forearmed.

I should like to watch on the stage of the microscope the
effect of spirit, at differing periods, on a section of fresh brain,
but unfortunately in the tropics the freezing of brain would
be a difficult matter.

I would like to suggest as matter for proof the effect of
different strengths of spirit and the correspondence or not of
the effect of methyl or ethyl alcohol.

I have not found the change influenced by moderately long
keeping of the brain. The same brain kept until decomposi¬
tion had undoubtedly begun gave almost identical result as
when it was transferred early to spirit.

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1883.]

The Data of Alienism . By Charles Mercjier, M.B. (LoncL),

F.R.C.S.

III.

The Organism—The Physique.* — Continued .

. The study of the Laws of Heredity, as conducted in the
preceding papers, has resulted in a definite conclusion, it is
true, but in a conclusion as to tendencies only; and whatever
facts we may ascertain in the family history of a patient,
however numerous and however damning they may be, they
can never warrant us in inferring anything whatever with
respect to that patient, beyond the existence of a tendency in
one direction or another. To ascertain how far, and in what
proportion, these tendencies, in so far as they concern the
Structure of the Organism, have become actualities, recourse
must be had to the study of the Physique, which is the out¬
come of the combinations, and conflicts of the laws of inheritance.
Or, in other words, the Physique is the form which the organism
has assumed under the action of the developmental forces.

The assumption of a certain form by an organism implies
that development—the resultant of the developmental forces—
has proceeded in a certain direction for a certain distance. It
is obvious that if development had taken another direction, or
proceeded further or not so far, the form of the organism
would have been different; and it is obvious, moreover, that
these two are the sole elements that determine the form of the
organism. They therefore, form a natural basis, and indicate
a natural division, of our investigations into the Physique. It

* It has been represented to me by several friendly critics that, whereas in
the paper on the Nature of Insanity, I had promised to follow on with schemes
for the investigation of Mind and Conduct, it has, in fact, been succeeded by
papers on a totally different subject. To this impeachment I must plead
guilty, and I have only to say in extenuation, that the promise referred to
resulted from a very inadequate estimate of the magnitude and difficulty of
the task. Further consideration convinced me that such schemes, involving, as
they will, an entirely new departure in the science, would have a very frail
chance of acceptance unless they were preceded by a preparatory treatment
of the simpler aspects of the subject, so arranged as to lead up to the more
difficult regions that lie beyond. Furthermore, closer examination showed
that in the science of the normal Mind large gaps existed, and these defects
in the foundation had first to be made good before any superstructure could
be raised. The promised schemes are, however, in course of preparation, and
a preliminary contribution to the first of them appears in the current number
of “ Mind.”

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must be borne in mind, however, that to follow the process of
development is no part of our task. All that we have here to
do is to estimate its results, taking these results, for the sake of
convenience, first in one aspect, and then in the other.

The direction in which development has proceeded deter¬
mines those features, so preponderant in the structure of the
organism, that characterise the Eace, the Temperament, and,
where it is present, the Diathesis; together with most of the
still more special characters which are proper to the individual,
and serve to distinguish him from others.

The height that development has reached is measured by
Reversion to characters that have been lost by the majority of
the race; by Survival in a well-marked form of characters out
of which the race is in process of emerging; by Persistence
to adult age of characters proper to embryonic life, infancy, or
childhood; and by the degree in which those characters are
assumed that appear at the highest tide of development.

The Pace and Nationality. —Few better instances could
be given of the fact, so frequently occurring and so persistently
ignored, that speculative questions of apparently the most
visionary character unexpectedly turn out to have a close and
powerful bearing upon practice, than this question of Eace
considered in connection with Insanity. In the treatment of
the insane, the one question whose importance transcends all
others to an immeasurable degree, is the use or non-use of
restraint; and during the past year, the use of restraint has
been justified by an American alienist, on the ground that the
type of insanity that occurs among those of American race is
so different from that occurring among the English, as to neces¬
sitate a radically different mode of treatment. Alienists on
this side of the Atlantic would approach such a question in a
very sceptical attitude, but the fact that it has been raised
shows the necessity for some reference to race among the data
of alienism ; and, should it be affirmatively established, it will
necessitate the estimation of racial influence in every case of
insanity that we have to treat.

The estimation of Eace and of Nation, while they are, for
the sake of brevity and convenience, grouped together, are yet
in reality distinct problems. Every modern civilised nation
has been formed by the amalgamation, at various times and in
various proportions, of many distinct races; and the same race
may not only have been so distributed as to become a factor
in the composition of several distinct nations, widely different
in locality and character; but, when it remains pure, it may

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by Charles Mercier, M.B.

become so modified as to present a widely different physique,
as we find in the Scotch and Irish Celts. The modern English
nation is made up of grafts, more or less extensive, from
almost every race of the Aryan stock; and most of these grafts
have become so intimately blended together, that their distinc¬
tive traits can be recognised, if at all, only as contributing some
modification to the general result. The first inhabitants of
these islands of whom we have any written record were Celts,
but who shall say how many waves of immigration had poured
into this country between the times of the cave-dwellers in the
age of Stone, and those of our earliest historical ancestors ? or
who shall determine how much of the blood of those humble
chippers of flint runs in the veins of our statesmen and philo¬
sophers ? This much, at least, is known, that for two thousand
years, that irresistible march of Aryan man towards the setting
sun, which has continued throughout an immeasurable past in
the Old World, and which still continues in full vigour in the
New, has maintained an influx of new blood into this country,
at first in isolated waves of conquest, and ever since in a steady
flow of peaceful immigration, that more than justifies the
dictum of Defoe :—

A true-born Englishman’s a contradiction,

In speech an irony, in fact a fiction.

That these heterogeneous elements have become to some
extent fused into uniformity of character, is shown by the fact
that among foreigners, even so closely allied to us as the
Germans and French, an Englishman can usually be distin¬
guished by his facial characters alone; but that the fusion is
but partial and incomplete, is indicated by the ease and certainty
with which various types of the original races can still be dis¬
tinguished within the nation. Thus, from the west of Ireland,
from the mountains of Wales, and from the Highlands of
Scotland we get Celts of pure descent, though of divergent
types, all of whom retain, in a marked degree, the mental and
social peculiarities, and some of the physical characteristics,
that distinguished their earliest historical ancestors. In the
rural districts of East Anglia we find people who are not only
peculiar in physique and dialect, but who bear in many
instances the very names that were borne by their Anglian
forefathers long before the Heptarchy; and the Jews we have
always with us. Besides these scattered remnants of the
component races, there are other distinctions which mark off
sections of our population—distinctions that are partly vestigial

XXIX. 8

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of the component races, but to a large extent have originated
within the nation and in the historical era. It is manifest that
in pre-railway times, when the population, and especially the
rural population, was of necessity very stationary, and migra¬
tion to any important extent was unknown, the inhabitants of
any one district must have been for generations subject to a
uniform set of environmental conditions, and must for genera¬
tions have intermarried. In this way there must have occurred
in each secluded district, a gradual assimilation of the inhabi¬
tants of this district to one another, and a gradual differentiation
of them from the inhabitants of surrounding districts; and thus
would be established a distinct sub-variety of man, which would
only need a continuance of the favouring conditions to develop
into a distinct variety and race. That the first part of this pro¬
cess has actually taken place is strongly indicated by the evi¬
dence of language. In tracing the history of the races of man,
no evidence is so much relied on, or regarded as less impeachable,
than that of language; and if this evidence is reliable as a
proof of kinship, equally reliable is it as an indication of
divergence. Moreover, as it is trustworthy in quality, so in
quantity it is abundant. The dialect of Lancashire is almost
unintelligible to a Londoner ; to a Kentish peasant it would
be quite unintelligible. The Yorkshire dialect, while allied to
that of Lancashire, is not the same. In East Anglia not only
are the vowel sounds different from the common, not only is
there a copious vocabulary of local terms, but there is a cadence
rising at the end of the sentence which is different from the
Scotch cadence, and is unknown elsewhere. The Midlands
have their own dialect. In Dorset and Devon not only is the
dialect widely different from pure English, but small localities
have their peculiarities of pronunciation, by which the natives
can recognise the district, and even the village, from which
the speaker comes.

Hence it appears, that while it would be indeed an idle task
to attempt in this country, and at this stage in the history of
the world, to disentangle the racial kinship of any individual
belonging to the bulk of our population, and especially of our
urban population; yet not very unfrequently we are called upon
to treat an individual of presumably or ascertainably pure race,
and in such a case it would be folly to neglect any indication
of his mental and ethical tendencies.* The bearing of racial

* The formation of local sub-varieties of man, to which reference has been
made, when collocated with the conclusions deduced in the last paper from
the second law of Inheritance, yield instructive results. One effect of that

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by Charles Mercier, M.B.

considerations upon practice, has already been illustrated by
the plea of American alienists for the use of restraint, and
other examples readily suggest themselves. Thus, the turbulent
and pugnacious spirit of the Irish Celt, which exhibits itself
so constantly in their history, which impels such a dispro¬
portionately large number of them to enter the army, which
appears in their passion for litigation, and which has been so
prominently displayed on a large scale in the last few years in
political movements,' materially helps us to understand why
they are among the noisiest and most violent of the inmates of
our asylums; and their hereditary aversion to continuous
employment, emerging into greater prominence and strength in
insanity, as underlying racial qualities are prone to do, deprives
us of our chief remedial agent, and necessarily renders prog¬
nosis less favourable in them.

The Temperament. —In the ease and certainty with which
a foreigner in a country is recognised as such by his aspect
only, we see how conspicuous and how constant are the
uniformities of structure that depend on racial and national
kinship; and in the ease with which each member of a race is
identified from the rest, we see the immense diversity that
exists superficial to the national resemblance. Thus it appears
that there are, in the characters distinctive of a race, certain
underlying uniformities of structure .that remain constant
throughout all the individuals of that race, and show through
the wide diversity that exists in more superficial characters.
Similarly, in the features in which the members of a family
resemble one another, there is a smaller group of uniformities
of structure of a less fundamental character, which exist
throughout that family, and yet leave a sufficient amount of
difference to enable the several members to be identified from
one another. The similarity in the latter case rises to a
higher level, and submerges many of the differences that exist
between the several families in a race. In both cases, how¬
ever, the similarities follow approximately the lines of kin-

almost sadden spread of railways over the country that took place 40 years
ago, has been to cause a flux of the whole population, that must have tended
powerfully to break up all such circumscribed groups; and the free inter*
marriage of the different local sub-varieties will, if those conclusions are
correct, have tended to the production of a generation of higher average
intelligence and more prone to insanity. That the general standard of intel¬
ligence is higher than it was 40 years ago, I think everyone will admit; and
the evidence of an increase in the proportionate amount of insanity is so
strong, that frequent efforts are made to explain it away. Without attributing
too much importance to the influence of crossing in producing these results, I
think it may fairly be considered a contributory cause.

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ship, and, like a fluid between two surfaces, rise to higher
levels as these become closer. But there is a third and a
fourth set of uniformities that, while yielding to a certain
extent to the influence of race and family, are yet largely
independent of them; and often appearing sporadically in
individuals scattered here and there, connect them together, by
well marked similarities of configuration and function, into
groups that intersect in an irregular and seemingly erratic
way the groups formed by blood relationship. These are the
characters which form the Temperament and Diathesis.
Underlying and leaving unaffected the differences by which
individuals, families, and races are distinguished, the characters
of Temperament yet give rise to resemblances so well marked
and so important, that we are enabled by means of them to
group together at a glance men of different nations even,
according to the Temperament they exhibit; and on the other
hand to trace clear distinctions between individuals of the
same family. Regard being had to the minor laws of inherit¬
ance, to the influence of reversion and prepotence, the fact that
members of the same family should exhibit wide differences
of Temperament is in no way remarkable; but the converse
fact—the persistent reappearance in their pure form of certain
definite types of structure and function, is at first sight
unaccountable, and merits far more attention than it has yet
received. In spite of the intermixture of parental qualities in
offspring—an intermixture that must become more intimate in
each successive generation, and must continually tend to reduce
original diversities to a uniform average;—in spite of this
powerful levelling influence, there still recur the same special
groups of structural and functional qualities;—groups so
peculiar that one can identify them with ease, and record the
identification in a name— and these named groups of characters
do not run in one family or one race—have no continuity of
succession, but crop out here and there, so that the same type
of frame, face, feature, disposition, and mind shall be found in
individuals who are virtually unrelated to each other—indi¬
viduals belonging to different nations, peoples, and languages,
and whose lives are divided, it may be, by hundreds of years.

Although the consideration of the Temperament falls within
the province of the Biologist rather than that of the Alienist,
yet, as it affords an important datum to the latter, and as it
has, during the present generation, attracted a surprisingly
small amount of attention, a certain space mav be fairly devoted
to it here. r J

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1883.] by Charles Mercies, M.B. 37

As commonly enumerated by the older writers, the Tempera¬
ments which are the most clearly distinguishable, and, with
their combinations or transition forms, the most widely pre¬
valent, are the Sanguineous, the Nervous, and the Lymphatic.
To these I would add a fourth, which, as it is the physio¬
logical counterpart of the Fibroid Diathesis of Dr. Sutton, I
would call the Fibrous Temperament.

Persons of Sanguineous Temperament are of variable stature,
but even when tall are rather slight than bulky; -their bones
are slight, and their extremities small. They are of fair com¬
plexion, the hair being usually light in colour, and, though
often dark, rarely black, and is fine, luxuriant, and curly. The
nails are long and convex in both directions. The skin is thin,
delicate and fair. The head is small and round, the face oval
in contour, and the features refined. The forehead is narrow,
and in the best forms high; the brows are arched; eyes large
(in the conventional sense), and the sight is often short. The
nose is straight and rather short, not thin. The mouth is
small, and the lips full. The upper lip, by which is meant
the space from the nose to the mouth, is of medium length,
and is concave; similarly the lower lip, from the chill to the
mouth, is of moderate length, and is yet more deeply concave.
Thus the red margins of the lips are well everted, and, viewed
from the front, their outline is strongly curved—the cupidon
lip. The jaws are small and the teeth large, so that in the
inferior forms the latter often overlap one another. The chin
is rounded. Persons of this temperament are very active ;
their movements are rapid, neat, precise, graceful, easily evoked;
but they are wanting in force. They have great energy, and
work with persistence, but they lack endurance; they are
soon fatigued. Consonantly with this, they are readily
influenced by their surroundings; easily susceptible to the
influence of alcohol. Usually of a buoyant disposition, they
are easily excited, elated and depressed ; sensitive to the
opinion of others. They are enthusiastic; feel keenly, but not
very lastingly; and feeling finds ready and forcible expression,
but is less apt to permanently influence conduct. They have
bad memories; are highly imaginative; in thought ready, prone
to abstraction and generalisation; in the best forms original
jn a high degree; often witty and subtle, but rarely complex.
In youth they are precocious; they age early, and, as they
grow old, they are apt to get bald, stout, florid, and often
lethargic; but their small features and florid complexions
often give them a boyish look in middle age. This is pre-

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eminently the poetic temperament; conspicuous examples of
its highest development being seen in Shakespere, Byron,
Shelley, and Mozart.

The Fibrous Temperament differs widely from the preced¬
ing. In it the bony frame is large; the stature is variable, but
the frame is always bulky. The extremities, too, are large;
the hair is coarse and thick; the nails flat, and often short.
The head is large and massive. The face is square or oblong
in contour, and the features large. The forehead is rather
broad than high, though often both; the brows are thick and
horizontal or inclined outward and upward; the eyes of
medium size and often deep set. The nose is, in the best
forms, long and aquiline, and often thicker and more pro¬
minent at the bridge. In inferior forms it has the shape
which is called in women retroussSe or tip-tilted, in men pug
or snub. The upper lip is long, often very long, straight and
vertical. In exaggerated forms it is convex, but in the type
it is straight. Similarly, the lower lip, from the chin to the
lower margin of the mouth, is long and straight, with, it may
be, a slight concavity at the upper part. The red margin of
the lips is thin and little everted. Viewed from the front the
mouth is wide, and its curves but slightly pronounced. The
lines leading down from its corners appear early in life. The
jaw is square and massive, the teeth regular and enduring.
In old age they may be seen worn down to mere stumps, but
without a trace of decay. The voice is loud, and often harsh.
Such men are active, but their activity is of a special kind.
Their movements are not rapid; are often clumsy, and wanting
in precision; but they are powerful. They are capable of
immense exertion; they have great endurance of fatigue and
privation; they work arduously and long, with little rest.
They are very tenacious, and, once attracted by an object,
will devote a disproportionate amount of time and trouble to it
rather than relinquish the pursuit. They are but little
influenced by their surroundings; bear with equanimity ter¬
rible responsibilities; alcohol has little effect upon them.
Their emotions are not easily stirred, but they feel deeply and
lastingly. They are undemonstrative, are little given to the
expression of feeling, but exhibit its influence in permanent
alteration of conduct. Hence they are of equable temper,
seldom excited. They have great force of character and
strength of will. In intellect they are essentially inductive.
They have good memories; they revel in complexity of
thought; are not given to generalize—are apt to look askance

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at generalizations; abhor abstractions, and love to grapple
with the concrete affairs of life. They live long, and are but
little subject to disease; maintain their activity to the end of
life; they are late in growing grey, but they soon become
wrinkled, and their skin falls into deep folds below the eyes
and around the mouth. To such men fall the prizes of life.
They are the men of action, the successful men. Excellent
examples of this temperament may be seen among the fore¬
most men in every walk of life—at the head of great houses of
business, managers of railways, successful generals, prominent
statesmen, dignitaries of the Church, leading financiers, and
perhaps the purest examples have been seen on the judicial
bench and the woolsack.

Persons of Nervous Temperament are often of small stature,
and as a rule of dark complexion, sallow skin, and spare habit.
The head is rather small, long and narrow. The forehead
narrow and often low. The eyes are deeply set, the nose
long, thin, sharply cut, aquiline and pointed. The upper lip is
short, in well marked forms extremely short; the mouth is
small, the red margin of the lips is thin, and but slightly
curved. The angle of the jaw is oblique, and the chin pointed.
The teeth are good, but small, so that there are often spaces
between them. In habits they are restlessly active; they are
apt to disturb those around them by their eager and inces¬
sant activity, an activity which does not readily tire, but
displays itself more in rapidity than in force of movement.
They display intense eagerness in pursuit, but they turn their
pursuit from one object to another with startling suddenness.
This quality, which displays itself in the lower forms as fickle¬
ness, becomes, in the higher forms, versatility. They have
little patience—little persistence, but they possess great
nimbleness both of body and mind. They are greatly in¬
fluenced by their surroundings, and the effect passes away
rapidly as the circumstances alter. They easily identify
themselves with the ideas and feelings of other people, and
thus, in passing from the influence of one person or group of
persons to that of another, they may appear in totally
different characters ; but not on that account are they untruth¬
ful ; the state of mind is genuine while it lasts. Their feelings
are intense but transient, are expressed with strong, emphatic,
and even exaggerated demonstration, but have little permanent
influence on conduct. In thought they are quick. Ready of ap¬
prehension, they readily acquire knowledge, and readily forget.
They have little initiative force, little power of impressing

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their will on other people, and often live under the domination
of some stronger mind. Like fire, they are good servants and
bad masters. Dryden's description of the Duke of Bucking¬
ham is, as far as conduct is concerned, the picture of a man of
Nervous Temperament.

The Lymphatic Temperament, which is rare in the pure form,
and may be regarded as a variety of the Sanguineous, is in many
respects antithetical to the preceding. In persons of this
Temperament the bones are small, but the habit is bulky. The
complexion is fair—often very fair—and the hair light, fine,
and luxurious, but soon lost. The head is round and small;
the features are like those of the Sanguineous Temperament, but
the face is a shorter oval, and as life advances becomes pear-
shaped from the increase of the jowl. The skin is pasty, the
limbs large, and there is a tendency to fat. The movements
are sluggish and have little force, but there may be much pas¬
sive endurance. Surroundings are slow to influence persons of
this temperament. Feelings are of moderate intensity, but very
enduring, and largely influence conduct. Their expression is
slow and slight. The mind is slow to apprehend, but tenacious
to retain; thought is rarely either complex or profound. Since
lymphatic persons rarely rise into prominence it is not easy to
find a good example among well-known men. The character
of old Joe Willett, in “ Barnaby Rudge,” is a caricature of the
type. Ethelred the Unready was doubtless of this Tempera¬
ment, and George III. certainly was so.

While pure, or nearly pure, Temperaments answering to the
above descriptions are, save the last, far from uncommon, it is
nevertheless undoubtedly true that the majority of human
beings exhibit characters intermediate between some two or
more of them ; but since the mental qualities and the forms of
conduct appear to be present in proportions generally corres¬
ponding with those of the facial characters, the study of tem¬
perament is not less helpful in these mixed forms than in the
pure types; and with temperaments as with races, the best
individuals are often the results of a cross. Thus the greatest
men of action have been those in whom a strong Fibrous Tem¬
perament was dashed with a tinge of the Nervous. Such men
were Julius Caesar and Napoleon Bonaparte.

To what forms of insanity are prone those who exhibit the
several Temperaments, is a question which is certainly very in¬
teresting, but which, so far as I know, has never been
investigated. As far as my own observations go—and, having
regard to their limited number, I would not attach much im-

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1883.]

by Charles Mercier, M.B.

portance to them—general paralytics are very often of Fibrous
Temperament; melancholiacs but rarely. On the other hand
mania is common among them all. The Nervous Temperament
not unfrequently becomes exaggerated into mania, and the
Lymphatic Temperament easily subsides into dementia. Acute
delirious mania rarely occurs in those of Fibroid Temperament.

When we inquire into the significance of the Temperaments,
we are confronted with two distinct problems. We have first
to explain how it is that like qualities appear sporadically in
unrelated individuals ; and secondly, we have to explain how it
is that qualities which have no discernible bond of union with
one another, appear together, and are together absent, with a
frequency which forbids us to suppose that their connexion is
accidental. Although these are, both of them, problems in
biology, and an exhaustive treatment of them is not required
here, yet since they nearly concern the alienist in other con¬
nexions besides this one, it will not be out of place to show that
there are, in the region of biology, many similar facts, which,
if they do not explain these occurrences, show in what direc¬
tion an explanation is to be sought.

The appearance of similar characters in individuals between
whom there is, in respect to that character, no blood relation¬
ship, is a frequent occurrence; and many of the qualities so
appearing are of a far more striking and exceptional character,
and occur in individuals very far more distant of kin, than any
instance of temperament can show. In the human race,hare-lip,
cleft palate, deaf mutism, and supernumerary fingers, appear in
this sporadic manner; and if we include, as we are bound to
do, lower organisms in our survey, the instances become em¬
barrassingly numerous. A small but notorious instance is
presented by the similarity in marking and colouring between
the zebra and the tiger. Although these two animals have a
common ancestry with respect to the main features of vertebrate
and mammalian structure, yet, with respect to marking and
colouring, there is no such blood relationship. Neither is there
any common circumstance in the habitat or mode of life to
which the similarity could be attributed. And if the characters
are referred, as probably they may be correctly referred, to
sexual selection, the difficulty is but postponed for a single
stage; for we then have to account for the similarity of taste,
and of nervous organization underlying taste, which leads two
animals so diverse to prefer characters so similar. A general
white colour, with dark tips to the ears and dark feet, charac¬
terises certain breeds of rabbits and certain breeds of cattle.

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When dogs are in colour black and tan, the colours often have
a precisely similar distribution in widely different breeds. In
several distinct breeds of fowls, and also in pigeons, there occur
varieties having feathered legs. The remarkable modification
of feather known as “ frizzling ” occurs independently in fowls
and in pigeons. Albinism is a striking instance of this class of
occurrences. Like the temperaments, it appears sporadically
in the most erratic manner, and without assignable cause. It
appears in identical form in widely different orders and even
classes of animals; among birds as well as among mammals.
Like the temperaments, it is sometimes hereditary. Like them
its physical peculiarities are accompanied by peculiarities of
mind and of conduct equally distinctive and constant. Like
them, it is not the expression of any direct conformity to envi¬
ronmental circumstances. A still more striking example is seen
in the well-known modification of structure that is seen in bull¬
dogs. The short and broad forehead, the prominent eyes, the
upturned jaws, the retracted lip, the protruding under jaw, the
wide nostrils, the short and bowed fore legs, all appear in almost
identical form in the pug dog. In this case it may be said,
although there does not appear to be any evidence on the point,
but it may be plausibly advanced, that the similarity is due to
direct descent or close collateral relationship. But what are
we to say of a breed of cattle—the niata cattle of La Plata—
which exhibit a closely similar modification of structure ? In
these cattle the forehead is described as short and broad, the
eyes project outward, both jaws are strongly curved upward,
the lower jaw projects beyond the upper, the upper lip is much
drawn back, exposing the teeth, and the nostrils are wide apart.
This variation of form appeared suddenly de novo , in historic
times—certainly since the 16th century. A similar conforma¬
tion existed, however, in the Sivatherium, a ruminant which
existed in India, and was extinct long before the niata breed
appeared. The characters of the improved breeds of pigs are
alterations in the same direction, and, more remarkable still,
an essentially similar conformation of head marks off a variety
of the common cod, which is called by fishermen the bull-dog
cod. I have also had under care a patient who exhibited such
a markedly similar conformation of jaws and lips, such
prominent eyes and wide nostrils, as to gain the nickname of
“ the bull-dog/ 5

In the vegetable kingdom analogous occurrences are found
to obtain. Thus, six or more varieties of the peach have at
different times, and in different countries, produced nectarine

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by Charles Mercier, M.B.

fruit; and each of the varieties of nectarine so produced have
undergone parallel variations. Several varieties of cherries, of
similarly distinct relationship, have produced fruit of the same
new shape and ripening at the same new period. The dark
colour that gives its name to the copper beech appears occa¬
sionally in the leaves of other trees, as the hazel and the bar¬
berry. The weeping habit breaks out with apparent caprice
alike in the willow, the birch, the ash, the elm, the yew, the
peach, the oak, and the thorn. Many more facts could be
cited, but these are enough to show how often like qualities
occur in organisms, that in respect to those qualities have no
kinship.

The instances of the tendency of characters to appear in
groups when they appear at all, and, for the characters thus
grouped to undergo concomitant variation, are even more
abundant. In some cases we can trace ah obscure connection
between the different qualities that vary concomitantly, but in
others no discernible community of origin exists. That in cats,
white fur and blue eyes almost invariably co-exist with deaf¬
ness ; and that, in certain cases, Mr. Darwin has noticed the
deafness to subside concomitantly with the occurrence of a
change of colour in the eyes, is, if not explainable, yet dimly
intelligible, when we remember that the skin and the special
sense organs are developed from the same layer of the blasto¬
derm. Similarly, the inactivity and low intelligence so
frequently seen in albinoes remind us that the brain has its
origin in an involution of the external layer which forms the
skin; and suggest that an error occurring very early in develop¬
ment may easily affect both ; but in other groups of characters
we can trace no such connecting links. Thus hare-lip and
cleft palate comparatively often co-exist, not only with one
another, which is explicable, but with supernumerary fingers,
and with bifid uterus, which is inexplicable. That albinism in
peafowl should always be accompanied by diminished size,
might be looked on as a part or an additional manifestation of
the defect in the organisation, were it not that other albino
animals, e.g ., moles, are larger than the common kind. That
the largest terrestrial mammals, the largest birds, and the
largest insects are vegetable feeders, may perhaps be accounted
for by the less concentrated food requiring a more bulky diges¬
tive system, and this again necessitating a larger frame; and
that all horned mammals are vegetable feeders may be ex¬
plained by the possibility of a descent from a common ancestor ;
but what explanation can we give of the fact that the large

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The Bata of Alienism ,

[April,

vegetable feeders, solely among mammals and birds, and
by far the most copiously among insects, are decorated
with horns on and about the head? In fowls, frizzled
feathers and a black periosteum always occur together.
In man, disease of the suprarenal capsules and bronzing of the
skin occur together. When, in any breed of animals, a varia¬
tion occurs in the length of the legs, a concomitant variation
occurs in the length of the head. Thus horses, dogs, pigs,
rabbits, and pigeons that have long legs have also long heads,
and vice-versd. The most remarkable, and, perhaps from our
point of view, the most important of these concomitant varia¬
tions occurs in regard to colour. If a black and tan dog has a
tan patch over the eye its feet are tan coloured. If a cat has
white feet the front of the neck or chest is white. In addition
to this correlation in colour of part with part, there is a most
important correlation of colour with fundamental properties of
constitution, which has been established unmistakably in pigs,
horses, cattle, and sheep. Thus there is in Virginia a certain
root which is poisonous to all pigs save those of a black colour,
and these eat it with impunity, so that no pigs of any other
colour are reared in that region. Another plant, in Sicily, is
poisonous to white sheep, and to them alone. Horses of various
colours, after eating mildewed and honeydewed vetches, have
had every spot of skin bearing white hairs inflamed, the
coloured parts being unaffected; and those horses which had
no white about them escaped entirely. Mr. Darwin, from
whose account most of the above facts are taken, gives many
other remarkable instances.

These examples, to which very many more could be added, are
enough to show that, when qualities exist in an organism, they
often exist in groups, and are correlated to one another in a way
at present inexplicable.

Hence it appears that the sporadic appearance of similar tem¬
peraments in unrelated individuals is but one instance of an
occurrence which is frequent in all classes of organisms; and
that the appearance in this manner of the large groups of corre¬
lated qualities which go to make up a temperament, and which
have no descemible community of origin, is similarly of frequent
occurrence.

The explanation of these occurrences, which is doubtless to
be sought in that part of the process of Evolution which exhibits
itself as Segregation, is a task for the biologist; it is enough
for our purpose to show that no objection need be felt to the
admission of the Temperaments among the data of alienism on

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1883.] by Charles Mercies, M.B»

the score of their want of consonance with other natural
phenomena.

Diathesis. Whereas by Temperament we understand a
peculiarity of configuration, associated with certain qualities of
mind and certain tendencies in conduct; by Diathesis is meant
a peculiarity of tissue, which gives a bias to all the vital pro¬
cesses, and especially to the process of inflammation, such that
this latter process tends to take a certain form and to end in a
certain way. Doubtless many of the distinguishing characters
of temperament depend on pecularities of tissue; and doubt¬
less, also, some of the diatheses, e.g., the Strumous, appear to
be exaggerations of the quality of tissue that obtains in a cer¬
tain temperament; and thus the distinction is not absolute.
Nevertheless, it is broadly enough marked to be of much prac¬
tical value. Being a peculiarity of tissue, the diathesis is, of
course, a matter entirely within the province of the physician,
and does not require a detailed consideration at the hands of
the alienist; but a brief enumeration of the various forms will
be of service. The accepted type of diathesis is that of Struma,
which may to some extent be considered the morbid counter¬
part of the sanguineous temperament, since it exhibits an
exaggeration of many of the peculiarities of tissue which that
temperament displays. In the Strumous Diathesis the bias
given to inflammation shows itself mainly in early life, and is in
the direction of persistence, chronicity, and caseous change.
In the Fibroid Diathesis, the bias, which does not come into
prominence until middle life, is toward slow changes of tissue
and an increase of the connective tissue element in the paren¬
chyma of organs, forming in this case granular kidney, in that,
fibroid phthisis, and, in another, sclerosis of brain or cord.
Allied to this is the Gouty Diathesis, in which the bias of in¬
flammation is toward the deposition of urates in the tissues; and
the next Diathesis—the Rheumatic—sometimes included with
the last under the head of the Arthritic Diathesis, is charac
terised by the tendency of inflammation to affect the joints
and fasci®, with the accompaniment of great pain, and to sub¬
side without suppuration. The Dartrous and Leprous Diatheses
are marked by the peculiarity of the skin affections to which
they are prone ; and the Syphilitic and Cancerous Diatheses
require no comment.

Persistence, Survival, and Reversion. —The determina¬
tion of the Diathesis concludes the consideration of those
qualities which indicate the direction taken by the develop¬
ment. The characters indicative of the height of development

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[April,

The Data of Alienism ,

reached, being for the most part matters of degree, are
necessarily somewhat vaguely defined, and do not permit of
precise limitation. Nevertheless, from a general survey of his
physique, we can form an approximate estimate of the grade of
organization reached by an individual, and thus obtain an im¬
portant help in determining whether it corresponds with the
grade of environment that he occupies. If we find that the
vestiges of his remoter origin are few and slight, and that those
characters which mark the highest development of his race are
in him well displayed, we may at once eliminate from the
consideration of his case a whole class of possible defects.

Since the successive stages of development passed through
by the individual embryo are reproductions of the stages passed
through by the race in its corporate history, it follows that the
persistence of an embryonic state is the appearance of an ances¬
tral state; and that Persistence, Survival, and Reversion are so
closely allied that doubt may often exist as to which category a
given defect belongs to. Nevertheless, since the ancestral
characters are assumed by the embryo in a modified form—
since although it always roughly resembles the adult form of
some ancestor, the resemblance is never complete—never more
than an outline sketch—it follows that characters due to per¬
sistence are usually distinguishable enough from those which
indicate reversion to justify a separate record. In Persistence
some part of the process of development has stopped short,
while the rest has gone on to completion; and in so far as this
part of the process is concerned the adult organism remains as
it was in the normal embryo. But in Reversion, a portion of
the process shunts off the main line of development, and runs
for some distance up an old and disused track; so that, in so
far as that part is concerned, the adult organism possesses a
character which is never assumed by the normal embryo, but
which resembles an adult ancestral form to a degree which
varies with the extent to which development has proceeded
along the obsolete track. Reversions are the still-adhering
tatters of a cast-off slough. While, therefore, the immature
condition which results from a stoppage of the process of
development may properly be termed Rudimentary, the rever¬
sion to an ancestral condition, which results from the develop¬
ment to a more complete stage of some character commonly
evanescent, is not properly rudimentary, but should be termed
Vestigial, a term which will include also cases of Survival.
While rudiments and vestiges have a different significance, and
should be distinguished in thought, yet since the distinction is

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1883.] by Charles Mercier, M.B.

not always possible, it is better, as a matter of practical conveni¬
ence, to consider them together.

In General Configuration the infant resembles the anthropoid
apes, and differs from the adult in the following respects. The
body, and especially the abdomen, are of disproportionately
large size compared with the limbs. The arms are long, and
the legs are short and bowed. The length of limb below the
knee is conspicuously deficient. In the ideal human form, as ex¬
hibited in the best sculptures, both of ancient Greece and
Egypt, and of modern days, the body is divisible into three por¬
tions of equal length by two horizontal lines, one touching the
upper margin of the patella, the other at the level of the um¬
bilicus. In the infant, on the other hand, the umbilicus is in
the middle of the length of the body, and in some anthropoid
apes it is even below. When, therefore, we find associated
together a large body, short neck, pot belly, short bowed legs,
long arms, short thumbs and short great toes, we may fairly
say that the individual who exhibits this configuration is of
low type, and we may begin our researches into his mental
qualities at a low level.

The size of the extremities should be noted for this reason,
that smallness of hands and feet means a comparatively pro¬
longed relinquishment of manual labour in the immediate
ancestry. It signifies, therefore, a comparative absence of
dealings with concrete things, and the existence of leisure and
opportunity for abstract thought; and hence is a guide to
tendencies of mind and conduct.

The importance of indications of the height of development
attained are of course greatest when they occur in the characters
of the head, and to this region therefore special attention must
be given. As to size, it is well known that the size of the head
is no criterion of intelligence. Not only the largest heads, but
the heaviest brains, on record have belonged to persons of low
intelligence. The brain of a vagrant drunkard and thief
weighed 67 oz.; that of an insane negro 70 oz. ; the average
weight of the male brain being 49^ oz. On the other hand
many men of exceptionally high intelligence, e.g.> Raphael and
Talleyrand, have had small heads; and some, e.g., Byron and
Shelley, have had heads much under the average size. Nor is
the shape of the head any more absolute guide ; for although
it is as generally true that a well shaped head goes with a high
degree of intelligence as that a large head does so, yet the ex¬
ceptions are just as numerous and important in the one case as
in the other. Many men of good intelligence have heads by

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The Data of Alienism . [Aprils

no means well proportioned, in fact asymmetrical, and every
large idiot asylum can show instances of well shaped heads in
persons of feeble mind. But as special forms of insanity are
associated with special shapes off head, indications from this
source should of course not be neglected. It is important to
bear in mind the ease with which the shape of the cranium may
be modified by apparently trifling causes, and the small harm¬
ful effect that such changes have upon its contents. In rabbits,
so small a circumstance as the lopping off an ear, is enough to
change the structure of the whole skull. The Samoans and
other savage tribes alter the shape of the skull by an elaborate
system of bandaging, but there is no evidence that any defect
of intelligence results from this practice.

The proportion that the size of the cranium bears to that of
the face is a more reliable indication of intelligence than either
the size or shape of the former. In the lower vertebrata, e.g.,
the crocodile, the proportion of the cranium to the face is in¬
considerable ; and, generally, the higher the grade of organiza¬
tion of an animal the greater does the proportion become. As
we rise from the lower animals to the higher apes, from the
apes to savage man, from savage to civilised, and from less
intelligent to more intelligent men, the increase of proportion
continues. In estimating this datum the most reliable method
is to view the head in profile, and take a line from the upper
border of the eyebrows through the meatus of the ear. Almost
the whole of the cranium lies above this line, and almost the
whole of the face proper lies below.

The connection between the configuration of the head and
the amount of intelligence has occupied the attention of so
many observers that it is not necessary to devote any more
space to it here ; and to enter upon the tendencies of mind
and conduct that accompany, and are indicated by the various
modifications of face and feature, would occupy more space
than the meagre advantage would warrant. The general
principles on which they should be studied are set forth in Mr.
Darwin’s book on the “ Expression of the Emotions,” and in
Mr. Herbert Spencer’s “ Essay on Personal Beauty.”

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1883.]

Marriage in Neurotic Subjects. By Geo. H. Savage, M.D.,
Bethlem Hospital.*

I trust that my subject will be definite enough, and of
sufficient interest to create a good discussion. It is one of
such vital importance to society that we should endeavour to
form very well defined opinions on it.

I find one set of physicians looking with horror upon the
idea of anyone marrying who is markedly neurotic, whereas
another class looks to marriage to cure nervous evils. I do
not entirely agree with either of these, and, though I have no
intention of trimming, I shall yet have to agree in part with
each.

The first thing to be done is to divide the subject, and
define my terms. By “ neurotic ” persons, I mean those who
have suffered from insanity, epilepsy, or grave hysteria, and
the near blood relations of such persons. This may be con¬
sidered by some to embrace too large a field, and that it
would be hard to know who would be allowed to marry at all;
but later I shall point out that I, for one, would not make the
question of marriage or non-marriage depend solely, or even
chiefly, upon the existence of neurosis in a family. I am
inclined to think that if it were possible for us to select those
who are to be married, and if we selected only those who are
nervously stable for the parents of the next generation, the
children might suffer from a want of adaptability. They
might, in fact, develop from nervous stability into nervous
rigidity. But it is almost folly to make too much of the
advice to be given in such cases. The few phlegmatic,
reasonable people who would consult the physician before they
became engaged to be married are very few compared with
those who, impelled by passion, would marry first, and discover
their error afterwards.

In considering somewhat in detail the relationships of mar¬
riage in the neurotic subject, we shall have to deal with its
bearings on the contracting parties, and its relationship to their
children. I am much more frequently asked by people about
to marry, who consult me, what my opinion is in reference to
their children, if they should have any ; and a thoughtful man
or woman will be much concerned with the possible inheritance

* Bead at the Quarterly Meeting of the Medico-Psychological Association,
held at Bethlem Hospital, February 21, 1883.

xxix. 4

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50 Marriage in Neurotic Subjects , [April,

of trouble which may be transmitted by his or her conjugal
partner.

In considering the effects of marriage upon the parents, one
would prefer to consider the effect of marriage upon the various
forms of neurosis that we have mentioned, and, to begin with
the simplest:—Does marriage generally do good or harm in
grave hysteria ? The day is passing, if it be not already past,
in which hysteria and ovarian disease are looked upon as inter¬
changeable terms; that the adolescent of either sex, in develop¬
ing sexual function, has to pass through a baptism of fire, I
admit; but this disturbance, though associated with develop¬
ment of a new function, may really be as well marked along
the nutritive or nervous lines as along the reproductive. A
change is effected in the whole organism at this period, and
the stress will probably fall most heavily upon the least stable
part. It would be harmful, in my experience, if every young
hysteric were then and there married. The relief, if any,
would be but temporary, and the result to the developing
organism would be disastrous. I do not believe myself that
hysteria is generally benefited by marriage. Most of us have
seen cases of severe hysteria occurring in married women. I
have not had many opportunities of observing grave hysteria
before marriage, and of seeing the same cases after they had
been married and had children; but, though somewhat in
opposition to the principle which I have laid down, I admit I
have seen one such case, in which anorexia nervosa and
extreme depression occurring in a young single girl passed off
after marriage and the birth of children. On the other hand,
I have seen several cases in which the hysterical girl has
become the insane mother, and the hoped-for cure by marriage
has proved a delusive dream.

After hysteria the relationships of hystero-epilepsy and
hysteria to marriage are to be noted. I think no one would
dream of recommending marriage in cases where epilepsy was
undoubted, and fully developed, if contracting parties could be
found foolish enough to enter into marriages with such
patients; but on more than one occasion I have been asked
my opinion in such a case as the following. A young woman,
the daughter of a nervous mother, at about 18, being a
large, massive, ill-regulated woman, developed some kind of
convulsive fits. The fits occurred now and again, at night,
were associated with loss of consciousness, a scream, and
biting the tongue, so that the epilepsy was undoubted. Should
this girl be encouraged to keep on an engagement into which

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1883.]

E !

by Geo. H. Savage, M.D. 51

she had entered, or should she at oace break it off? The
fits had not been numerous, and seemed to vary directly with
her physical condition, so that when she was in better general
health she had none of them, but when she got below par thev
reappeared. But few fits altogether had occurred, and the
lover was perfectly willing to go on with his engagement.
Personally I was against the marriage, but it took place, and
at all events up to two years afterwards there had been no
recurrence of fits. This one case will not prove that it is
good for epileptics to marry, but may point out the fact that
certain unstable, nervous persons benefit by the development
of their full animal natures. I should dread the effects of
marriage upon an epileptic almost more than upon those who
had been insane. The comparative rarity with which epileptics
get well, and the mysterious causation of the whole epileptic
condition, make it a dangerous experiment to recommend
marriage for the relief of these unknown conditions. In speak¬
ing of the hysterical and their marriages one has said nothing
about the possibility of the injury to the offspring, simply for
want of facts to go upon, i.e., undoubted facts. One has a
vague and general idea that insane people seen in an asylum
very frequently have hysterical relations, in fact, that there is
a definite relation between hysteria and insanity, but if one
were to attempt for a moment to prevent the hysterical from
maiTying, the world would become depopulated, at least of
legitimate children. On the other hand, the relationship
between epilepsy and insanity is very much more marked, and
more fully established, so that an epileptic parent may, like
Brown-Sequard’s guinea-pigs, beget children who are epileptic,
or insane even. Therefore, in speaking of marriage with
epileptics, one has not only the hopelessness of cure, but the
danger to the offspring to be considered. Next, and perhaps

this is the question that will chiefly interest most of us:_Under

what conditions are you to countenance marriage with either
insane patients, patients who have been insane, or patients
who have very strong nervous inheritance ? To begin with
insane people have no right to marry. As we have before
considered the relationship to divorce in such cases, I need
not say any more. Next, as to those who have once been
insane, the general public would say, of course, that they never
ought to marry, not only because of their insanity, which the
public still believes will necessarily return, but because it
believes that an insane mother must have an insane child.
Unfortunately, our general experience makes these two bold

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Marriage in Neurotic Subjects , [April,

propositions appear true. But before giving advice as to
whether a patient should or should not marry after having had
an attack of insanity, I think one should very definitely
investigate the cause of the insanity and the nature of the
attack, besides taking into consideration the nervous inherit¬
ance. Take an example. A man without any insane blood
relations, having been exhausted by some strumous glands
which had been discharging for a considerable time, is placed,
socially, in circumstances leading to great depression. He
was forced to live a subjective life. He was a highly trained
man, had been imbued with extremely strict High-Church
notions ; thus suffering from an exhausting discharge, living a
subjective life, and draining himself, as it were, of joy and
healthy relaxation, the man became melancholy, with suicidal
tendencies, and had to be placed in an asylum. After a time
he got stronger, and as he got stronger he lost his depression,
recovered his health completely, and was able to resume his
occupation with complete satisfaction to himself and his
clients. After keeping well for several years, he is told that
his chances of sanity depend to a great extent upon his leading
a more subjective and healthy life, and marriage is suggested
to him. Before going further he determined to consult two
or three doctors on the question, and here were several elements
of confusion. Those who knew nothing about insanity at
once advised him not to marry. Those who knew more about
the subject advised him to marry, after having definitely told
his history to any person whom he intended to make his wife.
In this case there was no inheritance. The causation of the
mental depression was traceable to physical weakness. The
man had not only recovered, but had been enabled to follow
his old occupation as well as ever before, so that there was
complete restoration; and I can see no reason why that man
should not stand as good a chance of keeping well as the
majority of men. One question quite apart from the medical
aspect of the case would have to be considered—that there are
marriages and marriages, so that if you could ensure the
prospect of comfort, that is, if you were able to see that the
selected companion was suitable as far as years and means
were concerned, the chances of maintenance of health would be
greater than if there were great disparity of years and a
certainty of poverty and anxiety to contend against. As I
told this gentleman, when he anxiously asked about the
possibility of any offspring being insane, such authorities as
Dr. Maudsley said there would be more chance of genius for

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1883.] by Geo. H. Savage/ M.D.

his offspring than there would be for the offspring of those
who had never suffered from any nervous disorder. Inciden¬
tally, I would here refer to conjugal frauds. Some would say,
let the danger be kept for the parents alone; let means be
taken to prevent offspring of the marriage of neurotic sub¬
jects. I myself should strongly oppose such measures, unless
the patient had had several attacks of insanity, or unless there
were already at least two children of the marriage. Most of
us know the unsatisfactory nervous state seen in women of the
middle and upper middle classes especially, who have no
children. Whether it be their fault or the fault of their
husbands, both suffer severely in mind and temper. Thus, as
one is in the habit of seeing, the sexual function is the function
which develops altruism, so without children the parents
become egotistical, and egotism and insanity are not far
apart.

Several other points have to be considered : for instance, the
forms of insanity, and their relationships to inheritance and
to recurrence. One would say to a person asking whether she
might marry, “ If you have strong insane inheritance, and if
you have had already one attack occuring at about 20, more
especially if there had been a tendency to hysteria or other
emotional disturbance, you will marry at very great risk of
breaking down after childbirth, and your future partner must
be fully warned of this fact; ” whereas if the insanity has been
more accidental, if I may use the term, more the result of some
other physical cause, the chances of recurrence are less, and
your advice may be given in accordance with that experience.
I am afraid, however, none of us are in a position to say what
cases will or will not recur.

Another point is when a patient may be married, that is, how
soon after an attack of insanity. Most of us have seen cases
in which the insane inheritance has been transmitted directly,
and, if I may say so, immediately. I have seen three or four
cases in which children have been begotten by insane parents
who were suffering from acute insanity at the time of their
begetting. Such persons are almost sure to be weak-minded,
idiotic, or imbecile from birth. On the other hand, the
greater distance there is between the attack and the begetting
of the child, the less danger is there to the offspring. I am
in the habit of saying that a general paralytic father rarely
begets an insane child, unless that child is begotten during
the active stage of the disease. I would even go further, and
say that I have seen cases of inheritance in which the inherit-

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Marriage in Neurotic Subjects . [April,

ance has been in distinct relationship to an injury to the
head, that a child begotten by the father a short time after a
severe concussion of the brain, had been the only one who
developed incurable insanity, the child next begotten being
nervous and hysterical, and the rest of the children being per¬
fectly natural. The point, then, upon which I would insist, is
that the danger to the offspring is directly in relationship to
the active insanity itself—that a parent who has been insane
may beget an insane child soon after recovery, before the
attack or during the attack of insanity, but that he may beget
perfectly sane children in the interval. I suppose most of
you will ask, who is to judge as to when the chance of
getting insane children is past ? and I am afraid I am not
in a position to make any definite answer. Collaterally, one
would also say that marriage may have a dangerous effect upon
a person of nervous inheritance. Every now and again one
sees such persons upset by the shock of marriage itself, and
each year one has one or more cases of so-called post-connubial
insanity. The dangers, then, to neurotic subjects in marriage
are that they may develope insanity, they may develope
hysteria, they may develope epilepsy as a result of the marriage.
They may develope insanity after child-birth, or, if children are
prevented, they still may develope nervous symptoms; and even
though the marriage may be put off till past the child-bearing
period, yet the patients are not safe from attacks of nervous
disease.

To sum up the whole matter, one would say that marriage
will relieve a certain number of hysterical cases, and that
it is justifiable in a certain number of cases who have suffered
from insanity. I should never advise marriage as a cure for
hysteria without warning the friends that it might or might
not be beneficial; and that the good depends not only on the
marriage, but upon so many other circumstances. I should
not oppose every marriage of those who have been insane, pro¬
vided, only one of the contracting parties had been so, and the
other was of good physical health and not of nervous disposi¬
tion.

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1883.]

On the Mental Condition in Hypnotism . By D. Hack Tuke,
M.D., F.R.C.P.*

Some of the members now present were in this room a few
weeks ago when Carl Hansen, a noted hypnotist from Denmark,
induced in several persons a more or less marked degree of
that condition known as hypnotism or Braidism, and we had
the opportunity of making some experiments upon the subjects
while in this state. Although the hypnotic phenomena were
by no means so striking as is often the case, there were some
interesting points elicited which, taken along with other
experiments of a similar nature which I have witnessed before
and since, will, I hope, form sufficient material for some con¬
siderations on the nature of the condition which is thus induced
psychologically and physiologically , though I bring forward
these remarks expecting to be enlightened myself in a delicate
and difficult problem rather than hoping to enlighten'those
whom I have the honour to address to-night.

I have for years been strongly impressed with the interest
and physiological importance of these phenomena, but I frankly
confess that often as I have endeavoured to form a clear idea
of the cerebro-mental condition of hypnotised persons I have
felt misgivings as to whether I had succeeded ; at any rate,
I feel sure that I, for one, am not justified in speaking dog¬
matically as to the physiology or psychology of hypnotism,
and as we go along we shall, if I am not mistaken, be disposed
to hold some views as possibly, others as probably, and a few
perhaps as certainly true.

The data upon which we have to attempt to form an opinion
or construct a theory are—

I. The conditions necessary to induce the state in question.

II. The objective symptoms of the hypnotised person so far
as we can observe them ; and

III. The subjective state experienced and described by him¬
self in those instances in which memory, more or less distinct,
is retained of what has been present to the mind during the
hypnotic condition.

I am fortunate in having obtained from several competent
gentlemen who have been hypnotised a description of their
own feelings during the state when conscious, one being Mr.
W. North, B.A., Lecturer on Physiology at Westminster

• Bead at the Quarterly Meeting of the Medico-Psychological Association,
held at Bethlem Hospital, Feb. 21,1883.

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On the Mental Condition in Hypnotism , [April,

Hospital, and for three years Sharpey Scholar at University
College, London ; another, Mr. M—, a medical student at St.
Thomas’s Hospital; the other a clergyman ; all able co-adjutors
in this enquiry.

Although the Mental Condition present in Hypnotism is the
title and object of my paper, I shall touch upon the matters
comprised under the first and second sections before entering
upon the third, as they bear more or less directly upon the
ultimate question discussed.

I. As. to the conditions necessary to induce the hypnotic
state.

As is well known, staring at a disc or some well-defined
object is a very frequent method employed for this purpose,
but we know that other methods are effective, as the mono¬
tonous sensory impressions produced by passes, by counting
up to several hundred figures, by listening to the ticking of a
watch, Ac.

In a milder form we do the same sort of thing constantly
in trying to go to sleep; in fact, I am often surprised that
persons do not sometimes throw themselves into an actually
hypnotic condition in attempting to go to sleep.

The principle common to the various modes of hypnotising
is, on the physical side, the stimulation, more or less prolonged,
of a sensory nerve in close relation to the brain, calculated
to ultimately exhaust some portion of that organ, and on the
mental side the rivetting the attention on one idea. Looking
at an object is not essential, for the blind man may be hypno¬
tised, and in susceptible persons the merely expecting to be
hypnotised is sufficient to induce it, the expectation in this
case involving the concentration of the attention to one point.

Mr. North, in his notes, says :— u I have not the smallest
doubt that, at first, I succeeded in abstracting myself,
as it were, from surrounding circumstances. I had been
reading very hard for days past on the subject of intestinal
digestion in relation to the bacteria produced, and I pictured
to myself the interior of the intestine and its contents; then I
tried to picture a special form of bacteria, and while I was
engaged in contemplating its changes of form I seemed to
lose all consciousness of persons around me.”

On a subsequent trial being made (see foot note, p. 60) he
looked at his boot, and thus describes the process :— €i I
ultimately succeeded in fixing my attention on six points of
light reflected upon my boot, and having some minute resem¬
blance in position to the constellation Orion. After looking

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1883.]

by D. Hack Tuke, M.D.

fixedly at this for what seemed to me a very long time, the
idea of the constellation vanished, and its place was taken by
the outline of the lower part of the face of a friend. All I
could see was his beard and mouth and part of his nose and
one cheek, the rest was abruptly cut off by a broad, black
area; the details were tolerably vivid.”

The voluntary surrender of the will—the subject placing
himself passively in the hands of the operator—is also an
important factor in nearly all the processes. It is the initial
step to the subsequent abandonment of the will of the subject
to that of another; but the concurrence of the will is not
absolutely necessary in those who have been already hypno¬
tised and are highly susceptible to sensory impressions, especially
if these are associated in their minds with the hypnotic sleep.
M. Richer of the 8alpetriere, whose researches in hypnotism
are well known, has shown that the subject may be surprised,
and even rendered cataleptic, the moment his attention is in the
least arrested. He is seized, and, as it were, instantaneously

E ?trified, whatever efforts he makes to resist the influence. M.

icher constantly induces hypnotism by throwing a brilliant
electric light upon the face of persons not expecting it, or by
suddenly striking a gong which had been concealed. Some¬
times it has happened that others have passed into this
cataleptic condition who happened to be on the spot, or near,
for whom the experiment was not intended. An amusing
illustration of this occurred one day at the Salpetri^re, and
occasioned a scene which, as M. Richer, in a communication
with which he has favoured me, says was u assez plaisante.” One
of the patients was suspected of stealing some photographs
from the hospital, but she indignantly denied the charge. One
morning M. Richer, after having made some experiments upon
other subjects, found the suspected thief with her hand in the
drawer containing the photographs, having already concealed
some of them in her pocket. M. Richer approached her. She
did not move; she was fixed—she was transformed into a
statue, so to speak. The blows on the gong made in the
adjoining ward had rendered her cataleptic at the very moment
when, away from the observation of all, she committed the
theft. M. Richer awoke her by blowing on her face. Her
confusion can be imagined. It was no longer possible to
deny her larceny. Were burglars but hysterical or neurotic
what a grand resource would the police have in hypnotism!

II. As to the objective symptoms of the hypnotised.

These necessarily vary with the stage or type, and before

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On the Mental Condition in Hypnotism , [April,

proceeding further I must here observe that it is essential to
bear in mind that no description of symptoms, whether bodily
or mental, applies to all the stages or classes of hypnotism.
I may remind you that Charcot and Richer, and, following
them, Tamburini and Seppelli, recognise three fundamental
types, the cataleptic, the lethargic, and the somnambulistic. In
the first the limbs retain the positions in which they are placed
for a considerable time, without effort; in the second (the
lethargic) the muscles which are relaxed are found to have the
remarkable property of contracting in a most definite way
under gentle mechanical applications; in the third (the som¬
nambulistic) the state of the subject answers much more to
what is popularly understood as the so-called magnetic or
mesmeric sleep. Contractions of the limbs can be induced,
but they are of a different character from those in the cataleptic
form or the excitability of the muscles in the lethargic state.

In face of the simulation so frequently practised, it is
especially important to note the objective symptoms in hypno¬
tism, but in describing them now I have more particularly in
view to give a complete picture of the symptoms presented
in hypnotism, for I shall not confine myself, as I have said,
strictly to the mental condition, seeing how much the state of
the body elucidates that of the mind.

Pupils .—There are, when the subject regards the disc, the
natural effects of increased accommodation, strabismus and con¬
tracted pupils; and even after removal of the disc, the eyes
often have a peculiar appearance from a very slight strabismus,
and the hypnotised person is unable to read a paper without
bringing it near to him.

After the first effect of looking at an object has caused the
pupils to contract, they become dilated if the individual passes
into the hypnotic state. Often I have observed them widely
dilated and sluggish, an indication of the functional activity
of the medulla oblongata as regards the sympathetic as well as
the respiratory centre.

On measuring Mr. North’s pupils before and during the
sleep we found them 3 and 6 millimetres respectively.

Mr. Braid speaks of the pupils being greatly dilated and highly
insensible to light, while after a time they become contracted,
but still insensible to light.

Tamburini and Seppelli find the pupils dilated and insensible
to light, but Heidenhain adduces their sensibility to light as a
proof that the corpora quadrigemina are not affected by
hypnotism.

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by D. Hack Ttjke, M.D.

1883.]

Cerebral Circulation .—Have we any means of determining
the state of the cerebral circulation in hypnotism ?

Sometimes there are indications of flushing and discomfort
of the head, and Mr. Braid says that he occasionally observed
the face so much flushed and the action of the heart so
tumultuous that he aroused the subject, but certainly anything
like serious cerebral disturbance appears to be very rare.

Heidenhain, in the first instance, believed the vessels to be
contracted, and that the anaemia caused the sleep. But as
those who are hypnotised are often flushed instead of being
pale, he began to doubt this. Then he asked Professor Forster
to examine the vessels of the retina with the ophthalmoscope.
The operation was difficult, for the bright light soon aroused
the subject. However, he succeeded in obtaining a sufficiently
distinct view of the retina to make out that there was no con¬
traction of the vessels. Heidenhain maintains that it can hardly
be supposed that the vessels of the cerebrum and eyes are in
an essentially different condition, and therefore finds another
proof that the brain is not anaemic in the hypnotic sleep. There
would, however, be a difference of opinion on this point, some
not regarding the condition of the retina as to vascularity as a
test of the state of the circulation in the brain.

That fulness of the cerebral vessels is not inconsistent with
the condition of brain in hypnotism is, however, shown by the
fact on which Heidenhain most relies, that persons can be
hypnotised who have inhaled nitrite of amyl, as happened to his
brother, and Dr. Kroner on whom Heidenhain tried the experi¬
ment of combining amyl and hypnotism with the result I have
stated.

Respiration and Circulation .—The respiration and the pulsa¬
tions of the heart are, as a rule, much quickened at first.

The pneumograph has been employed by Professor Tam-
burini, of Reggio Emilia, and some of his tracings are on the
table. He finds the frequency of respiration to be doubled at
first, and the inspiratory pause suppressed. Heidenhain says
he has seen the number of respirations in fifteen seconds rise
from 4 to 12, or even from 3 to 16.

M. Richer, at the Salpetri&re, has made similar tracings,
and finds them very significant. They are useful, also, as a
test of simulation. He says that with the cataleptic subject
the tracing is uniform in character from beginning to end.
With the simulator, on the contrary, it is composed of two dis¬
tinct parts. At the beginning respiration is regular and
normal ; in the second stage, that which corresponds to the

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On the Mental Condition in Hypnotism, [April,

indications of muscular fatigue, irregularity in the rhythm
occurs with deep and rapid depressions, manifest indications
of the disturbance of the respiration caused by the effort to
simulate.

The quickened action of the lungs and heart was strikingly
shown in the case of Mr. M—, of St. Thomas’s, when I saw
him hypnotised by Mr. Hansen a few weeks ago.

He writes: " After gazing for a few minutes at the disc that
Mr. Hansen had given me on first going on the stage, I was
beginning to fall comfortably asleep, but as soon as he began
passing his hands over my face I felt a sort of oppression
coming all over me; respiration became difficult, my heart was
beating violently, and I felt a great increase of temperature.”
And of a much later period of the experiment he writes: “ My
heart was beating as fast as ever, and my temperature was
still high. Respiration continued to be difficult/’

In Mr. North’s case* we observed the breathing and action
of the heart were, on the contrary, calm. A pulse tracing was
taken by Mr. Victor Horsley, but there was nothing to indi¬
cate any noteworthy change in the circulation.

Professor Tamburini has made careful pulse tracings also,
which I exhibit.

I may add that Mr. Braid found the rise in the pulse from the
simple muscular effort made to keep the legs and arms ex¬
tended for five minutes to be about 20 per cent., while in a
state of hypnotism it was 100 per cent. By rendering all the
muscles Umber the pulse, he found, fell to what it was before
the experiment, or even below it.

Muscles .—M. Richer has made tracings of the muscular con¬
tractions of the arms in a hypnotised person who is cataleptic,
which show the difference between the cataleptically rigid arm
and one held out by a person not hypnotised. I mention this,
although beside my immediate object, because when we
tested the subjects in this room by holding out our own arms,
the difference was not so great as might have been expected;
but had we had a myograph at hand the test would have been
decisive. In fact the myograph, the pneumograph, and the
sphygmograph are most valuable means placed at our disposal
by modern invention for obtaining trustworthy records of the
objective symptoms of hypnotism.

Reflex Action .—I need not insist here upon the well-known
fact that reflex actions are more easily excited in animals when

• On the occasion of a more recent experiment when Mr. Horsley and my¬
self carefully observed Mr. N’s. condition, while in the hypnotic state.

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1883.J by D. Hack Tuke, M.D.

the cerebral lobes are removed, and that, therefore, if we
assume, as we seem bound to do, that the cortex is rendered
more or less functionless in hypnotism—that its controlling,
inhibiting power is weakened if not suspended—it is only
natural that rigidity of the muscles should be so easily pro¬
duced reflexly by sensory stimuli. We were not, however,
prepared to expect—and Heidenhain forcibly points this out—
that the susceptibility continues for long after the hypnotic
condition has passed away.

Then there is a milder contraction of the muscles produced
by stroking or other mechanical means, which I have referred
to under the term neuro-muscular hyper-excitability. Charcot
and Richer have found they can produce contractions of isolated
muscles in this way, as definitely as Duchenne did with gal¬
vanism. Of these most interesting effects I have some photo¬
graphs here.

On the evening when Mr. Hansen experimented in this room,
some of you will remember that in the case of a boy he pro¬
duced well-marked distortion of the mouth by stroking the
muscles on one side with his finger, the boy being awake,
though remaining abnormally susceptible to reflex action after
being aroused from the hypnotic state.

In some stages of hypnotism the subject can bear with ease
a very heavy weight, owing, in this instance, not to the mental
impression that a heavy weight is a light one, but to the rigid
contraction of the muscles. Thus Mr. North, for example,
was placed with his head on one chair and his heels upon
another, and he says : “ I heard Mr. Hansen express his inten¬
tion of sitting on my legs. I remember wondering whether
my posterior knee-ligament would stand it, and making up my
mind not to interfere, i.e., to let my outer self do as it liked. I
remember being surprised when the strain came, for though
probably 15 stone, it felt like a large pillow, of no weight at
all.”

In a considerable number of cases I have observed the
tendon-reflexes to be the same as in the waking state; in some
instances, exaggerated. It appears to depend upon the par¬
ticular stage or type. It is stated by Richer that in the
lethargic type they are much exaggerated, in the cataleptic type
diminished, and in the somnambulistic type normal.

It is difficult to explain why in the supposed depressed con¬
dition of the hemispheres, the reflexes are not exaggerated in
all these stages.

The power of co-ordinating movements is perfect in the

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On the Mental Condition in Hypnotism , [April,

stage in which the muscles are not flaccid. Mr. Braid says
of hypnotised persons, “ The power of balancing themselves is
so great that I have never seen one of these hypnotic somnam¬
bulists fall.” (“ Hypnotism or Nervous Sleep,” p. 56.)

In the lethargic state the body sinks down, the limbs
become flaccid, hanging down; and when raised they fall
again heavily when left to themselves.

In the somnambulistic state resolution of the limbs is not so
marked as in the lethargic state.

Galvanic reaction .—I have so few observations on this
point that I can make no general statement. In one case,
Hypnotised at Bethlem Hospital, Mr. Lawford makes the fol¬
lowing note :—“ The muscles in the rigid arms of Mr. B—,
who was fully conscious, reacted to a faradic current, much
as in an ordinary arm, and with a current of 30 cells the rigidity
disappeared.”

M. Richer has found that galvanizing the muscles of the
face does not modify in the least degree the nervous condition
of a hypnotised person. The cataleptic condition is not affected
by galvanism, although, strange to say, a puff of air has
usually an immediate effect in rendering the muscles flaccid.

In the case of a girl at Guy’s, Mr. Price has found that she
readily feels a fairly strong interrupted current when applied
to the tips of her fingers, and a strong current very quickly
awakens her. I shall refer to her again.

III.—I now come to the subjective symptoms—those ex¬
perienced and described by the hypnotised person after he has
returned to his normal mental condition, as to his sensations,
consciousness, volition, and intellect.

In considering this section we must be careful to bear in
mind the very different mental states comprised under the term
Hypnotism. I have already said that Charcot and Richer, as
also Tamburini, recognise three grand types—the cataleptic,
the lethargic, and the somnambulistic—but they admit that
these classes are based upon very hysterical subjects, and that
in ordinary cases they pass insensibly one into the other, and
are not nearly so distinctive. I shall not adhere closely to
these distinctions, but would point out that the boy who in
this room remained, after looking at the disc which fell from
him, in the same attitude, his hand and arm retaining their
position, would be referred to the first category ; that the other
boy who fell into a sleep with his muscles flaccid, and who
when somewhat roused displayed the symptoms of neuro¬
muscular hyper-excitability, would be relegated to the second

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1883.]

by D. Hack Tuke, M.D.

class ; while the girl tinder Dr. Wilks, at Guy's, whom I have
seen, belongs to the somnambnlist division.

Sensation of Pain is, except in a very early stage, almost
always deadened or quite suspended. Of course in the case of
any subject in whose veracity one did not feel confidence, one
would not draw any inference from apparent insensibility to
pain, but there is ample evidence of anaesthesia being induced
by hypnotism without resting on doubtful instances. Of course
the degree of insensibility varies.

Mr. North, in his memoranda, says —“ A pin was plunged
into the ulnar side of my hand nearly up to its head. I heard
the preparation made to do it. I felt the operation begin ;
there was hardly any pain. It felt simply as though some one
was pressing an ordinary wooden match or some blunt instru¬
ment against my hand. When I was roused I distinctly felt
pain in my hand, and it hurt me considerably to withdraw the
pin."

On the second occasion, the muscular rigidity induced
caused great pain. Mr. North also says that the light hurt his
eyes when I raised the lids to examine the pupils.

In the case of the girl at Guy’s, there is marked analgesia,
but she exhibits all the signs of pain when she is told that the
prick of a pin is painful. In this way one can produce alter¬
nate analgesia and hyperalgesia at will.

Tactile Sensibility .—In the early days of mesmerism, it was
regarded as a proof of the insensibility to pain alleged to exist
in that state being feigned, that the sense of touch was un¬
affected. Now that sensation of pain and tactile sensibility
are shown to be physiologically distinct, the fact no longer
excites suspicion or surprise.

Muscular Sense .—As is pointed out by M. Richer, the
muscular sense may be the source of automatic movements
perfectly co-ordinated, which produce the action of which the
position of the limbs is the image. For example, the cataleptic
patient is made to stand upon a chair with the hands taking
hold of the folds of a curtain, as if climbing it; immediately
the subject scales it or tries to.

Special Senses. —(1.) As regards the sense of smell , we
applied assafcetida to the nose of a hypnotised boy in this room,
and he did not at first appear to perceive it, but soon after¬
wards said the smell was pleasant. Strong ammonia was
applied, and he bore it close to his nostrils for a much longer
time than any of us could bear it ; but at last it aroused him.
In regard to another case, I cite from notes kindly made at the

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64 On the Mental Condition in Hypnotism, [April,

time for me by Mr. Lawford, clinical assistant at Bethlem
w After being hypnotised by Mr. Hansen, he apparently did not
smell or feel the ammonia fumes; at least he was not aroused
by them/'

The girl at Guy's, when tested by Mr. Price, did not recog¬
nise the presence of scent (eau de cologne) on a handkerchief;
and on other occasions has not been able to recognise odours.

In some states of hypnotism, on the other hand, the vastly
heightened sensibility of the olfactory nerve is remarkable.

(2.) Sight . In an early stage—one, however, which may persist
without passing into a deeper one—the sight seems to be partially
affected. The subject appears to see, though confusedly, that
which is immediately around him, and with which he is in
direct relation, but to have a very vague, or no perception at
all, of what is beyond this range. Mr. M—, the St. Thomas’s
student, says (speaking of his experience of the early stage),
" When Mr. Hansen asked me to look at his eyes, I could not
recognise in him the same man I had seen a few minutes before ;
his eyes seemed to me as if they were rays of light thrown on
a prism. I could distinctly see a play of colours. Still I was
in my full consciousness.” The clergyman whom I mentioned
as being hypnotised, describes his visual sensations in very
much the same way. He says, “ I could see the operator's
eye becoming luminous like a ball of fire, then annulated,
then changing colours.''

To return to Mr. M—: When later on in the sleep I asked him
to write his name, he did so, and he informs me that he could
not see the letters distinctly as he wrote them. At a still later
stage when Mr. Hansen threw something on the floor, and
induced Mr. M— to think a baby was drowning in the water, the
latter, with his eyes wide open, threw himself down to rescue
it, but he assures me he could not see anything whatever at
this time, and that he had then lost his consciousness. He may,
however, have seen as some sleep-walkers see, although wholly
unconscious of it when aroused from their sleep. In fact he
must have heard Mr. Hansen, and yet cannot remember it now.

With the girl at Guy's Hospital, we found that, although
when induced to write a letter, she wrote better when nothing
was placed between her eyes and the paper, yet when walking
in the ward she fell against anything that came in her way,
and would have injured herself if not looked after.

Since writing the above I hear from Mr. Price that now,
when in the somnambulistic condition, she walks about, avoid¬
ing objects in her way just as when awake. This, however.

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1883.] by D. Hack Tuke, M.D. 65

has been in the ward in which she is placed, and not a strange
ward where I saw her walking.

M. Richer has observed that although the eye of the cata¬
leptic subject is fixed, and appears to see nothing (never
quitting the imaginary point to which he seems attached), if
an object be placed in the axis of vision and it is gently
oscillated, the gaze of the subject is soon seen to be attracted
to it, and able to follow all its movements; the rest of the body
may remain cataleptic, but the eyes turn in all directions in
spite of the experimenter, and generally the head follows the
movements.

(3.) As regards hearing , the subject evidently hears well
whatever is said to him, though in some instances he appears
to hear what the operator says much better than what others
say. The girl at Guy's hears one person as well as another. Mr.
North says that while he was placed on two chairs, his head
on one and his heels on the other, he heard Mr. Hansen express
his intention of sitting on his legs. He also heard music in
the room.

Mr. M— states that he heard distinctly what Mr. Hansen said
to him. He heard him ask him to open his mouth, to strike
Mr. Hansen’s chest, to follow him, and so forth. Speaking of
his condition just when he went off, he says, “ The persons
around me and the sounds they made seemed distant, and it
was only when some unusual sound was made that I took the
trouble to notice it.”

Tamburini and Seppelli state that they have constantly found
hyperaesthesia of this sense even in the most profound sleep.
The subjects heard the footsteps of persons approaching the
room in the distance, which the experimenters could not
perceive.

(4.) Taste. This sense seems suspended, and whatever taste
is suggested is adopted by the subject. With the girl at Guy’s
her tea tastes like coffee when she thinks it is the latter.
Heidenhain observes —“ I could put hot pickles in the mouth
of a hypnotised person, and on my making masticatory move¬
ments he would proceed to chew them. Only on awaking
would he perceive the hot taste.” ( u Animal Magnetism,”
p. 15.)

Mr. Price, a few days ago, tested the Guy’s patient first in
the normal and then in the hypnotised condition, with salt,
sugar, and quinine. In the normal state she immediately
recognised the first two, and said the third was very bitter, but
of course did not know it by name. When hypnotised a few
xxix. 5

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On the Mental Condition in Hypnotism , [April,

minutes after by Mr. Price, and then tested, she did not taste
the salt, sugar, or quinine; the sugar, however, which was
coarsely pounded, she said was gritty.

We found that Mr. North tasted plum jam.

I pass now from the Sensations to other mental states, and
I need hardly say we must recognize that very different con¬
ditions are comprised under the term Hypnotism, and that to
speak of this or that psychical character being present in Hyp¬
notism would be misleading, without any qualification.

1. There may be no unconsciousness whatever, and the
subject may appear very much like other people. A certain
susceptibility to impressions on the mental side, and to rigidity
of the limbs on the physical side, may be all that marks the
state of the subject.

Is it that the cerebral cortex is just sufficiently weakened in
function to have lost its supremacy, without parting with its
more secondary offices ? Indeed, the mind may be so roused
that there seems no abnormal mental manifestation whatever,
and yet volition over the reflex rigidity set up by sensory im¬
pressions on a limb may be suspended. If it be asked, why
in ordinary sleep, when the cortex is rendered so entirely
functionless, we cannot excite the same reflex rigidity ? the
answer, I suppose, is that the sleep has extended beyond the
cortex and involves the basal ganglia.

2. Let us take a deeper stage of Hypnotism, one in which
there is decidedly more alteration in the mental functions them¬
selves. The subject has more completely lost voluntary control
over his actions and his trains of thought, and whatever he is
told to do he does in obedience to the mandates or sugges¬
tions of the operator. Thus, if he is asked his name, he
replies correctly, articulating the word without the slightest
difficulty; but if he .is authoritatively told that he can not
possibly do so, he makes only futile efforts to say it. The
question arises, does he really forget his name ? or does he,
while remembering it, lose the power of using his muscles of
articulation, from the belief impressed upon him that he cannot
articulate his name ? It would seem rather due to the tem¬
porary loss of memory of the name, essentially similar to the
condition of a man who, in a normal state, when suddenly
asked someone’s name, especially if from any cause nervous at
the time, clean forgets it, and the more he struggles to recall it,
the more he becomes embarrassed. Has no one, even among
the medical psychologists whom I address, whose minds are of
course in an all but perfect state of mental training, ever rung

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1883.]

by D. Hack Tuke, M.D.

the bell at the door of a friend’s house, and in the interval
which elapsed between this act and the appearance of the
servant, passed into a reverie ? Then, perchance, having to
remember the name of the person upon whom he is calling, he
first fears he has forgotten, and then really does forget it, to
his own discomfiture and the perplexity of the janitor.

Those who were present in this room during the experi¬
ments I have referred to, may remember how a young man of
the name of Batt, although under the influence of Hansen, was
resolved to disprove the latter’s assertion that he could not say
his name, how he made valiant efforts to say it, and did so
several times, but how after some ridiculous grimaces the
“ Batt ” first became B, and then only silent gesticulations
remained at his command. Although he had forgotten his
own name, he at once gave Mr. Hansen’s correctly, showing
that his muscles were not paralysed. This man was not a
subject of Hansen’s, although he had been acted upon by him
before; in fact Hansen supposed him to be a medical student,
which he was not^

The hypnotised person may, however, not only be in this
mental state of temporary amnesia, but he can be also ren¬
dered unable to use his articulating muscles. There is com¬
plete temporary paresis of these or any muscles the operator
chooses to impress upon the subject’s mind he cannot use.
Darwin’s success in rendering several persons unable to sneeze
after actually taking snuff, is an illustration of a parallel con¬
dition.

In a subject who has passed completely into this deeper stage
of Hypnotism, what is his condition as regards conscious¬
ness ? Mr. North, in a graphic manner, says, when speaking of
a period after he was decidedly affected by looking at J;he disc,
u I was not unconscious, but I seemed to exist in duplicate.
My inner self appeared to be thoroughly alive to all that was
going on, but made up its mind not to control or interfere with
the acts of the outer self; and the unwillingness or inability
of the inner self to control the outer seemed to increase the
longer the condition was maintained.”

At a later stage Mr. North says, “ I am told I spoke German
to Mr. Hansen, and was not complimentary in my remarks. I
should. not like to say whether I was conscious of what I did
or no. I' think I was somewhat.” At a still later stage he
says, u Here I appear to have been absolutely unconscious for
some moments.”

There may be, we see from the above description by Mr.

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On the Mental Condition in Hypnotism , [April,

North, a double or divided consciousness, which brings out in
strong relief one feature of the singular mental condition in
Hypnotism.

This subject of duplicate consciousness (I avoid the term
double consciousness, as it applies to another mental pheno¬
menon) is one of great interest, and might alone occupy an
evening’s discussion. As Dr. Bastian intimates in his book

The Brain as an Organ of Mind ”), the wonder is that with
our two brains, presenting as they do marked differences in
their convolutions on either side, we are not always conscious
of a dual being.

That duplicate consciousness is by no means uncommon with
the insane patient is certain; and this is closely associated with
the confused sense of his relation to his former self, ending at
last in a complete loss of personal identity, as in the case of a
patient several years ago in Bethlem Hospital, who having lost
himself— i.e., the self he was most familiar with—used to seek
for himself under the bed.

We cannot for a moment suppose that this division of con¬
sciousness takes place between the cerebral hemispheres on the
one hand, and the lower ganglia on the other. It must be
either between the two halves of the brain or different centres
in the entire cortex. Mr. North's conclusion on his own case in
this particular is iC that the loss of consciousness is apparent
rather than real, and,” he adds, “ I cannot better express my
meaning than by describing my condition as one in which the
subject is conscious that he is playing the fool, and his superior
self looks on conscious of the absurdity of the actions or words,
but at the same time either unable or unwilling to control
them.”

Mr.. North gives, as an illustration, that he remembers Mr.
Hansen trying to suggest rats to him, and that he (Mr. N.)
repeated the Italian for rat, ei Topo, Topo,” several times.
“ I knew perfectly well,” says Mr. North, “ that I was doing so,
and that I was playing the fool, i.e., that my outer 9 self was
doing so, the inner self looking on, too idle to interfere.” I
may add that the Italian was suggested to Mr. North’s mind
by the fact that the previous day he had been reading
some Italian fables about rats in the Italian class at University
College.

The same splitting up of our consciousness occurs in the
closely allied state of dreaming, and is well illustrated by what
occurred to a friend of mine several years ago when in Switzer¬
land. After an Alpine climb of nearly 20 hours, he arrived

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1883.]

by D._ Hack Tuke, M.D.

one night at an inn where he was unable to procure a bed.
He had to sleep in the bureau, and was constantly disturbed.
He was also suffering intense thirst, and had to get up from
the sofa to drink water every few minutes. When he shut
his eyes innumerable visions passed before him associated with
water. At last he slept and dreamt. His ordinary occupations
when at home now suggested part of the dream. He dreamt
he was mad. He had arranged that he should be conveyed to
Bethlem Hospital, but he says one idea was that it would be a
simpler thing to die. Whether this was suggested by one half
of the brain I do not know, but one self asked the other self,
“ What will you die of ? ” He says the only answer that
could be found was that arising out of his thirst. “ Water
on the brain or serous apoplexy.” The other self responded,
“ Agreed/ 5 “ And, 55 says my informant, “ in my dream I died.
The malignant part of myself rubbed its hands and said, well
now, we’ll have a post-mortem,’ 5 and a post-mortem was made.
He saw his own calvarium removed, and the discovery made
that there was no brain at all, only a miserable bag of mem¬
branes. In consequence he realized (he says) for the first time,
“ what a swindle he had been all his life ! 5

Mr. M—, of St. Thomas’s, retained his consciousness during
the greater part of the time he was hypnotised. “ I knew
perfectly what was going on, 55 he writes, “ but at the beginning
of the fifth experiment I lost all my consciousness. I don’t
know what my operator did or said, except I remember he
asked me to nurse a baby which had been ill-used and was
crying, and when he told me that, I began to hear distinctly
the cries of the baby, but on awaking from my state and told
all that I had been doing, I could not believe it, as I had not
the slightest idea of it. 55

I now come to speak of Volition .

There is obviously no spontaneity in the subjects of Hyp¬
notism.

Sir William Hamilton observes that while we are wholly
unable to conceive a being possessed of feeling and desire,
and at the same time ignorant of any object upon which his
affections may be employed, and unconscious of these affec¬
tions themselves, we can conceive a being possessed of the
power of recognizing existence, and yet wholly devoid of all
feeling of pain and pleasure and of all powers of desire and
volition. That which was merely a conception with Hamilton
is actually witnessed in an early stage of Hypnotism.

How completely volition may be. suspended, and the subject

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On the Mental Condition in Hypnotism , [April,

become a mere automaton, is shown, and most graphically
described by both Mr. M— and Mr. North.

The former writes, referring to his mental condition after
entering the hypnotic state:—“I tried to get out from this
state but my efforts were vain. I felt it was too late, and I
saw that I was entirely at the mercy of my operator. I then
felt a sort of dull feeling, and saw that it was now out of my
power to use my own will. Mr. Hansen first shut my mouth
and asked me to try and open it again.” (I must add that Mr.
Hansen at the same time assured Mr. M— that he could not do
so). “ But it was utterly impossible for me to do it. I felt

that all the muscles concerned in this act were in a state of
rigor. In the second experiment he asked me to strike his
chest. I succeeded the first time, but afterwards I felt my
arm repelled from him. I knew that he was near enough to
me, but still each time my hand was about a couple of inches
from his chest it was pushed backwards by a power much
beyond my strength.” It will be seen that Mr. M— 5 s complete
subjection to Mr. Hansen led him to conclude that there was
an objective force influencing him, whereas the real interpreta¬
tion of the phenomenon is a purely subjective one, viz., that
he believed he could not strike Mr. Hansen, and therefore
could not, his brain being reduced to the peculiar condition
brought about by Hypnotism. The same explanation appears
to apply to the next experiment. Mr. M— proceeds —“ Mr.
Hansen ordered me. to follow him. I tried to remain in my
place, but Mr. H. had such an influence over me that I felt
dragged after him. I felt a great power was attracting me to
the operator/ 5 The next experiment is particularly interesting,
as showing how completely a hypnotised person may have lost
his control and passed into a state of automatism, and yet not
believe the fact insisted upon by the operator as the reason for-
performing a particular act. The act is performed because the
actor cannot help performing it; he is an automaton. Mr. M—
says—“ In the fourth experiment Mr. Hansen told me that my
hair was on fire. 1 touched my head and saw that he was
wrong. He then told me to put my head in cold water,
directing me at the same time to a gas-burner. I felt it was
not water. I felt the heat, but yet 1 could not refuse putting
down my head and trying to wash it.”

The clergyman whom I saw hypnotised, and who wrote down
for me a description of his sensations, experienced the same
feeling as Mr. M—, and interprets it in the same sense. He
writes, “ The attracting and repelling the subject was a very

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1883.]

by D. Hack Tuke, M.D.

successful experiment. I could describe it only as a gentle
power drawing or repelling the body. For stopping the speech
the operator must have formed a battery between the jaws.
It was but feeble, but sufficiently strong to make it pleasanter
to let them remain shut than to try to open them.”

But although the will is so strikingly subject to the operator,
there appears to be a limit, for even with the girl at Guy’s, who
does almost everything you tell her, we could not induce her to
drink a cup of tea when it was suggested that it was brandy,
and Mr. Hansen declares that a fine moral sense survives the
suspension of the higher intellectual functions.

Under the head of u Automatism at Command,” Heiden-
hain relates how he made his brother, when hypnotised, do
many things he certainly would not have done when awake.
Thus, a glass, containing ink was given him, and it was suggested
to him (or rather he was requested) to drink some beer. He
began to drink the ink at once. When ordered to thrust his
hand into a flame he did so. Lastly, “ he so unmercifully cut
off with scissors his whiskers which he had assiduously culti¬
vated for a year, that on awaking he was greatly enraged.”
This was rather hard lines for the poor brother, I must say,
but then it was in the cause of science—and Hypnotism.

Susceptibility to Suggestions .—Of the characteristics of the
mental condition in Hypnotism, this extreme susceptibility to
outside suggestions is most surprising. The individuality of
the hypnotic subject being deleted for the time, he represents
the logical consequence of the organization of men in society
who are practically will-less, who are at the mercy of every
suggestion however absurd, and every crotchet however wild
and unpractical. This ideoplastic state finds its analogue also
among the actually insane; the tyrant of their organization
—that which tyrannises over their thoughts and lives—being
some fixed idea or a disordered perceptive centre, or in the
absence of these, the unwholesome susceptibility to the influ¬
ence of others, as in the case of the unstable hysterical girl
who adores every curate she meets with, and would willingly
do anything he tells her to do.

Mr. Price writes as follows to me in regard to suggestions
made to the girl at Guy's Hospital

“ On its being suggested to her that she is dying, she
gradually relaxes her muscles to a certain extent, and if stand¬
ing falls backwards, not flat, at first, but gradually. When in
this state it is useless attempting to call her attention to any¬
thing. She pays no notice whatever. On being told, how-

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On the Mental Condition in Hypnotism, [April,

ever, that she is alive, she gets up and goes on as before.
Likewise on the idea being suggested to her that her hands are
being cut off, nothing can induce her to use her fingers. She
uses the hand as a stump. I have attempted, after waiting a
short time to catch her unawares, by asking her to hold or pick
up something, but without success. Frequently I have found
the effect of a command of any kind to wear off before many
minutes.”

The influence of suggestion in inducing a state of ecstasy
is so well marked, that if an artist wishes to have before him
a study of an ecstatic, he could not do better, from an art
stand-point, than hypnotise his model, and induce the beatific
vision, which elevates and refines the expression in so wonder¬
ful a manner.

Hallucinations are so easily induced that Hypnotism offers
a wide field for illustrating the analogous conditions familiar to
us in mental diseases. I cannot enter in detail on this tempt¬
ing aspect of the subject now; a few words must suffice.

The hallucinations induced during the hypnotic sleep may
continue for some time after the subject is awake, just as con¬
traction of a muscle will sometimes persist for hours after the
sleep has passed away. Further, the delusion created by the
operator may be retained in some instances afterwards. The
localized cerebral impression survives in spite of the return of
the intellectual functions, and of the subject’s having regained
possession of his senses and consciousness, so as to appear in
these respects as fully himself as before the experiment.
Yet the person does not the less persist in rambling on the
one point in relation to the hallucination or delusion.

Thus a person, to cite an actual example of a woman at the
Salp§tri&re described to me by M. Richer, will continue to see
a bird of which the image has been evoked during the hypnotic
sleep. Upon any other subject her intelligence and her special
senses are not in fault, but in spite of the assertions of those"
around her, she maintains that there is really a bird there, that
she sees it, that she touches it, with so profound a conviction that
to her it seems that all who assert the contrary are only mocking
her. This cerebral impression may persist some time, but it
ends by being effaced and disappearing along with the delu¬
sion with which it was associated. It is then curious to see
this patient try and find out how the bird has disappeared,
and inquire whether she has not been the sport of a dream,
without, however, being able to explain what has happened, to
her satisfaction.

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1883.]

by D. Hack Tuke, M.D.

I have seen a lady when hypnotised presented with a number
of strips of brown paper, the idea being suggested to her at the
same tiihe that they were flowers. Of these she at once made
a nosegay, and smelt them frequently as if enjoying their
fragrance. As when she was aroused she was wholly un¬
conscious of what had occurred, there was no means of ascer¬
taining whether she fancied at the time that she smelt the
imaginary nosegay or not, or whether the action of putting it
to her nose was the automatic motor action arising from the
idea organically linked with it.

Similar automatic actions or changes of facial expression
can be induced without a word being uttered by the operator,
simply by directing the look in particular directions calculated
to excite ideas associated with the position of certain muscles;
or again by the silent gestures of the operator. I have seen
this to perfection in some persons recently operated on in
London, and M. Richer* has made a series of experiments of
this kind. Thus he finds that when the look is directed
upwards the expression becomes radiant, and there are some¬
times signs of a gay hallucination; when, on the contrary,
the look is directed downwards, the expression is sombre, and
there may be indications of a terrible hallucination. Under
the influence of hallucinations thus provoked, the cataleptic
state may cease completely, and the subject walk about and
follow the object upon which the look is directed, assuming
attitudes in relation to the hallucination which may have been
suggested. But when the fixed object is rapidly withdrawn
from the field of vision, the eye immediately resumes its
original fixity, and the general cataleptic condition returns in
all its force. A gesture on the part of the operator is
servilely obeyed by the cataleptic. Upon a sign given by
the finger, the subject, without opposing the slightest re¬
sistance, rises, sits down, lies on the ground, rises again,
walks, and stands still.

There are other phenomena of automatism which are more
complex, and require for their production the unconscious opera¬
tion of the memory. If the eye is directed to anything
whose use is known to the subject, the cataleptic almost imme¬
diately emerges from this condition in order to proceed in
some degree irresistibly to the act for which the object is
intended. With patients susceptible to this mode of automa¬
tism (for all are not) the experiment has been varied in a

* The illustrations which follow have been kindly communicated by him to
the writer.

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On the Mental Condition in Hypnotism, [April,

thousand ways, and at the Salp6fcri&re has always yielded the
same results. A bonnet is placed in the hands of the subject.
She turns it about with her fingers, and soon places it upon
her head. If next a jacket is given her, immediately she
dresses and buttons it carefully; or a glass, she drinks; a
broom, she sweeps; fire tongues, she goes at once to the fire,
takes off the wood or coals, then puts them back; an um¬
brella, she opens it, and seems to feel the storm, for she
shivers. What happens if the object placed her hands is
suddenly removed ? Why, she immediately becomes cata¬
leptic.

There is no doubt that by being frequently hypnotised, a
person more readily performs certain acts; his muscles more
readily contract, and so forth; although he is unconscious and
is not intentionally improving upon previous exhibitions. As
M. Richer points out, such a phenomenon so far from
being a proof of trickery is but an illustration of organic
memory.*

That the higher centres exercise their functions to a certain
extent in some stages of Hypnotism is doubtless true, not¬
withstanding their depressed condition. The hypnotised
person, who is told his hair is in flames and convinces him¬
self by putting his hand to it that this is not the case, per¬
forms a mental process, in fact works out a syllogism however
simple it may be. Mr. North, again, while hypnotised began to
walk backwards, upon which a gentleman said to him,
“ Mr. North, can you not walk forwards f 99 This led to a
distinct though very simple use of the logical faculty. “I
remember,” says Mr. North, “ arguing out in my mind, wearily,
that it followed from this that 1 was walking backwards.”

We asked Mr. North, when hypnotised (the second time),
some simple questions in arithmetic. When asked to subtract
he added. He says, “ I half understood the questions, but felt
too lazy to do more than the easy operation of addition. The
question you asked as to 100 and 25 was very confused. I
seemed to see the figure 100 thus:—100ooooo25.” When
going off, Mr. North’s ideas were income respects intensified.
He says, “ I tried to realize the features of several persons in

* Hypnotism offers,’’ ‘observes M. Richer, “ the most remarkable example,
if I am not mistaken, of organic memory. Certain modifications, introduced
into the nervons system, are preserved there, and are reproduced without
any participation of the consciousness. With the exception of one par¬
ticular . (absence of consciousness), the resemblance between the two
Writ™)*' the 0rganic and the PBychological, is perfect/’— {Letter to the

1883.]

by D. Hack Tuke, M.D.

whose company I had been on the previous evening, and
succeeded in producing a most vivid impression of three or
four of them. Minute details seemed almost fangible.” The
features of a little girl were exquisitely distinct. In fact
what struck him most in going off was that instead of passing
into oblivion as in ordinary sleep, he passed into one of greater
mental intensity.

3. I pass on now to a different and a deeper stage of Hypno¬
tism—that to which the term somnambulistic should be
applied—one in which there is complete unconsciousness of
what is passing around, and the subject on being aroused
remembers nothing of what has occurred during this sleep¬
waking state, for waking as well as sleeping it is, since the
subject responds to questions, can write letters, can eat and
drink, can sew (if a woman), and can walk about, though not
always with safety. She may also be completely under the
influence of the operator, but is not able, as the subjects of
the earlier stage are, to attempt to oppose his mandates, in
fact they have no wish in the matter. A very good example
of this condition of artificial somnambulism is seen in the
girl at Guy's Hospital. I may add here that she was
admitted for pains in the head among other symptoms, and
was found to walk in her sleep. This induced Mr. Price, the
house physician, to try and hypnotise her, which he success¬
fully did again and again. When 1 saw her in this state she
was made to do almost whatever we suggested. She could be
rendered stone deaf, and the curious fact here was that
although she did not appear to hear what we said to her, the
moment we said, “Now you can hear,” she was released
from the spell. How could she when she was deaf hear us
say that she could hear ? This which appeared at first sight
almost a suspicious circumstance, is really consistent with what
we are supposing to be the mental condition of a hypnotised
subject. The girl was not really deaf as regards sounds, but
only believed herself to be deaf, and believing herself deaf
heard only when she thought she could hear.

As I have said, we got her to write a short letter. When
we interposed a sheet of paper between her eyes and the letter,
she wrote the line more crookedly. We asked her to write the
name of the house physician, which she knew, but she wrote
another; and her own name but she wrote quite a different
one.

Dr. Carpenter says he has seen Braid’s subjects write with
perfect regularity, even when a screen has been placed before

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On the Mental Condition in Hypnotism , [April,

the eyes, and dot an t or cross a t. Bat if the paper was
removed somewhat from the position it had been in, the
writer made the corrections on the place which would have
been right had the paper remained in situ , but out of place
after the paper which the writer could no longer see had
been removed.

I may add that we gave this girl her tea during the time
she was hypnotised, her tea seeming to her changed, through
suggestion, into coffee, and her bread and butter into cake.
After she was roused she was quite unconscious of having had
her tea, her visceral sensations not sufficing to inform her.
When she went into the ward she wished for her tea as
usual, just as if she had had none.

A similar experience occurred to M. Lasagne (whose able
extempore discourse at the International Congress in 1881
will not be forgotten by those who heard it) at the Necker
Hospital, Paris. He begged a young female patient, whom
he had hypnotised, to dine while in the artificial sleep. Her
family had that day sent her a plate of roast beef with which
she was much delighted. She ate her favourite dish with
great relish, and said she should be very glad if she could
always enjoy her meal as much. She was arrested from the
sleep in the midst of her enjoyment, and her eyes were at
once turned to her beloved beef. Great was her surprise and
vexation to find the plate empty, and when she was con¬
vinced she had dined in her sleep, her eyes moistened, and
she bitterly reproached the doctor for having prevented her
tasting her food.

An ophthalmic surgeon (the late Mr. Critchett, I believe)
had a patient suffering from glaucoma, who, for two years and
a-half before her death, was fed while rendered unconscious by
Hypnotism—and then only. She had no remembrance of
having taken food, and even solemnly asserted that she had
not done so.

It would seem probable, if not certain, that the hypnotised
person, unless perhaps when he is in a profound sleep,
receives the sensory impressions made upon his brain, but
that in his condition of reverie or abstraction he does not con¬
sciously recognise them, and therefore does not remember
them. It will often happen that the subject, who cannot after
waking recall what he has done, has the scene brought sud¬
denly to his mind subsequently, just as happens to ourselves
in regard to dreams; showing in both instances that the im¬
pression has been registered in the cortical perceptive centres.

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by D. Hack Tuke, M.D.

1883.]

although not consciously perceived. With the hypnotised,
the powerful concentration of the attention diverts the
thoughts and ideas into one channel to the exclusion of
others.

The influence of sensory impressions in causing responsive
movements in a hypnotised subject when he appears perfectly
unconscious, and on waking says, and no doubt says truly,
that his mind is a complete blank as to the past, was well
shown in a boy I recently saw hypnotised. He repeated
automatically every thing said to him; he moved wherever
the person who was en rapport with him moved, and in short
was an echo of everything said and done. Although illiterate,
he repeated Greek or German lines when they were said to
him, and so on ; but nothing happened, of course, if any¬
thing interposed between his senses and the external
stimulus. I may add that on one occasion this automatic
mimic could not be roused, and the operator was unable to
escape from his echo or shadow till four o'clock next morning,
when the former exclaimed in despair, “ Well , I shall go to
sleep ” The subject responding, “ Well, I shall go to sleep ”
remained quietly in the chair, and appears to have really
passed into ordinary sleep.

It must be observed that the loss of will and the loss of
consciousness are not equally suspended, for the loss of con¬
sciousness may be slight while the loss of will power is
complete.

It must be remembered that consciousness is an accident so
to speak, not an essential element in all our mental acts. For
the exercise of volition as ordinarily understood, consciousness
is no doubt required, but the converse is not true, for we see
there may be consciousness without volition, both in paralysis
and in Hypnotism. Again, although the cerebral . cortex is
essential to consciousness, the perceptive centres of the cortex
may be called into action without consciousness. In the girl
at Guy's we must suppose that not merely the basal ganglia
are in function, but that her speech centre, her graphic and
other perceptive centres, .are so also. It is not, therefore, a
question of the cortex of the hemispheres as a whole, on the
one hand, and the ganglia at the base of the brain, on the
other, but of different localized areas in the hemispheres them¬
selves. The reflex action of the cortex, apart from conscious¬
ness, as insisted upon by Prof. Laycock, is as great a fact as
the reflex action of the basal ganglia, the medulla, and the
cord.

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On the Mental Condition in Hypnotism, [April,

In addition then to the perceptive centres of the cerebraj
cortex which may be unaffected by Hypnotism, there may, as
we have seen, be certain mental functions in operation,
although the will is abrogated.

An able French writer on Hypnotism in the "Revue
Philosophique ” (M. Ch. Richet)* brings this out very strongly,
and observes that all is not said when one pronounces the word
"automatism,” and compares the hypnotised person to the
pigeon of Flourens deprived of its brain, and plunged into a
dreamless sleep, " for the somnambulist has a perfect memory,
a very lively intelligence, and an imagination which constructs
the most complex hallucinations.” I think this is a somewhat
exaggerated description; but no doubt in some instances there
is, along with depression of the will, exaltation of ideas—in
some cases, of the memory of the past; and therefore there
must be a certain functional activity of the cerebral cortex, at
the time when the will is suspended ; in other words we have
the reflex cerebral action of Laycock along with organic
memory; but the French physiologist appears to be unaware
of Laycock’s doctrine, and announces as new that " we must
admit side by side with somatic automatism a psychical auto¬
matism. As there are reflexes of the medulla oblongata, so
there are also cerebral, psychical, reflexes.”f

I have on a former occasion referred to Laycock’s theory of
the condition of the encephalic ganglia in mesmeric sleep,
where he points out that the great fact common to it and allied
states is that the will and consciousness are suspended, and
the brain is placed in the condition of the true spihal or
reflex system, recognising here two functionally opposite con¬
ditions as simultaneously present—rthe suspension or negation
of certain, that is the highest cerebral functions, and the un¬
antagonised positive reflex action of others. As Hughlings
Jackson justly observes on this opinion, " H attention be too
much taken up with the words ' odyle/ ‘ mesmerism/ and
€ electro-biology/ the reader may overlook the fact that how¬
ever nonsensical be the doctrines those words cover in the mind
of the populace, the sentence quoted [from Laycock] shows a
broad principle of great value in the investigation and classi¬
fication of disease; that there is a reduction to a more auto¬
matic condition, or in other words there is a duplex condition,
negative, and positive.”J

* “ Revue Philosophique ” (Ribot), Nov., 1880, p. 478.

t Op. tit. 480.

t “ The Medical Press and Circular,” Apr. 20, 1881.

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1883.]

by D. Hack Tuke, M.D.

Those who have read Heidenhain’s book on Hypnotism
know that he holds that the cause of the phenomena of Hypno¬
tism lies in the inhibition of the activity of the ganglion-cells
of the cerebral cortex, by prolonged stimulation of the sensory
nerves of the face or the auditory or optic nerve.

There appears to be nothing in the views held by the
highest authorities on inhibition,* against the possibility of a
sensory nerve inhibiting the supreme centres, and Laycock’s
doctrine would fit in with this mode of producing arrest of
volition as well as any other, but we certainly are at liberty
to suppose as at least equally feasible that the highest centres
are rendered inactive because they are exhausted, and not
because they are inhibited.

“ It will be found,” says Mr. Braid, “ that all the organs of
special sense, excepting sight, including heat and cold and
muscular motion or resistance, and certain mental faculties are

* at first prodigiously exalted .After a certain point,

however, this exaltation of function is followed by a state of
depression far greater than the torpor of natural sleep ” (op.
cit. 9 p. 29).

I agree with Mr. Romanes in the observation he makes in
his preface to Heidenhain’s book, that " the truth appears to be
that in Hypnotism we are approaching a completely new field of
physiological research, in the cultivation of which our previous
knowledge of inhibition may properly be taken as the starting
point. But further than this we must meanwhile be content
to collect facts merely as facts; and without attempting to strain
these facts into explanations derived from our knowledge of
less complex nervous actions, we must patiently wait until
explanations which we can feel to be adequate may be found to
arise” (p. xii.).

To sum up the chief poifits relative to the mental condition
present in Hypnotism :—

1. There may be consciousness during the state of Hypno¬
tism, and it may pass rapidly or slowly into complete uncon¬
sciousness, as in the somnambulistic state; the manifestations
not being dependent upon the presence or absence of con¬
sciousness which is merely an epiphenomenon.

2. Voluntary control over the thoughts and actions is sus¬
pended.

* In this connection, see the able papers on Inhibition, in “ Nature,” by
Dr. Lander Branton, March 3, et seq. t 1883.

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On the Mental Condition in Hypnotism . [April,

8. The reflex action, therefore, of the cerebral cortex to
suggestions from without, so long as any channel of commu¬
nication is open, comes into play.

4. While consciousness is retained, the perception of this
reflex or automatic cerebral action conveys the impression that
there are two Egos.

5. Some of the mental functions as Memory may be exalted,
and there may be vivid hallucinations and delusions.

. 6. Unconscious reflex mimicry may be the only mental
phenomenon present, the subject copying minutely everything
said or done by the person with whom he is en rapport .

7. Impressions from without may be blocked at different
points in the encephalon according to the areas affected and
the completeness with which they are hypnotised; thus an im¬
pression or suggestion, whether by gesture or word or mus¬
cular stimulus, may take the round of the basal ganglia only,
or may pass to the cortex, and having reached the cortex may
excite ideation and reflex muscular actions with or without
consciousness, and wholly independent of the will.

8. There may be in different states of Hypnotism exaltation
or depression of sensation and the special senses.

In concluding these imperfect observations on a most
interesting theme, let me anticipate a possible objection that
may be felt, if not expressed, namely, that these researches are
outside our specialty, and do not fall within the objects con¬
templated by the meetings of this Association. I would say
in defence that one of the objects of the Medico-Psychological
Association as deliberately adopted and laid down in our Rules
is “ the cultivation of Science in relation to Mental Disease,”
and I submit that to this disease the peculiar abnormal mental
condition presented to us in Hypnotism is in close, significant,
and most suggestive relation. I would also say that if the
consideration of the Mental Condition in Hypnotism does not
legitimately fall within our province, we are little better than
psychological hypocrites in publishing an organ bearing the
name of the u Journal of Mental Science.”

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1883.]

CLINICAL NOTES AND CASES.

Case of Feigned Insanity. By Alex. Robertson, M.D.,
F.F.P.S.G., Physician to the City Parochial Asylum
and Hospital, Glasgow.

In the “ Journal” for October, 1881, I recorded a case of
feigned insanity in a prisoner who was charged with the crime
of murder. The form of mental disorder assumed in that case
was acute mania; and the pourtrayment was so good that
even the experienced prison officials, who are accustomed
with attempts at imposture in all its varieties, were deceived by
his histrionic skill. The following case differs in many of its
aspects from that one, but it resembles it in respect that the
prisoner ultimately confessed his imposition; though, as in the
former case, not till after the distinct expression of medical
opinion that he was malingering.

On the 16th October, I was asked by the Public Prosecutor
(Procurator-Fiscal), in this city, to examine a man named John
Roberts, in the prison, and report respecting his mental con¬
dition. I was informed that the prisoner was charged with the
crime of theft by housebreaking, and that his trial was fixed
for the following day at the Court of Justiciary, which was
then sitting in Glasgow. In explanation of the shortness of
the notice, it was said that though the authorities were aware
that there had been indications of apparent insanity for a week
or two, it was supposed that the apparent disorder was feigned,
and it was hoped that he would give up his imposition before
the day of trial arrived. The prisoner did not, however, take
this anticipated step, but maintained his seeming condition, and
his agent likewise intimated that it was intended to plead
insanity in bar of trial; thereupon it was determined that the
opinion of a medical expert should be obtained.

I was informed that the theft was committed on the 12th
September, and that considerable ingenuity had been shown in
its execution. Roberts was sent to jail on the 19th of the
same month, after emitting a declaration of an ordinary kind
before the Sheriff. On inquiry I learned that there was nothing
in that statement, or in his demeanour at the time it was made,
calculated to give rise to the least suspicion of his mental
soundness.

Before seeing Roberts, I had first of all an interview witl*

xxix. 6

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Clinical Notes and Cases.

[April,

the warders who had been most with him since his admission
into the prison. Their testimony was to the effect that a few
days after he came under their charge he made an apparent
attempt at suicide. He had put a cord round his neck in a
running noose, then passed it through an iron eye in the wall
of his cell, near the floor, and afterwards round his foot, by
which means he could have tightened it so as to have strangled
himself without difficulty, had he been so disposed. The
gaoler found him with the cord round his neck, and in the
position described. This officer did not, however, think it a
real attempt at self-destruction, as the cord was not tight;
and as, in his belief, it had been put on just before his visit,
which was made at the usual time for the inspection of the
prisoners.

This was the first circumstance that directed attention to his
mental condition. But from this time a marked change was
observable in many respects. He now obstinately refused to
work, sometimes would not speak when addressed, and occa¬
sionally took very little food for some days together. Generally,
however, he spoke sensibly, except that he asserted he
had committed murder, and was to be tried on that charge.
Now and then he would lie on the floor of his cell, staring at
the ceiling intently, as if he saw someone there, or heard a
voice speaking to him from above. It was said that he had
not been noisy, but, on the contrary, rather quiet and gloomy,
and had been cleanly and correct in person and dress.

Two other prisoners, who had occupied the same cell with
him since the time of his doubtful suicidal attempt, corrobo¬
rated these statements of the warders; and they further testified
that occasionally he did not sleep well, and had two or three
times declared that he saw people at the window of the cell,
which, in their belief, must have been imaginary.

I found Roberts to be a man rather under the average
height, with a stout, firmly-knit frame. I was told that he
was 45 years of age. He has a head of average size, and well-
formed. His expression of countenance is restless, cunning,
and furtive. When I spoke to him he looked at me, though
he quickly averted his eyes, and was obviously indisposed to
bear a steady gaze. His replies to questions regarding his
previous career and other subjects were for the most part, but
not altogether, reasonable and apparently correct. When,
however, reference was made to the crime for which he was in
prison, he professed complete ignorance of any circumstances
relating to it, and declared that he was to be tried for murder.

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Clinical Notes and Cases .

It was quite true, lie alleged, that he had committed murder—
that he had seriously maltreated a woman with whom he
cohabited, and thereafter had pushed her into the canal, where
she was drowned. Though I assured him that I had positive
information that this woman was alive and well, and though he
thanked me for telling him so, yet in a few minutes he reverted
to his statement that he would be tried for her murder; he
further said that she came into his cell at night, and had even
brought a razor to him, which he refused to accept. He
became very pathetic in telling the story of his avowed crime,
and in expressing his compunctions of conscience regarding it,
so much so that even tears gathered in his eyes and trickled
down his cheeks. Besides this, the leading subject on which
he harped, he complained that thousands of rats came into his
cell at night. There were other absurd statements of a some¬
what similar kind, but these will suffice to convey an idea of
their character.

It now devolved on me to decide on the facts, so far as I had
been able to ascertain them. It may be mentioned that the
warders were distinctly of opinion that the prisoner was feign¬
ing ; but I could not find that, besides their impressions of the
apparent suicidal attempt, they had any clear or definite

S ounds to state for their beliefs. I was also informed that
\ Sutherland, the medical officer of the prison, held the same
view; but, unfortunately, I was unable to see that gentleman.
The course which I determined to take will be understood
from the following report which I sent to the Fiscal after
leaving the prison :—

I hereby certify, on soul and conscience, that I hare this day care¬
fully examined John Roberts, prisoner in Duke St. Prison, with a view
to determine his mental condition. My interview with him lasted
upwards of an hour. It has not, however, resulted in my being able
to express an opinion respecting his mental state. The case is of
such a nature that it seems to me the prisoner would require to
be re-examined at least on two other occasions, and, if practicable, at
intervals of some days.

Notwithstanding the terms of this report, I was asked to
see .Roberts on the two following days, and, if possible, arrive
at a conclusion regarding his alleged insanity, it being agreed
to postpone his trial till about the close of the sitting of the
Court. Accordingly, I had two other interviews with the
prisoner, respectively on the 17th and 18th October, after
which I informed the Fiscal that I was prepared to make a

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Clinical Notes and Cases.

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definite statement in the case. Previously, however, I was
told that if I had any hesitation his trial would be postponed
till the next circuit, which would be in December. This delay,
I said, was not necessary. My precognition was then taken.
It was to the following effect:—

I am of opinion that the prisoner is feigning insanity. The apparent
indications of mental disorder shown by him are not consistent with
real insanity. Thus, at one time of each of the last two interviews, he
declared that he had committed murder, and was lying under that
charge, that there was no hope for him, and that he was eternally
lost; while at another time he said that he had £400 in gold, that
he expected to inherit from £4,000 to £5,000, and intended going to
Callao in Peru, where he resided some years ago : there he would
purchase an estate, keep a riding horse, and had no doubt that he
would get into the best society. At the last interview, he asserted
that the island of St. Helena belonged to him.

These two kinds of apparent insanity are of a totally different
nature, and are not met with in real unsoundness of mind in the same
person at the same time. The one implies exaltation and the other
depression—states of mind that do not exist together.

Further, his memory is good with regard to many things, such as
remembering, without difficulty, the names of places in Peru and
Brazil, and the names of several firms in Glasgow by whom, he says,
he was employed during this year ; yet at both of my last interviews
with him, which were nearly as long as my first one, he declared that
he had never seen me before, unless it were some months ago, though
I tried him both with my hat off and on, and referred to incidents of
the preceding examinations.

Such correctness of memory in relation to a variety of subjects,
and extraordinary blanks in reference to others, are not met with in
real insanity at his age.

Again, his expression of face and general demeanour are not con¬
sistent with either of the two types of insanity which, in my opinion,
are simultaneously feigned by him. They are indicative of cunning
and suspicion, but neither of exaltation nor depression.

The trial, therefore, proceeded. The plea of insanity was
departed from by the prisoner's counsel, and the case went to
proof of the crime of theft. This was clearly brought home
to him, and the jury, without leaving the box, unanimously
found him guilty. A sentence of seven years' penal servitude
was passed, this being the same as one to which he had been
previously subjected.

. While at the bar, the panel persisted in looking to either
side in an odd sort of way, without giving apparent heed to
the evidence ; maintaining, in fact, to the close, the semblance

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Clinical Notes and Cases.

of insanity. However, since the trial, I have been informed
by Dr. Sutherland that he has fully confessed his imposition,
admitting that he had been feigning mental unsoundness.

The question arises : What could be the prisoner’s object in
pretending to be insane ? It is certainly by no means easy in
many cases to discover the motive for exceptional forms of
crime or imposture, but in this case it does not seem difficult to
find. He had, undoubtedly, good reason, in view of his
previous career, to apprehend, what actually occurred, that he
would receive a severe sentence. It might well be also that,
as the knowledge of the comforts of asylum life, with its
general amenities, is now wide-spread through all ranks of the
community, Roberts, being aware of it, might prefer that
form of confinement, with all its drawbacks, to the more
rigorous discipline of the prison. And it might also readily
strike him that, though committed to an asylum, his confine¬
ment in it need not be a protracted one, if after maintaining
his deceit for such a period as would allay suspicion, he should
seem to his guardians to have become gradually restored to
reason.

Case of Acute Loss of Memory. By Dr. Geo. H. Savage.

In describing the accompanying case, it will be seen that
the loss of memory has been more sudden and more extreme
than generally happens. This case suggests the difficult
question as to whether loss of memory is to be considered
as unsoundness of mind. Legally, one has no doubt but
that persons who have extreme losses of memory would
be considered as unfit to transact business. In noticing
the development of the higher nervous organisms, one
has to place memory as the great builder of nerve power.
The mere fact that impressions are received goes for little
in the construction of a mind, but the fact that these im¬
pressions can be stored and compared, points to the com¬
mencement of a highly-organised power. If, then, we meet
with cases in which the perceptions remain, but the storage
is wanting, the patient must be looked upon in very much
the same way as the undeveloped. Those of us who are used
to mix much with the insane, are aware of the persistence of
memory in the majority of persons suffering from ordinary
insanities, but we are also used to cases in which the memory
is affected in various ways and in various degrees, so that in

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Clinical Notes and Cases.

[April,

one patient suffering from acute delirious mania we learn,
after recovery, that there has been a blank in his recollec¬
tion—a blank that was represented by the period of extreme
delirious excitement, the time in which the incoherence and
inconsequence of ideas were most marked—when perception
seemed clear, but appeared to be associated with a peculiar
reflection, so that when a word was said or an action done,
it was repeated or mimicked by the insane person ; or else
the memory was so affected that groupings and verbal associa¬
tions of words existed, but the memory of them afterwards
was not retained. Again, we have patients in whom the
memory is lost after a severe convulsive seizure, whether
epileptic, apoplectic, or general paralytic. In these the
memory may he only temporarily affected, or may be per¬
manently affected. In epilepsy the memory is generally but
temporarily affected, the patient having no recollection of
what has happened during the attack, so that either with the
petit mat or grand mat the patient is unconscious of what
takes place. This was seen by me the other day in a little
girl of 11, who had neurotic inheritance, which was exhibited
by falls which were incomprehensible to her mother. The
child, without any cry or change of appearance, suddenly
fell, wherever she happened to be, or whatever she had in her
hand, frequently caused injury to herself and destruction of
property, but without the slightest knowledge that there had
been a lapse in her life. This case was treated as due to
epilepsy with the greatest advantage. Epilepsy, sooner or
later does affect the memory, and it is said that the loss of
memory depends directly upon the number of the fits, and
not upon their severity. In apoplexy one is quite used to
meet with cases in which the progressive dementia is most
marked by the progressive loss of memory; and again, in
general paralysis, of whatever nature the fits may be, the
loss of memory is progressive, increasing after each fit, then
for a time improving, to become again still more marked after
the next convulsive seizure. The case that I have to report
differs from all the classes I have already mentioned, and I
find it difficult to fix on a definite diagnosis. If forced to
give one, I should say that my opinion is that the case will
prove to be one of general paralysis. But if this is to be the
case there are sufficient points of interest still left to make
it worth while recording.

Hephzibah 8. C.* married, 40. A paternal aunt was said to have
suffered from s^me form of insanity. She has had one child, who is

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Clinical Notes and Cases.

1883.]

now 20 years of age. The supposed cause of her illness was the pro¬
tracted illness of her husband, which caused her great and continuous
nursing and anxiety, and at the same time reduced her means of living.
After much exhaustion, about the 8th Oct., 1882, she had a fit, which
was said by her friends to have been looked upon by the doctor as
simply hysterical; bat from this time it was noticed that her memory
was very seriously affected, so that she was said to have absolute loss
of memory. When she was admitted the certificate stated that she
said she had been married four years, yet had a child 16 years old.
She did not know what her husband’s occupation was, and did not
know where she was, or where she had been. She constantly repeated
the same question, without remembering that it had been answered.
The confusion about her age, the age of her husband, and that of her
child, was complete, and, though told within two minutes, she would
within two minutes have forgotton the answers. She was admitted on
the 28th October, and was then a tall, dark, healthy-looking woman,
with no delusions so far as one could make out, and no active signs of
insanity. She had no excitement, no exaltation, no hallucinations,
no delusions, no melancholia, so that the only thing for which she was
admitted was this mindlessness, as evidenced by loss of memory. We
tried carefully to gauge the loss, to see if there was any sudden break
in her intellectual life, but we found it perfectly impossible to fix any
limit of memory. She would remember the date of her birth, and the
day of her child’s birth. She remembered that she had a husband,
but unless paper was given to her she could not compute what the age
of her own child was, the date of birth and the date of the year being
given. She did not even answer a question as to the year twice alike,
so that when asked what the date of the year was, she would say that
she thought it was 1875 one day, and perhaps on the next day would
say that she thought it must be 1873. When asked the day of the
week she was quite at a loss, unless there was some newspaper or
other indicator as to what it was. When asked the month of the
year, she looked out of the window, and said she thought it must be
some time in the winter, and that she fancied from the fires and the
leaflessness of the trees that it was somewhere about Christmas. She
had no memory as to whether it was before or after, or whether any
Christmas festivities had taken place. She had no recollection of the
name of the doctor, or even of that of the nurse. Though told daily
where she was she could not recollect whether in London or in the
country. It seemed that there was no distinct difference in the
memory of either of the senses, so that when shown a picture and
spoken to about it on one day, and shown again the same picture on
the next day, she had no memory of it. If given an odour or a taste
on the one day, she did not remember it on the next. If a quotation
or an anecdote were brought to her notice, she had no recollection of
it on the next day. She said that she had a firm recollection of faces,
and it seemed to me that on one or two occasions she did recognise

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Clinical Notes and Cases.

[April,

the faces of people whom she had seen before, as doctors, or some of
the people connected with the asylum. One could never be sure,
because 6he retained a great deal of the polite, lady-like manner that
must have been habitual with her, so that when introduced to a person
and asked if she remembered him or her, she took it for granted that
she ought to have recollected them, and would qpy, u I ought to know
you/* or, " I think I have seen you before, but my memory is bad.”
Another important thing was that each day she would come up, and
in the same terms say, “ You know I feel quite myself again now; my
memory seems to have returned, and I feel quite well.” We tried to
see the duration of the memory, and found that within two minutes
facts or faces seemed to have faded away. After she had been in this
condition with very little improvement indeed till Dec. 2, she was
noticed by the attendant, on getting her out of bed, to totter and
appear giddy. She was then put to bed, and it was found that she
had lost some power in the left arm. There was conjugate deviation
of the eyes to the right side. She was then unconscious. She slowly
recovered consciousness, but was aphasic. In this condition she was
carefully examined, and it was found that there was no great loss of
power in the left arm, or any power lost in the left leg, but there
seemed to be some uneasy sensation on the whole of the left side, so
that while lying in a semi-unconscious condition, her head (?) was
slightly turned towards the right side. With the right hand she
constantly seized the left hand, and pulled it across her chest, as if
she felt that it was falling away from her. At the same time she
picked and stroked the left side of her face, as if there were some
uneasy sensation there. After remaining in this condition for several
hours, she slowly recovered consciousness, but then weakness seemed
marked on the left side. At least there was a tendency to drop in
the hand, although the grasp was about as forcible as before the
seizure. At the time the patient lost her speech, she still retained
a few words. These were chiefly German, and here it may be said
that she had lived in Germany for some years before her marriage,
and was a fluent German scholar. By Dec. 4th she was getting about
as usual, but still complained of uneasy feelings in her left side, but
in every other particular she was as before, saying, “ I have got my
senses to-day.” From this time up to the present date she has
remained as nearly as possible in the condition that she was in before.
I may say that the optic discs, being examined, gave evidence of no
change, and that the muscles of both arms reacted normally to the
continuous and interrupted current, the only difference being a slight
increase in excitability in the left fore-arm. Since the last note,
although the improvement in memory has been very small, one might
almost say doubtful, yet I am inclined to think that there is some sign
of gain, so that now she recognises me as one of the physicians of
this hospital; she recognises the nurse, and she distinctly recognises
our names when they are made use of. If she is asked what one’s

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1883.]

Clinical Notes and Cases.

name is, she will say, “ You are the doctor; ” and if one makes use
of a wrong name she will say “ No,” whereas if the right name be
given she says “ Yes, that is it,” and repeats the name. She knows,
also, that she is in an institution for people of disturbed mind. My
own idea is that she will have other fits, and that the loss of memory
and of mind generally, will be progressive.

The bearings of the convulsive seizure are important. One
feels justified in saying that any change that has taken
place is in the right side of the brain, the head being
turned to the right shoulder, and there being conjugate
deviation to the same side. The unpleasant feeling, as if the
hand were falling, and the persistent uneasiness, and an odd
feeling in the left arm, all point to some change that has
taken place in the right half of the brain, but whether one is
to look upon this as some cortical change, some effusion into
the membranes, or some degenerative change affecting perhaps
the right thalamus opticus, I will leave others to guess.

During the third week of January some friends came to
tell her that her husband had died, and asked me whether it
would be safe or well to convey that information to her in her
present mental state. I told them that I thought it was a
matter of perfect indifference, as the impression made by
their news would be lost as soon as they had left. The
friends saw her, and told her, and for a moment she
seemed overwhelmed with grief, but before they had time to
soothe her, she was astonished that she had been crying, and
wondered what it had all been about; and although a second
narration of the information produced a second emotional
disturbance, again she passed into a condition of perfect
indifference. This intelligence was repeated to her by me
from day to day, but I always found that she had forgotten
the details, and almost entirely the whole story. The only
evidence that she had not entirely forgotten was the ease
with which she received the news after it had been frequently
repeated. She would even say, “I hear. I have heard
something about my husband; *' and if I said, u Have you
heard that he is dead?” she would say, “Well, I think I
have.”

Besides the observations that I have already narrated, it
would be well for me to mention some other facts, showing
that her powers of association of ideas still exist, and that a
certain large number of fundamental facts and acquisitions
of her education remain much as they were in health. Her

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Clinical Notes and Cases.

[April,

knowledge and powers of using the multiplication table are
now as good as they were before. Her ability to read, her ability
to define an object, to name anything that is shown to her,
to recognise anything that is named in her presence, are all
complete, but the memory of a thing read is no more per¬
sistent than the memory of a thing narrated. I got her on
one or two occasions to read paragraphs from books, and
then asked her what she had read. She remembered the last
word or two of the sentence, and once the powers of asso¬
ciation came out, so that she linked several associated words,
as far as sound was concerned, with the last word read. Her
memory of music is as good as her memory of words, and
she can not only recognise notes by ear and by sight but she
can play from memory.

So much, then, for the case. Next, as to the propriety of
keeping such an one in an asylum. T suppose such a patient
might just as well have been cared for in a general hospital,
but for the fact that the physicians of a general hospital
w ould wonder what they had to treat in a person as healthy
as this one apparently is ; and though her bodily health
appears so good, and though there are no delusions, yet one
cannot consider that an individual whose impressions are no
more persistent than a shadow should be accounted respon¬
sible for her actions, or could be safely left at large to be the
prey of the stronger. I treat her as a case of progressive
dementia, and shall look for the pathology in something allied
to general paralysis, or else post-apoplectic changes.

Mental Symptoms, Precursors of an Attach of Apoplexy. By
Dr. Geo. H. Savage.

In an asylum one not uncommonly sees cases of weak-
mindedness consequent on apoplectic fits, but it is not very
common for one to have an opportunity of watching the
effects of mental disorganization associated with changes
which ultimately lead to apoplexy. In the subjoined case I
had an opportunity of seeing constantly for some months a
gentleman who finally died with severe apoplectic fits. He
was a man whom I had known for years, and therefore I was
better able to judge of any intellectual and other change
which occurred in him. He was married, and 55 years of
age, of a gouty habit, one who had lived well, eaten largely,

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1883.]

Clinical Notes and Cases.

and enjoyed life, but had never been intemperate. He had
never suffered from any severe constitutional disease, and up
to the last year of his life had been remarkable for his
constant work and general ability—a man of considerably
more than the usual amount of intellectual force and in¬
ventiveness. When first called to see him he was suffering
from sleeplessness, and some neuralgic pains, fixing them¬
selves chiefly in his eye-balls, so that he tried various kinds
of spectacles, and consulted many medical men, because he
thought there was some trouble associated with his eyes.
I was unable to make out any hallucinations of any kind at
that time, his one complaint being that of persistent sleep¬
lessness. About the same time he became irritable, and his
servants were constantly being changed. He was unable to
keep his coachman, and therefore suppressed his carriage.
He became emotional, and his memory failed. After these
symptoms had existed for some weeks, the sleeplessness
continuing, hallucinations of hearing became marked, so that
on several occasions he got up at night, believing a bell had
rung, and his wife was unable to persuade him that no bell
had sounded at all. He became troublesome in consequence
of these hallucinations, which troubled him most at night in
the way of bell-ringing; but during the day he had other
annoyances, which he said were due to his unusual keenness
of hearing, so that he declared that he could hear his servants
in the kitchen talking, this being impossible. He was
recommended for these symptoms to try a change, and he
went down to the Isle of Wight, where for a time he seemed
better. He always seemed benefited during a change, but very
rapidly relapsed on his return home. On one or two railway
journeys he caused annoyance and trouble to his travelling
companion by the worry he made because he fancied he heard
a Westinghouse break attached to the railway carriage. He
stopped at each of the stations on the line, and demanded
to see the station-master, whom he told that he would not
have the Westinghouse break fixed on to the wheel of his
carriage while it was in rapid motion. Nothing would per¬
suade him but that some break was attached to his carriage,
and was causing a most unpleasant jarring sound. When
his companion told him that no such sound was audible, he
became angered at contradiction, and prostrated himself on
the floor to listen to it the more readily. Change, with some
rest, and talks about the possibility of its being due to hallu¬
cination, did him good for a time. He had a change to the

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Clinical Notes and Cases.

[April,

sea-side, but after this, the sleep being rather better, and he
rather less emotional and irritable, he became loquacious,
and excessively fond of talking of his own worries and ail¬
ments, his memory remaining weak. He now developed
hallucinations of smell, and became a complete nuisance to
all his family and friends; he would accept none of their
statements that these stinks were subjective, but said that
there was always some smell of smoke, and that he believed
that in his household they were constantly cooking and burn¬
ing what they were cooking, and it was a disgrace that this
should be allowed to take place. He said it was not only his
nose that was affected, but also his eyes, and that his eyes
smarted and were uneasy in consequence of this smell. At
one time he was so convinced about these smells being real,
that he even abused friends into whose houses he went for
having the same want of method in cooking that he found
in his own house, and had almost got the idea that there was
a general conspiracy to annoy and worry him. At times
these sensations varied, so that besides those of smoke and
cooking, he also had smells as from drains. During the
whole of this time he was losing flesh, and becoming weaker.
The symptoms kept very much in the condition which I have
last described, till one day he had an apoplectic fit, affecting
the left side. The convulsions were extremely severe. He
never regained consciousness, but died within a week.

So far, then, we have seen that before the final breaking
down of an artery there had been bad nutrition of his brain.
Probably there had been some gouty atheroma about the
arteries at the base. It had impaired the circulation through
the brain, and thereby impeded nutrition ; and as a result
these hallucinations had occurred one by one. Each of them
might be looked upon in the light of a pain to the sense.
He was thus affected by a simple pain in the eyes, by bell¬
ringing, clanging, and rubbing noises in the ears, by a
feeling of smoke and fusty smells, as affecting the nose—
all painful sense-impressions, comparable, to my mind, one
with another.

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1883.]

OCCASIONAL NOTES OF THE QUARTER.

The Punishment of the Insane .

Pnnishment is the positive infliction of suffering as a righteous
result of wrong-doing, and as a deterrent from its repetition. But the
wrong-doing of the insane is the result of their malady, which pro¬
duces it either directly through delusion, or indirectly by perverting
their moral sense and relaxing their self-control.

There must therefore be a broad and absolute distinction between
onr treatment of criminals and our treatment of the insane, although
the line between crime and insanity may often be difficult to draw.
Better that some criminals should escape punishment under the shelter
of insanity than that one insane person should be dealt with as a
criminal.

This principle has long seemed to be universally accepted, and
therefore it is startling to be told, as we have lately been, that
nothing could be more absurd, and that the insane ought to be
punished for their good I We had imagined that the punishment of the
insane for their good had been tried sadly too long already, and that
the records of the trial were dark and shameful; but it is now
declared that when ordinary methods fail to induce a patient to work,
the infliction of punishment is imperatively demanded in his own
interest.

The insane person, we are told, should then be paralysed and terri¬
fied by the hypodermic injection of hyoscyamine, or should be com¬
pelled—with the stomach pump by preference—to swallow disgusting
mixtures, or should be shocked by plunge or shower baths, or should
be disfigured by cropping the hair from the head and face, or should
be degraded by ragged clothing, or should be burdened by heavy
weights attached to his body. These things—and it is said they are
infallible—are to be done to a poor lunatic, when he is obstinately
idle, in order to compel him to work!

Such a course, whatever the motive, is utterly unjustifiable, and
cannot be too strongly repudiated. It is an outrage on all that is
enlightened and humane in the treatment of the insane.

If idle lunatics are to be thus treated, what shall be the doom of
the dangerous and destructive ? Surely the lash would be as justifi¬
able, and more merciful.

We cannot believe that these things are really practised in any
asylum to-day. We are glad to find that Dr. Cameron, whose article
in the last number of the Journal has occasioned these remarks, does
himself repudiate them by saying in his Letter, which will be found in
our Correspondence, “ Of course a lunatic asylum is not a place in
which such measures can properly be practised, and it is almost need-

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less to say that they are not practised in this, or so far as I am aware,
in other asylums/* We certainly think that so far from being almost
needless,' it was very needful on Dr. Cameron’s part to make this
avowal. While, however, we gladly accept it, we think the general
principles advocated in his article are virtually retained in his Letter.
The insane are still to be “ frightened 99 into good behaviour.

The avowal of such principles sounds like a dismal echo from last
century, and is strangely out of harmony with a time when
reformers are telling us that walled airing-courts and locked doors
are remnants of barbarism and emblems of harshness and subjection.

Can it be possible that this is but another illustration of the
familiar truth that extremes meet ?

The essential elements of the modern treatment of the insane, un¬
fortunately named the M Non-restraint ” system, because restraint
was the root principle of former treatment, are kindly care and
sympathy, careful medical treatment, as much freedom as possible,
and as little as practicable of the feeling or the appearance of re¬
straint, safety being the only limit of freedom.

This is surely wide enough, but it does not satisfy modern
reformers. From what we are told now-a-days it would appear that
special dwellings for the insane are quite needless, that medical treat¬
ment is obsolete and useless, and that the insane only require to be
treated like other men, and to be kept always at work. Logically, the
next step would seem to be the discovery that the patience and charity
with which we have been regarding the misdeeds of lunatics is but
amiable weakness, and that the insane are so like other men that they
should be punished for their good.

If it be said that there are some patients in asylums who are really
not insane, and therefore properly punishable for their misdoings,
the obvious reply is that they have no right to be there, and ought to
be discharged. The idleness, irritability, and turbulence of insane
persons are truly part of their malady, and it would be as reasonable
and humane to punish an epileptic for manifesting physical convul¬
sions as to punish a lunatic for mental moods and explosions, which
are equally the result of disease.

It is quite true that crime and insanity are often strangely mixed,
and that some persons, especially young women, almost appear to be
sometimes on the one side and sometimes on the other of the narrow
line which, in their case, divides them. But these are the very cases
in which punishment seems to harden rather than to benefit, and in
which it does nothing to develop self-control, or promote recovery.
The records of every prison show that punishment, however frequent
and severe, is quite futile in such persons, and utterly fails to deter
from wrong-doing. Thus the only cases which, in an asylum, might
seem to afford the shadow of a justification for punishment, are just
those in which it has been abundantly proved that punishment is
worse than useless.

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To punish by means of drugs is the saddest punishment of all. It
is a degradation of medicine, and a double wrong to the patient. A
whip scores the skin, and the treadmill tires the limbs; but to poison
the brain by hyoscyamine, as a mere punishment, till the lunatic is
paralysed and comatose, and can afterwards recall the condition only
with abject terror, is a cruel injury. Such means might, perhaps, be
justifiable in dealing with an infuriated animal, but to expect by
punishment like this to restore reason, self-respect, and self-control to
a human soul, is a monstrous and melancholy mistake.

That the indulgences and rewards extended to the orderly and in¬
dustrious inmates of an asylum should be withheld from those who
will not use what self-control remains to them, is entirely right, and
is a valuable means of inducing them to amend their ways. A
special party or excursion, an extra supply of tobacco, a visit to the
circus, a day with friends, and similar privileges, are proper rewards of
industry, and may be rightly withheld from those who could easily
gain them if they liked, but refuse to do so. It is simply a misuse
of words to call this punishment.

These rewards, as a rule, do not go far enough, and the payment
principle, which has worked so successfully in some places, might well
be extended. For many it may be unnecessary, but with some it would
do more to promote regular industry, and therefore recovery and good
conduct, than any other means. Of course the principle must be
applied to all, and although the cost would be considerable, the results
would justify it. It is little to be wondered at that many patients
work listlessly when they get so little fruit of their labours, and it is
by increasing rewards, not by devising punishments, that industry is to
be fostered. The mere knowledge on the part of a patient that he
has something to his credit in the Asylum Savings* Bank, which he
could spend as he pleased, or could present to his boy, when he visits
him on his birthday, makes him a more orderly, industrious, and self-
respecting member of the community, and thus benefits both himself
and others.

If the discussion of the subject of tbe Punishment of the Insane
leads to a fuller recognition of the all-important one of providing
them with Employment, we shall have no reason to regret that our
pages have been the channel of the expression of views which, to say
the least, are liable to be misconstrued, as advocating practices against
which we have felt it absolutely incumbent upon us to enter our
earnest and emphatic protest.

Idleness is proverbially injurious alike to body and mind, and use is
essential to the health of both. The idleness of insane folk is
generally a symptom of their malady, the result of apathy or mental
preoccupation ; but it may, on the other hand, be associated with
actual laziness or perversity, since insanity does not banish, and may
even intensify, the moral weaknesses of humanity.

This apathy and preoccupation at once manifest and aggravate the

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malady; and the great aim of treatment is to awaken the mind from
its apathy, and to turn the thoughts into new and healthy directions.
With this object the patieut is surrounded with whatever is likely to
attract and interest; he is made to feel that he is among friends who
care for him, and wish to help him ; and, above all, he is induced to
engage in some active employment, if possible in the open-air. By
the attention which the occupation requires, and by the interest it ex¬
cites, the man ceases to be self-centred and self-absorbed, the insane
ideas which possessed him are replaced by normal thoughts and feel¬
ings, and there is gradually established the healthy and formerly
familiar habit of taking an active interest and an active share in the
daily duties of life. Simultaneously, sleep is promoted, the general
health improves, and thus occupation becomes as welcome as it is
beneficial.

Recovery very often begins from the time when the habit of daily
occupation is re-establislied, and it is matter of constant observation
that patients whose lives have been idle and useless, and to whom all
employment has seemed drudgery and degradation, are far less likely
to recover from an attack of insanity than those who have habitually
known the satisfaction of daily work well done.

Employment being thus of the utmost value in the treatment of
the insane, it is most desirable to provide as many varieties of occu¬
pation as possible, and to discover the form and manner of it which
has most attraction for each.

Some patients like their usual avocation, others prefer something
wholly different ; some like to work with a party at a common
employment, others prefer to work by themselves, allowing no par¬
ticipation and accepting no assistance. Some will not work unless
they appreciate and approve the object, others are equal only to the
mechanical monotony of a pump or a wheelbarrow ; some work from
gratitude, others to curry favour ; some work fitfully, others with
systematic regularity; some work cheerfully, and even beyond their
strength, so that they need to be restrained ; others are skulkers and
eye-servants, only working lest they forfeit the rewards of industry.

Not for curable patients only, but likewise for those whose recovery
cannot be expected, regular employment is of the greatest value. It
lessens excitement by turning the activities into a regular and useful
channel; it banishes ennui by giving life an interest and an object,
it develops self-respect and self-control, by teaching the man that he
is good for something; and it promotes health, contentment, and
happiness, as nothing else can.

The benefit to the patient is the great object of work, and this
should determine both the kind of employment and the time spent at
it. The economic value of the work, although an important, should
be quite a secondary consideration.

Asylum attendants are apt to think more of the work to be done
than of the gain to the workers, and they need to he constantly

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reminded that to get a little work done by an excited, troublesome,
or idle patient, is far more important than a whole day’s labour of
their steadiest worker.

The universal rule that example is better than precept holds true in
the employment of the insane, and the example of others is the most
potent teacher. Hence the attendant should work with his patients,
not merely order them to work, and the prevailing tone of an asylum-—
• its atmosphere, ever present and all-pervading—should be one of active
industry. It should be deemed a matter of course that every one is
employed, and a new patient who is capable of employment should
not be asked if he will work, but should be placed at once, and as if
any other course were inconceivable, at the work which seems best for
him. It is wonderful how readily the weakened mind yields to the
influence of example, and how naturally a patient accepts the prevail¬
ing tone of his new abode.

He is, of course, further stimulated by arguments addressed to his
understanding and self-interest, especially by the great argument that
work is the way to recovery and discharge ; and special inducements
and indulgences are offered to him as the reward of industry.

In a word—and this is the sum of all the moral treatment of the
insane—the appeal is to all that is sane in the man to conquer and
correct all that is insane in him.

However idle or rebellious the patient may prove, there is, we
assert, no possible place or excuse for punishment in dealing with
him.

County Board Bill and Pensions of Medical Officers of

We direct the attention of our readers to the Corres¬
pondence of the Parliamentary and Pensions Committee of
the Association with the First Lord of the Treasury, the
Commissioners in Lunacy, and the President of the Local
Government Board, which will be found in a Notes and
News.”

We stated in our last number (see p. 652) that at a
meeting of the Parliamentary and Pensions Committee held
in London, Nov. 29, 1882, a sub-committee was appointed
to carry out their views and address a letter to the First
Lord of the Treasury suggesting that in the Government
Bill said to be in preparation in regard to County Boards,
certain changes should be made in reference to the payment
of salaries and pensions of medical superintendents. The
result was the correspondence above referred to; and
although the Government has deferred the introduction of
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98 Occasional Notes of the Quarter. [April,

such Bill, the importance of having taken prompt action
in a matter so closely affecting the interests of the Associa¬
tion must be evident. The Association is under great
obligation to Dr. Lockhart Robertson for the interest. he
has taken and the efficient help he has rendered in this
question.

PART II.—REVIEWS.

UH6r6diU Psychologique. By Th. Ribot. Paris: Germer
Bailli&re et Cie. 1882.

The thesis of this book stands or falls with Darwinism.
In applying the law of evolution to the explanation of
psychological phenomena, the writer adopts the method and
many of the facts of Darwin, and corroborates many of the
conclusions already suggested or demonstrated by that great
thinker. Indeed any one familiar with the writings of
Darwin, Herbert Spencer, Galton, Laycock, and others, must
already have foreseen that a law which is believed to be
universal must of necessity govern mental phenomena.
Whilst the Darwinian-believer, as he peruses M. Ribot’s
book, must constantly feel that he is reading what he
already knows and accepts, he cannot avoid being pleased
with the manner in which the subject is treated and illus¬
trated.

Adequately to review this book would require an elaborate
essay as long, if not longer, than the treatise itself. Under
the circumstances this is neither possible nor desirable. The
Evolutionist will see in M. Ribot’s book much to please him
and strengthen him in his views. But whilst he enjoys a
rich intellectual feast, others may view the food as poison, a
deadly poison capable of shaking belief in revealed religion.
It is greatly to be regretted that such doctrines should be
considered antagonistic to true religion. M. Ribot deserves
much credit for expounding his ideas without unnecessarily
wounding religious susceptibilities. Some of his remarks
and arguments must shock the ultra-orthodox*; but this is
inevitable from the nature of the subject, not due to the
pugnacity and irreverence of the writer.

The book is divided into three parts : 1st, the facts; 2nd,
the laws; 3rd, the consequences. With the first division

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all asylum physicians are familiar, or should be, for they
possess unusual opportunities for observing heredity in one
of its most striking forms, in mental diseases. What is
wanting in his own experience he can have supplemented by
reading either philosophical works, which view the subject
as a whole; or psychological works, which limit the field to
mental phenomena, normal and diseased. It may be pre¬
sumed that every one pretending to culture has read
Darwin’s works and tried to make something of Herbert
Spencer. It may therefore be presumed that every English
reader is familiar with part 1. So with part 2, there is
nothing novel; but an excellent epitome of our present
knowledge.

When the consequences of Heredity are discussed in part
3, we come to some questions which do not appear capable
of solution at present, such as the relation of heredity and
free-will. It cannot be doubted, however, that good follows
from the efforts made to arrive at conclusions, and if we
trust in evolution, we can believe that what is impossible for
us in 1883 may be quite possible in 2883.

It is specially interesting that M. Ribot and Dr. Arthur
Mitchell should arrive at a similar conclusion, though start¬
ing from very different premises. In his essay on Civilisa¬
tion Dr. Mitchell contends, and correctly, that civilisation
and nature are antagonistic. Nature condemns the weak to
destruction; civilisation preserves them, and makes good
use of them too. Viewing the question from a different and
more limited aspect, M. Ribot finds that heredity, a portion
of the great law of nature, and civilisation are also antago¬
nistic.

Early in the discussion we have an exceedingly good
definition and discussion of instinct, and it is very properly
asked, if some so-called primary instincts are acquired, why
may not all of them be so ? Many other points occur which
might be noticed fully, were any special object to be gained
by so doing. For instance the attack on Lucas’s law of
inneity. The refutation is complete, but we thought that
the hypothesis had long ago received.its quietus. But we
prefer to recommend the book to our readers. It is
delightful reading. The style is clear; the points well put,
and the discussions not unnecessarily protracted. Even to
one tolerably familiar with the literature of evolution the
work will be welcome; an important section is ably and
fully discussed. To any one, if such there be, as yet

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ignorant of the great topics handled by Darwin and his
apostles, this book will be useful as an introduction.
Having mastered what is here offered him he will doubtless
have a taste excited for more, and he will be able to view
the ordinary phenomena of insanity in a much more philoso¬
phical and satisfactory way. He will see that, in spite of
much that is inexplicable, there are great laws of nature at
work now ; that we do not yet see the end, but that nature
may have a destiny for man in this world far higher than it
has entered into the heart of man to conceive.

T. W. McD.

Female Education , from a Medical Point of View. By T. S.

Clouston, M.D. Being Two Lectures delivered at the

Philosophical Institution, Edinburgh, Nov., 1882.

“ I think we have some business here—a little! ” as Meg’s
eyes said, or seemed to say, to Trotty Veck. Yes, medical
psychologists have some business with Female Education—
a little ! and it is their own fault if they do not make their
business known. None ought to know better than they the
capacity for education possessed by the female sex, the
peculiar dangers attendant upon her mental labour, and the
precautions needed to protect her from injury. Dr. Clouston
could not have chosen a more practically useful subject for
a popular lecture, and well has he succeeded in bringing into
relief the evil done at the present day by educators; and
the necessity for checking it promptly and effectively.
There is nothing approaching to exaggeration in the state¬
ments made. There is, as there ought to be, a constant
appeal to the physiology of woman, couched in language
which cannot be misunderstood, but which is at the same
time suited for a popular audience. All life, while enshrined
in a bodily structure, has throughout its existence a limit in
its development, beyond which it cannot be forced by human
pressure; woman’s mental and bodily life are no exceptions
to Nature’s inexorable rule—this must be impressed upon
the pedagogue as the fundamental law which he cannot
break, although alas I in attempting to ignore it, he can
break on the wheel the delicate vessel which he is endeavour¬
ing to mould. There is something terrible in the thought of
the power thus wielded by the potter. People have learnt
that the growth of the human mind cannot be forced back

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without destruction, but in the rebound from this dismal
error they have committed the opposite mistake, and have
again exemplified

“ The falsehood of extremes.”

They have sought to force the mind forward till it has burst
from its own plethory.

Vital Energy again has its necessary limits. It cannot be
employed to excess in one direction without being weakened
in another. If the mental powers are cultivated dispropor¬
tionately, the muscles, bones, and general nutrition suffer,
and this is especially true of woman’s development during
the period of adolescence from 13 to 25.

Inseparable from this law is the truth that in one term of
human existence the vital force may be consumed which
should have extended over several. The oil of the lamp of
the foolish virgin has gone out at twenty-five. We are
wrong; we do her an injustice; the folly is not hers, but
thehs by whom her lamp has been trimmed and lighted.

The law so obviously true of the individual is also true, we
may well suppose, as Dr. Clouston asserts it to be, of a
generation. Indeed the one seems to follow from the other.
Excessive pressure put upon one generation lessens thereby
the force available for the next. We should not be disposed
to say that so much force is alloted to a generation, and that
the succeeding one has much or little according to the
amount expended, that is to say in the sense that so many
volumes of vital energy are meted out, as so many pounds of
meat are weighed and distributed for the day’s dietary in a
pauper asylum. It is true only in the sense that individuals
transmit less forde to their descendants if they have ex¬
hausted their own energies before their offspring are born.
The greater the number of individuals who do so, the worse
for the aggregate generation which succeeds them.

Most definitely and specially important of all, however, in
regard to “ Female Education ” is the adolescent era of her
life. Its importance must be constantly kept before the
educator. It is well described by the lecturer:—

Then bodily energies of a new kind begin to arise, vast tracts of
brain quite unused before are brought into active exercise. The
growth assumes a different direction and type, awkwardness of move¬
ment becomes possible, and on the other hand a grace never before
attainable can be acquired. . . . For the first time distinct individual

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mental peculiarities show themselves. The affective portion of the
mental nature begins to assume altogether new forms, and to acquire
a new power. Literature and poetry begin to be understood in a
vague way, and the latter often becomes a passion. The imagination
becomes strengthened, and is directed into different channels from
before. The sense of right and wrong and of duty becomes then
more active. Morality in a real sense is possible. A sense of the
seriousness and responsibility of life may be said then to awaken for
the first time, the knowledge of good and evil is acquired. The reli¬
gious instinct arises then for the first time in any power. Modesty
and diffidence in certain circumstances are for the first time seen.
The emotional nature acquires depth, and tenderness appears. The
real events and possibilities of the future are reflected in vague and
dreamlike emotions and longings that have ’much bliss in them, but
not a little, too, of seriousness and difficulty. The adolescent feels in¬
stinctively that she has now entered a new country, the face of which
6he does not know, but which may be full of good and happiness to
her. The reasoning faculty acquires more backbone, but is as yet the
slave of the instincts and emotions. A conception of an ideal in
anything is then attainable, and the ideal is very apt to take the place
of the real.

Dr. Clouston impresses on his audience the necessity of
bodily development corresponding to all these mental
changes, and reaches one of the practical points he doubtless
had in view in giving his addresses, that “ the girl student
who has concentrated all her force on cramming book know¬
ledge, neglecting her bodily requirements, is apt to suffer
the effects of an inharmonious and therefore an unhealthy
mental and bodily constitution.” “ There is- no time or
place,” as he forcibly puts it, “ of organic repentance pro¬
vided by nature for the sins of the schoolmaster,” and he
asks, “ Why should we spoil a good mother by making an
ordinary grammarian ? ” He does not think that many
great men have had highly educated mothers. Had they
had such—that is to say women who when at school “ had
worked in learning book knowledge for eight or fen hours a
day in a sitting posture, stimulated by competition all that
time, and had ended at twenty-one in being first prizemen,”
their sons would have been distorted or deformed, instead of
being the lights of the world. Speaking of school work, the
lecturer says:—

As the result of my inquiries among pupils and teachers in the
advanced schools for young ladies, I find that about five or six
hours of actual school work, and from two to four hours of prepara-

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103

tion at home, may be taken as the time that is each day occupied in
education. Many of the ambitious, clever girls, in order to take high
places and prizes, work for longer than the time I have mentioned in
preparing at home, especially if the musical practising is taken into
account. At certain times of the year, before examinations, some of
these girls will work twelve to fourteen hours a day, and take no
exercise to speak of, and but little fresh air.

Of the pupil teachers in Board Schools Dr. Clouston
speaks as having in some instances simply continuous work
all day, their food being far from abundant. “ In both these
cases—the scholars in the higher class of girls’ school and
the female pupil teachers—the range of subjects to be
learned at the same time is often enormous. Six, seven,
eight, nine, and even ten different subjects, all being learned
at once, is no uncommon thing!” although, in the best
schools, this state of things is now being corrected.

Dr. Clouston observes that as melancholy a “ Song of the
School 99 could be sung as Hood’s celebrated “ Song of the
Shirt.” We agree with him, and perhaps a parody some¬
what after this fashion might help to arouse public feeling
in the cause of educational reform:—

THE SONG OP THE SCHOOL.

With features weary and worn,

With eyelids heavy and red,

A school-girl sat by her book-laden desk,
Painfully grasping her head.

Write—write—write,

Without rhyme or reason or rule,

And still, oh the pitiful, pitiful, sight !

She sang the “ Song of the School/*

“ Learn—learn—learn,

Till the brain begins to swim ;

Learn—learn—learn,

Till the eyes are heavy and dim.

With grammar, figures, and dates,

My burden’d memory teems
Till full of my books I cannot sleep,

Or work at them still in my dreams.

“ 0! men with sisters dear!

O! men with mothers and wives 1
It is not school-books you are wearing out.
But school-girls’ brains and lives.

Lesson on lesson and lesson,

Till they make the scholar a fool,
Treading at once with a double step
The path of the Grave and the School.

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44 But why do I talk of Death P

My own face so pale has grown
I hardly fear his terrible shape,

It seems so like my own—

It seems so like my own.

Because of my want of sleep ;

Ah! that common-sense should be so dear,
And the health of girls so cheap !

44 Learn—learn—learn—

No time for a romp or play,

And what is the gain P A lot of marks
And a public prize they say,

In the oak-roofd hall with its polished floor.

And a noble lord in the chair.

When on its walls my shadow falls,

'Twill be scarcely visible there.

44 Cram—cram—cram,

From dreary chime to chime;

Cram—cram—cram,

Like turkeys for Christmas time.

My task-book thumb'd and thumb'd,

Recitations line upon line,

Till the heart is sick and the brain benumb'd,

And aches the weary spine.

44 Oh ! but to breathe the breath

Of the cowslip and primrose sweet,

Instead of this stifling room,

Or the murky air of the street,

For only one short hour
To feel as I used to feel,

Before I knew what a headache was,

Or my feet to be oold as steel.”

With features weary and worn.

With eyelids heavy and red,

A school girl sat by her book-laden desk.

Painfully grasping her head.

Write—write—write,

Without rhyme or reason or rule,

And still, oh the pitiful, pitiful, sight!

Would that parent and mistress might read it aright!

She sang this 44 Song of the School.”

Dr. Clouston draws attention to “ one most unaccountable
want” in city schools for girls—the absence of a playground.
“ A girls’ school without a playground, a gymnasium, or
public park near, I look on as a garden without sunshine, or
a boat with one oar.” The training of the educator has not
taught him “to notice or know the meaning of narrow
chests, or great thinness or stooping shoulders, want of appe¬
tite, headaches,” &c. We are not in the least surprised to
find Dr. Clouston writing—

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It is enough to make one despair of the inherent reasonableness. of
human nature to think of the amount of time and toil that are given
in Edinburgh to the learning of things for which there is no inherent
capacity in the learners ; things that go against the intellectual
grain, that are learnt poorly and with much difficulty, against nature,
and are forgotten at once in accordance with nature’s laws. Think
of the girls that toil at music who have no inherent musical capacity,
of the time that is taken in committing to memory rules of grammar,
and doing parsing, the real meaning of which the girls’ brains could
not comprehend if they lived till they were ninety; of the labour and
sorrow given to acquire languages, by girls whom nature meant only
to speak their mother tongue ; of the futile attempts to take those
past the rule of three whom nature intended to stop at simple divi¬
sion. The sad thing is that we all know each of those could do
something or other very well, and to some purpose in after life, if we
could only hit on what it is.

The results of overwork and ill-ventilated schoolrooms,
and want of exercise, are rapidly treated of by the lecturer
under the heads of anaemia, nervousness, headaches and
neuralgias, hysteria, and insanity, on which he observes :—

I could adduce many lamentable examples from my own experience
of most brilliant school careers ending in insanity. If I had written
down the fierce apostrophe of a young lady of twenty on her entry
into the asylum at Morningside at the end of a school career of un¬
exampled success, the reading of it would do more to frighten the
ambitious parents of such children from hastening their daughters
forward at school too fast than all the scientific protests we doctors
can make. She was well aware of the cause of her illness, and with
passionate eloquence enumerated the consequences of her losing her
reason.

As Dr. Clouston says in concluding his lectures, the
question of the future is, how can we get, and how much
can we get, of intelligence and book culture, combined
with health?

The principles laid down in these addresses, and the
practical good sense by which they are permeated, will do at
least something towards helping parents and teachers to
answer this question, and we heartily hope the pamphlet
will be widely circulated among those principally concerned
in Education.

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A Practical Treatise on Electro-Diagnosis in Diseases of the
Nemous System . By Hughes Bennett. H. K. Lewis,
1882.

During the last few years electricity has assumed a vast
importance in every relationship of life, and it seems as if
we were passing from an age of steam into an age of elec¬
tricity. Medical men generally find it hard to keep abreast
with the special developments of science, even in their
practical relationships with medicine. They therefore feel
sincerely grateful to anyone who, with sufficient knowledge,
has also enough patience and power of application to sum up
for them the facts and principles by which their treatment
should be guided.

One can with confidence recommend to the attention of the
profession this small book, written by Dr. Hughes Bennett.
J t is simple and yet trustworthy. It takes nothing for
granted. It gives a complete summary of the relations of
electricity to the human body in health and in disease.

The book begins with some very well arranged plates,
exhibiting the motor points and other noteworthy indicators
which must be studied and observed by any one wishing to
make use of electricity. This work points out how the electric
batteries may and should be properly used—not as they have
been hitherto, mere toys, to amuse both doctor and patient—
or to be used by the former very much as the shower-bath
has been, as a means of terrorising, or, as the doctor would
probably say, of “rousing” his patient from a state of
lethargy into one of greater nervous energy.

A short practical introduction follows, pointing out the
uses of electricity as a physical agent in the diseases of
the nervous system. Then a description of the necessary
apparatus is given, with information regarding the best
general accessories, such as the galvanometer and the com¬
bined electrodes. In Chapter III there is a resume of the
anatomical knowledge necessary for electrical diagnosis,
followed by a description of the methods of applying elec¬
tricity in diagnosis; and after this are described electrical
reactions in health. Experimental researches follow, and
descriptions are given of the anatomical changes resulting
from injury to nervous tissues, and the effects of such injuries
upon the electrical reactions. In describing all such injuries,
and also in* examining generally into the condition of the
nervous system, .Dr. Bennett proceeds from a general to a

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particular investigation, so that the spinal cord and its
reactions are examined first, then the motor nerve* and later,
the voluntary muscles. These may be tried respectively by
Faradism or galvanism, and useful tables in parallel columns
are given, pointing out the reactions before and after injuries.
Thus, on page’ 62, a table is given showing the relation which
exists between the anatomical changes in nerve and muscle,
and the electrical reactions, in the case of serious injury to
a nerve. The electrical reactions which occur generally in
types of paralysis are given, so that we have a description
of the normal reactions in paralysis, and an investigation of
the quantitative changes, such as simple increase as seen at
one time, or simple diminution at another. The effects of
interrupting the currents in forms of paralysis are also
pointed out.

After the practical investigation, the theory of electrical
reactions in disease is discussed. With chapter VIH we come
to electrical reactions in special paralyses, as illustrated by
cases ; and here we have paralysis from disease of the brain
well exemplified, cases of hemiplegia, probably haemorrhagic,
paralysis, probably embolic, pointing to normal reactions in
some, quantitative increase in others, and quantitative decrease
in others. In the same way, reactions which occur in
paralysis from diseases of the spinal cord, are considered—
locomotor ataxy, spastic paralysis, multiple sclerosis, paralysis
agitans, and the like. Progressive muscular atrophy provides
a good number of illustrative cases ; in fact, it is hard to find
any variety of paralysis that is not fully and carefully dis¬
cussed in its electrical relations. Probably, in time, investiga¬
tion of this kind will be made more generally, and already
one has heard of some extremely important diagnoses which
have been made by means of the electric current. Dr.
Hughes Bennett not only discusses the reactions as they
occur in real disease, i.e., in what are more commonly called
coarse (?) nervous disease, but also the modes of testing in
hysterical cases and in malingerers.

In Chapter IX we have the conclusion, and a brief statement
of the practical utility of electro-diagnosis. As Dr. Bennett
properly says, “ like all other methods of physical diagnosis,
electricity must not be depended on alone as the sole means
by which we are to arrive at a just conclusion in investigating
the nature of disease. It is only one of the aids which we
employ, but one which, in conjunction with other facts and
observations, is a powerful auxiliary.”

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Those who wish to make use of this powerful auxiliary
cannot do* better than to get Dr. Hughes Bennett’s handy
little volume.

On the Causation of Sleep . By Dr. Cappie. 2nd Edit.

Re-written. James Thin, Edinburgh, 1882. 8vo.

In this book we are presented with a somewhat startling
view of the causation of sleep, based, as the author himself
states, solely on analogy, and conclusions deduced from one
solitary fact of scientific experiment. The author’s peculiar
method of investigating an interesting and complex physio¬
logical phenomenon, such as sleep, leads him not only to
neglect the ordinary precautions which the experimental
method demands, but also to omit all notice of the progress
which has been made in the physiology of the circulation
during the last fifty years. It must be confessed that the
resuscitation of the idea of the capillary circulation, after
having been laid to rest by Majendie and Poiseuille
(“Muller’s Archiv.,” 1834, p. 365), is the last thing we
should have expected to find in a modem physiological
treatise; yet this is what our author would have us believe
to be the prime agent in the causation of sleep. In brief,
his theory may be summed up as resting on two props, the
first being this chimsera of the capillary circulation, and the
second being the well-established fact that increase of the
intracranial pressure produces unconsciousness.

The superstructure raised upon this untrustworthy foun¬
dation is as follows:—The degree of cerebral activity is
supposed to determine changes of force in the capillary
circulation of the brain ; consequently, supposing the cerebral
processes to become enfeebled, the capillary circulation
grows weaker. Under these circumstances, the vis a tergo
being diminished, the author believes that the veins of the
pia mater become distended from the back flow of blood
caused by the atmospheric pressure on the large veins in the
neck, and it is the compression (!) exerted on the cortex of
the brain by these distended veins that produces sleep.

We need not trouble to notice the share which the author
supposes the capillary circulation to take in the production
of sleep, but the second point, viz., the relationship of uncon¬
sciousness to sleep, is one of wide and important interest.

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Sit* Henry Holland is quoted in favour of the idea that
sleep may pass into coma, and that <c the proximate physical
conditions are nearly the same in both.” Hitherto the most
essential point of difference between these two states seems
to have been overlooked, viz., ,that in the case of coma from
pressure upon the cerebral cortex we have a condition
almost instantly produced in an active brain, while, on the
other hand, the condition of sleep is specially characterised
by a gradual onset, the nerve centres being fatigued. It is
impossible that these two conditions can be considered
similar in any way except that in both there is uncon¬
sciousness, this being brought about in the first case by
actual mechanical interference with the vibrations of the
nerve-energy (vis nervosa) of the cerebral corpuscles and
commissural fibres, while in the second we. have evidently to
do with a complex condition, in which, perhaps, most of the
cerebral structures comprised in the encephalon take part.
This leads us to the consideration of the various theories
which have been promulgated in attempting to explain the
sleeping state.

The chief of these may be named the circulation theory and
the chemical theory respectively. The former is based mainly
on the original experiments of Mr. Durham, repeated by
Hammond and others, and may be expressed as a primary
anaemia of the brain, the result of which is defective action
of the cerebral corpuscles, these passing into a condition of
rest. Granted the primary anaemia, the inference is perfectly
consistent with the well-known fact that partial anaemia of
the cerebral centres, produced by external compression
or ligation of the carotid arteries, is followed by
defective action of the cortical corpuscles, as evidenced
by the resulting unconsciousness. The further experi¬
mental proof required to establish the last conclusion
is to be found in the well-known Leipsic case (Striimpell,
“ Deutsche, f. Klin. Med.” xxii.), where removal of all possible
causes of activity (namely, external stimuli) of the cerebral
corpuscles was followed by unconsciousness. We may be
pardoned for digressing further to point out the extreme
importance of this unique case, being, as it is, the only
recorded complete experimental demonstration of the fact
that consciousness is entirely dependent upon the action of
external stimuli on the cerebral cortex.

In considering the circulation theory it is obvious that we
are still as far from the truth, since under these circum-

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stances the causation of sleep will be synonymous with the
causation of this primary anaemia, no explanation of which
has yet been given.

The chemical theory suggests that sleep follows from the
accumulation of effete products in the whole system, and
especially in the nerve centres, while it also embraces the
idea that the chemico-physical changes in the cerebral cor¬
puscles grow weaker from fatigue as well as this condition.

It is not stretching analogy too far to say that that condi¬
tion of the brain which leads to sleep is similar to the state
of a muscle after severe work, and that, just as in the latter
case the contractions grow feebler as the excretory products
accumulate, so in the brain the supply of nerve-energy
gradually fails as the nerve corpuscles become more and
more hampered in their action from the same cause. But
experiment has shown that exactly in proportion to the
depth of sleep there is marked anaemia of the cerebral cortex,
a condition which cannot be supposed to result directly
from the aggregation of fatigue products in the cerebral
corpuscles, since the wide changes in the calibre of the
vessels could only be produced by local stimulation or
through the agency of the vaso-motor system. Unfortu¬
nately the known facts concerning the intracranial vaso¬
motor mechanisms are so few (and n«>t very concordant) that
only extremely theoretic conclusions of little value can be
drawn from them. It is possible (to take the analogous case,
of muscle again) that the same mechanism which determines
vascular dilatation in a muscle in activity and the converse
in a muscle at rest also acts in the case of the cerebral
circulation. Moreover, there is no reason a priori why there
should not be local vaso-motor centres in the brain just as
in the other viscera and tissues, and it is conceivable that
such vaso-motor centres may be influenced by the state of the
tissues, and so give rise to changes in the circulation. This
theoretic view suggests the obvious conclusion that the
phenomenon of sleep is not brought about by changes in
only one of the elements of the cerebral structure with
unimportant secondary changes in the remainder, but that
both the nerve tissues proper (i.e., the corpuscles and con¬
necting fibres) and the vessels enter together into a condition
of rest. If either of these stands in a causal relation to the
other, it is evident that we should give the greater import¬
ance to the nerve tissue. But it is idle to speculate further
in the absence of experimental facts additional to those

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1883.]

above quoted, and we can only express the hope that future
papers on this subject will contain more observation and less
imagination.

We notice at the end of the book letters from Professor
Turner, the late Sir Robert Christison, and the late Dr. John
Brown, conveying their appreciation of Dr. (Jappie’s hypo¬
thesis. From the survivor, whose opinion carries with it so
much weight, we should be glad to know how he reconciles
Dr. Cappie’s views with accepted physiological teaching.

PART III.—PSYCHOLOGICAL RETROSPECT.

1. Retrospect of Mental Philosophy.

By B. F. C. Costelloe, B.Sc. and M.A. Glasgow.

“ Mind,” Nos. 26-29 (April, 1882—Jan., 1883).

“ Revue Pbilosophique,” Nos. 73-84 (Jan., 1882—Jan.,1883).

During the long period embraced in the present Retrospect, the
most important incident that has happened in the philosophical circles
of this country is the death of Professor T. H. Green, of Oxford—a
man who for many years had been silently acquiring, not only by his
power of thinking but by his strong and blameless personal character,
a marked position and a unique influence among the leaders of
thought in England. His philosophical position would perhaps best be
defined by saying that he became the chief of that small, but notable,
band of speculative students, centred mainly in Oxford, Glasgow,
and Edinburgh, who are reviving the spirit of the systems of Kant
and Hegel, in its application to the new scientific, political, and reli¬
gious problems of the day. His distinguishing characteristics were
his modesty and his earnest sense of duty—qualities perhaps not so
conspicuous as they might be amongst the better known of -modern
psychologists. His modesty was such that he never assumed that he
had mastered the secret of any writer, until he had bestowed the
most extravagant labour and thought in exploring difficulties and
obscurities on which the man himself had probably never bestowed a
second thought. His earnestness was so thorough that he believed it
to be merely his duty to struggle with the fundamental questions of
the Sphinx of modern criticism, and find for himself and others not a
negative but a constructive answer, no matter what toil and trouble it
might cost. For he held that those who contribute, as we all in some
way do, to the formation of public opinion upon the vital subjects of
life and conduct, are under a terrible responsibility if they mislead
their neighbours, or even if they refuse by sloth or vanity or cynicism
that healthy guidance which their own attainments would enable them

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112 Psychological Retrospect . [April,

to give. These remarks are suggested by the fact that the first
article of the April number of “ Mind ” is from Prof. Green’s pen.
Indeed it is one of the last pieces of work he ever personally sent to
press ; although we are glad to know that the great Ethical work on
which he had long heen engaged is left with his philosophical friends
in so complete a form that it will be published immediately. The
April article is the second of three essays on the question, 44 Can there
be a natural science of man ? ” of which the third holds the leading
place in the July number. The scope of the essays, as well as of the
44 Prolegomena to Ethics,” to which they were in a sense introductory,
will be best indicated if we quote a note added in tlje July number by
Prof. Green's literary executor, Mr. A. C. Bradley.

44 In these pages Professor Green notices a state of mind common
among educated men. They are ready to accept the current notion
that the subject-matter of moral science differs in no essential respect
from that of the physical sciences, and to consider the acceptance of
this notion as a sine qud non of any moral philosophy worth attending
to. Yet at the same time they, or the best of them, are greatly
affected, through the medium of poetry, by ideas about human life
which cannot be reconciled with this notion; and though they
cannot in consistency regard such ideas as scientifically true, they
practically find in them the expression of their deepest convictions.
This state of things really means, however, that their deepest convic¬
tions exist only on 4 scientific sufferance,’ instead of being examined
and reduced to a form in which they can be accepted as truth. And
the way to such an examination is barred by the fixed idea that there
is no essential difference between the moral action of man and the
phenomena dealt with by some of the physical sciences.”

The second article in the April 14 Mind ” has also to do with Hegel,
but it is not from the pen of a believer. It is an extremely keen and.
amusing criticism of the system by Prof. Wm. James of Harvard,
whose writing is to our mind the ablest of all that appears in
44 Mind.” The present attack, however, is made almost comic by the
44 note ” which follows it, and which seems of a piece with the whole ;
in which Prof. James gravely recites the experiences which he had in
the state of nitrous-oxide-gas intoxication. In that condition he says
he had a 44 tremendously exciting sense of an intense metaphysical
illumination,” the first result of which was 44 to make peal through me
with unutterable power the conviction that Hegelism was true after
all.” To illustrate it he transcribes a few sentences of those which it
seems he dictated in the intoxication under the influence of what he
oddly calls 44 a perfect delirium of theoretic rapture.” We would
seriously advise mental doctors to see to this, for if Prof. James’ ex¬
periments be verifiable, some odd scientific and psychological deduc¬
tions may be drawn. The characteristic feature of this state is the
44 identification of opposites,” and Prof. James thinks something like
it may probably be a chief part of the temptation to alcoholic

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drunkenness also. Here are a few of his transcripts, which will
themselves best illustrate what he means :—

“ Reconciliation of opposites : sober, drunk, all the same !

Good and evil reconciled in a laugh !

It escapes ! It escapes ! But—what escapes ? What escapes ?

Emphasis, mphasis! there must be some emphasis in order for
there to be a phasis.

No verbiage can give it, because the verbiage is other.

Incoherent—coherent—same !

And it fades 1 And it’s infinite ! And it’s infinite !

If it wasn’t going , why should you hold on to it ?

Don’t you see the difference, don’t you see the identity ?

Constantly opposites united ! ”

We would not quote this curious raving, but that Prof. James
vouches for it that it is a fair specimen of the result, not only on him¬
self in repeated experiments, but also on everyone else on whom he
tried it, of inhaling nitrous oxide, if not continued long enough to
produce incipient nausea. Perhaps it is only on a metaphysician that
such an effect is produced; but it would be quite worth trying.

The April number contains a very interesting list of reviews, in¬
cluding an inappreciative notice by Dr. Burns Gibson of Father
Harper’s remarkable volumes on the “ Philosophy of the School¬
men,” two excellent notices of Max Muller’s “ Translation of Kant,”
and of Dr. Hutchison Stirling’s “ Textbook to Kant,” and a short
critique by Mr. Wm. Wallace on Prof. Mayor’s “ Sketch of Ancient
Philosophy from Thales to Cicero.” The notes and discussions are
also well worth attention. Mr. Edmund Gurney gives us a sugges¬
tive paper on “ The Passage from Stimulus to Sensation,” followed
by one on the “ Localization of Brain Functions ” by the Editor, and
one by Mr. James Sully on “ Horwicz’s Study of the Coenaesthesis,” in
the “ Vierteljahrssclirift fur Philosophic,” The last, however, is
really only a summary of points, and our readers would do well to
consult rather the original article, which is of much importance and
ability.

The July “ Mind ” opens, as already noticed, with Prof. Green ;
but it contains besides an unusually long list of specially psycholo¬
gical articles and reviews. Mr. James Sully discourses on “ Versa¬
tility ” at some length, in a chatty but not very profound fashion.
He rightly notices the connection of the faculty and its development
in youth with the problems of the Examination System, but he gives
up the puzzle apparently, and offers no suggestion. The problems of
the examiner’s table are a fruitful subject for students of psychological
medicine, but they are so difficult that most people seem only anxious
to avoid them. Mr. Thomas Davidson, who has revived for English
readers the remarkable philosophy of Rosinini, is well represented ;
for Dr. Burns Gibson contributes an elaborate account of his excellent
xxix. 8

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sketch of Rosmini’s system, and he himself reviews a recent treatise
on natural philosophy by a Jesuit, Fr. Pesch. Mr. Sully sends a too
short notice of Prof. Preyer’s important essay towards a systematic
account of early human mental development—“ die Seele des Kindes.”
This book is the first attempt to combine into a scientific whole the
various studies of children that have poured in upon all philosophical
publications since Darwin and Taine led the way. The knowledge so
accumulated displays, it is true, much inconsistency, and is indeed in
a hundred ways conjectural and hazy. But Dr. Prcydr, with a truly
German and businesslike treatment of his subject, examined, observed
and experimented upon his own baby three times a day at least for
the first three years of its life. The result is a very erudite and
interesting account—first of the development of the senses, then of
the manifestation of will, especially in the way of u expressive move¬
ments,and finally of the growth of the understanding, including
the early history of speech. The discrimination of colours was
tested about the end of the second year, and resulted in clear proof
that the child recognises and distinguishes the colours at the red end
of the spectrum sooner than the other. “Yellow comes first, then
red, lilac, green, and last of all blue.” Mr. Carveth Reed’s review by
no means does justice to Mr. Seth’s able book on “ the Development
from Kant to Hegel.” Neither to our mind does Mr. Grant Allen’s
scanty note sufficiently recognise the importance of M. Ribot’s
“ Her&lit4 Psychologique ”—a book no doubt well known to many of
our readers. Of the Notes and Discussions, which are not very im¬
portant, the best are on Descartes by H. Sidgwick, and on “ Two
Schools of Psychology ” by Mr. W. H. S. Monck, of Dublin.

The October issue is not a bad one, but our readers will find less
than usual relating to their special range of subjects. The editor
prints a very short note of the theory of Dr. C. Yiguier as to the
“ sense of direction ” in connection with the hypothesis as to the
semicircular canals suggested by M. Cyon in an early number of
“ Mind ” (xii.); and he has also a few observations on the meaning
and analysis of motives, in view of the difficulties suggested by
Seth’s work, reviewed at length in the July number. The best
review is that of Mr. Edwin Wallace’s excellent book on the “ Psy¬
chology of Aristotle ” by Thomas Davidson. In truth, the remark¬
able work, truly scientific in its methods, and yet truly metaphysical
in its speculative reach and depth, which Aristotle did in relation to
psychology in almost all its aspects, has never been properly
recognised by modern inquirers. Both the careful review and the
able and scholarly book itself are strorigly to be commended to the
attention of students of mind. The review by Mr. Baynes of Prof.
Lazarus’ collection of monographs on psychological subjects, entitled
“ Das Leben der Seele,” is a slight structure raised on a scanty
basis; but it deals, inter alia, with the history of the theories relating
to the origin of language—still one of the “ opprobria psychologies.”
The summaries of “ New Books ” refer to Sir John Lubbock’s u Ants,

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1883.] ' Psychological Retrospect. 115

Bees, and Wasps/' and Mr. Romanes' " Animal Intelligence” as
“ bringing animal psychology fairly into line with other sciences ” in
the scientific series to which they belong. The papers which form the
bulk of the number are undeniably vague, but Mr. Thoma3 Davidson
has some interesting things to say about “ Perception.” The miscel¬
laneous pages contain obituary notices of Prof. Stanley Jevons and
of Dr. W. G. Ward, the late editor of the u Dublin Review.”

The first number of “ Mind” for the current year is stronger in
reviews than in other matter. Mr. Frederick Pollock reviews his
rival expositor of Spinoza, Dr. Martineau, with great sympathy and
suggestiveness. Mr. Grant Allen deals with a critic of Herbert
Spencer's “ unification of knowledge,” and Dr. Burns Gibson devotes
a long article to a curious anonymous work called “ The Alternative :
a Study of Psychology,” which merits attention by its daring origin¬
ality, if by nothing further. Mr. James Sully also devotes seven
pages and unstinted praise to a young German, Herr G. H. Schneider,
who has new light to throw upon “ the human will from the point of
view of Darwinism.” The radical and far-reaching nature of this
new departure will be indicated by Mr. Sully's remark that “ the
growth of the mind alike in its intellectual, emotional, and volitional
aspect can only be made clear and intelligible by the help of the well-
grounded hypothesis that the history of the individual is in a manner
determined by and a reflexion of the history of the species or rather of
the whole ascending series of species .” Truly, a difficult, if not a rash
investigation, with our present means of knowledge. Amongst the
essays stand an unimportant study by Prof. Bain “ On some Points in
Ethics,” a paper by Prof. Croom Robertson “ On the Distinction
between Psychology and Philosophy,” as to which he is hardly clear,
and the first of a series of criticisms directed by Mr. Sidgwick
against the English Kantians, who have been recently attacking his
own ethical views with vigour and success. This reply is a remark¬
able index of the times ; for Mr. Sidgwick practically confesses to a
sense of the seriousness of the attack made upon the reigning English
school of psychological thought by such men as Profs. Hutcheson
Stirling, Caird, Max Muller, Wallace, Adamson, and Watson. When
the reigning school begins to be on its defence against so powerful an
attack, it is permissible to suspend one’s judgment before accepting
its myriad hypotheses and its tolerably startling new lights, as a work¬
able basis for students in related or collateral lines of inquiry. Mr.
Sidgwick indeed does not seem, at least at the outset, so wholly confi¬
dent as one might expect. It is significant that he quotes, and
italicises, Prof. Wallace’s “ briefer, but yet more solemn phrase —learn
Kant; ” and more than once in the pages that follow, we are inclined
to doubt whether the point of view of the German “ critical” philoso¬
phy as it is taught by its qualified disciples in this country, is even
yet very, clear to the mind of Mr. Sidgwick. And if not to him,
certainly not to many others who still more confidently despise it.

Regarding the “ Revue Philosophique,” we are sorry that the

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116 Psychological Retrospect . [April,

constant pressure on our space has prevented us from doing justice
to so excellent a periodical. But we take this opportunity of at
least summarizing the more important matters contained in it during
the year, many of which have been adverted to in this Journal
from time to time. The January number of 1882 had nothing of
special interest beyond an admirable article by Ch. L4veque on the
44 Psychology of Vocal Music ” in France, but the February number
was important. Besides reviewing the 44 Rivista Sperimentale di
Freniatria ” and the 44 Archivio di Psichiatria,” it contained a sug¬
gestive essay by M. Perez on the faculties of the child at birth and
in early infancy, an analysis of Dr. Mosso’s book on the circulation in
the brain, a notice of Prof. Fraser’s 44 Berkeley,” and of Prof.
Maine's 44 Primitive Institutions,” and a short account of Dr. Paul
Radstock’s brochure on 44 Gewohnung und ihre Wichtigkeit fur die
Erzieliung.”

The interest of the March number lay chiefly in a second essay by
M. L4veque on 44 The Psychology of Musical Instruments,” and in
a review of Pollock’s Spinoza. In April Mr. Gurney’s 44 Power of
Sound ” is highly praised, and there is a weighty criticism of the
psychological method of the school of Wundt by G. S4ailles, fol¬
lowed by the first of a series of articles on the 44 Psychology of Great
Men ” by M. H. Joly. Except some Russian reviews, May was un¬
interesting, but June brought out a sociological essay by M. Espinas,
a note on certain optical illusions of movement, and notices of the
44 Annales Medico-Psychologiques ” of 44 Brain ” and of 44 L’Encd-
phale.” In July, Dr. Viguier’s article already referred to, on 44 le Sens
de l’Orientation et ses Organes chez les animaux et chez l’homme,”
has the first place, M. Joly continues his 44 Psychology of Great
Men,” and the editor studies the will as a power of arrest and
adaptation. There is, also a long and able review of Dr. Charlton
Bastian’s book. August is a less important number, and September
is more of speculative than of psychological interest, except for a note
by M. H4rault on 44 La Memoire de l’intonation.”

The October review contains an important analysis, with plates, of
Prof. Munk’s 44 Functionen der Grosshirnrinde ”—an important con¬
tribution to the literature of localization of brain functions. There is
also a notice of Legoyt’s 44 Suicide Ancien et Moderne,” and of Perez’
work on infant psychology already noticed. In November M. Joly
concluded his 44 Psychology of Great Men,” and M. Espinas his
sociological studies, but the other articles were of less consequence.
The December number was distinguished chiefly by an interesting
study from the pen of M. P. Tannery on the 44 History of the Con¬
cept of the Infinite in the Sixth century b.c.” The Italian periodicals
are summarized, and Lazarus’ 44 Leben der Seele in Monographien ”
is reviewed at length. Much space is also given to a well-written
review of Mr. W. Grahams 44 Creed of Science,” which the French
critic studies in its relation to Mallock’s 44 Is Life worth Living ? ”

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1883.]

117

Psychological Retrospect.

and other systems of the same class. We hope shortly to review at
greater length the numbers of the “ Revue ' J for the present year,
which fully maintain its high average of versatility, interest, and scien¬
tific value.

2. German Retrospect.

By William W. Ireland, Preston Lodge, Prestonpans.

Comparative Size of Crania of Townspeople and Villagers.

Johann Ranke, of Munich (cited in the u Centralblatt fur Nerven-
heilkunde,” 1 Juni, 1882), has studied the relative size of the crania
of the inhabitants of the town and country, upon a hundred males and
a hundred females from villages, and two hundred skulls from the city of
Munich. He finds that, though the size and stature of the country
people are greater, the cranial capacity is less in both sexes. The mean
capacity of 200 skulls of both sexes was

For the town population, 1442 o.o. For the rural population, 1419
Of 100 males, 1323 Of 100 males, 1303

Of 100 females, 1361 Of 100 females 1335

The mean capacity of the maxima most frequently observed in
crania from the rural population was found to be about 50 c. c. less
than the mean maxima of the civic population. In the latter there
were more big skulls, and fewer small skulls, than were observed with
the villagers.

The First Bridging Gyrus in Man and Apes.

Dr. N. Riidinger, as we learn from a notice in the “ Centralblatt
fur Nervenheilkunde,” Nr. 12, 1882, has given special study to the
interparietal fissure and the convolution, called by Gratiolet, premier pli
de- passage superieur externe (gyrus occipitalis primus of Ecker, or
the first bridging gyrus of Turner). This convolution increases in
fulness from the lower monkeys to the primates, and varies in size
and fulness in the human brain perhaps more than any other part of
the cortex. In women it is generally simple and smooth ; but in
men’s brains, especially in those of intellectual persons, this convolution
is more developed, more complicated, and considerably longer.
Through the greater development of this gyrus, the curve of the
interparietal fissure is diminished : it runs in a straight line from
behind forwards.

Another peculiarity of the female brain consists in the weak develop¬
ment of the sulci which go on both sides from the anterior portion of
the interparietal fissure, while these secondary fissures in the brains
of learned men are increased not so much in number as in width.

Nothing characteristic is observed in the brains of murderers and

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118 Psychological Retrospect. [April,

robbers, as regards the interparietal fissure, so as to distinguish them
from the brains of men of low intelligence.

The author explains this difference in the parietal lobe by the
assumption that a higher grade of mental activity has for accompani¬
ment an increase of the surface of the brain. The greatest com¬
plexity of the folds of the parietal lobe is found in men of great
intellectual powers. We must suppose that the cerebral activity which
is exerted by these parts must be of a kind connected with the intel¬
lectual faculties; for were it a motor or sensory function, the
difference in their conformation would not vary according to the
vigour of the intellectual powers.

The Results of Removal of Parts in the Brain of New-Born Rabbits.

Dr. C. Monakow has found that by removing a limited portion of
the brain in new-born rabbits, he can cause atrophy in other parts
(“ Arcbiv.” Band XII., Heft 2 und 3).

He gives the result of his researches as follows :—

1. After, extirpation of circumscribed regions of the cortex in new¬
born rabbits, some tracts dependent upon them become atrophied, and
that without reference to their physiological function.

2. More than one tract stands in connection with particular zones of
the cortex.

3. The single nuclei of the optic thalamus, as well as those of the
corpora geniculata externa and interna, stand in close connection with
definite zones in the cortex cerebri.

4. The corpora geniculata externa and interna are analogous
structures, like the nuclei of the optic thalamus, and should be viewed
as belonging to the latter structure. x

The, Empirical Theory of Vision.

(“ Neurologisches Centralblatt,” 1 Februar, 1882.)

Professor H. Schmidt-Rimpler operated on a boy who had lost his
sight at the age of two years and four months, and who had remained
blind a year. His vision having been previously good, he had learned
to distinguish many surrounding objects. On regaining his sight, it
was found that the child had quite forgotten the appearance of things
and the estimation of distances. He had to feel objects before he
recognised them. After practising for three days, his power of recog¬
nising objects and calculating distances began to improve. The child
now walked without stumbling, but still only recognised a few things,
and was soon wearied with the perplexing effort to adjust his visual to
his tactile impressions. The author declares these observations are in¬
compatible with the views of Herbert Spencer and Dubois-Reymond
on our mental relations to space. If the power of interpreting the
impression of sense is truly not present in the new-born infant, but
grows with the growing mind, as several ideas appear in a certain

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1883.] Psychological Retrospect. 119

time of life, it would be impossible that these faculties once developed
should be altogether lost. One can only unlearn or forget what one
has learned or committed to memory through his own intellectual
exertions.

A New Aesthesimeter.

Dr. Buch, who has been busy for two years at a work on the sensi¬
bility of the skin, has invented a new instrument for measuring the
degree of pressure that may be applied without exciting pain. It is
considered superior to that of Bjornstron, inasmuch as the pressure is
applied directly to the surface, and there is no need to gather up a
fold of skin, which cannot be done on regions where observation is
desirable, such as the scalp, the palm of the hand, the finger, or the
sole of the foot. There is a description of the instrument, with an
engraving, in the “ Centralblatt liir Nervenheilkunde,” 15th August,
1881.

Munk’s Visual Centre •

Dr. Munk (“ Centralblatt fur Nervenheilkunde,” 1 September,
1882) has renewed his experiments on a number of monkeys. He has
extirpated the gyrus angularis in six of these animals without pro¬
ducing hemiopia or amblyopia. Where only a passing hemiopia
resulted from lesion of the occipital lobe, he thinks that too limited a
portion of the cortical matter must have been removed. At first
there would result a more or less observable amount of blindness,
owing not only to the loss of the portion removed, but also to the
injury of the surrounding parts, and the residual deterioration of
vision might easily escape detection. He thinks that, where
hemiopia has resulted from removal of the gyrus angularis, the inflam¬
mation must have extended backwards to the occipital lobes or to the
fibres which connect the occipital lobe with the optic ganglia. He
says that there is a band of fibres running from the occipital lobe
forwards and outwards under the superior corner of the gyrus
angularis, which, if injured, canses hemiopia on both sides.

Munk holds that the lateral half of the visual area is in connection
with the retina of the same side and the mesial or inner half with the
retina of the opposite side, and that the optical meridian of the decus¬
sating and non-decussating portions of the retina runs through the
middle of the macula lutea. On the right of this line the retina is
in connection with the right hemisphere ; on the left side of the line,
with the visual area of the left hemisphere. The side of the retina
which goes to the hemisphere on the same side is much larger in the
monkey than in the dog. After many failures he succeeded in
removing the outer half of the visual area in the left occipital lobe,
and the inner half on the right side, and likewise managed to keep
the monkey alive long enough to note the result. The animal was
almost blind with the left eye, seeing only a very little with the outer
side of the left retina ; but the sight of the right eye was unaffected.

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120 Psychological Retrospect . [April,

In four experiments he removed the lateral half of the convexity of
the occipital lohe, taking the sagital line as the boundary ; and this
in every case produced hemiopia of the eye on the same side without
any injury to the opposite eye.

He concludes, from some experiments, that in the monkey the
portion of the visual centre in functional relation to the macula lutea
extends widely over the convexity of the occipital lobe, and that the
portion corresponding to the fovea centralis lies in the posterior half
of the convexity of the lobe.

Professor Fiirstner, at the meeting of Neurologists in Baden-
Baden, on the 21st May, 1881 (“ Centralblatt,” 1 Sept., 1881),
made a demonstration of the brain and spinal cord of a patient
afflicted with congenital malformation and secondary disease of the
brain and spinal cord. The frontal lohe was much affected, especially
the third convolution. This patient had never been aphasic, hut was
left-handed. The spinal cord was divided into two at the dorsal
region ; higher up into many portions. The patient had worked in
diving-bells, which is supposed to have induced secondary disease.

Professor Fiirstner also gave the result of his experiments on the
influence of lesions of one side of the medulla oblongata upon the
development of the hemispheres in new-born dogs. In opposition to the
results of Munk and Yulpian, he failed to produce in fifteen experi¬
ments any atrophy of the opposite occipital lobes. In ten of these
dogs, however, there was a diminution in size which extended from
the extremity of the occipital lobe to the spot where the second parietal
lobe passes into the gyrus post-frontalis. The diminution was most
marked at this very point. In four dogs there was no difference in
the size of the hemisphere ; in one the diminution in size was on the
same side as the lesion. The examination of the tissues with the
microscope led to no result.

The Auditory Centre.

Dr. Munk, in a communication which he made to the Berlin
Academy of Science (quoted in the “ Centralblatt fur Nervenbeil-
kunde, 1 August, 1881), places the auditory centre in that portion
of the temporal lobe below the visual centre and above the gyrus
hippocampi, always excepting a piece of the fourth outer convolution
near the fissure of Sylvius. After destruction of this area on both
sides there is deafness, and in a few weeks after the dog ceases to
bark or whine, just as it does if the apparatus of both ears is destroyed.
If the auditory centre is extirpated, and the internal ear on the same
side is also destroyed, the animal becomes deaf, and soon dumb. This
shows that the peripheral apparatus of each acoustic nerve is con¬
nected with the brain on the opposite sid^, so that each auditory centre
is exclusively connected with the opposite ear.

Munk has also sought to find out if the different regions of the
auditory centre have the same physiological function. He has arrived

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1883 .]

Psychological Retrospect.

121

at the conclusion that the anterior part of the auditory area is used
for the perception of the high notes, the posterior part for the deeper
tones, and that the usual hearing of the dog is connected with the
under part of the auditory centre.

The Overtasking of Pupils at Schools .

In the “ Zeitschrift,” xxxviii. Band, 2 und 3 Heft., Dr. Snell
brought before the Association of Alienist Physicians of Lower
Saxony and Westphalia the question of,the overtasking of the pupils
of the higher schools. He gave three examples of injury which
scholars had derived from over-exertion. The first of these, a boy
of 17, had suffered from diphtheritis, which made him lose ground
with his class, so that he redoubled his application in order to regain
it. In the end he became sleepless, complained of persecution, and at
last became maniacal, but soon calmed down, though it was above a
year and a half before he could be dismissed as cured. Another lad
had been the dux of the gymnasium. He had no hereditary tendency
to insanity. He was believed to be of only moderate capacity, some¬
what nervous, liable to indigestion, but docile, religious, and very
hard working. He showed heaviness and apathy alternating with
excitement, brooded over his condition, talked with contempt and
hatred of the discipline of the school, and the conceited pedantry of the
teachers, and tried to prevent his younger brothers being subjected to
the same system. Though there were explosions of fury, the general
character of his insanity was towards apathy. There were delusions
and diseased sensations, with the character of persecutions. He was
18 when he became insane. His recovery is not yet recorded.

The third was a boy of 16, also dux at a gymnasium, who had
two aunts with abnormalities of character, but no wise insane. He
had great capacity and emulation. He worked very hard at school,
and at last passed into a condition of maniacal excitement, with
intervals of rest and occasional fits of cataleptic rigidity.

Dr. Snell considers that the mental strength of young people is often
overtasked at the higher schools, and refers for support to the work
of Dr. Petermann, who advocates a thorough reform of the school
system in Germany. The result of the existing system he considered
to be a culture of superficial character with a tendency to over¬
wrought brain, nervous weakness, and sexual irregularities.

Dr. Wahrendorff referred to the overweening importance which
each teacher gave to his own subject, without allowing for the
relative importance of other branches of knowledge. It was men¬
tioned that the subject had been discussed at the International Con¬
gress at Brussels. Complaints of the overburdening of scholars had
come from Sweden, Belgium, France, and England.

Dr. Burghard had found the bad effects of examinations more fre¬
quent with girls than with boys, especially with female teachers at
the higher normal schools. It was proposed by some of the speakers

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122

Psychological Retrospect. [April,

that there should be examinations of the scholars to ascertain whether
they were capable of higher instruction, that is, I suppose, a new and
earlier examination should be added, to ascertain whether the pupils
should be allowed to work for another examination at a later date.
In this case the object would be best attained by excluding the docile
and diligent pupils, and then the duller and lazier ones would not be
compelled to work so hard in the race for competition.

Disorders and Deficiences of Speech in Children.

R. Coen (“ Archiv fiir Kinderheilkunde,” 2 Band, 8 und 9 Heft,
1881, quoted in the 4 * Centralblatt, ,, 15th October, 1881) has studied
110 children of from three to 14 years of age, who were troubled
with disorders of speech. Of these 54 stuttered ; 20 stammered ; 13
had lisping, snorting, or other peculiarities of utterance; 23 were
affected with alalia idiopathica, which he defines as a congenital in¬
capacity to form articulate sounds in contradiction to acquired aphasia.
Of the children so affected, 1 2 were boys, and 11. girls. The youngest
was three years and a half; the oldest ten. They were mostly
healthy, blooming children, presenting no outward visible symptom,
with good hearing, and no trace of paralysis or abnormality of the head
or body. The affection seemed to. be inherited; more rarely it was
due to traumatic or mental influences. Dr. Coen thinks that the
deficiency was due to the incomplete development of the motor centres
of the muscles of the vocal apparatus, or to interruption of the centri-
fugally conducting tracts.

Porencephaly .

In the “ Centralblatt ” (1 Dezember, 1881) there is a review by
Dr. Muller, of Graz, of a monograph by Kundrat on Porencephaly, a
deficiency of the outer wall of the hemisphere which penetrates more or
less deeply, so that in pronounced cases the subarachnoid space com¬
municates with the lateral ventricles. The space is generally filled
with clear serum. Kundrat has collected 32 cases (that of
Mierzejewski mentioned in our Russian Retrospect, 1882, is not given).
To these Kundrat has added twelve of his own. Porencephaly is not
always congenital, but may be caused after birth by a destructive
lesion of the cerebral matter between the ventricles and the surface of
the hemisphere. One example is given in fuller detail. A woman of
sixty-three at her death had be<*n, eighteen years before, suddenly
seized with hemiplegia of the right side and aphasia. There was
some improvement in the condition of the lower extremity ; but the
paralysis of the arm persisted, and there was contraction at the elbow
and the fingers. During the illness there were epileptoid attacks,
which at first returned every four or six weeks, but in course of time
became less frequent. A year after the paralytic attack she began to
learn again to speak like a child. During the last years of her life
she became subject to amnesic aphasia. She died in the hospital of

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1883.] Psychological Retrospect. 123

inflammation of the lungs. On examination it was found that the
cranium was thicker, by from five to six millimetres on the left frontal
region than on the right. There was a deep depression or pit in the
brain substance in the region of the island of Reil, bridged over by
the thickened arachnoid membrane. This cavity was caused by the
destruction or contraction of the extremities of the third frontal, the
median gyri, and the first temporal. The left hemisphere was some¬
what smaller than the right through the flattening of its convexity over
the depression. The nucleus lenticularis and the optic thalamus of
the left side were in great part destroyed ; and there was degeneration
of the left crus cerebri, left side of the pons, the anterior pyramid, and
of the right lateral column of the cord.

Kundrat enumerates four forms of porencephaly in their order of
frequency.

I. Porencephaly through arrested development.

II. Through alterations after the parts have been normally de¬
veloped.

III. Connected with hydrocephalus.

IV. From cicatrization.

The fourth form is very rare. As regards the situation, he finds
eight acquired, and nineteen congenital cases in the parts supplied by
the artery of the Sylvian fissure; four, all congenital, in the region Of
the anterior cerebral artery; and five, two acquired and three con¬
genita], in that of the posterior cerebral. Sixteen of the cases were
males, and twenty-four females. Of eighteen born with porencephaly
only three lived beyond the period of infancy. When the poren¬
cephaly dates from intra-uterine life, the gyri radiate from the depres¬
sion as from the cup of a wheel. While the arachnoid bridges over
the cavity, the pia mater descends to line the walls down to the
ependyma of the ventricles. This malformation seldom supervenes
earlier than the fifth, generally from the sixth or seventh month. In
the acquired form the pit is hollowed out by the destruction of the
substance of the gyri; the pia mater does not cover its walls, which
are formed simply by the altered cerebral substance. The ganglia at
the base of the brain are in many cases stunted in development on the
defective side; in some instances they have entirely disappeared.
There is sometimes want of symmetry in the form or arrest in the
growth of the cranium. The clinical symptoms vary according to the
extent and situation of the deficiency, as well as the period in which
it has been produced. Idiocy, though not a constant sequel of con¬
genital porencephaly, is commonly present, in most cases accompanied
by mutism.

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124

[April,

PART IV.—NOTES AND NEWS.

THE MEDICO-PSYCHOLOGICAL ASSOCIATION.

The usual Quarterly Meeting of the Medico-Psychological Association was
held on Wednesday evening, 21st February, 1883, at Bethlem Hospital, Dr.
Hack Tuke in the Chair. There were also present:—Drs. J. Adam, J. O.
Adams, H. Ashwell, C. Clapham, J. E. M. Finch, H. Gramshaw, C. K. Hitch¬
cock, Victor Horsley, P. Horrocks, W. R. Huggard, 0. Jepson, J. B. Lawford,
H. C. Major, W. J. Mickle, A. W. F. Mickle, G. Mickley, J. H. Paul, J. A. P.
Price, G. N. Pitt, H. Rayner, G. H. Savage, W. J. Seward, H. Sainsbury, D. G.
Thomson, C. M. Tuke, E. S. Willett, W. Wood, R. Wood.

The following gentlemen were elected members of the Association, via.:—

Dr. J. A. Mac Munn, 110, Newtownard’s Road, Belfast.

W. Banks, M.B., The Friends’ Retreat, York.

A. W. T. F. Mickle, M.B. and C.M., Edin., Kirklington, Ripon.

W. Murdoch, M.B., C.M., Kent County Asylum, Banning Heath.

D. Walsh, M.B., C.M„ Kent County Asylum, Banning Heath.

F. J. R. Russell, L.K.Q.C.P., 48, Lupus Street, W.

Dr. Tuke having vacated the chair, it was occupied by Dr. Wood, who
called upon him to read a Paper “ On the Mental Condition in Hypnotism,”
(See Original Articles.)

At the conclusion of the paper, Dr. Tuke remarked that they were very
fortunate in having Dr. Wood now in the chair, as many years ago that
gentleman paid considerable attention to hypnotism—in the time of Dr.
Elliotson, when it bore the name of mesmerism.

Dr. Wood said that many years ago he was clinical clerk to Dr. Elliotson,
when the subject of mesmerism was brought up, and it became his duty to
observe the practical operation of it, and to see a good many very remarkable
cases. The word “ hypnotism ” had not been used then. As a consequence of
what was at that time observed, a leading surgeon at Manchester, Mr. Braid,
investigated the subject, and was the first who proposed to adopt that designa¬
tion. He (Dr. Wood) went to Manchester to see his process, which consisted
in fastening a cork on the forehead, or holding a bright object in front of it,
and requiring the person to look up continually at it till he was hypnotised.
This, undoubtedly, did produce a very remarkable condition, which was per¬
fectly genuine. His (Dr. Wood’s) observation on that process led him to
confirm what Dr. Tuke said as to its nature and effects. It seemed to him
that some portion of the brain was exhausted, and that the consequence of
that exhaustion was the disturbance of the due balance between the two
portions of the brain, resulting in those peculiar symptoms noticed in
hysterical cases. The resulting condition, as far as he saw it, did not go to
anything like the extent which it did in what was usually called mesmerism.
The same principle, however, was involved—the exhaustion, disturbing the
balance of the mind. The personal influence certainly had a great deal to do
with the matter; and, if rightly applied, was very important. Personal
influence was also one of the greatest aids they could possibly have in the
management of the insane. There was, it must be remembered, another side
to the question. If they were really able to produce an abnormal condition,
which for the time so closely resembled insanity, did they not run some risk
of establishing a condition which they might not be entirely able to control,
and a risk, moreover, that the repetition of that condition so produced might
lead to the establishment of a permanently morbid state? The question,
therefore, should be well considered as to how far they should advocate the
use of hypnotism as a remedy; although, certainly, as applied to insane

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Notes and News.

125

1883.]

persons, it was not open to the same objection which might exist in the case
of sane persons. They could hardly substitute anything worse than the
condition existing in insane persons, so that if hypnotism did give them the
means of substituting a new condition, one would be inclined to risk it. In
that sense, at any rate, the subject seemed to come fairly within the province
of the Medico-Psychological Association.

Dr. Savage said it was as well for each of them to say in a few words
what they had thought on the subject. There were very interesting points
about the personality of the mesmerised or hypnotised. How rarely they
met any one who willingly owned to being mesmerised. At present one
might almost as soon belong to the Salvation Army, or the Blue Ribbon
Army, as own this. Were the people who were most readily hypnotised of
a weaker mental character than those not so easily hypnotised? He, for one,
would distinctly say no. It was simply an accident that certain persons
were in the hypnotising relationship to certain others—that there was an in¬
fluence exercised by one person over another—just as one man might have an
influence over a dog which another might not have. Therefore the hypnotic
relationship was not to be considered as one of weakness. A person might
be hypnotised without being a fool. It was a pity, then, that there should be
that kind of dread of the thing. One was constantly struck with the effect
of attention. A person was thinking of something else. His hand would be
shot off. He does not feel it. A person having a sudden shock at a full meal
might afterwards vomit an undigested meal. He would prefer to regard the
condition of hypnotism as one of inhibition of attention rather than ex¬
haustion. At their recent experiments at Bethlem he himself had tried to be
hypnotised, but without success. He longed to know what it was like.
Certainly he exhausted his senses as far as possible, but all in vain. He be¬
lieved rather in the inhibition of the mind—the diversion of the mental force
—rather than in its simple exhaustion. They were, doubtless, in the face of a
new science, and could not explain it fully yet. Years and years ago, it was
said that the savage explains, and the wise man investigates. All they had
hitherto done was to investigate, until some scientific charlatan would arise
and would explain too much. He thought it was possible they might
not hear much more of hypnotism in the sense of finding a satisfactory
explanation for some twenty years. He believed they were not yet in the
position to explain these things, and he regretted that they had not had in
the experiments made at Bethlem some one whom they knew, fall under the
hypnotic influence, so that they. might have seen what honest hypnotism
really was. The unfortunate part of the thing was that everything was
satisfactory on the evening referred to, except the people who fell under the in¬
fluence—they were outsiders. He quite believed they were honest people,
but the fact that the hypnotist succeeded on that occasion upon outsiders,
and did not succeed in hypnotising those who were there, was a misfortune.
He merely said it was a pity that tney could not always get cases such as they
wanted, and such as Dr. Tuke had succeeded in obtaining information from as
to their own feelings when hypnotised. Perhaps when the science had been
more carefully investigated they would be able to show that certain persons
would affect certain others. A point of great importance was whether the
physical state of the hypnotised or hypnotiser affects the power of the
influence. A woman A, subject to nerve storms could influence a person
B when she was in health. Could she do that when she was suffering
from illness? In cases of thought-reading he had heard remarks such as
this:—“I cannot influence so-and-so when I have one of my sick head¬
aches. I have tried to do so, but I could not/’ In another case he had reason
to believe that a certain lady when she was menstruating could not exercise
the same influence which she could at another time. That repetition led to
the facility with which these experiments could be made, he had seen over
and over again. Then there was the medico-legal aspect of the subject.

^Google

126

Notes and News.

[April,

Supposing that hypnotism should become a widely-spread thing, it seemed
to him there was a danger of its being made use of for improper purposes.
As an instrument, for instance, for the fabrication of wills. As far as they
knew it at present it seemed open to such abuses, but when they knew more
about it, they might, perhaps, smile at what they had thought before they
understood it better.

Dr. Hack Tukb, in reply, said that there was very considerable force in
what Dr. Wood had said with regard to the risks incurred in hypnotising. He
had known neurotic cases where it was obvious that frequent repetition was
very undesirable. He thought that Dr. Savage was correct in what he said
as to the cases which might be subject to hypnotism. It was not necessarily
any sign of a weak, nervous, or mental organization; and he might recall the
fact that Mr. Hansen said that he found the best rowers and athletes at the
Universities the most subject to bis process. Then Dr. Savage had said that
he inciined to think that it was not explained by simple exhaustion. The
position which Dr. Savage took really amounted to very much the same thing,
and was in accordance with Laycock and Hugh lings Jackson. What Dr. Savage
said, “ A diversion of the force ” was similar to the position described by Dr.
Jackson. The fact that the higher centres were in abeyance must, he thought,
be admitted, and this was a very important point for consideration in regard
to explaining the phenomena. Dr. Savage’s remarks as to “outsiders”
were much to the point, and he wished that on the evening the experiments
took place they had had a myograph and other instruments which would have
enabled them to determine several doubtful points. As regards the physical
state affecting the influence, there was no question at all. Hansen himself
connected his loss of influence, when it occurred, with the loss of vital power
—what he would call magnetic force power—when he was “ below par. The
case of thought-reading was rather different. In the case Dr. Savage referred
to it was not, he thought* that the lady was trying to influence another person,
but she was trying herself to read his thoughts. In reference to the medico¬
legal aspect of hypnotism, there was the recent case in Paris of a young
man who was taken up on the charge of an outrage upon public decency. He
was sentenced to some imprisonment, but the judgment was reversed on
appeal, in consequence of M. Meenet and M. Motet coming forward and giving
evidence that the man was a somnambulist—in fact, spontaneously hypno¬
tised. They did more; they offered to induce the same condition in the
prisoner as at the time of the alleged misdemeanour, and the President of the
Court permitted them to do so. The experiment succeeded, and the Court
was convinced the man was not responsible.

Dr. Savage read a Paper “ On the Marriage of Neurotic Subjects.” (See
Original Articles.)

Dr. Mickle said that he should be personally disposed, under such circum¬
stances, to restrict marriage more than the author of the paper. The marriage
was so clearly productive of misery and woe to the offspring, that although
the contracting parties might be quite ready to run the risk, they had hardly
the right to entail the suffering upon their progeny. A very important point
was that if a neurotic person married, the choice of the mate might be
judiciously determined by the temperament of the patient. In neurotic per¬
sons they had a diathesis, and be did not think they should choose a diathesis
which would intensify the other ; but a person of the lymphatic temperament
would probably be the best person for the patient to consort with.

Dr. Wood said that when their advice was asked upon the question of the
marriage of neurotic subjects a good many of them would be naturally dis¬
posed to suggest the advice given by “ Punch,” and say “ Don’t! ” but it
would be scarcely doing justice to society if they allowed the fear of a very
possible danger to cause as much misery, jterhaps, by disappointment, as
would be likely to occur from the development of disease in the progeny. It
was a peculiarity of man’s nature that he did not shrink from danger. The

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1883.]

Notes and Nercs.

127

schoolboy did not neglect his games because they were attended by a certain
amount of danger ; and although in the point under consideration there was,
undoubtedly, a serious danger of what might occur, yet on the other hand
there was a danger which was apt to be overlooked which might arise from
the disappointment of those who had made up their minds that they ought to
marry. Moreover, in the majority of cases, although their advice was asked,
it was Very rarely taken. Of course they would all say that a patient who
was at the time insane would be very likely to have a child who would
become insane; but if the causes of the man’s insanity had entirely ceased he
would be as unlikely to have a recurrence of his malady as if he had not had
it at all. A great many of those who have been insane have been so from
causes which have been temporary, and which have been entirely removed,
and may never occur again. If the children born were bom at a period sub¬
sequent to the disease of their progenitor he did not see why the insanity
should be perpetuated. They were all familiar with the expression that genius
was closely allied to madness. To a certain extent that might be true, but
there was a marked difference, and it did not follow that one should degenerate
into the other. A person of very distinguished intelligence might come
through flights of genius to an eccentricity nearly approaching insanity, but
it would be wrong to the State to say that such a person should not marry.
He might marry a wife who had no taint whatever, and the admixture might
produce a child of fine mental power. He thought that if they took pains to
ascertain the whole of the circumstances of the case, and if they were satisfied
that there had been a sufficient interval, and that the history aid not. point to
a continuous hereditary taint, there was no reason why marriage should be
forbidden. It all depended upon how far the recovery had been confirmed,
and how long it had continued.

Hr. Hack Tuxe said that one point of importance, which had been some¬
what overlooked, was whether the wife had passed the child-bearing period.
There were many cases where one could fall in with the proposed marriage of
those who had been insane when there was no chance or probability of a family.
Unfortunately, however, whatever they might decide on the question of mar¬
riages they would not, he feared, prevent the increase of families in the
already married in consequence of the return home of the recovered patients and
those out on trial; and it was a very melancholy aspect of the question that
in proportion to the greater number of recoveries obtained, so there was the
probability of a greater number of cases of insanity through hereditary
transmission. He had been consulted as to whether it would be honourable
or desirable to give up an engagement under such a condition of things as the
following. A youngmedical man had called upon him saying that he had become
engaged to a young lady whoee mother had been insane for many years ; in
fact was of unsound mind when she married, and the young lady herself was
very neurotic and easily excited. The question in these cases had to be
decided whether a man was justified in giving up an engagement, especially
when such a course would very likely induce an attack of insanity in the lady
who is rejected. Again, he knew the case of a gentleman who made an offer
of marriage to a lady. She refused him, and in consequence of that he became
insane. He recovered, and she then accepted him. They married and had a
family, ife was not aware that any had shown mental symptoms. The
wife died, and in consequence of her death he again became insane. He again
recovered, was again married, and had now another family, and was, he
believed, mentally well. In relation to another class of cases—those of great
ovarian irritation and erotic tendencies—a mother would ask, “ Is it not really
most desirable that my daughter should marry ? " In such cases he had no
hesitation in declining to g^ve any encouragement to the idea of such persons
marrying. The husband ought also to be considered.

Hr. Crochlky Clapham—W hat advice did you give to the young man?

Hr. Tuke—I told him that I thought it was a very serious thing to marry,

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Notes and Newt.

128

[April,

and that he would not be acting dishonourably, under the circumstances, in
giving up the engagement (hear, hear).

Owing to the lateness of the hour Dr. Savage replied very briefly, saying
that the paper was meant simply to be a suggestive one. Nearly all the
speakers had quoted facts, and if the facts could only be put together much
good would accrue. He, therefore, hoped that the members would accept his
paper as merely a suggestive one, and nil up the details for themselves.

Correspondence of the Parliamentary and Pensions Committee of
the Medico-Psychological Association with the First Lord
of the Treasury , the Commissioners in Lunacy, and the
President of the Local Government Boards in December ,
1882, and January, 1883.

[The Sab-Committee appointed at the Meeting of the Parliamentary and
Pensions Committee of the Medico-Psychological Association, held in London
on the 29th November, 1882, Bnbmit, for the information of the Members, the
following Correspondence.]

1 .—Letter Addressed by the Chairman of the Parliamentary
and Pensions Committee of the Medico-Psychological Asso¬
ciation to the First Lord of the Treasury .

To the Right Hon. W. E. GLADSTONE, M.P., First Lord
op the Treasury, &c., &c., &c.

Sir,

The Parliamentary Committee of the Medico-Psycholo¬
gical Association desire with reference to the County Government Bill,
one of the measures said to be in preparation for the coming Session,
respectfully to direct your attention to the financial relations existing
since the Parliamentary grant of 1874 between the Government and
the County and Borough Pauper Lunatic Asylums.

Last year this grant from the Treasury for England and Wales
alone towards the maintenance of the lunatics in these asylums
amounted to £418,632. A great opportunity appears to us to occur
in the establishment of County Financial Boards for placing the
expenditure of this grant on a surer and more satisfactory footing.
At present, as you are aware, the Treasury pay 4s. a week to the
several Unions for every pauper lunatic maintained in asylums.

There is a general concurrence of opinion with the Committee of
Visitors and their Medical Officers (as shewn in their several annual
reports to the Quarter Sessions) that the present distribution of this
grant leads directly to a needless increase in the admissions to the
asylums of aged lunatics, harmless imbeciles, chronic cases, and idiot
children, who formerly were and can, with great economy and equal
benefit, be kept under proper arrangements in the workhouse wards.

In their last Report for 1882, the English Commissioners in
Lunacy, in the following remarks confirm the opinion we entertain of

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1883.]

Notes and News .

129

the injury thus done by the present application of the 4s. grant :—

“ In our experience there is now frequently a tendency to send to the
asylum patients who might be sufficiently cared for in workhouses.
We have no doubt, indeed, that the effect of the Parliamentary sub¬
vention of 4s. a week allowed to Boards of Guardians for every insane
patient maintained in an asylum has, in many instances, tended to
promote the removal to asylums, and has prevented the return back
to workhouses from asylums, of patients who could, with slightly
more liberal provision in the way of food and supervision, be adequately
dealt with in workhouses* The rate of maintenance in county asylums
is in many districts so moderate that, deducting the 4s. subvention,
the cost to the Guardians is less than if the insane person were
retained in the workhouse. One of the consequences has been an
increased demand for county asylum accommodation, and an increased
burden on the county rate, though there has been, by means of the
subvention, some relief of local charges as regards the poor rate.”

The yearly increase in this Parliamentary grant of 4s. is startling.
For the financial year 1875-6 it amounted to £337,126, in 1881-2
it rose to £418,632 for England and Wales only. To these figures
have to be added the payments made in 1881-2 to Scotland and
Ireland, viz., £79,711 for Scotland, and £87,250 for Ireland, being a
total of £585,593. In the estimates for 1882-3 there is a further
increase of £8,500 for England, £3,412 for Scotland, and £2,078 for
Ireland on this 4s. grant. Here, then, is a yearly increasing expendi¬
ture of over half a million voted by Parliament under the idea that
thereby relief is given to the landed interest at the cost of the
Imperial Treasury; yet the only result is to increase alike the total
expenditure on the maintenance of pauper lunatics in asylums, and by
increasing their number to compel the counties to incur fresh expendi¬
ture in the enlargement and increase of the county asylums, all of
which expenditure tends directly to increase the county rate.

The total cost of maintenance in the. county asylums paid by the
unions in 1875 was £859,073. In 1881, this sum increased to
£1,033,780. During the same period the yearly admissions into the
county asylums increased from 8,792 to 10,758, and the ratio of the
pauper lunatics in asylums to 10,000 of the population, rose from
13*22 to 16*40, while the total proportion of pauper lunatics to the
population stood at 23*07 and 25*40 in these six years. Thus, while
the total increase of pauper lunacy to the population was only 2*33
per 10,000, the increase in the same period of pauper lunatics main¬
tained in asylums was 318.

In the report of the Scottish Commissioners in Lunacy for 1881
the influence of this grant on the total number of pauper lunatics in
asylums has been very carefully analysed in a statistical study of great
merit. We can here only indicate their conclusions, viz., that the
grant has increased the number of pauper lunatics in asylums and
raised the cost both of maintaining them and providing accommoda-

„ xxix. 9

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180

Notes and News.

[April,

tion for them ; a result identical with that at which, as we have said*
the visitors and medical officers of the county asylums in England
have arrived.

We might greatly extend these remarks, but we think we have
said enough to forcibly direct your attention to the importance of
re-adjusting this grant, so that instead of leading as now to wasteful
expenditure and adding, by the required increase in asylums, to the
county rate, it may be made, as was intended by its author, the
means of relieving the local expenditure on the accommodation and
maintenance of pauper lunatics.

The suggestion we offer for your consideration is that this grant
be paid, not to the several unions, but to the new County Financial
Boards for the payment of certain definite items in the cost of the
provision and maintenance of pauper lunatics in the county asylums.
We propose that the salaries and wages should be the first charge on
this fund, and which, being part of the maintenance cost, would be a
direct relief to the unions of about 2s. 3d. a week per patient. The
next charge on this grant should be the pensions which now fall on
the county rate, and may be put at 9d. The remainder, Is., should
be applied to the repairs and enlargement of the fabric, also a county
rate charge. This rate does not average more than the Is. to be
thus applied. On this scheme the Unions would benefit to the amount
of the salaries and wages, and the average maintenance charge in the
county asylums would be reduced from 9s. 6d. to 7s. 3d. (See
appendix B.) The temptation to remove incurable lunatics from the
workhouse wards to the asylums would be removed owing to the
continued higher rate of maintenance in the county asylums, while
yet a marked reduction of the weekly charge would be made to the
Unions. The county rate, again, which really represents the landed
interest which this grant was intended chiefly to relieve, would gain
the amount now charged against it for pensions and repairs of the
fabric; and, what would still be a greater saving, the yearly cost of
increasing the asylums and providing others to meet the present
influx of chronic lunatics from the workhouses would cease.

Should this principle of the application of the 4s. grant to these
items of expenditure be accepted by you, the opportunity is then
given of placing the superannuation allowances granted by statute to
the officers and servants of the county and borough asylums on a
more stable and satisfactory footing than they are at present. We
have suggested that these be made the second charge on the 4s. grant,
and said that 9d. would amply meet all demands in the county rate
for this item.

The lvii. section of “ The Lunatic Asylums Act, 1853,” and
section xii. of “ The Lunacy Acts Amendment Act, 1862,” provide
that the Committee of Visitors may, if in their discretion they think
fit to do so, recommend to the Quarter Sessions for a retiring
pension not exceeding two-thirds of the salary and allowances payable
at the time of retirement, any officer or servant of fifteen years’

Digitized by v^ooQle

Notes and News .

131

1883.]

service, and not less than fifty years of age. In practice, this
clause has led to very variable results. Some Quarter Sessions, as
the Surrey this year, have granted the full allowance after fifteen
years’ service and fifty years of age. In others the question has
been differently viewed, and great uncertainty prevails in the minds
of the officers of these asylums as to their prospective pensions.
We venture to suggest that this is the occasion to revise the
conditions of asylum pensions. It may on the one hand be
admitted that under the present statutes the service required is too
short, fifteen years, and the age at which pensions may be granted
too low, fifty—both of which conditions, doubtless, have been the
cause of the difficulties and differences in the application of the
pension clauses which have hitherto prevailed at Quarter Sessions.
On the other hand, the officers of these asylums feel very deeply
the uncertainty of permissive pensions granted only at the pleasure
of the Quarter Sessions, and they feel that the same or even greater
uncertainty will attend the future of their pensions should they be
left at the control of the County Financial Boards.

In their perplexity they turn to the provisions made by Parlia¬
ment for the superannuation of the civil servants under “ The
Superannuation Act, 1859,” and they desire respectfully to urge on
your consideration the justice and expediency of placing the officers
and servants of the county and borough asylums on an equality
with the other civil servants of the State. They are ready to waive
the claims they now have to a pension of two-thirds of their salaries
and allowances after fifteen years’ service and fifty years of age, and to
accept the requirements of that statute as set out in sections n. and iv.

The Bill introduced by your Government last Session, “The
Police Act, 1882,” had for its object to assure the right of constables
to pensions after a fixed period of service. The officers of county
and borough asylums ask a similar gift at your hands, and desire to
be placed like other civil servants under “ The Superannuation Act,
1859,” with the allowances and safeguards contained in its pro¬
visions. If our suggested re-adjustment of the 4s. grant meets with
your approval, the 9d. appropriated to the relief of the county rate,
for the payment of these pensions, appears to us to justify their being
placed under the Treasury regulations, as provided in “ The Super¬
annuation Act, 1859,” the provisions of which we regard in the
assurance of an equitable superannuation allowance as just and fair
alike to the State and to its civil servants, and which, for the officers
and servants of the county and borough lunatic asylums, we should
thankfully accept at your hands.

I have the honour.to be, Sir,

Your most obedient, humble servant,

(Signed) C. LOCKHART ROBERTSON, M.D.

Chairman of the Parliamentary and Pensions
Committee of the Medico-Psychological Association.

London, December 20, 1882.

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132

Notes and News.

[April,

2.— Letter from the First Lord of the Treasury to the Honorary
Secretary of the Medico-Psychological Association .

10, Downing Street, .Whitehall,

23rd December, 1882.

Sir,

I am directed by Mr. Gladstone to acknowledge the
receipt of your letter in which you do him the honour to forward to
him a communication from the Medico-Psychological Association in
connection with the maintenance of Pauper Lunatics, and to inform
you that he will not fail to bring it under the attention of the proper
authorities of the Government.

I am, Sir,

Your obedient Servant,

(Signed) HORACE SEYMOUR.

Henry Rayner, Esq., M.D.

3.— Letter from the Honorary Secretary of the Medico-
Psychological Association to the Secretary of the Com¬
missioners in Lunacy .

County Asylum, Hanwell,

g iR 20th December, 1882.

I am desired by the Parliamentary Committee of the
Medico-Psychological Association to send herewith for the information
of the Commissioners in Lunacy a copy of a letter which they
forwarded on the 20th inst. to the Prime Minister.

The Committee feel assured of the interest the Commissioners
already take in securing to the Officers of County and Boro’ Asylums
a due consideration of their claims for pension, and they now send
this copy of their present letter in order to inform the Commissioners
of their wishes and suggestions in this matter, one alike to them and
to the due administration of the County Asylums of so vital import¬
ance.

The Committee trust that should the occasion offer, the Com¬
missioners will, if they see an opportunity, support these proposals of
the Association.

I am, Sir,

Your obedient Servant,

(Signed) HENRY RAYNER, M.D.

Honorary Secretary of the

Mecfico-Psychological Association.
Charles Spencer Percival, Esq.,

Secretary to the

Commissioners in Lunacy.

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1883.]

Notes and News.

133

4. —Letter from the Secretary of the Commissioners in Lunacy

to the Honorary Secretary of the Medico-Psychological

Association .

Office of Commissioners in Lunacy,

19, Whitehall Place, S.W.,

January 9th, 1883.

Sir,

I am directed by the Commissioners in Lunacy to ac¬
knowledge with thanks the receipt of your letter of 20th December with
copy of a communication addressed to the Prime Minister; and to
say that should an opportunity offer they will gladly do what they can
to promote the object of placing the pensions of the Medical Officers
of County and Borough Asylums upon a more certain and satisfactory
basis.

I am, Sir,

Your obedient Servant,

CHAS. SP. PERCIVAL,

Henry Rayner, M.D., Secretary.

Hon. Secretary of the

Medico-Psychological Association.

Copies of this letter have also been sent to the Rt. Hon. Sir
Charles Dilke, M.P., President of the Local Government Board, and to
the Right Honorable H. C. E. Childers, M.P., now Chancellor of
the Exchequer.

5. —Letter from the Chancellor of the Exchequer to the Honorary

Secretary of the Medico-Psychological Association.

11, Downing Street, Whitehall,

1 February, 1883.

Sir,

I have to acknowledge your letter to the Chancellor of the'
Exchequer, enclosing, by desire of the Parliamentary Committee of
the Medico-Psychological Association, a copy of a letter addressed to
Mr. Gladstone in December last, with reference to the financial rela¬
tions existing, since the Parliamentary grant of 1874, between the
Government and the County and Borough Pauper Lunatic Asylums.

Your Committee may feel assured that the circumstances to which
they drew attention, and their suggestions, will receive the careful con¬
sideration of the Chancellor of the Exchequer.

I remain, Sir,

Your obedient Servant,

J. M. CARMICHAEL.

Henry Rayner, Esq., M.D.,

Honorary Secretary,

Medico-Psychological Association.

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134

Notes and News.

[April,

Appendix A.

Table showing the Sums paid from the Consolidated Fund for the
Maintenance of Pauper Lunatics 1875-82 (Eight Years).

Tubs.

ENGLAND AHD

Wales.

Bcotlakd.

Ireland.

Total.

1875

337,126

59,483

69,948

466,557

1876

339,113

62,637

77,907

479,658

1877

380,593

65,470

80,380

426,443

1878

379,968

68,533

82,053

530,556

1879

394,483

71,272

84,810

550,566

1880

406,047

73,833

85,841

,565,722

1881

418,632

76,856

87,250

582,738

Estimate for
1882

433,500 (estimate)

80,000 (estimate)

90,000 (estimate)

603,500 (estimate)

Note.— In addition to these totals, £164,772 6s. Od. was paid to the Unions in
England and Wales for the half-year ending September, 1874. For Ireland, £55,692 was
voted in 1874; but not being expended, was repaid to the Exchequer.

Appendix B.

Table showing the Average Weekly Expenditure in the County Lunatic
Asylums from the Union and County Pates respectively with the
Proposed Readjustment of the same by the me of the 4 s. Grant .

Weekly

Amount.

Reduction
by re-adjust¬
ment of
4s. grant.

Remaining
Charge to
Union Main¬
tenance Rate

Remaining
Charge to
County Rate

Remarks.

1. —Charged to Union Mainten¬
ance Rate —

Salaries and Wages .

Provisions.

Clothing.

2s. 3d.

4s. 6d.

8d.

Is. Od.

2d.

lid.

2s. 3d.

none.

4s. 6d.

8d.

Is. Od.

2d.

lid.

By the payment of the
4s. grant to the County
Financial Boards, and
by the re-adjustinent
of the expenditure
suggested by the
Medico - Psychological
Association, the aver¬
age Union Mainten¬
ance Rate of the
County Lunatic Asy¬
lums would be reduced
from 9s. 8d. to 7s. 3d.,
while the charge on
the County Rate for
superannuation and
repairs would be en¬
tirely paid ; a definite
and ‘ immediate relief
to the landed interest.

House Necessaries, Fuel, ^
Light, Washing, &c.i

Medicine, Wine, Spirits, &c. ...

Furniture, Bedding, Ac.

Total Union Maintenance Rate...

9s. 6d.

2s. 3d.

7s. 3d.

2. —Charged to County Rate—

Superannuation Allowances ...

Repairs, &c., of Fabric.

9d.

Is. Od.

9d.

Is. Od.

none.

Total Charge on County Rate.

Is. 9d.

...

none.

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1883.]

Notes and News .

135

PROPOSED REPRINT OF SCOT’S “DISCOVERIE OF WITCHCRAFT.”

[We gladly draw attention to this proposed reprint, and heartily wish it
success. The facts speak for themselves. Those who are willing to assist
Dr. Nicholson’s praiseworthy object, will most effectually do so by requesting
him to add their names to the list of subscribers.— Eds.J •

Reginald Scot, the author of the “ Discoverie of Witchcraft,” first pub¬
lished in 1584, was on this subject over a hundred years in advance of his
age ; the first contender against the reality of witchcraft in England, and,
Wierus being the first, the second in Europe. His book is also of interest,
because, in confuting the opinions of his day, he necessarily gives them.
Thirdly, he was greatly read at the time. Among others by Shakespeare,
Middleton, King James, and S. Harsnet, afterwards Archbishop of York.
That Shakespeare read it is, I think, shown by at least two passages; and
James’ Demonology was brought forth against—“ the damnable opinions of
two, principally in our age, whereof the one called Scot, an Englishman, is
not ashamed in publicke print to denie, that there can be such a thing as
Witchcraft: and so maintains the old errour of the Sadducees in denying of
spirits. [An odd allegation against one whose tractate, ‘A Discourse of
Divils and Spirits,’ was printed as a part of his * Witchcraft,’ and with a con¬
tinuous pagination.] The other called Wierus a German.”

From these causes and from its rarity, I would assay the reprinting of it.
But a book then in advance of its age may, by most, be considered behind
ours, and few are interested in old world wizardry, any more—perhaps less—
than in the Hieroglyphics of Egypt, though not a few are in the so-called
Spiritualism,.the modern re-development of witchdom. This being the case,
and my own means unable to risk a republication, I therefore—though
opposed as a rule to limited issues—must restrict myself to the number of my
subscribers, fixing my minimum at 100, and making it a necessary condition,
that the book be paid for on delivery.

If possible the reprint will be from the first edition, but this—indeed all—
are so scarce, that I have as yet failed to obtain even the loan of a copy.
From personal collation I can however testify, that the first (1584) and

second (1654) editions are identical, beyond such differences as - ly for

- lie , and the like. Indeed, the errata noted on a blank space in the first

have been, as a rule, corrected in the second. It is worth noting also that the
first edition was the only one that appeared during the author’s lifetime.
Whichever be used, the reprint will be thoroughly collated with both, and
will be a faithful copy. Copies of the very full but differing title pages of
both will be given, and the specimen pages opposite may be taken as a
sample of the type, size of page, width of margins, and paper that will be
employed, the last named being the “toned paper” adopted by Ruskin. Any
subscriber can, however, have white hand-made, for its actual difference in
price; though, in my opinion, printing on ribbed paper is as unpleasant to
the eye as print on the rippling of a stony brook. Glossarial notes as well as
a few others will be added. Exclusive of these, the number of pages will be,
so far as I can judge, rather over 570, those in the second edition being 441.
The copies will be issued in a stout paper wrapper, that each may bind his
according to his own taste. The price, should there not be more than 100
subscribers, will not exceed £2 2s., it not being my intention to seek for more
than a slight recompence for my time and trouble. A larger list of sub¬
scribers will therefore diminish the cost of each copy.

Should this reprint meet with success, I would also gladly reprint James I.’s
small counter-work, 84 pages, in the 1603 edition—consulted by Shakespeare
before writing his Macbeth—collating the editions from 1597 to that of the'
Bishop of Winton’s in 1616. But at present I only mention this.

Bbinsley Nicholson, M.D.,

306, Goldhawk Road, Shepherd’s Bush, London, W.

P.S.—The editions of 1665 and 1695 contain some additional curious
matter by other hands. These will be inserted in their places.

Digitized by ^.ooQie

136

Notes and Nens.

[April,

Obituary .

FRANCIS KJER FOX, M.D.

Our obituary this quarter comprises members of the Association in the
prime of life, for whom a much longer career might have been reasonably
anticipated. In the death of Dr. Fox, however, on the 7th of January, at the
age of 78, we have to record the removal of one who might have years ago
retired from active life, and felt justly entitled to enjoy a well earned and
honourable repose.

Dr. Francis Ker Fox, the son of Edward Long Fox, the founder in 1806 of
Brislington House Asylum, near Bristol, has for nearly sixty years been
identified with that establishment, first as assistant to his father, and after
the death of Dr. E. L. Fox, in 1835, as the senior partner with his brother, the
late Dr. Charles Joseph Fox. The latter retired in 1867, when Dr. Francis Fox
was joined by his son, Dr. Charles Henry Fox.

Dr. Fox studied in Edinburgh, Paris, and Gottingen, and was a graduate of
Cambridge University. He was one of the earliest to recognise the merits of
the non-restraint system, which he carried out consistently.

Dr. Fox was an eminently practical man. He was not a writer, and never
contributed an article to this Journal. This is to be regretted, for one who
had so long an experience, and so successful a practice, must have had much
to say which would have been of the greatest interest and value to alienist
physicians.

Dr. Fox was twice married: first to Janet, the daughter of the Rev.
John Simpson, formerly Yica/of Congresbury, and afterwards of Keynsham,
by whom he had several sons and daughters, amongst them being Dr. Edward
Long Fox, of Clifton, Mr. Francis F. Fox, and Dr. Charles H. Fox; and,
secondly, to Mary Bradley, the sister of the present Dean of Westminster, by
whom he had several sons, including Dr. B. B. Fox, who has for several years
assisted in carrying on tbe asylum, and is now a partner. As a local paper
justly says, “ Dr. Fox was a man of most urbane manners and great kind¬
ness of heart, and hie death will be much regretted by the inhabitants of
Brislington, by whom he, with the other members of the family, were highly
esteemed.” He will also be mourned by a much wider circle of friends.

HENRY CLIFFORD GILL, M.R.C.S.

Mr. Gill, born in 1846, entered as a medical student at University College in
1863, after having passed the matriculation examination of the London Uni¬
versity. He distinguished himself during his college career by obtaining the
gold medal in the class of medicine, and after holding the appointment of house
physician at University College Hospital, he became a clinical assistant at the
Brompton Consumption Hospital. Accident rather than inclination led him
into the branch of the profession he subsequently pursued, and after six months*
study at Bethlem Hospital, he went to the asylum at Nottingham from whence,
in 1869, he passed to the North Riding Asylum at York, as assistant superin¬
tendent, remaining there until 1874, when he succeeded to the sole charge of the
York Lunatic Hospital, Bootham, within the walls of which he succumbed on
Monday, the 12th February, to an attack of pleuro-pneumonia. In the course of
his brief career, he shaped his conduct by an unflinching sense of duty, and
spared no pains in carrying out his work. No slight share of the success of the
jubilee meeting of the British Association at York was due to his energy and
intelligence as secretary of the Museum Committee, in the discharge of which
office he had much responsible labour in acquiring and arranging the interesting
exhibits which went far to make the meeting memorable. His path necessarily
restricted the circle of his professional acquaintance, but as a member of the
Medico-Psychological Society, he regularly attended its meetings; and he also took
an active share in the proceedings of the York Medical Society, the members of

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1883.]

which ancient" body honoured him by electing him their President last year.
Several of his papers read before them deserved much wider audience. By his
few intimate friends, Mr. Gill was regarded with feelings of more than ordinary
admiration, for he possessed an intellect of no common order. The most divers
forms of scientific inquiry successively attracted him, and he did not cease until
he had mastered, at least, their principles. Those who knew him well will miss
a good friend, from whom much was to be learned, and many a germ for future
thought obtained.—British Medical Journal .

We may add that Mr. GilTs communications to the work of liis own special
department were'not numerous; but one on Hyoscyamine in the treatment of
the insane was much appreciated, and the last number of the Journal contains
an interesting record by him of insanity in twins. Ten years ago, when a
fresh impetus was given to the investigation of the brain in the insane, Mr. Gill
threw himself with ardour into the inquiry, and prepared a large number of
microscopic sections, many of which are unsurpassed to the present day.

GEORGE MACKENZIE BACON, M.A., M.D.

The unsparing hand of death has suddenly deprived our specialty of one of
its most valued members. Dr. Bacon, the Superintendent of the Cambridge¬
shire Asylum, succumbed on February 22nd to an attack of peritonitis, com¬
plicated with congestion of the lungs and kidneys.

His acute illness lasted only three days, though he had not been in his usual
health for several weeks.

Having passed through his medical course at Guy’s Hospital, and become
a member of the College of Surgeons in 1858, Dr. Bacon joined the Lunacy
Branch of the Profession as Assistant Medical Officer of the Norwich County
Asylum in 1861.

From thence he was appointed, in 1864, Deputy Superintendent at the
Cambridgeshire Asylum at Fulboum, during the illness of Dr. Lawrence; and
he graduated at St. Andrew’s, the same year. After two years Dr. Lawrence
died and Dr. Bacon succeeded him.

For 15 years he carried on the arduous and Irying duties of the asylum
without any Assistant, and it was only two years ago that he succeeded in
getting an Assistant appointed.

During his period of office Dr. Bacon effected numerous alterations and
improvements m his asylum, so that it was made more healthy, commodious,
and cheerful, and it will now bear favourable comparison with the majority
of English Asylums. The numbers increased under his superintendency from
about 200 to 376.

Dr. Bacon was a clever alienist and a shrewd physician. He was also well-
read in many scientific subjects, being an antiquary, a numismatist, botanist,
and analytical chemist.

He was Secretary to the Cambridge Medical Society, at whose meetings he
was a regular attendant and frequent contributor.

His contributions to Psychology and General Medicine were numerous;
amongst them may be mentioned “The Handwriting of the Insane,”
“Crime arid Insanity,” “ Lunacy in Italy,” “ On Athetosis,” “On Epilepsy,”
and on “ General Paralysis,” besides many accounts of cases, mental, medical,
and surgical.

He for a long time delivered Clinical Lectures at his asylum gratuitously
and spontaneously, in acknowledgment of which the University of Cambridge
conferred upon him in 1877 the honorary degree of M.A.

His sudden death came as a great shock to all who knew him.

At the asylum, where he spent so many years of his life, and where he was
universally admired and esteemed, the blow has been very much felt. His
funeral, which took place at Cherryhinton, near his asylum, was very largely

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Notes and News.

[April,

attended by bis relatives, many medical friends, and the majority of the
asylum staff.

Dr. Bacon was a man of solid ability, and sound judgment; amiable,
hospitable, and generous to a fault. He was rather reserved and diffident,
and the real amount of his work and his kind actions are known only by a
few besides those he befriended and helped.

Dr. Bacon always took a lively interest in the welfare of our Association,
and contributed numerous valuable papers to its Journal. He also often
rendered assistance in an unobtrusive manner, without his name appearing,
by forwarding to the Editors anything he had observed in the public prints
which he thought should find a place or be commented on in our pages. In
the capacity of one of the Secretaries at the Psychological Section of the
British Medical Association, when it met at Cambridge in 1880, Dr. Bacon
was untiring in his efforts to make the meeting a success, and read a
valuable paper himself which led to a very interesting discussion. He also
entertained members of the Section in the most hospitable manner, and
placed his time entirely at their disposal.

Correspondence .

To the Editors of The Journal op Mental Science,

Gentlemen, —My remarks on the subject of “ punishment ” in the January
number of the Journal seem to have given rise to impressions quite different
from what was intended by me. In offering an explanation of what I said
on this subject, I wish it to be understood that 1 disclaim all intention of
having represented either the views or the practice of Scotch asylum super¬
intendents. While industrial occupation is held to be of paramount
importance in the treatment of the insane, the general opinion in Scotland is
strongly averse to the employment of coercive measures to induce patients to
work. With most cases there is no difficulty experienced, but exceptional
cases do sometimes occur where able-bodied and intelligent patients refuse
to work, and expend their superfluous energies in stirring up strife and
abusing their neighbours. These are the cases in which I recommended
some form of punishment, or (to use a less objectionable although
synonymous term) coercion, as being calculated to improve their self-control
and insure peace and quietness to the other patients. For such purpose I
consider hyoscyamine well adapted, for it not only restrains tempo¬
rarily, but in the case of wilfully vicious patients it has the effect of
preventing subsequent outbreaks of excitement. This result I do not attri¬
bute to any real medicinal value; the disagreeable physiological effects of
the drug are sufficient to explain it, just as a sufficient explanation of the
action of assafoetida in hysteria is afforded by its disagreeable, nauseous taste
without necessitating any elaborate inquiry into recondite medicinal pro¬
perties. In the one case patients are frightened, and in the other disgusted ,
into exercising their powers of self-control.

These views are the basis on which I have suggested various coercive
measures to insure universal industiy among patients not unfit for work from
either mental or bodily causes. Of course a lunatic asylum is not a place
in which such measures can properly be practised, and it is almost needless
to say that they are not practised m this or, so far as I am aware, in any
other asylum. My suggestions were thrown out as indicating what I
consider would be a rational mode of treatment in certain cases, and as
pointing to the absence of institutions midway between lunatic asylums and
houses of correction, in which the more vicious of lunatics and the more
insane of criminals might with advantage be placed.

I am, &c.,

Midlothian Asylum, ROBERT W. D. CAMERON, M.D.

February, 1883.

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139

INDEX MEDICO-PSYCHOLOGICUS.

JOURNALS BEARING ON PSYCHOLOGY.

English.

The Journal of Mental Science. Quarterly.

The Journal of Psychological Medicine. Semi-Annual
Brain. A Journal of Neurology. Quarterly.

Mind. A Quarterly Review of Psychology and Philosophy. London.

British Guiana.

The Asylum Journal. Berbice Monthly.

American.

The Alienist and Neurologist. St. Louis, Miss.

The American Journal of Insanity. Utica, N.Y. Quarterly.

The Journal of Nervous and Mental Diseases. New York. Quarterly.

French.

Archives de Neurologie. Paris. Quarterly.

L’Encephale. Paris. Quarterly.

Annales Medico- Psychologiques. Paris. Bi-Monthly.

Revue Philosophique. Paris. Monthly.

Belgian.

Bulletin de la Soci6td de Medicine Men tale de Belgique. Gand. Quarterly.

German.

Archiv fur Psychiatrie u. Nervenkrankheiten. Berlin. Irregular.

Allgemeine Zeitschrift fur Psychiatrie, etc. Berlin. Irregular.

Centralblatt fur Nervenheilkunde, etc. Leipzig. Fortnightly.

Der Irrenfreund. Heilbronn. Monthly.

Neurologisches Centralblatt. Berlin.

AUSTRIAN.

Jahrbuch fur Psychiatrie. Wien.

Italian.

Rivista Sperimentale di Freniatria e di Medicina Legale in Relazione, etc.
Regio-Emilia. Quarterly.

Archivio Italiano per le Malattie Nervose e per le Alienazioni Mental)*. Milano.
Bi-Monthly.

Archivio di Psichiatria, Scienze Penali ed Antropologia Criminate. Torino.
ARTICLES IN JOURNALS

See Index in Journal of Mental Science , January , 1882, page 638.
ALTERNATING INSANITY—

De l’asphyxie locale des extremities dans la p^riode de depression de la folie d
double foi'me. Dr. Ant.* Ritti. Ann. M6d r Psych., Juilliet, 1882, p. 36.

Note sur la folie a double forme, etc. - Dr. Doutrebente. Ann. M6d. Psych.,
Mars, 1882, p. 192.

Folie a double forme et paralysie g6n£rale. L'Enc^phale, No. 4,1882, p. 684.

Note sur la folie a double forme. Paris, 1882, 8vo, par M. Doutrebent.
ATROPINE as a sedative. J. R. Gasquet, M.B. Journ. of Ment. Science, April,

1882, p. 61.

ALIENISM (Data of) by Charles Mercier, M.B., Journal of Mental Science, Oct.,
1882.

ACUTE DISEASES—

Ueber den Einfluss acuter Krankheiten auf die Entstehung von Geisteskrank-
heiten. Dr. E. Krapelin. Arch. f. Psych., xii.,p. 65 • 2, p. 287.

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Notes and Newt.

[April,

ASTHENIA OF BRAIN—

Ueber Asthenie deg Gehirns. Dr. Julias Althaus. Erlenmoyer’s Centralblatt
etc., 1882, p. 153 ; p. 177.

BKAIN WEIGHT—

Untersuchungen iiber dag Gewicht des mengcblicbea Gehims, etc. Dr. Pfleger.

Jarbb. f. Psych., 1881., iii., 1 Sc 2, p. 77.

BROADMOOR CRIMINAL LUNATIC ASYLUM—

Dr. A. Motet Ann. M6d. Psycb., Not., 1881, p. 411.

CATALEPSY—

Bin Mittel “ Katalepsie w zu erzeugen. Dr. Geo. Riobter. Erlenmeyer’s Cen¬
tralblatt, 1881, p 290.

CEREBRAL STRUCTURES. Examination of—

Methods of preparing, examining, etc., cerebral structures in health and disease.

Dr. Bevan Lewis in Brain, part xvii.,Ap., J8*2, p. 74.

CEREBRAL ANATOMY. (Development of Hemispheres)—

Weitere Mittheilung iiber den Eintiuss einseitiger Bulbuszerstorung auf die
Entwicklung der Hirnhemispbaren. Prof. Fiirstner. Arch. f. Psych., xii.,
13, p. 535.

CEREBRAL ANATOMY—

Mittheilung fiber durch Extirpation circumscripter Himrindenregionen bedingte
Entwicklungshemmungen des Eaninchengebims. Dr. y. Monakow. Arch,
f. Psych., xii., i., p. 141 ; xii, 8, p. 535.

CEREBRAL ANATOMY and Pathology —

Casuistische Beitrage zur Localisation der Gehimfunctionen. Dr. Enecht.

Arch, f. Psych., xii., 2, p. 480.

CEREBRAL ANATOMY and Physiology —

Die cerebralen und cerebellaren Yerbindungen des 3-9 Hirnnervenpaares. Die
spinalen Wurzeln der cerebralen Sinnesnerven. Dr. C. F. W. Roller. Allg.
Zeitsch. f. Psych., xxxviii., p. 238.

CEREBRO-SPINAL LOCALIZATION—Destructive lesions of encephalon.
Disease of Cord. Dr. W. J. Mickle. Journ. of Meat. Science, April, 1882, p. 65.
CEREBRAL PATHOLOGY. (Separation of Grey and White Matter)—

Note sur une alteration du oerveau caract£ris£e par la separation de la substance
grise et de la substance blanche des circonvolutions. Dr. Baillarger. Ann.
Med. Psych., Janv., 1882, p. 19.

CEREBRAL PATHOLOGY. (Diseases of Central Nervous System)—

Zur Casuistik der Erkrankungen des Centralnervensystems. Dr. Claus. Arch,
f. Psych., xii., 3, p. 669.

CEREBRAL PATHOLOGY, (Cerebellum, Atrophy and Sclerosis of)—

Ueber Atrophie und Sklerose des Kleinhirns. Dr. Kirehhoff Arch. f.
Psych, xii., 3, p. 647.

CEREBRAL PATHOLOGY (Tuberculosis)—

Drei Falle von Tuberkelgeschwiilsten in Mittel und Nachhirn. Prof. O.

Heubner. Arch. f. Psych., xii., 31. p. 586.

CEREBRAL PATHOLOGY. (Disturbances of Sensibility, etc., in the lesions
of the meninges)—

Beitrag zur Lehre von den Storungen der Sensibilitat und des SehvermOgens
x bei Lasionen des Hirnmantels. Prof. Bernhardt. Arch. f. Psych, xii. B.,

p. 780.

CHOREA AND INSANITY—

Two cases of insanity associated with chorea. Dr. Joseph Wiglesworth. Journ.
of Ment. Science. April, 1882, p. 56.

CHOREA, WITH MACROCEPHALY. Macrocfcphalie avec chorSe. Par. M.

Chambard. L’Encdphale, No. 2, 1882, p. 279.

CLASSIFICATION OF INSANITY. Par M. Delasiauve. Archives de Neu-
rologie. Juillet, 1882, p. 1.

COMPLAINTS BY INSANE PATIENTS. Dr. J. A Campbell Journ. of Ment.
Science, Oct., 1881, p. 342.

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1883.]

COLONIES FOR THE INSANE—

Studien liber Irrencolouien. Dr. Flamm. Jahrb. f. Tsych., 1881, iii., 1 & 2,

p. 120.

CRIMINAL LUNATICS’ BRAIN. By Dr. Ferrier. Brain, part xvii., Ap.,
1882/page 62.

CRETINISM—

Le Cretin des Batignolles. Par Prof. Ball. L’Encdphale, 1882, No. 2, p. 233.
DECORATION AND FURNISHING OF ASYLUMS. Dr. A. R. Urquhart.

Journ. of Ment. Science, July, 1882, p. 167.

DELIRIUM (Acute)—

Ddlire Aigu. By M. Magnan. ProgresMed., 1881, vi., 407.

Delire Aigu. By MM. Ball et Chambard. DioL Enoycl. d. Sc. M4d., 1881, i.,
b. xxvi., 408-34.

DELIRIUM (Intermittent)—

Contribution a l’4tude du d61ire intermittent. Dr. Tagne. Ann. M4d. Psych.,
Mars, 1882, p. 208.

DELUSIONAL INSANITY—

Ueber die Verriicktheit. Dr. Jung. Allg. Zeitsch., f. Psych., xxxviii., p. 661.
DEMENTIA (Acute)—

Dementia acuta und Stupor (und verwandte Zustande). Dr. Schiile. Allg.
Zeitsch., f. Psych., xxxviii., p. 265.

DEMENTIA (Acute). A. D. in an old man with recovery. By Dr. Hughes.
Alienist and Neurologist, No. 2, 1882.

DEMONOMANIA. Dfemonomanie. Par'M. Ritti. Diet. Encycl. d. So. M6d.,
Paris, 1881, xxvi., 682-93.

DIPSOMANIA—

De la Dipsomanie. Par Prof. Ball. L’Enc^phale. No. 3, Octobre, 1881.
DISEASES OF WOMEN, and Mental Diseases—

Ueber die Beziehungen der sogenaunten Frauenkrankheiten zu den Geistesstorun-
gen der Frauen. Dr. Ripping. Allg. Zeitsch. f. Psych., xxxix., p. 11.

“ DOUBTING MADNESS ”—

[Folie du doute.] De la folie du doute. Par Professor Ball. L’Encdphale,
No. 2, 1882, p. 231.

EARLY PHASES of Mental Disorder and their Treatment- Dr. W. B. Kesteven.

Journ, of Ment. Science, Oct., 1881, p. 353.

EDUCATION of the Insane, and the school system as carried out at the Rich¬
mond District Lunatic Asylum. Dublin. Mr. John Fox. Journ. of Ment.
Science, April, 1882, p. 16.

EMOTIONAL INSANITY with homicidal violence. PhilojudicUs. Journ. of
Ment Science, Jan., 1882, p. 527.

EMPLOYMENT in the treatment of mental diseases in the upper classes. Dr.

David Bower. Journ. of Ment. Science, July, 1882, p. 182.

ENTERIC FEVER IN INSANITY—

On the effects of enteric fever in the insane. Dr. C. M. Campbell. Journ.

of Ment. Science, July, 1882, p. 212.

ENDARTERITIS WITH INSANITY—

A case of endarteritis with insanity and aphasia. Dr. Richard B. Mitchell. Journ.

of Ment. Science, July, 1882, p. 223.

EPILEPSY. State of pupil in—

Note sur l*6tat de la pupille chez les 4pileptiques en dehors des attaques. Par
Dr. Marie. Archives de Neurologie, Vol. iv., No. x., p. 42.

Etwas liber die Schwankungen des Gewichtes der Epileptischen. Dr. V. v.

Olderogge. Arch. f. Psych., xii., 3, p. 692.

Pupil in, its Significance. By Dr. L. C. Gray. Amer. Journ. of Insanity, No. 1,
1882

EPILEPSY—

Epileptiforme AnfAlle bei Magenerkrankungen. Dr. Schuchardt Allg. Zeitsch.
f. Psych., xxxviii., p. 703.

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EPILEPSY—

1st der Verlust an Eorpergewicht ein Erkennungszeichen eines vorausgegangenen
epileptischen An fall a ? Dr. G. Kranz. Allg. Zeitsch. f» Psych., xxxix., p. 35.
EPILEPTIC INSANITY—

Ueber epileptoide zust&nde mit Einschluss dm transitorischen Irreseins. Dr. A.

Hollander. Jahrb. £. Psych., 1881, iii., I Sc 2, p. 55.

EPILEPSY, associated with imperative conceptions. By Dr. Spitzka. Amer.
Journ. of Neurology and Psychiatry, No. 1,1882. Two cases with anomalous
epileptoid symptoms. Ibid, The Epileptic Change in Feeble-minded chil¬
dren. Alienist and Neurologist, No. 3, 1882.

EPILEPSY. (Atropiain)—

Vorlaufige Mittheilung iiber den Einfluss des Atroplns anf epileptische Kranke.

Dr. Kollner. Allg. Zeitsch. f. Psych., xxxviii., p. 803.

Ueber die Entwicklung von Geisteskrankheiten aus Epilepsie. Dr. Gnauck.

Arch. f. Psych., xii., 2, p. 337.

EXHAUSTION—

Die Erschdpfungszustande des Gehirns. (Aufsatz.) S. Lowenfeld. Miinchen;,
1882*

FAMILY HISTORY—

The genealogy of a neurotic family. Dr. William W. Ireland. Journ. of Ment.
Science, Oct., 1881, p. 398.

FEIGNED INSANITY, Case of. Dr. Alex. Robertson. Journ. of Ment. Science,
Oct, 1881, p. 384.

Feigned Insanity. Folie simulee par une alienee inculpfce de tentative d’assas-
sinat, par M. Marandon de Montyel. L’Enc6phale, No. 1, 1882, p. 47.
Feigned Insanity. Simulation of I. by the insane. By Dr. Kiernan.

Alienist and Neurologist, No. 2, 1882.

FAECAL ACCUMULATION (Case of in a lunatic)—

Case of prolonged faecal accumulation with great distention of bowel. J. Carlyle
Johnstone. Journ. of Ment. Science, July, 1882, p. 220.

FEVER, INTERMITTENT (of emotional origin)—

De la fifcvre intermittente d’origine Emotive. Dr. Roussel. Ann. M4d. Psych.,
Mars, 1882, p. 222.

INVOLUNTARY OR IMPULSIVE THOUGHTS—

Zur Lehre von den Zwangsvorstellungen. Prof. Wille. Arch.f. Psych., xii., 1, p. 1.
“ FOLIE AVEC CONSCIENCE »*—

Recherches cliniques sur la Folie avec Conscience, Par Marandon de Montyel.
Archiv. de Neurol., Vol. iv., No. 2, Sept., p. 188.

GENERAL PARALYSIS. (Disease of Cortex)—

Beobachtungen uber atypischen Verlauf und complicirende Herderkrankung
der Rinde bei Dementia paralytica. Dr. Eickholt. Arch. Psych., xii., 2, p. 433.
General Paralysis. (Acute Paralytic Delirium)—

D61ire aigu paralytique. Mort le douzi&ne jour. Dr. Foville. Ann. M4d.
Psych., Mars, 1882, p. 227. (Case.)

Notes of a case of general paralysis at the age of twelve. A. R. Turnbull.

Journ. of Ment. Science, Oct., 1881, p. 391.

General Paralysis. (Diseases of Spinal Cord. Knee-jerk, etc., in)—

Ueber Erkrankungen des Riickenmarkes bei Dementia paralytica und ihr Ver-
haltenzum Kniephanomen und verwandten Erscheinungen. Dr. Claus. Allg.
Zeitsch. f. Psych., xxxviii, p. 133.

General Paralysis . (Pathological Anatomy)—

Contribution a l’etude anatomo-pathologique de la paralysie g6n6rale. Ph. Rey.

Ann. M6d. Psych., Juillet, 1882, p. 55.

General Paralysis. (Treatment in)—

Ueber Schadeleinreibungen bei allgemeiner fortschreitender Paralysis. Ur.

Oebeke. Allg. Zeitsch. f. Psych., xxxviii.. p. 294.

General Paralysis. (Atheroma and yellow softening in)—

De la d5mence paralytique dans des rapports avec l’atherome artSriel et le
ramoUissement jaune. Dr. Cullerre. Ann. M6d. Psych., Mai, 1882, p. 386.

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1883.]

General Paralysis,

Erkrankung der Hinterstrange bei paralytischen Geisteskranken. Prof. West-
phal. Arch. f. Psych., xii. B., p. 772.

General Paralysis (Cerebral haemorrhage in)—

Hemorrhagic c£r£brale a foyers multiples chez un paralytique g^ndral. M. Bey.

Ann. Med. Psych., Mars, 1882, p. 237. (Case.)

General Paralysis. (Ophthalmoscopic appearances in)—

Des lesions ophthalmoscopiques dans la paralysie g6nerale. Par M. Ch. Dutergne.

Ann. M6d. Psych., Tome viii., No. 2, p. 211.

GOUTY INSANITY. By Dr. Rayner. Trans. Internat. M. Congress. Lond.,
1881., iii., 640.

HALLUCINATIONS. (Physiological theory of)—

Thdorie physiologique de l’hallucination. Dr. Prosper Despine. Ann. Mdd.
Psych., Nov., 1881, p. 367.

Hallucinations . (Pathogeny of Hallucinations)—

Note sur la pathogAnie des hallucinations, eto. Dr. V. Parant. Ann, Mdd.

Psych., Mai, 1882, p. 375.

Hallucinations .

Der halluoinatorische Process. Dr. E. Pohl. Jahrb. f. Psych., 1881, iv., 1 & 2,
p. 107.

Note sur un cas d'hallucinations unilat^rales de Touie, consecutive? a une in¬
flammation chronique de l’oreille moyeDne. Dr. B£gis. Ann, Mdd Psych.
Mai, 1882, p. 459.

Hallucinations. Physiologic pathologique des hallucinations. By M. Fournid.

Trans. Internat. M. Congress. Lond.. 1881. iii., 594.

Hallucinations from disease of ear. Un cas d’hallucinations de Pouie consdcu-
tives A une inflammation chronique de Poreille moyenne, par professeur Ball.
L’Encdphale, No. 1,1882, p. 1.

Hallucinations in general paralysis of the insane ; especially in relation to the
localization of cerebral functions. Dr. Wm. Julius Mickle. Journ. of Ment.
Science, Oct., 1881, p. 3 ; Jan., 1882, p. 503 ; April, 1882, p. 26.
Hallucinations and heart disease. Troubles psychiques, hallucinations dans un
cas d’insuffisancetricuspide, par M, Duplaix. L’Encdphale, No. 2,1882, p.287.
Unilateral Hallucinations. By Dr. Alex. Robertson. Trans. Internat. M.
Congress, Lond., 1881, iii., 632.

HISTORY OF THE INSANE in the British Isles. By Dr. D. Hack Tuke.
London, 1882.

HYDROCEPHALUS (Case of)—

Note sur un cas d’hydrocdphalie chronique. Dr. J. Christian. Ann. Mid.

Psych., Mai, 1882, p. 366.

HYPERzEMIA of Brain and its Membranes—

Ueber die BehandJung der Hyperamie des Gehirns und der Hirnhaute mit
Hautreizen. Dr. Buch. Arch. f. Psych., xii., 1, p. 189.

HYPNOTISM, Experimental Study of, by Prof. Tamburini. Trans. Int. M.
Congress, 1881, iii., 640.

Hypnotism (its causes, &c.). Ueber den Hypnotismus, seine Ursachen, etc.

Dr. C. Spamer. Jahrb. f. Psych., 1881, iii., 1 u. 2, p. 24.

Hypnotism (in hysterical subjects). Contribution k l’etude de Thypnotisme
chez les hystdriques, par Charcot et Richer. Archives de Neurologic, Juillet.
and Oct., 1881, pp. 31, 173, and Mars, p. 129, Mai-Juin, p. 310, 1882.
HYPOCHONDRIASIS—

Cas de ndvrose viscdrale avec hypochondrie par M. Chambard. L’Encephale,
No. 1, 1882, p. 32.

HYOSCYAMINE—

Ueber Hyoscyamine. O. Kretz. Allg, Zeitsch. f. Psych., xxxix., p. 24.
Hyoscyamine. The Special Therapeutic Value of H. By Dr. Hughes. Alienist
and Neurologist, No. 2, 1882.

Hyoscyamine. The Physiological action of H. By Dr* Shaw. Journ of Nerv.
and Ment. Dis. No. 1, 1882.

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HYSTERIA—

Caractfere, mceurs, &tat mental des Hystdriques. Par Dr. H. Hachard.

Archives de Neurologic, Mars-Avril, 1882, p. 187.

Les hystSriques, dtat physique et 4tat mental, etc. Par Legrand du Saulle.
Paris, 1883.

HYSTERIA (AND EPILEPSY)—

De la coexistence de l'hyst^rie et de l'lpilepsie avec manifestations des deux
nfevroses, etc. D’Olier. Ann. Mbd. Psych., Septembre, 1881, p. 192.
HYSTERIA (AND TRANSFER OF SYMPTOMS)—

TJntersuchungen und Beobachtungen uber Hysterie und Transfer! Prof.

Rosenthal. Arch. f. Psych., xii., 1, p. 201.

Un cas de d6doublement de la personnalitA Period© amnesique d’une an nee
chez un jeune homme hvst&riaue. Dr. Camuset. Ann. M6d. Psych., Janv.
1882, p. 75. (Case.)

HYSTERO-EPILEPSY—

Notes pour servir a 1 ’histoire de PHyst^ro-Epflepaie. Par C. F6r6. Archives
de Neurologic, Mars-Avril, 1882, p. 160; Mai-Juin, p. 281.

HYSTERIA AND GENERAL PARALYSIS—

Bur les rapports de l’hyst^rie et de la paralysie g^udrale. Paris, 1882, 4to.,
Thesis, No. 116.

HYSTERICAL PARAPLEGIA, in a boy. By Dr. C. Allbutt. Brit. M. J., 1882,
i., 267.

HYSTERO-EPILEPSY—

Hystdro-Epilepsie par M. Mabille. L’Encdphale, 1882, No. 3, 25 October, p.
463.

IDIOCY (Multiple Sclerosis)—

Ueber multiple, tuberose Sklerose der Hirnrinde. Ein Beitragzur pathologischen
Anatomie der Idiotic. Dr. 0. Brhckner. Archiv. f. Psych., xii., 3, p. 550.
Idiocy, Morphological and historical aspects of. Dr. F. Beach. Trans. Interoat.
M. Congress, Load., 1881, iii., 615.

Idiocy, Cranial characteristics of. By Dr. Shuttleworth. Trans. Internal M.
Congress, Lond., 1882, p. 610.

Idiocy, Case of, with paralysis and congenital aphasia, etc. Dr. James Shaw.

Jouro. of Ment. Science, July, 1882, p. 210.

INDEX—

Namen und Sachregister der Allgemeinen Zeitschrift fur Psychiatric, viii-xxxvii.

Band. Allg. Zeitsch. f. Psych, xxxviii., 5 u. 6.

INDEX MEDICO-PSYCHOLOG1CUS—

Bericht iiber die psychiatrische Literatur im 1 Hatbjabre, 1881. Allg. Zeitsch.
f. Psych., xxxviii., 4, p. 381-560 ; id. im 2 Halbjahre, 1881. ibid , xxxviii.,
Supplemen theft.

Index Medico-Psychologicus. Jouro. of Ment. Science, Jan., 1882, p. 637.
KNEE-JERK in Epilepsy. By Dr. Chas. Beevor. Brain, part xvii., April, 1882,

p. 66. . *

Knee-Jerk in General Paralysis. By Dr. Mickle. Journ. of Ment. Science.
Oct., 1882.

INSANITY, with Intercurrent Spinal Paraplegia—

Katatonische Verriicktheit. Intercurrente spinale Paraplegic mit psychischer
Klarheit, etc. (Case.) Dr. Knecht. Jahrb. f. Psych., 1881, iii, 1 u. 2,
p. 73.

INSANITY, with incendiary monomania—

Contribution a l’4tude de la monomanie incendiare. Dr. Rousseau. Ann. M6d.

Psych , Nov., 1881, p. 384.

INSANITY (with intermittent fever)—

Note sur les rapports de l’alienation mental© et de la fi&vre intermittente. H.

Mabille. Ann. Med. Psych., Sept., 1881, p. 227.

LUNACY IN ENGLAND AND WALES—

Journal Psych. Med., vol, 8, part i., p. 128.

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Notes and News.

145

LUNACY IN ENGLAND—

Address at the opening of Section VIII. of the International Medical Congress,
Dr. C. Lockhart Robertson. Journ. of Ment. Science, Jan., 1882, p.483;
and in the Trans. Internat. M. Congress, Lond., 1881,579.

LUNACY IN THE NETHERLANDS-

Ueber das neue niederlandische Irrengesetz. Prof. H. Obersteiner. Erlenmeyer’s
Centralblatt, etc., 1882, p. 25.

LUNACY IN SILESIA—

Die Entwicklung des Irrenwesens in Schlesien ini Allgemeinen und der Irren-
heilanstalt Leubus im Besonderen, etc. Dr. Jung. Allg. Zeitsch. f. Psych.,
xxxviii., p. 355.

LUNACY IN RUSSIA—

Organisation de la clinique des maladies mentales a Saint-P6tersbourg. La
legislation russe sur les ali£n£s. Dr. G. Marchant. Ann. Med. Psych.,
Juillet, 1882, p. 81.

MEDICO-LEGAL—

DIVORCE AND INSANITY —

Divorce. La folie et le divorce. Par Legrand du Saulle. Gaz. d. Hop.,
Par. 1882, lv., 241.

Folie et Divorce. Par M. Luys. L’Encephale, No. 3,1882, p. 439.

La folie doit-elle 6tre consid^ree comme une cause de divorce ? Dr. Blanche.
Ann. M4d. Psych., Juillet, 1882, p. 72.

Divorce. La folie doit-elle etre consideree comme une cause de divorce? Par
M. J. Luys. L’Enc^phale, No. 2, 1882, p. 214.

Le divorce et l’alienation mentale a l’acaddmie de medecine. Par M. Luys.

Ann ales M6d. Psych., Tome viii., No. 2, p. 303.

Lefroy. Plea of Insanity in his case. Journal Psych. Med., Vol. viii., part 1,

p. 122.

Guiteau, Case of.

Guiteau. The case of G. By Dr. Beard. Journ. of Nerv. and Ment. Dis.,
No. 1, 1882.

Guiteau, l’assassin du president Garfield. Ch. Folsom. Ann. M6d. Psych.,
Mai, 1882, p. 418.

Guiteau, Case of. Journ. of Ment. Science, July, 1882, p. 236, p. 301.

Guiteau. The United States v. C. J. Guiteau. Amer. Journ. of Insanity. Nos.
3 and 4,1882.

The Psychological aspect of the Guiteau case. Dr. Mann. Journ. Psych. Med.
Vol. viii., part 1, April, p. 28.

Guiteau. Was he insane ? By Dr. W. A. F. Browne. Ibid , p. 96.

Guiteau’s Case, Plea of insanity in. Dr. Bucknill. Brain, part xviii., July, 1882.
Aymes, Case of.

Rapport m£dico-l£gal sur l’etat mental du sieur Aymes, meurtrier du Dr.

Marchant. Dr. V. Parant. Ann. Med. Psych., Sept., 1881, p. 245.

Grappotte, Case of. (Criminals’ Brains.)

The Grappotte case. By Dr. Spitzka. Amer. Journ. of Insanity and Psychi¬
atry, No. 2, 1882.

Bellingham, Case of.

Trial of Bellingham. Amer. Journ. of Insanity, Nos. 3 and 4, 1882.

La famille Loch in. Drs. Reverchon et Pag&s. Ann. Mdd. Psych. Juillet,

1882, p. 18.

Sexual Feeling, Disorders of.

Zur “ contraren Sexualempfindung ” in klinischforensischer Hinsicht. v.

Krafft-Ebing. Allg. Zeitsch. f. Psych., xxxviii.

Judicial Sentences passed on the Insane.

Ueber die strafgerichtliche Verurtheilung Geisteskranker. Dr. Schlager. Allg.

Zeitsch. f. Psych., xxxviii., p. 577.

Incendiaries.

Les incendiaires. Revue de medecine-16gale. Dr. A. Giraud. Ann. M6d.
Psych., Janv., 1882, p. 87 ; Mars, p. 257.

xxix, 10

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Notes and News.

Nervous dulness in its physical and moral aspects and its bearing on the
question of capital punishment. Mr. Wm. Henry Eesteven. Journ. of
Ment Science, July, 1882, p. 176.

Mental experts and criminal responsibility. Dr. D. Hack Take. Journ. of
Ment. Science, April, 1882, p. 36.

Crime by a Melancholiac.

Extrait d’un rapport de MM., Lunier, Foville et Magnan ayant pour objet
de determiner les caract^res speciaux du delire chez un melancholique
qui a causd la mort d'un ami, etc. Archive^ de Neurologic, Vol. iv., Num.
10, Juillet.

Quelques matfcriaux apportes a la mldecine legale des ali6n£s. Dr. Baume.

Ann. Med. Psych., Sept., 1881, p. 264; Nov., 1881, p. 446.

Testamentary Incapacity. By Dr. Bucknill. Trans. Internat. M. Congress,

1881, iii., 615.

Passanante.

Medico-legal investigation. By Tommasi, Verga, Biffi, Buonnomo, and Tam-
burini. Bivista Sperimentale di Freniatria e di Medicina Legale. Anno v.,
Fascic. 2 ; Amer. Journ. of Insanity, Nos. 3 and 4, 1882.

French Lunacy Legislation. Dr. A. Foville. Journ. of Ment. Science, July,
1882„p. 156.

Criminal Psychology. Some observations on the state of society, past and
present, in relation to criminal psychology. Dr. David Nicolson. Journ.
of Ment. Science, Oct., 1881, p. 359 ; April, 1882, p. 6.

MANIA (followed by Hyperaesthesia)—

Notes of a case—mania followed by hyperaesthesia and osteomalacia, etc.

Dr. James C. Howden. Journ. of Ment. Science, April, 1882, p. 49.
MEGALOMANIA—

Note sur la m^galomanie, etc. Dr. Ach. Foville. Ann. M6d. Psych., Janv.

1882, p. 30.

Megalomanie. M. Foville. Trans. Internat. M. Congress, Lond., 1881, iii.,593
MORAL INSANITY. J. R. Gasquet, M.B. Journ. of Ment. Science, April,

1882, p. 1.

MORAL (AFFECTIVE) INSANITY. By C. H. Hughes, M.D. Journ. Psych.
Med., Vol. viii., part 1, p. 64.

Appointments.

Francis, L., M.B., appointed Resident Clinical Assistant to the West Biding
of Yorkshire Lunatic Asylum, Wakefield.

Gayton, Francis Cartabet, M.B. and C.M., Aberdeen, M.R.C.S.Eng.,
Assistant Medical Officer, Co. Asyl., Bodmin, Cornwall, appointed Senior Assis¬
tant Physician to the Surrey County Asylum, Brookwood.

Layton, H. A., L.R.C.P.Edin., and M.R.C.S.Eng., appointed Assistant
Medical Officer to the Co. Asylum, Bodmin, Cornwall, vice F. C. Gayton, M.B.,
resigned.

Mitchell, T. H., appointed Assistant Medical Superintendent to the Ayrshire
District Asylum.

Neil, J., M.B., appointed Assistant Medical Officer to the Portsmouth
Borough Lunatic Asylum, vice A. N. Davis, L.R.C.P., resigned.

Edgar Abler Hunt, M.R.C.S.Eng., and L.R.C.P.Edin., has been appointed
Assistant Medical Officer to the Eastern Counties* Asylum for Idiots, Colchester,
but without extra expense to the Institution.

James Rutherford, M.D., of the Lenzie Asylum to be Medical Superin¬
tendent of the Crichton Royal Institution, Dumfries.

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No. 126. (New Series, No. 90.)

THE JOURNAL OF MENTAL SCIENCE, JULY, 1883.

[Published by authority of the Medico-Psychological Association .]

CONTENTS. *

PART I.—ORIGINAL ARTICLES. page

John Cleland, M.D.— On the Seat of Consciousness.147

P. M. Cowan, M.D.— Lunacy Legislation in Holland ..... 158
W. Bevan Lewis, L.R.C.P.Lond.— Caffeine, in its Relationships to Animal Heat

and as Contrasted with Alcohol ..167

Henry Sutherland, M.D.— Prognosis in Cases of Refusal of Food . . . 178

D. G. Thomson, M.D.— The Prognosis in Insanity ...... 188

T. Olaye Shaw, M.D.— On Large and Small Asylums.205

Clinical Notes and Cases.—Cases of Self-mutilation by the Insane; by James
Adam, M.D.—Tubercular Meningitis in Insane Adults ; by Wm. Julius
Mickle, M.D.—Cases of Senile Insanity, with Remarks; by Geo. H.
Savage, M.D.—Case of Genera! Paralysis in a Young Woman, com¬
mencing at the age of fifteen ; by Joseph Wiglesworth, M.D.—Two
Cases of Rapid Death, with Maniacal Symptoms ; by Geo. H. Savage,
M.D.—Symmetrical Tumours at Base of Brain ; by Dr. Strahan . 213-248
Oooasional Notes of the Quarter.—The Beer Dietary in Asylums.—The Monas-

terio Case.. . . . 248-257

PART II-REVIEWS.

A History of the Criminal Law of England. By Sir James Fitzjames

Stephen. 258

Injuries of the Spine and Spinal Cord, without apparent Mechanical Lesion,
and Nervous Shock, in their Surgical and Medico-legal Aspects. By

Herbert W. Page, M.A.270

The Alternative : A Study in Psychology.271

Die Alcoholisohen Geisteskrankheiten im Basler Irrenhause, &c. Vom

damaligen Assistentarzte. Yon Wilhelm von Speyr .... 278

PART III.—PSYCHOLOGICAL RETROSPECT.

1. English Retrospect. Asylum Reports for 1881 . 284

2. Danish Retrospect.—By T. W. McDowall, M.D..306

PART IV.—NOTES AND NEWS.

Quarterly Meetings of the Medico-Psychological Association held at Bethlem
Hospital, and at the Hall of the Faculty of Physicians and Surgeons,
Glasgow.—The Sentence on Joseph Gill.—Notices of Forthcoming
Meetings.—Obituary.—Correspondence.—Index Medico-Psychologies.

—Appointments, &c.311-328

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THE JOURNAL OF MENTAL SCIENCE.

[Published by Authority of the Medico-Psychological Association,']

No. 126. ™Vo E r 8 ’ JULY, 1883. Yol. XXIX.

PART 1-ORIGINAL ARTICLES.

On the Seat of Consciousness . By John Cleland, M.D.,
LL.D., F.R.S., Professor of Anatomy, University of
Glasgow.

In accepting the invitation kindly given me in this Journal
last October to explain more fully my views on the relations
of the nervous system to the operations of consciousness, I feel
that I labour under more than one .difficulty. The questions
raised are not to be solved in the main by experiment, though
. the biologist of the present day is too liable to take for granted
that his science can be forwarded by observation and experi¬
ment alone, and that there is no art required to draw just
conclusions from these. Then for the most part my statements
remain unassailed, and the role left for me seems to be princi¬
pally one of reiteration and re-attack. On one point I cannot
too much insist, namely, that to prove one theory false it is not
necessary to be prepared with another which is true to replace
it. The question whether the prevalent theory is correct must
not be confused with any other; and I submit that the objections
against the current doctrine of sensation, to which I gave
publicity at the Liverpool meeting of the British Association
in 1870, remain unanswered, not because they are unknown,
but because, as I have found physiologists are ready to own,
they are incapable of refutation.

What are those objections ? They are two in number; but
one is more important than the other, because it asserts the
received theory to be inconsistent with anatomical fact. The
received theory demands that each distinctly recognisable spot
of the body must be joined by a separate tract with its own
cerebral terminus, a thing which is anatomically quite impos¬
sible, and so obviously so that no competent anatomist will
ask the question to be argued. As, moreover, in respect of
common sensation a distinct tract from every spot which can
be separately felt is required, so in the case of vision, the theory
xxix. 11

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148

The Seat of Consciousness ,

[July,

demands a separate tract for every nerve termination of the
retina capable of producing by its affection an appreciable
point in the picture presented to the mind; while, in point of
fact, the communications of the bacillary elements with the
ganglionic layer and of that layer with the brain are of such
a sort as to make it impossible that there can be a separate
tract from each bacillary element to a terminus in the brain.

The other objection, namely, that the received theory informs
us of no mode by which the mind of the child learns to asso¬
ciate the changes taking place at the cerebral termini with
changes taking place at differents parts of the surface,—that is
to say, to translate them as things happening at the surface,—
is possibly so psychological as to be incomprehensible to some
excellent persons, and undoubtedly may be said to allege
incompleteness rather than falsity. Still, it is an incomplete¬
ness so great that, taking it into consideration, one is surely
entitled to say that the received theory, after compelling us to
view sensation as the arbitrary result of complex and unac¬
counted-for arrangements, leaves us with a difficulty facing us
of such importance that we may well doubt the propriety of
considering the theory as an explanation at all.

The prevalent theory of the seat of consciousness assumes
that consciousness is entirely localized within a definite and
unvarying part of the encephalon. No one may have ex¬
pressed it so, but rather the assumption has been made, simply
because it has not occurred to anyone that it could be otherwise.
Proceeding on that implicit assumption, the next point has
been to determine what is the exact extent of brain in which
consciousness is localized. On this subject nothing can be known
without experiment on the living animal, and as the experi¬
mental evidence could not be put more plainly than it has
been by Professor Ferrier in his “ Functions of the Brain/’ I
shall use his account as a guide in my remarks; which will be
the more convenient, as I shall have the satisfaction of
reviewing the grounds of the opinions of one who considers
as mere reflex action much which I cannot explain, save by
supposing some faint consciousness to be present. Of such a
character are the movements in frogs deprived of the brain
which come under the following description :—“ They are
movements either of defence or preservation, and are in general
adapted either to .withdraw the part from the source of irrita¬
tion or to repel the irritant itself. Thus the extended leg
becomes flexed or withdrawn when the toe is pinched, and if
the irritant be applied to the anal region, adapted movements

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149

1883.] by John Cleland, M.D.

of both legs are made, with a view to remove it.” (Op. cit.,
p. 19.) These are the words in which phenomena familiar to
every physiologist are described by one who, like Goltz, looks
on them as mere reflex movements. In the last six words of
the quotation he slips unpremeditatedly into a form of expres¬
sion appropriate only to the imputation of consciousness.
Think how improbable it is that frogs should possess a com¬
plex arrangement of reflex mechanism for the removal of
foreign bodies from their anal region—animals not during life
.ever subject to the introduction of foreign bodies at that part
to require removal. It is in the last degree puzzling to imagine
how such a mechanism could have come to exist. A teleologist
will find it hard to discover what purpose is served by it, and
a Darwinian, even the least particular about the hypotheses
which he accepts as facts, may find his imagination at fault to
discover the advantage in the struggle for life which led to be
preserved as ancestors to frogs those animals whose limbs
responded in a particular way to irritation of the anal region.

I remember to have been much struck with similar move¬
ments in a large tipula, which I had caught by the head,
crushing the head and part of the thorax between finger and
thumb. The tail moved about uneasily, and the tip of the
ovipositor seemed to seek for a convenient place to lay eggs,
which it forthwith deposited on my finger; and as egg suc¬
ceeded egg, when a larger egg than usual appeared, causing
difficulty in its extrusion, it stroked it down with its hind legs
until it had completed the delivery, and proceeded with the
deposit of other eggs as before.

“ When a drop of acetic acid is placed on the thigh of a
decapitated frog the foot of the same side is raised, and
attempts made with it to rub the part. On the foot being
amputated, and the acid applied as before, the animal makes a
similar attempt, but failing to reach the point of irritation
with the stump, after a few moments of apparent indecision
and agitation, raises the other foot, and attempts with it to
remove the irritant. This experiment has been appealed to by
Pfluger (who made it) and others as a proof of ‘psychical or
intelligent action on the part of the spinal cord.” (Op. cit., p.
20.) I accept Pfliiger's conclusion as not only that of a
physiologist of the highest authority, but as being, on exami¬
nation of the merits, obviously correct. Dr. Ferrier dissents
from it. He simply asserts that u it is an established fact that
adapted actions, such as intelligence would also dictate, are
capable of being called into play through our spinal cord

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[July,

The Seat of Consciousness ,

entirely without consciousness.” That is an allegation rather
than a fact, and one would like to know on what foundation
“ it is established.” He proceeds to point out very properly
that a reflex action is not necessarily confined to the side on
which the irritation is applied, and that continuance of the
irritation may bring the other leg into play by associated reflex
action. No one will doubt this; but the action of the second
limb ought on that principle to be exactly similar in kind to that
of the first, in which case it would not cross the middle line,
but would scratch the spot symmetrically corresponding on its
own side with the point of irritation.

Dr. Ferrier appeals to the well-known experiments of Goltz
to show that the apparently purposive movements of decapi¬
tated frogs are simply reflex, and considers that against at¬
tributing a sensory function to the spinal cord he has a strong
argument furnished by the experiment in which Goltz raised
the temperature of a vessel of water containing two frogs, the
one decapitated and the other only blinded. The frog with
uninjured brain died of tetanic heat-rigidity at a temperature
of 42° C., while the decapitated frog sat perfectly still, and
died of heat rigidity at 50° C. This frog, however, made the
usual defensive movements, while sitting in the water, when
acetic acid was applied to the skin. Well, that experiment is
certainly curious, and appears to show that a decapitated frog
, is not made uncomfortable by the gradual heating of its whole
skin, but it is remarkable that neither is it excited to reflex
action by that cause. The experiment seems to show that
local chemical irritation of the skin is felt by a decapitated
frog, though the heating of its whole surface does not incom¬
mode it; but we know nothing of the nature of the discomforts
which the frog possessing a brain feels on being heated, and
have no right to assume that they are cutaneous or amount to
pain. It ought also to be remembered in appealing to experi¬
ments of this kind, that no one alleges that a frog is as
conscious when deprived of its brain as when possessing it.
On each successive portion being removed it is granted that
there is a diminution of consciousness, and on the other hand
the abundant existence of reflex action is admitted by all. The
only question is whether movements exhibiting purpose can
be accounted for by calling them reflex, or whether they de¬
mand the presence of some trace of consciousness, however
faint.

How careful we ought to be in attributing phenomena to
pure reflex action without intervention of consciousness is

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151

by John Cleland, M.D.

exemplified abundantly in human physiology. Thus it is
known that in some persons irritation of a particular spot in
the canal of the external ear is followed by violent coughing,
and this might seem to be ordinary reflex action, but, as I pointed
out in the “ Lancet,” 5th December, 1874, it is not so; for the
immediate effect of the irritation of the ear is a sensation of
tickling in the glottis, and only when this tickling has become
unbearable does the coughing follow. Sometimes sneezing
will follow sharp irritation of a spot on the surface of the
nose, but the sneeze is preceded by the usual sensation in the
mucous membrane. In both these cases there probably would
be no spasm without the sensation which usually excites it.
So also in vomiting from nausea the immediate effect of the
irritant is the sensation of nausea, and it may be questioned if
that sensation is not often a necessary link in producing the
result. Again, winking on approach of a finger to the eye is
often spoken of as a reflex action, while in point of fact there
are two varieties of such winking quite different in their nature.
When the finger is approached suddenly without touching, the
wink is merely the effect of the desire of self-preservation
outrunning self-control, but when the gently-approached
finger comes into contact lightly with the tips of the eye¬
lashes a continuous winking is kept up as long as the titil¬
lating contact lasts. Contraction of the pupil, as we all know,
may be produced by exposure to light or by adjustment of the
eye to a near object, but it is not so generally (if at all)
recognised that in the latter case the action has no title to be'
called reflex. The contraction of the pupil in looking at near
objects is no mere reflex consequence of the position of the
eye-balls; for if one eye be shut and the other adjusted, first
to a far object then to a near object in the same direction, the
pupil of the eye employed will be seen to contract, though not
in every case as rapidly or completely as when both eyes are
employed. This is in no respect different from the action of
voluntary muscles. In one case you will to move, let us say,
your hand without knowing the muscles employed; in the
other you will to see the object distinctly at which you are
looking, and the appropriate muscles in like manner perform
the action.

I make use of all these examples mainly to show how care¬
less physiologists are in imputing phenomena to reflex action,
and imagining that they have thus explained them. Otherwise
they are not of importance for my present argument.

No purposive acts have, so far as I am aware, ever been

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The Seat of Consciousness , [July,

alleged to take place in response to irritation of the trank or
limbs in either mammals or birds which have had the brain
removed or severed from the cord. There is an acknowledged
difference to that extent between the experimental evidence
of the action of the cord in the frog and its action in higher
animals; and that being the case, we are not entitled to argue
that because there is no consciousness in connection with a
mammalian cord severed from the brain, therefore there is none
in connection with the frog’s cord after removal of the brain ;
and in the circumstances one may well take into considera¬
tion that in the pithed frog the main mass of that embryolo-
gical unity, the cerebro-spinal axis, lies behind the site of
division, while in the pithed mammal it lies in front of it.

But Dr. Ferrier, after giving no better reasons than those
that we have been examining for considering that the actions
of the decapitated frog are quite devoid of consciousness,
suggests, on the strength of them, the absence of consciousness
in the acts performed by fishes, frogs, and mammals, after
removal of the hemispheres alone. His words are:—“The
mere faculty of adaptation is not necessarily a proof of con¬
sciousness, for, as we have seen, it exists in some degree in the
spinal cord, and if it is not regarded as proof of conscious
action on the part of the cord, neither can it be taken as such
here; for it may be that the more complex adaptation mani¬
fested by the mesencephale is simply the result of more com¬
plex and special afferent and efferent relations/’ {Op. cit. p.
43.) This is really the argument of the prevalent school of
physiologists put by a writer well able to do it justice, and only
.shows how careful we should be in estimating what is inferred
in adaptation, whether exhibited by the cord or brain.

Of course, the accomplished physiologist, whom I quote, and
those who have arrived at similar conclusions, are fully im¬
pressed with the appearance of consciousness in many of the
actions performed by animals after removal of the hemispheres,
and it is by a special gymnastic feat in the interest of science
that they persuade themselves that they can be accounted for
by reflex action; but, in doing so, it would be still more
scientific if they could venture to sketch out in detail any
arrangement whatever by means of which the individual
phenomena could be reduced to reflex action. Take the
examples of apparent vision after removal of the hemisphere of
the frog. On the hypothesis of reflex action, according to
Ferrier, “the leap to the side which the brainless frog makes,
so as to avoid an obstacle, would be merely the resultant of two

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153

by John Cleland, M.D.

simultaneous impressions, the one on the foot and the other on
the retina.” (Op. cit . p. 42.) It would be perfectly compre¬
hensible that variations in kind and in degree of the stimulus
applied to any organ of sense should lead to results of different
descriptions; that the contact, more dr less firm or prompt, of
a rough or smooth surface, or sharp or blunt point, with the
skin, should be followed by effects varying with precision ac¬
cording to the variety of the stimulus, or, in like manner, that
the effects of light should vary according to the amount, the
kind, or the abruptness of its application or removal. Ac¬
cording to the theory of reflex action, it would be perfectly
explicable if an experimenter were to get twenty different
results by holding up twenty different coloured screens before
the animal’s eyes, and were to be able constantly to reproduce
any one particular effect with one particular screen. But it is
not possible by an allegation of reflex action to account for an
.unconscious animal avoiding an obstacle as the mechanical con¬
sequence of the difference which that obstacle makes on the
picture falling on its retina. Though the consciousness of even
an uninjured frog must be something enormously different from
anything in our experience, yet even in a mutilated frog there
must be some sort of vague but sufficient idea of an obstacle to
enable the frog to avoid it.- Every physiologist knows perfectly
well that there is a great gulf even between the consciousness
of the picture before the eye and the translation of it into ob¬
jects at different distances; and it is an object at a definite
distance which the mutilated frog is said to avoid. Therefore,
there is a still greater gulf between the condition which enables
the frog so to act, and the physical effects of the mere irritation
or non-irritation of portions of the retina by the presence or
absence of rays of light, Accepting, then, the facts as correct
in the quotation given, how terribly absurd is the explanation
which the quotation offers, and yet how uncommonly scientific
to a careless thinker it sounds !

To my mind, it would be difficult to find anything more
crucially decisive than this; and it seems unnecessary to multiply
instances in which the phenomena exhibited by animals de¬
prived of their hemispheres are more easily explained on the
supposition that a certain .consciousness is present than on the
theory that there is none—seeing that the perpetual effort to ex¬
plain them, without recourse to consciousness, is itself an ad¬
mission that they suggest consciousness; while I frankly own
that, if I have not succeeded in showing these efforts to be futile
in the instances which I have passed in review, I am not likely

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The Seat of Consciousness,

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to succeed by criticising a greater number of them. If, how¬
ever, my arguments have been successful, then I have shown
that a certain amount of consciousness persists in mammals
after removal of the hemispheres, in frogs after removal of the
whole encephalon, and in insects after destruction of the
eephalic ganglia.

In the case of birds the experiments termed removal of the
hemispheres have, as a mere anatomical fact, consisted in re¬
moval of the corpora striata as well; and it does seem extra¬
ordinary that physiologists should have been so slow to
appreciate so elementary a fact in comparative anatomy as that
in birds the hemisphere-vesicle consists of a developed root-
part of the vesicle, and an altogether undeveloped and mere
membranous covering to represent the distributed part or
mantle. Tiedemann was the first to point out in the develop¬
ment of the human brain that the hemisphere-vesicle was a
hollow bladder, with the corpus striatum in the bottom of it.
But it was left to Reichert to show that the whole vesicle was a
single structure, divisible into two parts—one, the mantle, con¬
sisting of the whole convoluted part, with the exception of the
island of Reil; the other, the root-part, exhibiting the corpus
striatum interiorly, and the island of Reil on the surface. Com¬
parative anatomy has long been acquainted with reptilian
hemispheres exhibiting a well developed vesicle with a rather
small corpus striatum in its floor, and with the ornithic corpora
striata covered by a mere membrane of cerebral substance
above; and when we take into account the superior intelligence
of birds to reptiles, it is surely plain that in birds the f unctions
of intelligence, relegated in mammals principally to the mantle,
are performed entirely by the root-part of the hemisphere-
vesicle. All this I described and illusti'ated with figures ten
years ago in my “ Animal Physiology”; and though I made no
claim to bringing forward anything new, I am not responsible
for the circumstance that so many honest workers prefer to
follow the fashions rather than acknowledged facts in Nature
not brought forward under sufficiently influential auspices.
Perhaps these facts are inconvenient to those who think they
have a group in nature expressed by the word sauropsida.

With regard to the experimental evidence as to the functions
of the corpus striatum, it is notorious what different results have
been obtained by different experimenters as the consequence
of injury or extirpation—the differences no doubt depending
on differences in the sites of lesion consequent on difference
of method and difference of species in the animals chosen.

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by John Cleland, M.D.

155

But the results narrated by Ferrier as obtained/ both in his
own experiments and those of Carville and Duret, from direct
electrical irritation, entirely coincide with that which develop¬
ment and comparative anatomy would indicate as probable.
“ Apparently the individual movements excited from the various
regions of the hemisphere are all thrown into action simul¬
taneously, the flexors predominating over the exterior muscles.
* * * In the corpus striatum there would appear to be an

integration of the various centres which are differentiated in
the cortex/’ (Op. cit. p. 161.) Into this last sentence the
word €i motor ” might have been introduced before t€ centres,”
and then the reader would understand that the result
amounts to this : that the irritation applied to a corpus striatum
affects all the motor tracts at once, which are gathered together
from different parts of the hemisphere. Electric irritation
simply throws no light on the relations of either the corpus
striatum or the hemisphere to sensation and the operations of
intelligence; and thus the teachings of experiment, as far as
they go, are in perfect harmony with the anatomical doctrines,
.that the whole hemisphere and corpus striatum are one organ,
the connection of which with the rest of the brain passes
through the part bounded above by the optic thalamus and
below by.the crus cerebri.

The sum of this evidence is—first, that consciousness is not
a function confined to the hemisphere-vesicle, as is most
evidently shown by experiment on animals with lowly organized
hemispheres, although, probably on account of the large pro¬
portion of the hemispheres to the rest of the nervous system,
their removal in the higher animals is followed by greater loss
of function than in the lower; secondly, the very different
development of the hemisphere-vesicles in birds from what is
found in reptiles and mammals points distinctly to the conclu¬
sion that in different animals the same functions, including
those of consciousness, may be performed by different parts of
the hemisphere-vesicles, though, doubtless, we may await with
interest the results of further experiment on the motor relations
of different regions of the hemisphere-vesicles in birds.

The first of these propositions is evidently favourable to my
theory of the seat of sensation. If once you cease to be able
to limit, or rather, once you appreciate that you cannot de¬
finitely limit the seat of consciousness, there is no difficulty in
believing that consciousness may extend along the nerves. No
doubt in lesions of the cerebro-spinal axis you find that the con¬
sciousness continues in connection with the larger mass of

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The Seat of Consciousness ,

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nervous substance, and after division of a nerve the distal part
can no longer affect or be affected by the consciousness ; and
thus, neither spinal cord nor nerves give evidence of an inde¬
pendent connection with consciousness. But if they have such
a connection through continuity with the main mass of the
brain, then the continuity must be functional as well as
anatomical; the communication must be in that condition in
which alone nervous substance can do any work.*

Therefore, I judge that we feel the irritation of a nerve-
extremity in virtue of the functional continuity of the nerve
with the brain. Probably, in health, no part supplied with
cerebro-spinal nerves is ever completely cut off functionally
from the brain. The muscles have a certain amount of con¬
stant tonic contraction, differing from the complete relaxation
following division of the nerves supplying them, and probably
also there may be a constant slight residual activity in the
sensory nerves ; but if my theory be true, then, in directing
attention to a part of the body, the sensory nerves must (it
appears to me) enter into the active condition by stimulus from

* Having occasion thns to allude to the active condition of nerve substance, I
am constrained, though in the position of defending views of my own that are
unsympathised with, to refer to an article on “ Inhibition ” by Dr. Lauder
Brnnton, which appeared March 1st, in Nature. The well-founded reputation
of Dr. Brnnton, and his admirable work, dispose one to receive favourably the
vjews which he may suggest; but we may well pause before accepting his pro¬
posed explanation of inhibitory phenomena by the assumption of an interfer¬
ence of vibrations. The active condition of nerve is an altered state of nutrition,
involving the cessation of certain chemical and other processes, and establish¬
ment of others. No doubt the immediate result of these changes may be an
unknown vibration, just as was suggested by Dr. McDonnell in 1875
(“Lectures and Essays*’ p. 217). The immediate result of analogous changes
in muscle is change of form, and there can be little doubt that the molecular
changes are also analogous which lead to alteration of form in amoeboid cor¬
puscles and to the exercise of the specific functions of secreting and absorbing
corpuscles. Even so, in the case of nervous structures, it is certainly possible
that vibrations may be the immediate result of the known nutritive changes
which accompany the active condition ; but we have no proof of the existence
of such vibrations, and the assumption of them seems singularly inconvenient
in the explanation of the stimulus to muscular contraction, in which it appears
more probable that the chemical and electrical change in the nerve directly
propagates similar change in the muscle, than that the two are separated by
the intervention of a tertium quid. In these circumstances it seems scarcely a
happy idea to explain inhibition as analogous to the phenomena of interference
in light and sound. With greater probability, explanation might be sought in
the different modes of connection of different poles with the protoplasm of
nerve-corpuscles. One can conceive (though this also is a mere conception)
that by such difference of origin, or by some other means, a certain resistance
might be offered to the passage of the irritation into channels which, once
entered, might yet be very efficient to divert it from channels entered more
easily.

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by Johk Cleland, M.D.

the centre, which is a thing with an importance both theoretical
and practical. The theoretically important point is that in that
case sensory nerves are capable of a centrifugal as well as a
centripetal order of sequence in the entrance of their successive
parts into the active state, a centrifugal current, as it is often
called; and if this be the case, we are in a position to believe
that the motor fibres to the muscles can, at the same time, be
the means of communicating muscular sense. The practical

f rint, to which I allude, is this : that if it be really the case, as
do not doubt, that when attention is directed to a part of the
body, the sensory nerves of that part are roused into activity,
there is an obvious physical advantage gained by distracting a
patient's attention from a local malady.

The other propositions at which we arrived, guided thereto
by consideration of the hemisphere-vesicles and intelligence of
birds, namely, that the same functions, including those of con¬
sciousness, may be performed by different parts of the hemi¬
sphere-vesicles in different animals, brings us to the subject of
localization of functions .in the hemispheres. Now, it ought to
be distinctly understood that I have never expressed the
smallest scepticism as to the results of Ferrier and others who
have worked in the same direction. There is no reason that I
should. Their results do not in the least clash with my views.
I even own to some little surprise, that my most friendly critic
in this Journal should think I have “ hastily dismissed them,”
in my lecture on the “ Relation of Brain to Mind ” ; but fancy I
have been myself to blame by being less cautious on this sub¬
ject of localization in my earlier memoir than in the later
lecture. It is to be remembered, however, that the memoir on
the “ Physical Relations of Consciousness ” was written so long
ago as 1870. Undoubtedly, the experiments of Hitzig and
Ferrier show a special relationship between exceedingly limited
and definite areae of the brain and the movements of limited
portions of the body or action of certain, of the senses. They
seem to indicate that tracts in connection with different
muscles and organs of special sense have their cerebral ex¬
tremities at these different areae. But how little this tells us as
to the details of the relationship of these particular areas to
consciousness! It tells us simply their relationship to certain
parts of the periphery. But, as centres of voluntary move¬
ment, they must have relation also to the parts of the brain in
connection with which those operations of consciousness are
going on which lead up to the movement.

Now, as regards the connection of mental operations with the

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The Seat of Consciousness .

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hemispheres, three theories may be distinguished. According
to one of these, different portions of the hemisphere are the
organs of different mental qualities; and that is distinctively
the theory of Gall. According to another hypothesis, indivi¬
dual memories and other notions are represented as stored up
in individual nerve-cells, as if they were so many quantities of
matter, or of some condition of matter; and that idea un¬
doubtedly crops up over and over again in the language used
by many biological writers of the present day, though I am
not aware that anyone has attempted to demonstrate its truth.
According to a third view, there is no foundation for believing
that either the qualities or the acts of the mind are lodged in so
many separate receptacles, and that is the position which was
taken up against Gall’s phrenology before the second hypothesis
crept in.

It is not at all obvious that either of the two first theories
throws one bit of light on the results as to motor and sensory
termini obtained by experiment; while, on the other hand, the
third is quite as compatible with those results. I have not the
slightest idea how it is that the will acts on hosts of muscles of
which the mind is ignorant, to make them take each one its just
part in bringing about a result of which the mind is conscious,
and do exactly what the will commands; neither, therefore, can
I be expected to tell how it initiates those actions in cerebral
termini, of which it is likewise ignorant. It is as if unknown
imps obeyed the will. But while I can add no light myself,
I maintain my liberty to point out that the light declared to
be seen by other people is no light at all.

Lunacy Legislation in Holland. By F. M. Cowan, M.D.,
Physician to the Provincial Lunatic Asylum, Meerenberg,
near Haarlem.

As in France, so in the Netherlands there is but one law
relating to the care of persons of unsound mind. It was issued
on the 29th of May, 1841, and consequently is posterior by
about three years to the French law.

Although this law had worked in a satisfactory way for up¬
wards of forty years, the reiterated complaints of superin¬
tendents that the different asylums were overcrowded, decided
the legislative powers to take the subject seriously in hand,
and the result was a project of an entirely new law. Both the
existing law and the projected one have their faults, still I

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1883.] Lunacy Legislation in Holland.

believe the general opinion of alienist physicians in Holland to
be that it would be far better to revise the old law and to add
some necessary articles to it, than to introduce the new one. -

As perhaps our English colleagues may feel interested in the
subject, I wish to glance at our present and our projected legis¬
lation relating to the insane, and to compare their respective
merits and demerits.

I need not here dwell upon the state of the insane before
1841 ; suffice it to say that, by the strenuous efforts of
Schroeder van der Kolk, the lot of these unfortunate sufferers
was vastly improved, and that they were henceforth treated
as human beings.*

One of the first things the law of 1841 had to deal with was
the widely different conditions of existing asylums and
hospitals for the reception of lunatics. They were divided into
medical asylums and asylums for incurables; at the same time
it was enacted that in future no more asylums for incurables
were to be opened. Private houses receiving more than one
lunatic not related to the occupants, are to be considered as
asylums. The legislature, anxious to isolate persons of
unsound mind from those suffering from other diseases, added
a clause by which people afflicted with ordinary diseases were
to be treated in the same building with lunatics, only in urgent
cases, with royal consent, and then always in separate wards.

Who can tell how often this article has clashed with the
one which defines private houses as asylums ?

It requires royal consent to open an asylum, and such consent
brings with it the obligation to submit to such control and
supervision as Government may think fit.

It need hardly be mentioned that in this country, as every¬
where else, countless reclamations have, at different times,
arisen from people who, considering themselves unjustly
detained, loudly complained of the infringement upon their
personal liberty. It, therefore, was a wise measure to subject
the admission and the residence of lunatics to certain
formalities, in which medical and judicial powers go hand-in-
hand.

Whenever a person is thought insane, his friends or relatives
obtain a certificate to that effect from a physician. This certi¬
ficate, which must be signed within 14 days of admission,

* The history of this reform, and the condition of onr asylums in 1853,
are given in an article, “ The Asylums of Holland : their Past and Present
Condition,” by Dr. D. Hack Tnke, in the “ Psychological Journal ” of the fol¬
lowing year.

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is put into the hands of a solicitor, who addresses a request to
the president of the tribunal under whose jurisdiction the
patient in question resides. This request petitions the
authorisation for preliminary admission into an asylum, which
must be expressly named.

If a physician attached to the medical staff of an asylum
signed the certificate, the preliminary admission must not be
into that asylum.

The president of the tribunal being satisfied that the person
mentioned in the certificate is really insane, then consults the
officer of justice (public prosecutor), and decides that such a
person be received in the- asylum named in the request. Such
a decision may be carried out immediately, it need not be pre¬
viously registered, is not pronounced publicly, and is only
valid for fourteen days after it has been passed.

Once the patient is admitted into the asylum, the physician,
under whose care he is there placed, has to observe him
accurately for twenty-eight succeeding days, to make his
daily notes, and at the end of that time to draw up a resume
of the case, in which he declares it necessary or not that the
stay of such a person in the asylum should be prolonged (i for
a year or so much shorter time as may prove necessary for
recovery.”

At the end of this probationary year, this certificate is to
be renewed for another year, and so on.

Superintendents of asylums must give notice of the admis¬
sion, dismissal or decease of every patient, to the officer of
justice under whose jurisdiction the asylum stands, and to the
corresponding official, attached to the tribunal that first
authorised the patient’s admission.

In the case of a dangerous lunatic, the local authorities of
a community may order his provisional admission into an
asylum, under obligation of giving notice thereof to the officer
of justice within twenty-four hours.

A register, in which the names of all patients are in¬
scribed, is kept in every asylum, and is examined by the
different inspectors, who sign it. After a sojourn of three
years in an asylum, the patient is placed under interdiction,
i.e. } he is placed under the tutelage of a “ curator” (guardian)
and is considered as a minor. This article of the law
is easily and frequently eluded by the relatives taking a
patient out of the asylum, be it only for a single day, and
having him re-admitted immediately after, when all the
formalities have to be gone through anew.

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by F. M. Cowan, M.D.

161

In order to provide against illegal detention, two inspections
are ordered by the law. The one by the officer of justice,
takes place quarterly, the other must be held at least once in
three years, by the inspectors of lunatic asylums. Besides^ the
governors of the provinces have free access as often as they
may think fit, and are to send a report to the Minister of the
Interior. However, as far as I know, these functionaries very
rarely visit.

The officers of justice are always accompanied by a medical
officer, called the medical inspector of the province, an,d visit
very regularly; so do the inspectors, who, although only obliged
to come at least once in three years, always do so once a year.

Whenever the inspecting officials consider a person illegally
detained they may order his release. I am proud to say, such
an order has never yet been given.*

In order to prevent, as far as possible, the public peace being
disturbed by persons formerly inmates of asylums, the law con¬
tains an article by which such cases have been provided for.
Whenever the dismissal is demanded of a patient with
suicidal tendencies, or dangerous to others, the superintendent
acquaints the officer of justice with the case, who then forbids
the release of such a person.

Last of all, let me add that Article 8 orders every province,
in which no asylum exists or need (?) exist, to treat with the
managers of other asylums, in order suitably to provide for
their insane patients.

The new law was projected in 1880, and from the first its
provisions were rather unfavourably received by several
members of the second Chamber of the States General. The
effect of the proposals upon the alienist physicians was to cause
an outburst of indignation; Still it is only due to say that it
contained several improvements upon the present legislation
relating to the insane.

The main points of difference between the existing law and
the projected one may be briefly summed up under five
heads:—

1st. State control and supervision over the insane who are
not treated in asylums—a point now altogether neglected.

2nd. Increase of legal guarantees for the proper treatment
of patients in asylums.

3rd. Provisions that there be a sufficient number of asylums
—a matter not stringently enough enforced by the present law.

* The value of this .fact must, of course, depend upon the vigilance, in¬
dependence, and courage of the inspectors.— [Eds.]

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Lunacy Legislation in Holland , [July,

4th. Modification of the formalities necessary for admission
and discharge of patients, and likewise increase of measures
guarding against unjust admission or detention of sane persons.

5th. Suppression of obligatory interdiction after a three
years’ stay in an asylum.

As to the first point—State control and supervision over
lunatics not treated in regular asylums—this was unanimously
considered a great improvement, and it may well be thought a
grave omission in the present law that no provision is made for
the care of these persons. Statistical returns showed that in
1879 there were about 1,750 insane people not living in
asylums, and there are excellent reasons for believing that
these figures remain below the real number. Indeed, it may
be called an anomaly that provincial and municipal asylums,
accurately and conscientiously managed by respectable citizens,
should be subject to severe and repeated inspections, while
people who may consider the care of a lunatic merely as the
means of making money, with very little, if any, regard to his
welfare, should be exempt from any supervision whatever.

The omission of a definition of insanity in the new law was
considered an improvement. The diagnosis of insanity de¬
pends entirely on the psychological analysis of the whole
individual, on a dissection of his character, Bacon would say.
In fact to quote the writer of a paper which appeared in tins
Journal some time ago :—“ If we met a person here, who went
about naked and could only count to five, we should consider
such a man an idiot, while if he had a black skin and
promenaded the banks of the Congo, he might probably be
considered a specimen of average intelligence there. Again,
if we heard his Grace the Duke of Omnium order out his
carriage and four, nobody would consider this order strange ;
but if a poor bricklayer were to give the same order he would
most likely be thought insane.” The present law contains the
following definition :—“ All persons entirely or partially de¬
prived of the free use of their intellectual faculties shall be
called insane.” It is superfluous to remark that it is in¬
sufficient and rather too metaphysical; besides, it is impossible
to give an exact definition of disease, and the same thing
holds good for insanity, which after all is only a species of
brain disease.

The most odious articles in the projected law, were those
relating to the increase of legal guarantees for the proper
treatment of patients in the asylums.

It was thought the quarterly inspections by the officers of

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163

by F. M. Cowan, M.D.

justice were not frequent enough, and henceforth these officials,
accompanied by the medical inspectors of the provinces, were
to have free access whenever they might think fit. The
quarterly inspections were to be held as before.

The Association of alienist physicians protested against this
measure, which they considered a violation of privacy on the
following grounds : —

That the visiting officer of justice will be continually
troubled by patients considering themselves unlawfully
detained, and this will consequently add to the turbulence and
agitation of several wards;

That he will most likely misinterpret many expressions and
acts of patients;

That it seems an insult to a physician to see an incompetent
umpire judge his rule of action;

And last, not least, that several patients will greatly dislike
the idea of being continually under the eye of justice, like so
many criminals.

In fact it would be very wrong to have strangers visiting
the premises too frequently, and especially visitors who might
consider it their duty to keep testing the mental powers of the
. different inmates. There should be a boundary wall round
every asylum—a wall which, to repeat the expression of a
British physician, serves to keep the public out, not to keep
the patients in.

Another article (Art. 8), not much relished by boards of
managers but applauded by physicians, ordered that as soon as
an asylum contained more than twenty patients, at least one
physician was to be resident; besides, the Crown was to fix
the maximum number of patients and the minimum of
physicians to every asylum. Asylum physicians, it was said,
were overburdened with work and could not devote as much
time as they might wish to scientific work. However, strange
to say, a little further on the projected law proceeded to add a
large mass of writing-work to their daily business.

The commission charged with the making of the new law,
very truly remarked that in no country were so many
formalities to be gone through and so many intermediate per¬
sons required for admitting a lunatic into an asylum, and drew
the very logical conclusion that these formalities required
simplification. England, France, Belgium, and Sweden were
cited as countries where these things were better, i.e ., more
easily, managed. However, instead of simplifying, the com¬
mission introduced only a slight modification. Instead of
xxix. 12

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sending the petition to the president of a tribunal through the
medium of a solicitor, it was to be sent direct to a justice of
the peace. The reason lay, it was said, in the fact of the
tribunals often being at a great distance, and consequently
more difficult to reach than a justice of the peace. It is a
fact, that a justice of the peace has a smaller district under his
jurisdiction than a tribunal, still even these districts often are
too large to reach the justices easily. Why then, it was asked,
not grant the local authorities (burgomasters) the power to
authorise a patient’s admission ? These functionaries are
always easily and quickly reached, and time, which is so
precious for the patient’s recovery, is not lost. Moreover, if
a burgomaster authorises admission, there is no objection to
let the tribunal pass sentence for further residence in the
asylum. This would have the advantage that the judicial
powers controlled the administration.

The power of interference given to officers of justice was so
much increased, that an article even appeared ordering
physicians to send a short account of the patient’s state to these
officials daily, during the first three days. Now it is
altogether inconceivable what interest a judge can possibly
place in a dry summing up of symptoms; and what insight can
this measure give a non-professional man in a case ? Besides,
what is a physician to note in a case of folie circulaire , in
many cases of monomania, or in the case of a malingerer ?

The physician was henceforth to be placed in an altogether
inferior position with respect to the judges. Not only were
they to decide whether a person was insane or not, but Article
31 goes still further. It says that, “ whenever the officer of
justice finds a person in an asylum who has been unlawfully
admitted, or is being so detained, he shall order his release,
etc. When he meets a person there who, though duly and
legally admitted, is no longer insane, he shall order his release
if the physician agree with him as to such a person’s sanity.
If the physician does not agree, then the tribunal (not medical)
is to decide.” This clause contains a curious contradiction.
If the physician agrees with the justice that a patient is re¬
covered, he certainly does not require an order to release such
a person; and if he does not agree, the arbitrium of a pro¬
fessional man is to be set at nought by the super-arbitrium of
a body of non-professional men.

Article 22 of the new law contained an addition to the pre¬
sent one, authorising the judges to hear the patient himself,
the physician being present or not at the examination. In the
now existing circumstances, it is very expressly said that “ in

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165

1883.] by F. M. Cowan, M.D.

no case shall the lunatic be heard.” In fact the amount of
trouble a man, suffering from delusions of persecution, may
give a judge, who wishes to thoroughly investigate his case,
will be tremendous.

Article 23 so far modified the present law, that it decided
that after at least eight, and within fourteen days after admis¬
sion, the physician in charge was to send his resumS of
symptoms and certificate as to the insanity of the patient to
the tribunal. Why shorten the time for observation from
twenty-eight days to a fortnight ? In cases exhibiting, as Dr.
Maudsley has it, “all that imagination can picture of the ridicu¬
lous, the noisy, the fantastic, the furious, the violent, the dis¬
gusting/’ a very short time will suffice to diagnose the disease;
but how in cases of monomania, etc., in which very often
indeed four weeks are too short a period to form a diagnosis ?

I just now mentioned an increase of writing to be done by
physicians, in case of the law being passed. One of the tasks
is this : During the first fortnight after admission the physician
shall write his notes on the case daily, then during at least six
months weekly, and afterwards monthly. This, it was said,
was introduced to make sure that the patients were visited
regularly.

I have carefully perused the instructions of several of our
Netherland asylums, and have found it ordered in them all that
the physicians shall see their patients twice a day ; as far
as I know, the inspectors never complained of any negligence
in that respect, so that what called forth this disagreeable
suspicion was a riddle to us all. The case books always con¬
tain concise accounts of any intercurrent disease, and, as a rule,
the post-mortems. Besides, what will there be to mention about
the majority of asylum inmates, viz., the hopelessly demented,
people for whom life passes as a blank ?

Article 24 orders that in every asylum a register shall be
kept, in which the physicians sh&ll daily inscribe the names of
patients placed under mechanical restraint and the particular
means employed.

Although I have the honour of belonging to the medical
staff of an overcrowded asylum, containing upwards of 900
patients, in which, thanks to the brave efforts of our superin¬
tendent, Dr. van Persyn, strait waistcoats, gloves, and so
forth, are unknown instruments, and in which no restraint in
the widest sense has been applied for upwards of 25 years, I
cannot but protest against this Article. Restraint is a
system as well as no restraint; both have their warm partisans,
and it is only due to each that we should respect another’s con-

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166

Lunacy Legislation in Holland , [July,

viction even if we do not share it. However laudable it may
seem to propagate this measure—the system of no restraint—•
I believe that if it were introduced, the tribunals might just as
well decide what medicine is, or is not to be, given to the
patients.

Article 26 obliges every Netherlander who sends a fellow-
countryman to a foreign asylum to give notice thereof, within
eight days, to the officer of justice under whose jurisdiction
the patient lived whilst residing in this country.

I have only a little to say with regard to this clause.
Lunacy is quite as little a fashionable disease here as anywhere
else, and the amount of untruths told by friends and relatives to
conceal the occurrence of the disease in members of the
family, is quite as stupendous. For this purpose of conceal¬
ment, as well as to elude the number of formalities required
for admission, the well-to-do classes often send their sufferers
to Germany.

I mentioned the care for a sufficient number of asylums in
the third place. Article 10 decides that there shall be one or
more State asylums. They were to receive such persons who
depend upon Government for maintenance, and in the first
place lunatic criminals ; in fact, it was to be an imitation of
Broadmoor. Under existing circumstances. Government has
contracted with some asylums for the reception of these
people, and has thus, unwillingly, been setting several pro¬
vinces a bad example.

This highly commendable plan was coldly received by some
members of the legislature.

Conclusion .—All parties agree that the law of 1841 has
worked well, and consequently, although its weak points have
come out during these thirty years, still it should not be ruth¬
lessly destroyed.

Both judicial and medical authorities received the project for
the new law very coolly, if not with aversion. I have heard
officers of justice declare that they did not wish for the heavy
amount of responsibility which it heaped upon them, for the
simple reason that they could not use it; that although they
seemed the first person, they must necessarily be the docile
followers of the physicians. The opinion of physicians, and
especially of alienists, I have already given above.

A thorough revision of the now existing law is what would
find most favour, viz. :—

1. Suppress the definition of insanity. Every physician
who has to do with lunatics knows what is meant, though he
may not be able to express it in words.

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by F. M. Cowan, M.D.

167

1883.]

2. Simplify the formalities for admission of patients into
asylums. This may be readily done by granting the local
authorities the power of allowing the provisional admission for
four weeks, while the tribunals.pass sentence for the prolonga¬
tion of residence. As I have already said, these authorities are
always at hand, and the assistance of a solicitor might be
dispensed with.

3. The present law leaves the care for the insane to the
provincial authorities, and orders those provinces in which no
asylum exists, or need exist, to deal with the managers of
asylums for a certain number of beds. This is simply an
anachronism. An asylum need exist in every province, and an
Article should be inserted requiring every province suitably to
provide for its insane inhabitants within the limits of that
same province.

By all means let us follow the example of England, and let
us have our Broadmoor. No country should be without one.

It would be a fine measure to fix a maximum number of
patients for every asylum. The appointment of a minimum
number of physicians might, perhaps, be an interference with
certain household arrangements.

4. Suppress the obligatory interdiction after a three years'
stay in an asylum. As I have already said, this part of the
law is easily and frequently evaded.. And, besides, is it not
ridiculous to go through an expensive and tedious procedure in
the case of a pauper lunatic, of whom it need not be feared
that he will mismanage what he does not possess, viz.,
property ?

Caffeine , in its Relationships to Animal Heat and as Contrasted
with Alcohol,* By W. Bevan Lewis, L.R.C.P.Lond.,
Senior Assist. Med. Officer, West Riding Asylum.

The observations now to be recorded relative to the physio¬
logical action of Caffeine upon animal thermogenesis were
carried on several years ago as part of a series of experiments
in the same direction with numerous potent alkaloids, atropine,
solanine, hyoscyamine, strychnine, and others. +

The experiments with Caffeine and Alcohol J were to me a

* While the title of this article may seem at first sight to have little to do
with 44 Mental Science/’ its great importance in relation to the treatment of
mental as well as other diseases, and the nse of alcohol in the asylum dietary,
must be admitted.— [Eds.]

f 44 Calorimetric Obs.,” West Riding Asylum Reports, Yol. vi.

X 44 Physiological Action of Alcohol in Relationship to Animal Heat.”
44 Journal of Mental Science,” Vol. xxvi.

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168 Caffeine , in its Relationships to Animal Heat , [July,

source of special interest from a consideration of the importance
of both as entering so largely into the dietetics of modem life,
and I had purposed greatly enlarging the scope of such obser¬
vations when the restrictions of the anti-vivisection enactments
compelled me to abandon my object. Several important papers
have lately appeared upon the physiological and therapeutic
actions of Caffeine; and, as the active principle of Coffee cannot
fail to prove of interest to the physiological enquirer, especially
from our present point of view, I have ventured to detail the
results of my observations, incomplete though they be, as a
small contribution towards our knowledge of a subject of general
interest.

The calorimeter made use of was one recommended for such
observations by Dr. Burdon Sanderson. It was repeatedly
tested by various methods to gauge its accuracy, and always
with satisfactory results. The water in the outer chamber was
kept in constant movement, and an extremely sensitive centi¬
grade thermometer used in taking its variations in tempera¬
ture. As to the atmosphere of the room, deviations in
temperature during the course of these observations were
carefully recorded, and found always to be insignificant, every
precaution having been taken to ensure an equable temperature
and the elimination of any probable fallacy.

The animal chosen for these experiments was the rabbit, and
the alkaloid in solution was injected into the stomach by a
suitable and ready arrangement. Each rabbit was carefully
weighed, and its normal heat production in the calorimeter and
variations in body temperature noted prior to the administra¬
tion of the drug—the same animal never being employed for
a second series of observations. It will be seen from the
tabulated experiments that each observation is devoted to three
problems :—

a. The total heat formation of the animal expressed in
gramme-units for periods of quarter of an hour before
and after the use of the alkaloid.

ft. The diminution, augmentation, or stationary condition of
the body temperature.

y. The total heat formation for each interval expressed in
gramme-units per gramme of body weight.

As the animals differ much in weight they would conse¬
quently shew great variations in heat production on this
account; hence the last estimate is necessary as affording at a
glance the proportional heat formation in the various animals
operated upon. The following Tables afford typical results ob-

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169

1883.] by W. Bevan Lewis, L.R.C.P.

tained from a large series of experiments under different doses
of the alkaloid. We will begin with the minimum doses
administered.

Table 1.

(Observations £ hour each.)*

Rabbit given 2-£ grains of Caffeine.

Weight of Animial,

Total Heat-

Loss or Gain in

Fresh Heat-Forma¬
tion per Gramme of
Body-Weight.

2198 Grms.

Formation.

Body-Temperature.

Observation 1.

2633

— 1216

1*19

„ 2.

3850

Nil.

1-75

The amount of Caffeine here given was not above ’00113
grains for every gramme of the animal’s weight, and in the
succeeding experiment a still smaller dose was given (the rabbit
being much heavier), corresponding only to *001 grain for each
gramme of body weight.

Table 2.

(Observations £ hour each.)
Rabbit given 3 grains of Caffeine.

Weight of Animal
2940 Grms.

Total Heat-
Formation.

Loss or Gain in
Body-Temperature.

Fresh Heat-Forma¬
tion per Gramme
of Body-Weight.

Observation 1.

3687

— 105

1*17

„ 2.

4746

— 100

1*57

„ 3.

997

— 671

0*298

In these two animals the normal heat formation prior to
administration of the Caffeine varied betwixt *96 and 1*17 heat-
units for each gramme of body weight; hence we find the im¬
mediate result of the alkaloid to be a slightly augmented heat
formation, the highest registry 1*75 being attained within half

• The figures in each column represent gramme-units of heat,

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170 Caffeine , in its Relationships to Animal Heat, [July,

an hour where the stronger dose was given. In the last case
the third observation reveals a fall far below the normal
(0*298 gr. un.), as the sequel to the primary heat augmentation.
Corresponding to this increased formation and evolution of heat,
we likewise observe, in Table 2, a loss from the body-tempera¬
ture amounting during the last interval to 571 heat-units, the
rabbit’s temperature having fallen from 102*7° Fah. to 101*8°
Fah.; and in Table 1, when the stronger dose was given, 1216
heat-units were lost, a fall in temperature from 103*5° Fah. to
101*9° Fah. It will, however, be noted that in the last case
during the second interval the animal’s temperature remains
stationary, the loss or gain being stated as nil, and that this
corresponds also to the period of greatest heat formation. Thus,
in doses corresponding to little over one thousandth of a grain
for each gramme of body weight, we have as a result a primary
slightly augmented heat formation with a lowering of body tem¬
perature —the latter most marked, but more quickly checked,
where the larger dose is given.

Let us now give our attention to somewhat larger doses of the
alkaloid. In Tables 3 and 4, where two or four grains
respectively of Caffeine have been administered, we see on refer¬
ence to the animal’s weight that the actual amount given is
about the same in both cases (*0013 grains per gramme of body
weight), but above that given in Table 1.

Table 3.

(Observations J hour each.)

Rabbit given 2 grains of Caffeine.

Weight of Animal
1525 Grms.

Total Heat.
Formation.

Loss or Gain in
Body-Temperature.

Fresh Heat-Forma¬
tion per Gramme of
Body-Weight.

Observation 1.

3867

—

1265

2*53

.. 2-

1833

—

499

1*20

„ 3.

3084

284

2.02

,, 4.

4184

354

2*7

„ 6.

3177

424

2083

3850

Nil.

2*52

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1883.]

171

by W. Be van Lewis, L.R.C.P.
Table 4.

(Observations \ bour each.)
Rabbit given 4 grains of Caffeine.

Weight of Animal
2928 Grms.

Total Heat-
Formation.

Loss or Gain in
Body-Temperature.

Fresh Heat-Forma¬
tion per Gramme
of Body-Weight.

Observation 1.

2729

— 1494

0-932

„ 2.

7165

— 534

2-44

n 3.

6787

-f 814

2-81

4247

— 279

1-45

In Table 3 the most striking feature is the prolonged dura¬
tion of the stage of augmented heat formation, which, for a
period of one hour, is represented by two gramme-units per
gramme of body-weight during each observation, and at one
period the product reaches 2*7 gramme-units. The first two
observations in this Table represent an exceptional condition,
which occurs with some animals when placed in the calorimeter.
In this instance the first two observations give the results prior
to administration of Caffeine, and yet we find an augmented
heat-formation and a large primary evolution from the body-
temperature, both conditions greatly diminished during the
next interval at the end of which the alkaloid was given. This
primary action is due to the comparatively unnatural state in
which the animal is placed, and the stimulus to heat-formation
appears to be induced by the chill of the surrounding fluid
where the balance betwixt the temperature of the latter and
the atmosphere has not been fairly established, as was the case
during the earlier stage of the experiment. Towards the
termination of the first half hour a more normal condition of
thermogenesis has set in, and now, Caffeine being given, a fur¬
ther rapid increment of thermal units takes place, together with
an addition to the body temperature . This addition of heat-
increments, which tends to re-establish the norma of tempera¬
ture, proceeds-for three quarters of an hour.

In Table 4, the first observation represents the normal state
of the animal in the calorimeter, the three remaining observa¬
tions being the results of the four grains of Caffeine. Here

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172

Caffeine , in its Relationships to Animal Heat , [July,

also the immediate effect of the surrounding fluid is to cause a
loss from the body-temperature of 1494 heat-units, but no
augmentation of the fresh heat-formation occurs as in the pre¬
vious experiment. The heat-formation is, under the operation
of Caffeine, augmented to about the same extent, and a sudden
attempt at restitution of body-temperature is also seen at the
third observation.

A further increase of the dose of Caffeine shows in the
strongest light the characteristic action of the alkaloid when
given in large quantity. Three experiments may be here cited
as typical of the conditions thus induced. In Tables 5,* 6, 7,
Caffeine was given in doses varying from to 4 grains, which,
when the relative weight of the animals is considered, corres¬
pond respectively to ’0018 grs., *0021 grs., and *00218 grs.
for each gramme of body weight. In the two last experiments,
therefore, the dose given was quite double that of the experi¬
ments detailed in Tables 1, 2.

Table 5.

(Observations £ hour each.)

Rabbit given grains of Caffeine.

Weight of Animal
1343 Grins.

■

Total Heat-
Formation.

Loss or Gain in
Body-Temperature.

Fresh Heat-Forma¬
tion per Gramme of
Body-Weight.

Observation 1.

2055

—

744

1*53

„ 2-

6010

—

122

3-73

„ 3.

6206

186

4-62

,, 4,

4308

3-20

„ 5.

2850

183

2-12

An explanation is required relative to this last experiment
(Table 5). As before stated the loss from body-temperature,
which occurs in the normal state when the animal is placed in
the calorimeter, appears partially due to the unnatural surround¬
ings and partly to the struggles which most rabbits make when
handled and confined within the chamber, a transient and
abrupt evolution from the body-temperature usually occurring
at this period.

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1883.]

173

by W. Bevan Lewis, L.R.C.P.

Table 6.

(Observations £ hour each.)
Rabbit given 4 grains of Caffeine.

Weight of Animal
1880 Grins.

Total‘Heat-
Formation.

Loss or Gain in
Body-Temperature.

Fresh Heat-Forma¬
tion per Gramme of
Body-Weight.

After much exertion
and struggling.

— 1735

•

Observation 1.

4315

— 351

2*29

10095

— 171

5*37

„ 3.

8019

4-26

„ 4.

5452

2*90

In the experiment illustrated by Table 6, I had to deal with
an unusually sensitive and timid animal which struggled fran¬
tically, and which was therefore allowed to rest out of the
calorimeter for a period of 15 minutes, at the termination of
which period it was found to have lost 1735 gramme-units of heat
from its body temperature. Exhausted by its previous
struggles the animal offered little or no resistance to the
administration of the alkaloid, and was immediately transferred
to the calorimeter.

Table 7.

(Observations \ hour each.)

Rabbit given 4 grains of Caffeine.

Weight of Animal
1830 Grms-

Total Heat-
Formation.

•

Loss or Gain in
Body-Temperature.

Fresh Heat-Forma¬
tion per Gramme of
Body-Weight.

Observation 1.

4101

— 1265

2*24

»» 2 .

5447

+ 80

2*97

„ 3.

3225

+ 426

1-76

„ 4.

7633

+ 167

417

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174 Caffeine , in its Relationships to Animal Heat , [July,

In each of these three last experiments the thermometric ob¬
servations reveal an exceptionally exalted state of thermo¬
genesis. The fresh heat formation amounts to quite double what
was registered in Tables 3, 4. In Table 6, especially, is this
maximum result seen, where, in the second observation, 10095
gramme-units are formed within the period of 15 minutes, cor¬
responding to 5*37 heat-units for each gramme of body-weight.
Each experiment illustrates, in a striking manner, the follow¬
ing features, as especially characteristic of the action of these
larger doses:—

1. Great increase of fresh heat-formation.

2. Prolongation of the above stage of stimulated thermo¬

genesis.

3. Maximum of heat-formation attained at a later period

with the augmented dose of the alkaloid.

4. Early efforts at the restitution of the norma of tempera¬

ture—seen in all cases alike.

Thus in Table 7, the stage of exalted thermogenesis extends
over one hour , at the termination of which period the maximum
is attained, the animal having in this case taken the strongest
dose of Caffeine as yet given.

So also in Tables 5 and 6, the same stage is seen extending
through the whole of the first hour subsequent to the adminis¬
tration of Caffeine; in Table 5 (the smaller dose), the greater
heat-formation occurs in the earlier observations; in Table 6
(the stronger dose), this occurs later on, yet not so long de¬
ferred as in the next case (Table 7), where the largest amount
of Caffeine was given.

Table 8.

(Observations £ hour each.)

Rabbit given 6 grains of Caffeine.

Weight of Animal
2207 Grins.

Total Heat-
rormation.

Loss or Gain in
Body-Temperature.

Fresh Heat-Forma¬
tion per Gramme of
Body-Weight.

Observation 1.

6391

— 1425

2-896

>> 2.

3701

— 1502

1-677

„ 3.

6023

— 203

2*274

„ 4.

4440

Nil.

2*011

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1883.]

by W. Bevan Lewis, L.R.C.P.

175

Still larger doses (6 grs.) of the alkaloid were given, but
always with the effect of causing such intense cerebral excite¬
ment, with irritability and violent struggling, that the results
were peculiarly interesting. The characteristic heat-augmenta¬
tion of the Caffeine was still more protracted and delayed in its
appearance, whilst the earlier stages were chiefly characterised
by great loss from body-temperature. This earlier stage, in¬
duced by very large doses of the alkaloid, are represented in
Table 8, the later stages not being included.

Perhaps I cannot better illustrate the effects upon animal
heat of the larger doses of Caffeine than by tabulating two
typical experiments along with calorimetric observations upon
rabbits (a) in the normal state (b) after the administration of
alcohol; and (c) after Caffeine in strong doses combined with
alcohol.

The animal in the normal state was experimented upon under
most favourable circumstances ; and I have on several previous
occasions taken the results given in the first column as a fair
average statement of thermogenesis in the healthy state. It
will be noted how low the heat formation is in this case when
compared with that registered after strong doses of Alcohol, and
also after Caffeine; for whilst in the normal state 1*08 heat
units is the maximum attained, and usually the registry is not
above 0*96, in the case of the stronger dose of Caffeine the
maximum is 4*62; and in the case of Alcohol 4*28, the stage of
exalted thermogenesis extending over an hour with both.
Again, when the cases treated with Caffeine are compared with
those which have had Alcohol, a great distinction is observed as
regards body temperature. In the former case the primary
discharge is succeeded shortly by retention and addition to the
body temperature; in the latter case a continuous and pro¬
longed discharge of the body heat occurs, gradually diminishing,
however, and restitution commencing at the sixth observation,
so that, by the end of one hour and a quarter from the adminis¬
tration of the Alcohol, the animal’s temperature had fallen 6*5
degrees Fahrenheit, i.e ., from 103*8° to 97*3°. The animal to
which three drachms of diluted Alcohol had been administered
was profoundly affected, apart from this inability of the system
to reinstate the norma of temperature; beyond the dulness,
heaviness, and somnolence from which it suffered, there was
paralysis of its limbs and frequent severe rigors, with almost
constant trembling.

We may, I think, rightly conclude from these comparative
observations that whilst both Caffeine and Alcohol alike increase

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Table 9.

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Caffeine , in its Relationships to Animal Heat . 177

to a great extent the normal heat formation, they differ in the
very important feature that alcohol by an excessive and pro¬
longed discharge of heat greatly lowers the body-temperature ,
whilst on the other hand Caffeine tends rapidly to reinstate the
norma of temperature by retention .

As to the parts played by the respiratory and the general
cutaneous vaso-motor systems in the loss of animal heat, I have
but one remark to offer. Whenever by any mischance the
slightest interference with respiration took place in a rabbit
whose temperature was reduced by Alcohol, as for instance by
the-regurgitation of a little fluid into the trachea, the increased
thermogenesis was immediately checked, and the body tem¬
perature fell so low as to render a fatal termination imminent.

When large doses of Caffeine and Alcohol combined are
administered the interesting results seen in Table 9 are apparent.
An early stage of diminished heat-formation precedes the in¬
creased thermogenesis, whilst the fall in body-temperature,
which characterises the action of alcohol, appears more or less
completely antagonised by the Caffeine.

In all cases treated by Caffeine the contracted pupil, increase
of salivary secretion, and mucous discharge from the bowel were
prominent symptoms. To these were superadded changes in
the vaso-motor condition of the ears, and occasionally, as before
remarked, violent struggling as the result of cerebral excite¬
ment. All these symptoms have been described previously as
characteristic of a group of alkaloids, containing Caffeine,
Theine, Cocaine, and Guaranine.*

In the valuable report to which I allude the effect of the in¬
jection of Theine and Caffeine into the rabbit indicate very
clearly a primary lessened and subsequent increased tempera¬
ture of the ears, variations rapidly induced by the mode of
administration. In all my experiments the alkaloid was given
by mouth, and the dose never pushed up to the lethal point.
It appears to me, in conclusion, to be a point of great interest,
and one suggestive of further observation, that whilst stimu¬
lating heat formation Caffeine should differ from Alcohol in
retention of heat and addition to body-temperature, and should
antagonise so effectually the vast heat-discharge which occurs
in the vaso-motor paresis induced by Alcohol. It would be
premature to attempt any very definite deductions from the
above series of experiments, but I venture to assume they have
therapeutic and dietetic indications, which may prove of value.

* See " Report on the Antagonism of Medicines,’* by J. Hnghes Bennett,
1875. Being the Report of the Edin. Committee of the Brit. Med. Association.

Digitized by LjOOQle

178 Caffeine , in its Relationships to Animal Heat . [July,

Universal experience points to the unfavourable action of
Alcohol where retention of body heat is essential; and we even
have the verdict of Arctic explorers and others of similar experi¬
ence and import as to the preference given to tea, coffee, and
their allies over spirits as an article of diet, considered from the
point of view of conservation of temperature; and although the
physiological action of Alcohol may prove of especial value in
some cases, we can well conceive those other conditions where
its use either therapeutically or dietetically considered cannot
fail to prove highly prejudicial.

Prognosis in Cases of Refusal of Food . By Henry Suther¬
land, M.D.

“May good digestion wait on appetite, and health on
both.” So speaks the greatest of our English poets—the
immortal Shakespeare.

Who can estimate too highly the blessing of a good
appetite ? Who is there amongst us who does not feel that loss
oi appetite is one of the greatest curses that can be inflicted
upon suffering humanity? Is not a good appetite the
greatest proof that we are in good health ? Is not loss of
appetite, in however small a degree, an evidence that there
is something wrong with us ? and is not complete loss of
appetite a sure indication of approaching dissolution and
death?

The causes of loss of appetite are so various that it is
almost impossible to arrange them under any definite heads.
All ages are affected by it, from the puking child to the
hoary-headed man of fourscore years. Both sexes are
liable to it, although as will be shewn the female is more
prone to it than is the male.

Civilization undoubtedly increases it, from the fact that
more artistically prepared foods excite us first to eat too
much and then make us loathe our food from our excesses.
Moral and physical causes both play their part in its pro¬
duction. Mental causes are almost innumerable, from the
mere loss of appetite due to reasonable grief, down to the
insane suicidal attempt of a lunatic to destroy himself by
refusal of food under the influence of delusion.

Somatic influences again are equally powerful and varied,
sometimes depending upon a mere trifle, such as loss of

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1883.] Prognosis in Cases of Refusal of Food. 179

teeth, and again being associated with the most severe forms
of disease with which we are acquainted.

External influences also play an important role, as when
anorexia ensues from excessive indulgence in alcohol, tobacco,
opium, ganga, bang, churrus, or any of the many sedatives
which in moderation are a blessing to man, but in excess are
a curse.

And if the causes are so numerous and varied, how much
more varied must be the treatment! Are we to lay down
rules and appty them according to the nomenclature of
diseases recognised amongst practitioners ? Or are we to
deal with each individual case ? Both modes must un¬
doubtedly be accepted, but we must ever be mindful that we
are treating patients and not diseases. Again, can any¬
thing be done in such cases beyond a mere exhibition of
drugs? Certainly there are weapons at our hand more
potent than the pharmacopoeia itself, such as the removal of
the cause of anorexia when the disease is in its early stage,
the moral influences such as threats or persuasion suitable
in different cases; and last, though by no means least, the
employment of the various modes of artificial feeding, which
have recently been brought to such a state of perfection.

But about such matters let us not talk loosely.' We must,
if possible, gather statistics of disease from well-kept records,
where we can ascertain the causation, symptoms, treatment
and result, of those cases which we have had for some length
of time under our own observation.

With this object in view I have ascertained from my case
books the number of patients requiring artificial alimenta¬
tion in the last 100 males and in the last 100 females dis¬
charged from my asylums, or who have died there. My
reason for not taking the percentage on the admissions being
that I wish to demonstrate the ultimate result of such treat¬
ment in those cases who required feeding by mechanical
means.

These patients were all insane, and upon their peculiarities
I propose to found the remarks I shall make in this essay.

At the same time should these cases suggest any observa¬
tions upon others in their right mind who have required any
special mode of feeding in private practice, I shall allude to
such patients, as it were in parenthesis, hoping that the
treatment adopted in their cases may assist in illustrating
the therapeutic value of food administered against the
patient’s inclination.

xxix. 13

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180 Prognosis in Cases of Refusal of Food , [July,

Of the last 100 male patients who have left the asylum or
have died the forms of insanity were—
in 70 cases Mania,

„ 14 „ Melancholia,

„ 16 ,, Genend Paralysis.

100

Of the last 100 female patients who have left the asylum
or have died the forms of insanity were—
in 66 cases Mania,

„ 34 „ Melancholia.

100

Of the same last 100 males above-mentioned—

22 were discharged recovered,

44 ,, „ relieved,

18 „ „ not improved,

16 died.

100

Of the same last 100 females above-mentioned—

34 were discharged recovered,

41 „ „ relieved,

17 ,, „ not improved,

8 died.

100

I am unable to discover that the age, condition as to
marriage, or occupation of the patients fed artificially in any
way influenced prognosis.

The form does not in females; but of course all cases of
general paralysis complicated with refusal of food are fatal
in the male. No case of general paralysis has ever been
admitted to my female asylum.

The cause of the attack does not seem to influence the
prognosis in feeding cases.

The bodily condition on admission does affect the result
materially, very emaciated patients dying rapidly, and those
who are suffering from any severe bodily disorder also suc¬
cumbing very soon to their illness.

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1883.]

181

by Henry Sutherland, M.D.

The mode of feeding does not materially affect the prognosis.
But it is true that feeding by the mouth tube allows of more
solid farinaceous matter being forced into the stomach.

It is also true that the patient is often kept alive for a
long time by feeding by the nose alone; and in certain ex¬
ceptionally favourable cases, life may be actually prolonged
by an exclusive course of alimentation by the rectum.

Ten cases out of the 100 males refused food. The form
of insanity was—

in 5 cases Mania,

„ 4 „ Melancholia,

„ 1 case General Paralysis.

Eight cases out of the 100 females refused food. The form
of insanity was—

in 3 cases Mania,

„ 5 * „ Melancholia.

Out of the above-mentioned 10 male cases 3 died, 2 were
discharged not improved, and 5 recovered.

Out of the above-mentioned 8 female cases 1 died (set. 71)
and 7 were discharged recovered.

Prognosis is, therefore, more favourable in cases of refusal
of food by the female than by the male.

I must confess to a feeling of disappointment as regards
my statistics. I have fed so many patients in private practice
that the remembrance of their cases led me to believe I had
fed a much larger number in my asylums. In this I was
deceived, for, as I have shown above, only 10 males and only
8 females required feeding in 200 cases, that is to say 10 per
cent, males and 8 per cent, females.

As statistics have given me so little information, I must
attempt to supply the deficiency from notes of private cases
and from memory, and shall now endeavour to bring to your
notice the circumstances under which prognosis may be con¬
sidered favourable or the reverse in patients requiring
artificial feeding, illustrating my remarks by describing
cases which have been under my own care and observation
during the last twelve years.

1. Prognosis is good when there is only a disinclination
for and not a distinct refusal of food.

la. Prognosis is bad when there is a persistent refusal of
food.

2. Prognosis is good when disinclination and refusal of
food depend upon some removable bodily cause.

2a. Prognosis is bad when the bodily cause is irremovable,

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182

Prognosis in Cases of Refusal of Foody [July,

and most unfavourable in cases of general paralysis of the
insane complicated with some severe bodily disorder.

3. Prognosis is good when the refusal of food occurs
during a lirst attack of mental alienation.

3a. Prognosis is bad if the refusal occurs during a second
or subsequent attack.

4. Prognosis is good if after once being fed artificially the
patient takes his food naturally.

4a. Prognosis is bad if the patient requires to be fed more
than once, the recovery to mental health being less likely
to occur in cases which have been fed a great number of
times.

5. Prognosis is good if the health and weight of the patient
remain about the same.

5a. Prognosis is bad if the patient loses flesh, although fed
daily, the tendency to death being very marked in such cases.

5b. It is also bad if the patient gains much flesh under the
feeding, at least as regards the recovery to mental health,
such patients drifting usually into a contented state of
dementia.

6. Prognosis is good if the patient wishes to recover.

6a. Prognosis is bad if the patient has persistently suicidal
tendencies.

7. Prognosis is good if the treatment both by drugs and by
feeding is resorted to early.

7a. Prognosis is bad if the treatment by drugs and proper
feeding is delayed.

These propositions will now be illustrated by appropriate
cases.

1. Prognosis is good when there is only a disinclination
for and not a distinct refusal of food.

In support of this argument I may quote the case of
Sarah Baskerville, one of the most notorious patients at the
present time in London, in consequence of her having lived
for not less than three years upon no other food but Koumiss.

This girl came under my care about seven years ago with
suspicious symptoms of phthisis, such symptoms being very
feebly marked. These signs have cleared up, but during the
last three or four years she has been troubled with the most
obstinate vomiting. All the known remedies for vomiting
were tried without effect—opium, hydrocyanic acid, bismuth,
creasote, carbolic acid, and many others. The vomiting con¬
tinued, and the patient became much emaciated, as she could
keep down no food.

Digitized by Google

by Henry Sutherland, M.D.

183

1883.]

Having found Chapman’s koumiss of great service in
certain cases of vomiting in alcoholic insanity, I resolved to
give it a trial, and I may say with perfect success, as the
patient has now lived upon koumiss and no other food for
more than three years. Latterly she has been under the
care of Dr. Jagielski, who has tried various articles of diet
mixed with the koumiss, such as mashed potatoes, peas¬
pudding, &c., but only with the result of making her sick
if she resorted to any other food except koumiss. The
patient, however, is able to take a little sherry wine, and
also a mixture of quinine and orange. This case is, I believe,
unique, and fully illustrates this point, there being only a
disinclination for food consequent upon the tendency to
vomiting; the patient has been kept alive, and has even
gained flesh.

la. Prognosis is bad when there is a persistent refusal of
food.

A handsome young Jewess, aged 16, was brought to me
suffering from hysterical mania. True to her religious
opinions, she refused to take meat unless it had been killed
according to the Jewish methods. This point was yielded
to, and for a day or two she lived upon nothing but a farina¬
ceous diet. Soon religious delusions appeared, with a com¬
plete refusal of food. Being unwilling to risk injuring her
teeth, which were very beautiful and regular, I fed her by
the nasal tube with milk, beef tea, wine, and castor oil,
three times a day for some days. She had the power of
appearing perfectly sane between her attacks of mania.
During one of these lucid intervals her parents visited her,
and believing that she had recovered, insisted on removing
her, against iny express will, from the asylum. She broke
out again that night, refused food, and attempted to get
over their garden wall. They implored me to readmit her,
which I declined to do, as she had been removed contrary to
my advice and orders. She was treated at home by a doctor
who fed her artificially. She became worse and- worse,
always persistently refusing her food, and ultimately I saw
her some years later in the Kent County Asylum, where she
was in the wards considered to be a hopeless dement, her
mind gone, her beauty faded, her teeth irregular, her figure
fat and shapeless—a mere wreck of her former self. Patients
who persistently refuse food either die or drift into dementia.

2. Prognosis is good when a disinclination and refusal of
food depend upon some removable bodily cause.

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184 Prognosis in Cases of Refusal of Food , [July,

Such bodily causes may be loss of appetite from consti¬
pation, from want of exercise, from the abuse of alcohol or
of tobacco, from biliousness, and I have also known it occur
in certain cases of syphilis.

A gentleman was admitted to my asylum on the 5th of *
February, 1872. He had been in bed for eight years pre¬
viously, and under the delusion that he had neither hands
nor feet. Unlimited beer and tobacco were supplied tb him
in the house, and at the same time his appetite declined from
want of exercise and excessive drinking and smoking. At
first he was unable to walk, but there being no real loss of
power either in the hands or feet, he was persuaded gradu¬
ally to use them, and he can now walk a fair distance every
day. Had he been allowed to go on declining food and exer¬
cise, I have no doubt he would have died from pure loss of
appetite. Fortunately he was rescued in time from a con¬
dition of utter filth and neglect, and under proper hygienic
treatment he regained his bodily health. He, however, still
remains in a state of incurable dementia.

Another insane gentleman under my care was cured of loss
of appetite from biliousness by a course of nitric acid and
mercury. He recovered both his mental and bodily health.

A woman with a soft chancre was under my care for a short
time, suffering from syphilitic melancholia. She refused
food. I fed her with the mouth tube, and under treatment
with mercury and iodide of potassium she made * a speedy
recovery to mental and bodily health.

2a. Prognosis is bad when the bodily cause is irremovable,
and most unfavourable in cases of general paralysis of the
insane complicated with some severe bodily disorder.

A man under my care was afflicted with acute mania with
refusal of food. I fed him for some weeks with both the
mouth and nasal tube, and as the end approached also by the
rectum. He had a large inguinal hernia, which I reduced.
He was, however, strongly suicidal, and pushed the rupture
down again. I again returned it, and also very reluctantly
placed him in a strait waistcoat. The case was also com¬
plicated with phthisis. The man died soon after admission
from exhaustion from acute mania.

Another similar case, complicated with a large umbilical
hernia, also ended fatally.

A man under my care suddenly refused food. I fed him
cautiously. He died unexpectedly in the night. On post¬
mortem examination the colon was found to be distended to
the thickness of a man's thigh. It had also the horseshoe

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1883.]

185

by Henry Sutherland, M.D.

(downwards) displacement so frequently met with in the
autopsies of the insane. Loss of appetite was here due to
the distension of the alimentary canal.

Another man under my care declined to take food, assert¬
ing that his oesophagus was stopped up. I carefully passed
the mouth tuba and came upon an obstruction. I then
quietly pumped liquid food through the tube. This caused
partial distension of the stricture, and the tube was then
sent on to the stomach. Matters got worse. The oesophagus
was blocked. Feeding by the rectum was resorted to. The
man died. Malignant stricture of the oesophagus was found
after death.

A prostitute with a hard chancre was admitted under my
care. She had a large ugly node on the forehead. At first
erotic, she soon became demented. I fed her with the mouth-
tube without a gag. She made no resistance. She soon
died of constitutional syphilis. .Post-mortem, a hard node
on the inside of the frontal bone was found, which corres¬
ponded with the node outside. Pressure of this node on the
brain doubtless accelerated the onset of dementia.

A man with general paralysis complicated with boils as
large as two fists on every part of his body where pressure
was exerted, was for some time under my care. I fed him
with the mouth-tube three times a day. I opened the boils
with an amputation-knife, and gave him quantities of iron,
quinine, brandy, and nourishing food. As might have been
expected he soon died.

Another case of general paralysis complicated with phthisis,
was admitted to my asylum. I fed him with the mouth-tube
and by the rectum. He died from exhaustion from maniacal
excitement.

3. Prognosis is good when the refusal of food occurs dur¬
ing a first attack of mental alienation.

A young lady, aged 20, was under my care with acute
hysterical mania. She had taken very little food for days
before the attack, and was yet able to take a great deal of ex¬
ercise by walking and rinking. Being much exhausted and
refusing to take food, after all means had been tried, I fed
her once through the nose. The effect was magical. She
made a speedy recovery, and has not since then had a second
attack. She is one of the chief ornaments of the ball-rooms
of London.

3a. Prognosis is bad if the refusal of food occurs during a
second or subsequent attack.

A gentleman was admitted to my asylum. He refused

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186

Prognosis in Cases of Refusal of Food , [July,

food. Recovered from acute mania, and was discharged
recovered . Unfortunately he fell from his horse, injuring his
head. He was again admitted as insane, the attack being
doubtless due both to the predisposition from a first attack,
and to the injury to the head. He again refused food, and
was on the second occasion discharged not improved.

4. Prognosis is good if after once being fed artificially,
the*patient takes his food naturally.

A colonel in the army was admitted to my asylum. He
had attempted suicide by precipitating himself from a
window. His father had saved him by catching hold of his
legs, and then keeping him down on the floor until assist¬
ance arrived. He was a very clever lunatic in action and in
speech. Soon he refused food altogether, intending to destroy
himself. He was fed once with the mouth-tube, and speedily
recovered. His bulk and weight remained the same during
his whole residence in the asylum, extending over some
months.

4a. Prognosis is bad if the patient requires to be fed often.

A patient was admitted to my male asylum on the 29th of
March, 1881, and discharged not improved on the 2nd of
November, 1881. During this period of six months he was
fed 148 times both with the mouth and with the nasal
tube. He has since his discharge been at Bethlem Hospital
in a state of incurable dementia.

5. Prognosis is good if the bulk and weight of the patient
remains about the same.

A gentleman was sent to my asylum from New York. He
was under my care for two months, neither gaining nor losing
flesh, although occasionally requiring artificial feeding. At
the end of that time he was discharged relieved, and went
with the doctor who had accompanied him from America to
an English watering-place. Soon afterwards he returned to
New York cured.

5a. Prognosis is bad if the patient loses flesh.

An officer in the army, aged 40, was admitted suffering
from general paralysis and phthisis. He refused food, and
was fed three times daily by Paley’s feeder, by the mouth-
tube, and at last by the rectum. He lost flesh daily, and
died two months after admission.

56. Prognosis is bad if the patient gains flesh under the
process of feeding.

A tradesman, aged 30, was admitted last year. He obsti¬
nately refused food, but would at times take it naturally if
allowed to steal it from another patient. Maniacal and fairly

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1883.]

187

by Henry Sutherland, M.D.

intelligent at first, he soon drifted into a state of chronic
dementia. He left the asylum much stouter than he was on
admission. He was with me for seven months, and was then
transferred to a public asylum, where I am told (three
months later) he continued in the same demented condition.

6. Prognosis is good if the patient wishes to recover.

A young lady, aged 25, was under my care suffering from
enteritis. She was perfectly sane and anxious to recover.
Under my direction she was fed for six weeks by nutrient
enemata, no food whatever being taken by the mouth during
the whole of that period. She made a complete recovery,
but died four years later of phthisis.

6a. Prognosis is bad if the patient is persistently suicidal.

A gentleman under care in my asylum refused food with
suicidal intention. I fed him frequently by the mouth and
the nose. He also attempted to destroy his life by refusing
to pass his faeces or water.

Injections and aperients were given, and catheters were
passed with the greatest difficulty, as the patient resisted in
every possible way. He also made three distinct efforts at
self-destruction; one by throwing a long sheet over the top
of the wall of the padded room, drawing the sheet from
without inwards through the peep-hole in the door, tying a
noose in the end of the sheet into which he inserted his head,
and then pulling the other end of the sheet which still re¬
mained hanging over the top of the wall of the padded
room, so that his head was pulled by his own efforts up
against the peep-hole of the door. He was discovered before
he had completed his arrangements, and his life was saved.

His second attempt was by biting through the radial
artery over the wrist.

And the third was by an endeavour to strangle himself
with his braces. He was discharged as incurable six months
after admission.

7. Prognosis is good if the patient is treated by drugs and
feeding early in the attack.

A lady, aged 24, was admitted with acute puerperal
mania, the day after the attack commenced. She was homi¬
cidal, having attempted to take the life of her child, but not
suicidal beyond the fact that she altogether refused to take
food. The child was removed from her, belladonna plasters
were applied to the breasts, which had the effect of speedily
drying up the milk; vaginal injections of Condy’s fluid and
warm water were applied, as the lochia were offensive, and a
mixture of tr. ferri perchlor. 20 drops, and pot. bromidi, a

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188

Prognosis in Cases of Refusal of Food . [July,

drachm, was given with proper aperients in the fluid food.
She had beautiful teeth, and I therefore fed her three times
a day with the nasal tube. She recovered in three weeks,
and left the asylum four weeks after admission perfectly well.

7a. Prognosis is bad if the treatment by drugs and by feed¬
ing is delayed.

A gentleman aged 43, was admitted, suffering from ad¬
vanced general paralysis. He was in a state of great filth,
and his own relations confessed it would have been better if
he had been treated properly three months sooner. His life
could not have been saved, but it might at least have been
prolonged for some years. His circulation was feeble, and
his vitality at a low ebb. There was only partial refusal of
food, which was overcome by ordinary spoon feeding. Gan¬
grene of the legs set in, and he died ten days after admis¬
sion from blood poisoning.

This illustration will conclude the series of propositions I
have attempted to lay down concerning prognosis in cases
of refusal of food.

From what has been advanced it will be readily seen that
the therapeutic value of food administered against the patient’s
inclination depends far more upon the condition of the patient
himself than upon the mode of administration or the kind of
food administered .

The Prognosis in Insanity . By D. G. Thomson, M.T).

II.

(Continued from Vol . wxviii., p. 210 .J

Mental Exaltation , Mania .—The question of the Prognosis
in Mental Exaltation—Mania—in its various forms, is a far
more debatable and uncertain matter than in melancholia.
The symptoms in melancholia being of a negative character
due to a lowering or suspension. of brain activity, we do not
look for all those diversities, endless varieties and aspects
which we may find in mania, be it simple, acute, or chronic.
Generally there is an increased vitality, a state of hyperacsthesia,
an increase in the activity of the brain, generally of the whole
brain, and we must believe that these states will not so easily
end in complete resolution as the condition of merely depressed
action, or rather no action, which obtains in melancholia—I
mean in melancholia generally, and not those states of acute
melancholia which are supposed to be closely allied to the state
which in other brains and under other subjective circumstances

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189

1883.] The Prognosis in Insanity .

would give rise to mania from a pathological point of view. If
this increased activity does not rapidly terminate in resolution,
one of two things must occur—either exhaustion or atrophy,
resulting in death or dementia, will supervene, or abnormal
tissue will invade or replace healthy nerve paths or areas, and
chronic aberration of mind ensue.

Thus, then, we are at once brought to the influence of dura¬
tion on the prognosis, for, with rare exceptions, recoveries after
long periods of mania do not occur, as is not unfrequently the
case in melancholia. As prognosis in mania depends greatly
also on the amount or degree of exaltation, it is advisable to
consider the marked varieties of mania separately.

Firstly, as regards simple mania, it may be stated as an
axiom that with the exception of acute maniacal delirium, the
Delire aigu of the French, a good prognosis may be given in
proportion to the degree of acuteness of the attack. Bucknill
and Tuke state that boisterous, noisy mania, particularly occur¬
ring in the adolescent, is generally perfectly recovered from,
but in mania without delirium or excitement, with, as a general
rule, delusions in which the symptoms point rather to perver¬
sion of the mental powers than to mere excess of normal
activity (although the latter may be also perverted more or
less) the prognosis is very grave. More particularly is this-
the case when the person who, to tbe casual observer, may not
appear insane at all, who may be able to attend in a measure
to his affairs, and conduct himself pretty much like his sane
fellow-creatures in the social economy, yet on examination is
found to be the subject of fixed and permanent delusions which
may be few in number, showing that the new nerve paths, on
which these abnormal thoughts and conclusions travel, have
become well trodden. Then we have evidence that an ineradicable
habit has been formed and an unfavourable prognosis may be
given accordingly. Such a patient may appear in fair bodily
health, sleep and eat well, and show no cause for the alienation.
Recovery in such cases is rare; the tendency being for them to
remain chronic, not exactly in statu quo y for gradually the
aberration increases in extent, involving by degrees other
mental faculties.

They may, however, live long lives, and show no tendency to
lapse into dementia, as often happens after acute mania.
Instances are on record in which such cases have been restored
by severe mental shock, such as fright, operations, acute inter¬
current diseases, and other violent stimulation of the mind,
showing that the intellect is rather “ unhinged ” than physi-

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190

The Prognosis in Insanity , [July,

cally diseased. Yet I cannot say, although I have seen all of
these events occur in this form of mania, that I have seen benefit
arise therefrom.

Secondly, acute maniacal delirium. This differs chiefly from
acute.mania by the presence of a higher degree of fever, shown
by high pulse, temperature, great tissue-waste and consequent
exhaustion.

The fatal exhaustion is ushered in by a sudden cessation of
the excitement, and a gradually increasing stupor. This stupor
in the last six deaths from exhaustion after acute mania which
have been under my notice, has been well marked ; to the in¬
experienced it might be looked upon as a good sign, for instead
of the ravings and gesticulations, the patient exhibits a placid
calm, as if sound asleep; the pulse, however, is feeble and
rapid, and the respiration shallow and frequent, but the patient
can still be roused, and the conjunctive are sensitive; gradu¬
ally, however, the stupor deepens into coma, the face is bathed
in cold sweats, the pulse becomes imperceptible, and the breath¬
ing stertorous, and in from 24-48 hours from the subsidence
of the maniacal symptoms, death takes place. In such cases
the tongue all along is in the condition known as typhoid, the
breath is foul, and there is general decomposition and putridity
in the sordes collected on the teeth and gums; in three eases
of which I have notes, death seemed to be accelerated by rapid
inflammation of the parotid gland, with the formation of septic
abscesses in the gland structure. Whether the generally foul
state of the secretions in the mouth actually spreads up the
gland duct, and so gives rise to inflammation of a septic
character or not I cannot say, but I think it highly probable.

Dr. Conolly records seven cases in the “ Lancet ” many
years ago, all of which proved fatal. On the other hand, Mr.
Carswell, late Assistant Medical Officer at the Barony Parochial
Asylum, Lenzie, relates in the " Glasgow Medical Journal ”
for Nov. 18th, 1879 (page 355), several cases of acute delirious
mania which did well under perfect rest, quiet, and a darkened
room, and he insists strongly on the importance of a correct
diagnosis between acute mania and acute maniacal delirium,
the pathology of the two diseases necessitating a different form
of treatment. The prognosis in this disease ought to be better
now than formerly, seeing the increased number and efficacy
of remedies such as quinine, chloral, &c., which we now
possess.

Thirdly, ordinary acute mania, "raving madness.” The
prognosis in the early stages of the disease is quite uncertain.

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1883.] by D. G. Thomson, M.D, l9l

and it is impossible to give rules applicable to individual
cases, so much depends on the progress, history and course of
the case.

Now, any case of acute mania, while it may yield rapidly to
treatment, may end in death by exhaustion, may, after tempo¬
rary recovery, recur as intermittent or recurrent insanity, or
alternate with other mental states, or become chronic, or lastly
may terminate in melancholia, stupor, or dementia.

Bucknill and Tuke state (op. cit.) that in ordinary acute
mania the prognosis is most favourable, and that the disease is
usually recovered from. The mortality of those admitted to
the York Retreat in a state of mania was, in observations made
for 44 years, about 4 per cent., certainly a very low mortality
indeed for so serious a disorder. Griesinger, Maudsley, Pliny
Earle, Dr. Clouston, and others, all tender evidence and opinion
to the same effect.

Dr. Blandford (op. cit.) states the prognosis to be favourable.
“ Although, of course, our opinions will be modified by the dura¬
tion, for if the disorder continues unimproved for some months
our hopes will be less, but yet such patients often continue their
noisy, violent conduct, and yet at last recover. Cases of recovery
after three and even five years have come under my notice; then
the character of the mania—if great noise and turbulent excite¬
ment are the predominant features with no very marked delu¬
sions, or with ever-changing delusions, we may have hope, but
if the delusions do not vary, and, above all, if the patient hears
voices, the cure is very doubtful.

“ The age of the patients; the younger they are the greater
is the chance of recovery, and it is noteworthy that men recover
oftener than women.

“ Then, if at the commencement of the attack, the patient
be greatly debilitated, or if there be other disease, the violence
and want of sleep will still further reduce the strength and
interfere with the chance of recovery, and if in such cases
there be much difficulty in getting the patient to take food the
prospects are still more gloomy.”

I cannot do better than use this summary of Dr. Blandford’s
as a text for a few additional observations.

The majority of the chronic insane in our asylums (how best
to deal with whom constitutes one of the most difficult prob¬
lems of the day) are cases of incomplete recovery from simple
or from acute mania. Thus the prognosis in acute mania
is of the first importance. As before stated, it is im¬
possible in the early stages to say much more than that

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a high percentage of such cases recover, provided the
subject be youug and healthy, the more so as it is a
disease very amenable to treatment, that such cases should
recover, seeing that, even in the worst cases where death
occurs, little or po obvious pathological change is found at the
autopsy, and that it generally attacks the young and vigorous,
although it may occur at all ages. So that when a case of
acute mania is presented to us, we can most certainly give a
favourable prognosis. The greater difficulty is when resolution
having begun and the acute symptoms are passing off, a sub¬
acute stage is ushered in. Mere noisiness, dirtiness of habits,
and destructiveness are not sufficient to guide us, for these
often continue for long and yet the patients ultimately get
well.

There are several points which will assist us in knowing
if our case is going to recover or is going over to the list
of incurables. First, one of which I see little mention in the
books, viz., a peculiar and characteristic change in the patient’s
appearance, the most salient point in which is a loss of hair, a
general thinning of it all over the head, chiefly so in the frontal
and parietal regions, quite different from ordinary baldness of
the vertex. The hair is sparse and coarse in persons
who, according to their relatives’ account, previously pos¬
sessed fine heads of hair, even making due allowance for the
difference produced by careless dressing. I have been struck
by this in many photographs which I have taken of chronic
cases which show a considerably increased prominence of the
parietal and frontal regions chiefly on this account. This point
is particularly noticeable in women, but also exists in men.
After a time, when chronic mania is thoroughly established,
the hair may grow luxuriantly again, or may remain dry and
straight. Probably this condition of the hair is due to dis¬
ordered nutrition, which is evidenced in another way by haema-
toma auris or the “ insane ear.” With the causes and varieties
of the insane ear I have at present nothing to do ; suffice it to
say that Brown Sequard maintains it is due to an irritation
of the base of the brain, and can be artificially produced
in guinea pigs by irritation of the restif&rm body. These
hsematomata are usually regarded when occurring after the
subsidence of acute mania, or in other forms of insanity, as
a certain sign of incurability. That it is a very bad sign,
showing evidence of grave cerebral disorder, there can be no
doubt, but that it is a sign of absolute incurability is certainly
not correct, even when not due to a blow.

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1883.] . by D. G. Thomson, M.D.

Three cases of mania under treatment at Camberwell House
Asylum have recovered. Two were gentlemen and one a lady ;
one of the former relapsed and died here, but the other two are
well and occupying good social positions since their recovery
some five years ago. Of these cases I have been informed by
Dr. Schofield, the medical superintendent, and have seen one
of the gentlemen, a clergyman, myself lately; both his ears
were quite shrivelled up, but their owner was perfectly sane.

In unfavourable cases we also note an alteration in the facial
expression—gradual obliteration of the lines in the face, giving
rise to a flat expressionless countenance.

Another bad symptom in the subsidence of acute mania is
that whereas the delusions formerly were ever changing and
evanescent, seeming to bubble up and effervesce, so to speak,
from the heated brain, they now begin to assume a more fixed,
definite, and purposive character. Such a symptom, if it also
be accompanied by hallucinations, auditory or visual, especially
the former, is indicative of serious mental changes. Dr.
Blandford, in. an able paper on auditory hallucinations, in the
“Journal of Mental Science,” January, 1874, states, “We
are called, it may be, to pronounce an opinion on a recent case.
The symptoms may be somewhat acute, and have begun sud¬
denly ; generally the health is fair, and youth may be on the
side of the patient, there may be everything to lead us to give
.a favourable prognosis, yet time goes on, and although there
may be apparent amendment, there is no recovery, and one
time or other, perhaps not till after a considerable period, we
discover our patient hears voices, and our prognosis changes
from 6 favourable 9 to 'most grave/”

The retention of the memory is not per se of much value in
the prognosis. I have seen the most hopelessly chronic maniacs
exhibit wonderful powers in this direction, although it can be
readily imagined that the converse is equally true—that if the
memory become worse and worse, it is a sure sign of dementia.

Do physical signs in any way help us ? On the whole our
answer must be in the negative, unless it be body weight, for
here as in melancholia increase in body weight if attended
even with but slight improvement, is a good augury; yet stout¬
ness without mental amelioration forecasts dementia.

There is nothing characteristic for prognosis in the pulse as to
frequency or the sphygmographic tracings it yields, nor yet in
the ophthalmoscopic appearances of the retina to guide us as
to whether a case will recover or not. Dr. Clifford Allbutt and
Dr. Hughlings Jackson, who have investigated these points,

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The Prognosis in Insanity, [July,

beyond showing their importance on the pathology of the dis¬
ease, chiefly in coarse organic forms, do not contend for any
special value in them in the question of prognosis.

When dementia supervenes upon mania, then practically all
is lost; for, to quote Dr. Hayes Newington, true dementia is “ the
tomb of the mind,” the bourne from which no errant intellect
returns. Yet here we must be very sure of our diagnosis, for
(especially in females) there is a condition of anergic stupor
which, to the casual observer, is exactly similar to the ordinary
secondary dementia, but there is an important difference in the
result of the two conditions, viz., that anergic stupor, which is
common in women after acute mania, is generally recovered
from, while in dementia proper it is not. This anergic stupor
is very different from the fatal stupor of exhaustion above
referred to, and is chiefly to be distinguished from it by its
very gradual onset after all acute symptoms have passed off.
(See the “ Journal of Mental Science,” Oct. 18th, 1874).

From the above considerations it will be seen that the prog¬
nosis in mania is a very uncertain matter, and only by a careful
watching and grouping of all the mental and bodily symptoms,
can we hope to approach any degree of certainty in our fore¬
casts, never forgetting that while on the one hand, the strong
and young generally recover, on the other, in the middle-aged
and weakly, whose cases may show the most unfavourable signs,
cases of recovery, even after long periods, are not unknown.

Alternations of Depression and Exaltation .—It is not neces¬
sary to speak of the other forms of insanity due to functional
derangements at the same length as I have done of the two

S reat typical departures from mental health, Depression and
xaltation, but I will at once briefly consider the prognosis in
alternating states of mania and melancholia—the FoXie circu -
laife of French authors.

On consulting the text-books on this subject, I find but little
mention of the patients’ prospects in this disease, and must
therefore base my few remarks on cases which I have seen.
The prognosis is invariably bad. Not that the patients will
die or become absolutely demented, but that the transitory
states of mania, of comparative sanity, and of melancholia
succeed each other with relentless certainty. All attempts to
prolong the period of comparative rationality seem useless.
Antiperiodics and other like treatment, from which one might
anticipate good, are of no avail, so that when the case becomes
a well-marked one of Folie a double forme or circular insanity,
our prognosis must be in accordance with the unpromising

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195

1883.]

nature of the disease. One typical case I have notes of—a lady
aged 50, married, healthy and strong in body, has for 10
years regularly alternated between sanity, mania, and melan¬
cholia, each state lasting with wonderful regularity about
three months, and always in the same order. It does not
matter whether she be under treatment or not, whether she
be at her home, which is a happy, comfortable country one, or
in different kinds of wards (noisy or quiet) in the asylilm.
Many such cases have come and are under notice here, and
we can prognosticate in all of them that the period of mania,
with its sleeplessness, noisiness, dirty and destructive habits,
will pass away, and the period of melancholic stupor also, but
as surely will the transitory, though it may be perfect, state of
mental health give way to one or other of these states and the
disheartening cycle continue.

Different is it, however, with the purely recurrent insanity,
whether it occur as recurrent primary dementia, recurrent
melancholia, or recurrent mania, for all of the conditions
obtain in the most pronounced and definite manner, although
recurrent mania is the most common form of recurrent
insanity.

The prognosis here is not so uniformly bad, and it is self-
evident that when we talk of recurrent insanity it means that
the patients get well of individual attacks, but that the
recovery is not permanent; in fact, that it is a Folie circulaire ,
as it were, with only two states to alternate between, instead of
three, as in true circular insanity.

First let me say a word as to the individual attacks them¬
selves. These may be of the most prolonged and severe
character, with symptoms which, if observed in an ordinary
attack of mania occurring in a previously sane person for the
first time, would augur badly as to the prospects of recovery;
yet when these attacks are of a recurrent character, no matter
how severe, or how weak or elderly the subject, recovery is
almost certain.

In our present state of knowledge the prognosis is very
unfavourable, the period of mental soundness intervening
between the attacks becoming, as a rule, gradually shorter and
shorter until a chronic condition of insanity is established. I
have, however, notes of two or three cases which, at all events,
have not recurred for over two years, and which at one time
used to recur several times a year. If it be true that these
recurring attacks are—in some cases at least—due to the
accumulation of some deleterious matter in the blood or nerve
xxix. 14

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196 The Prognosis in Insanity , [July,

cells, may we not hope in time to combat this, and so render
the prognosis more favourable ?

This form of insanity is most common in women, but appears
in the cases which have come under my notice to have no
special connection with the menstrual periods, Ac., one or
two having continued after the menopause. In one case the
utter absence of any defined cause and apparently entirely
idiopathic nature of the disease is well brought out in the
case of a handsome, accomplished young married lady brought
by her friends to Camberwell House every three months or so
on account of recurring attacks of profound melancholic
stupor. Inquiries were made if there had been intemperance,
and the answer was a decided negative, while to the inquiry
if there had been over sexual excitement the answer was that
for the last six months she had not cohabited with her husband.
Examination of her thoracic and abdominal viscera, urine, Ac.,
reveals no disease. Menstruation natural, and showing no
relationship to the disease. Yet all day she sits motionless on
a chair in the ward, and having all the appearance of being
stupified with some narcotic poison, utterly indifferent to her
surroundings, abjectly filthy in her habits; not wilfully so, but
being apparently unconscious that her evacuations pass. It is
needless to add that she takes no notice of anything said or done
to her, and, of course, she is unemployed. She has to be fed
by the nurse like a child, and even then with difficulty.
Then in a fortnight or so after admission, without any special
treatment, convalescence begins, ushered in by a gradual loss
of the blank expression, her countenance traversed at intervals
by placid smiles, as if in a pleasant dream. She begins to take
an interest in things around her, soon brightens up, and from
an inanimate, heavy, dull, lifeless-looking object wakes up, so
to speak, and developes into a sprightly, active, fascinating
woman, joining actively in the asylum amusements and dances,
a skilled musician and lively conversationalist. Now this
person, who used to be subject to these attacks every six
weeks or so, has not had one for six months, and this although
at home and managing her household. May we not in such a
case incline to an ultimately favourable prognosis, and more
especially when we come to know the nature of and remedies
for the cause of the attacks of transitory mental stupor from
which she sufEers ?

Delusional Insanity and Insanity with Hallucinations of
Sight and Hearing .—As Bucknill and Tuke state (page 136
op. cit.), “ delusional insanity is not a hopeful form. Mono-

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1883.]

by D. G. Thomson, M.D.

197

mania in the sense of a deeply-rooted delusion or false
conviction in respect to one class of subjects generally resists
treatment obstinately. Still more unfavourable are the delu¬
sions of grandeur and riches. Hallucinations and illusions of
one or more senses are unfavourable except when due to any
acute or febrile state of the system.” Little more than this
can be said in elucidating to any practical extent the prognosis
in such cases. The alienation is greater than is implied in the
particular delusion or hallucination, and their apparent sanity
on subjects unconnected with the delusion is not, as one would
at first expect, favourable to their chance of recovery, for
such patients seem less and less able as time goes on to realize
the difference between what they call “ the spiritual voices ”
and the real, material, spoken words.

An accomplished, highly-educated lady in this asylum
converses freely and rationally on the subject of her hallu¬
cinations, and will relate that she knows a difference between
real uttered words and the voices which she hears, but
that she is apt to act on the promptings of this spiritual
voice, which appears so real at times, and so frequent, that in
spite of all her efforts she cannot drive it from her mind.
Sometimes, according as she is above or below par in her
general health, she gives way to the promptings of these voices,
and thus constitutes a dangerous but much-to-be-pitied patient,
for, although at times quite alive to the falsity of the voices,
she is now in such a nervous hyperaesthetic state from irrita¬
tion at her condition, sleeplessness, &c., that she is morbidly
suspicious and ready to give way when a voice seems to
proceed from a slanderer or anyone talking ill of her. For
years she had been subject to these hallucinations, and she
tells me, that in spite of her reason and its efforts, they in¬
crease rather than diminish.

If in such a case, where the intellect, comparatively sound,
and, above all, capable of the admission and cognizance of the
falsity of the hallucinations, recovery does not take place,
how much more unfavourable will be the prognosis in cases of
hallucinations and illusions of the senses, accompanied by
signs of more general mental disorder. In the paper read
before the Medico-Psychological Association some years
ago, Dr. Blandford drew attention to a class of patients
who have hallucinations of hearing, but who do not hear
voices, but only sounds, and “this,” he says, “is a less
formidable and altogether milder disorder—one which we may
hope with confidence will subside. Such cases are not very

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The Prognosis in Insanity , [July,

uncommon. The sufferer complains that he hears voices made
in the next room for the purpose of annoying him, but this is
a different state from that of the man who hears a voice com¬
manding him to commit homicide or suicide and obeys it. I
have known these voices subside for years and disappear,
occasionally returning if the mental health of the patient for
some reason or another declines.”

Dr. Lockhart Robertson, writing 20 years ago in the
€t Journal of Mental Science,” says :—“ Their influence ”—
that is, hallucinations of hearing—“is most unfavourable.
They are so apt to lie dormant for a time, and then reappear,
that I should at any time be sceptical of the recovery of a
well-marked case.”

As an addendum to the above, I should note that the hallu¬
cinations of hearing and sight met with in the delirium of
alcoholic insanity generally pass off; indeed, this is also true
of all the acute forms of insanity in which temporary and
varying hallucinations and illusions of the senses exist as a
common enough symptom.

As will be alluded to hereafter, in the insanity from alco¬
holism it often happens that delusions and hallucinations
remain after all the acute febrile symptoms have passed off.
These, however, as a rule, gradually subside, although they
may be long in taking their departure—in one case I remember
lasting for a year.

In cases of weak-mindedness and what might be included
under moral insanity, due to chloral- and morphia-excess and
habit, illusions of the sense of sight are a common symptom ;
and although obstinate, they are generally got rid of when the
habit is stopped, and the mind gradually gains power and
strength from appropriate treatment, and is no longer drugged,
irritated, and perverted by narcotics.

Dementia , Primary and Secondary .—Primary dementia is
by many alienists considered to be generally recovered from.
Bucknill and Tuke state broadly that dementia is, generally
speaking, a hopeless condition, but they do not include under
this head those cases which often pass as examples of acute
dementia, but which are really nothing of the kind. I have
seen many cases of so-called acute dementia recover, and the
reasons for this are obvious. First, it is generally due to a
moral, and not a physical, causation, such as fright or sudden
calamity, these inducing, as in cases recorded by Dr. Handfield
Jones in his “ Functional Disorders of the Nervous System,”
a condition of temporary cerebral paresis; secondly, it gene-

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by D. G. Thomson, M.D.

199

rally attacks the young and vigorous, whose recuperative and
latent powers are great; and thirdly, there is no apparent
organic lesion.

Dr. Blandford says in his book on insanity —“ How are we
to distinguish this primary from secondary or chronic de¬
mentia ? In other words, how can we say whether the patient
will recover or not ? I confess this is not easy, for the general
appearance of the patient in the two diseases is identical. You
are shown a young man or woman in a state of fatuous imbe¬
cility, of stolid expression or smiling idiotically, lost and dirty
—nothing can be less promising. But if you are told that this
condition came on almost suddenly, and if you observe the
symptoms indicate great prostration of the circulation, you may
pronounce favourably as to the result; but if the patient has
slowly, gradually, but steadily drifted into this state without
any assignable cause, then you may state that although
improvement may take place, recovery is impossible.” In these
cases, then, according to Dr. Blandford, the prognosis accords
with the diagnosis, for if we diagnose primary dementia we
prognose recovery, and, on the other hand, if secondary or
organic dementia, the reverse.

There are, however, exceptions which have come under my
notice, notably where cases of prolonged secondary dementia
after acute mania have recovered, of which the following is a
well-marked example, although some might call it a case of
anergic stupor occurring after an acute attack :—

A young lady, H. R. S., aged 25, received some shock or
fright. She fainted, being in a swoon for 15 minutes. On
awaking she became hysterical, impatient, and excited, soon
becoming wild and violent, having delusions of fear, and being
sleepless at night. This happened about the beginning of the
year 1879. She was at first treated at home, but her violence
and noise rendered this impossible, and she was removed to
Bethnal Green Asylum. She was transferred, “ not improved,”
to Bethlem Hospital in July 1879. Here she was said to
be the most destructive, impulsively violent, and excited patient
in the asylum, conducting herself more like a wild beast than a
human being. She remained a year at Bethlem, and as she
did not improve, had, in conformity with the rules of that
establishment, to be removed, Dr. Savage, however, hoping, I
am told, that she would ultimately recover. In this same
mental state she was admitted to Camberwell House Asylum in
July, 1880. She became in three months' time less violent,
noisy, or destructive, but none the less idle, and dirty.

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2 00 The Prognosis in Insanity , [July,

She had all the appearance of being hopelessly demented,
sat silent as if deep in stupor, never spoke, never ate unless
food were actually put in her mouth, and was filthy in her
habits, passing all evacuations under her where she sat, or defiling
her room at night by spreading her excrement about her
clothing and room floor. This, then, was the state of the
apparent secondary dementia, due to exhaustion and degrada¬
tion, but not atrophy, of the higher intellectual centres after the
prolonged excitement or maniacal state. This state of dementia,
from which we never expected a return to health, lasted, how¬
ever, only for eight months, when a gradual improvement
began. This was very gradual, but certain. She became less
dirty and neglectful, began to take notice of those about her,
took up a little sewing and reading, and in two months was
quite well, presenting to the ordinary observer no trace of the
degraded and varying condition of mind she had been in for
three years. She was discharged “recovered” towards the
end of 1881.

This case will show, then, that we must be chary in prog¬
nosing ill in even the most apparently hopeless cases, for in the
young, where the recuperative powers are great, there may be
a return to health.

The cases which do recover may do so either exceedingly
slowly or comparatively suddenly.

The duration of primary dementia varies, and depends
greatly on external circumstances, and facilities for treatment,
among which temperature may be particularized, for these
cases suffer much from and their recovery is greatly retarded
by cold, which acts prejudicially on the feeble circulation.

The ophthalmoscopic appearance in this disease is pallor of
the discs, which improves during convalescence, so that this with
other evidences of improved vascular tone and circulation
generally, v/ould aid us in our forecast during the progress of
the case. Recurrence of primary dementia is rare, although
the apparent dementia or stupor arising from alcoholism recurs
with the drinking habit.

Of Impulsive Insanity I can scarcely speak at all, having
seen only one really well-marked case—I mean of pure impul¬
sive insanity as I understand it, for, of course, the acts and
ways of the insane are commonly impulsive, more or less, but
do not constitute “ uncontrollable impulse.” This never
occurs in my experience per se , but in the cases of semi-
demented patients, who are, as a rule, quiet, well-conducted
patients. The case is that of a woman, aged 25, who is a most

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201

1883.] by D. G. Thomson, M.D.

uncertain and dangerous creature. She is generally quiet and
harmless, smiling and talking to herself, and apparently good-
natured and happy. This girl has a daily outburst of the
most sudden and violent kind ; it occurs without any warning
or premonition. It comes on by day or night. If at night
she suddenly screams and yells very loud, tears the strongest
rugs and ticking-blankets to ribbons, beats her face and head
with her fists, gets into a perfect state of frenzy, and as
suddenly becomes calm and tranquil, her face being very pale,
suggesting the epileptic nature of the outburst (she is, how¬
ever, free from all ordinary epileptiform seizures). If the
attack comes on by day, she flies at her nearest neighbour, no
matter how big or strong she may be, with lightning velocity,
or she may take up a chair or anything at hand and propel it
at windows, or even people. She has, of course, constantly to
be watched ; medicines have little or no effect on her, and she
has no prospect of recovery.

The impulsive insanity associated with epilepsy will be found
under that heading. I am of opinion that in this country
true impulsive, homicidal, or suicidal insanity is a rare aliena¬
tion.

Insanity Depending on States Normal or Pathological
of the Generative System.

(a.) The Insanity of Pubescence .—The insanity observed and
described by writers as occurring at puberty, must be con¬
sidered comparatively infrequent.

Dr. Skae points out, in the Morisonian lectures for 1873,
that the prognosis is good, and that it is generally recovered
from, the disturbed mental balance being restored after the
changes in the system at puberty are perfected, provided the
habit of masturbation be not contracted, in which case, as may
be readily imagined, symptoms of imbecility and dementia
come on, and the usual return to health does not take place.

Dr. Skae is also of opinion that the influence of heredity on
the prognosis is also greater in this alienation, for if it be
very strong, it militates seriously against recovery.

In cases where epilepsy has come on at an early age, say
under ten years, it is often found that the child may be able to
increase in mental development in spite of fits, be able to go
to school, learn to read and write like other children; but when
puberty supervenes the epilepsy seems to choose, so to speak,
this time to commence its destroying influence on the mind,

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202 The Prognosis in Insanity , [July,

producing, more or less, imbecility, culminating as years go on
in incurable dementia.

(6.) Gestational Insanity .—The insanity of pregnancy is
also a comparatively rare affection, although less so than the
preceding form, especially if we take into account the many
cases which never reach an asylum. It may be characterised
by maniacal excitement or melancholic depression, or simple
clouding or obfuscation of mind, and is in the second case
probably only an exaggeration of the distressed and fearsome
state which exists in many women, especially the unmarried
and in middle-aged primiparae at the thought and prospect of
parturition.

I have seen four cases of well-marked mania with pregnancy,
but, in spite of its description in books, I would have been at
a loss to recognise it as the mania of pregnancy unless I had
looked lower than the head for symptoms. In two out of the
four cases, of which I have notes, recovery took place after
child-birth, but in two others it did not. Of the two whom
delivery did not materially affect one was excited and the
other depressed; the birth of the child seemed to have no
effect, either in tranquillizing the one or rendering cheerful the
other.

Dr. Playfair, in his book on midwifery, quotes Dr. Batty
Tuke to the effect that the prognosis on the whole is very
favourable. Out of Dr. Tuke's 28 cases 21 recovered, five
became demented, one died, and one remains under treat¬
ment. According to Marce there is little hope of recovery
until delivery is effected, for only two out of his 19 cases re¬
covered soundness of mind before the birth of the child. The
prognosis we must believe to be still more favourable when
we reflect that only the very worst and most urgent cases are
certified lunatics, for Dr. Playfair states that the great
majority of these cases progress to recovery without having to
be sent to asylums, and thus do not find their way into lunacy
statistics.

I should add that the tendency to dipsomania and depraved
appetites, occasionally met with in the insanity co-existing
with pregnancy, usually disappears post partum, as it is simply
a part of the general moral perversion and not a distinct mania
as in true dipsomania.

(c.) Puerperal Insanity .—The period at which puerperal
insanity ends, and the so-called lactational insanity begins, is
an arbitrary one, but may be in accordance with the views of
Bucknill and Tuke set down as two months from delivery. By

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1883.] by D. G. Thomson, M.D.

this time involution should have taken place and the system
recovered from the mental and bodily shock of child-birth,
and on the other hand the anaemia and weakness arising from
lactation is beginning to tell on those of weakly habit. The
symptoms arising from puerperal insanity generally partake of
an acutely maniacal character, although melancholia and
stupor are not infrequent. We are anxiously asked at this
more than usually distressing juncture, what the chances of
recovery are, and the probable duration, so the prognosis here
is an important matter.

Firstly, then, puerperal mania. If we look merely at the
cases admitted into public and private asylums, and the per¬
centages of their recoveries, it cannot be considered the very
hopeful one it is generally stated to be, but it must be remem¬
bered that in this form of insanity especially it is only the very
worst cases that are brought to an asylum, especially among
the private class. Of the last 100 admissions of female
patients to Camberwell House Asylum, there has not been one
case of puerperal mania.

The two last cases of puerperal mania admitted died.

Of 73 cases at the Edinburgh Royal Asylum eight died,
seven became demented, two were relieved, and 56 recovered.
The cases of Dr. Ripping, of Siegburg, related by Bucknill and
Tuke, were less favourable. Of 82 cases only 38 recovered,
nine improved, 25 did not recover, four died, and six remained
under treatment. Dr. Playfair quotes Dr. Batty Tuke to the
effect that the mortality in such cases is 10 per cent. If they
do not die in a short period, recovery takes place, chronic
puerperal insanity being rare.

The unfavourable indications in cases which are likely to
end unfavourably are these—great pyrexia, rapid pulse, foul
tongue, lips and teeth covered with sordes, constant excitement
and low delirium, and also refusal of food and drink.
The mild cases and those almost certain to recover are where
there are delusions regarding self or the child, inciting to
suicide or child murder, accompanied with more or less ex¬
citement. After the acute and early stages pass off, the same
generalisations apply to the existing delusions and hallucina¬
tions as in other forms of insanity.

The duration is a difficult matter to prognose, and is given
differently by authors. Dr. Webster states, as the result of
his statistics, that three of every five cases may confidently be
expected to recover within a year, and 34 out of 53
recoveries took place within the first six months of the attack.

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The Prognosis in Insanity . [July,

Brierre de Boismont states that cases of puerperal mania,
exclusive of melancholia, have recovered on an average under
his care in about a week ! In Dr. Savage's carefully tabulated
cases the great majority recovered in a little under three months,
but even after 18 months’ duration two cases recovered.

Puerperal Melancholia .—It is an often quoted aphorism of
Gooch’s that " mania is more dangerous to life and melan¬
cholia to reason."

This is so far true that the mania is very dangerous to life;
but the melancholia is no more dangerous to reason than the
mania, in fact, less so. When puerperal melancholia, which is
much rarer than puerperal mania, exists, the prognosis is much
the same, the disease is more obstinate, the delusions more fixed
and permanent, and relapse common, yet recovery generally
takes place. One case I remember of a young married woman
who became melancholic after her first child. She developed
strong suicidal tendencies, and had dreadful delusions. In
three months she got well, but soon relapsed, and, in spite of
excellent bodily health, remained full of melancholy delusions
for six months. She ultimately got well, and has remained so
for a year and a half.

(d.) Insanity of Lactation .—This form of insanity is much
more common than the insanity of pregnancy, but less so than
true puerperal insanity. It is generally a state of melan¬
cholia brought on by the anaemia and debility induced by
prolonged suckling. The causes being removable and amen¬
able to treatment, the prognosis is very good ; in all the cases
which I have seen, recovery was effected. It must be
noted, however, that there is a considerable tendency to
dementia in some cases.

(e.) Hysterical Insanity or Utero-Mania .—I will not enter
here into the question of the existence of either of these forms,
especially the latter, i.e ., as to their being specific forms of
mania apart from the ordinary types of mental alienation.

In many cases of women suffering from hysteria and
maniacal symptoms, between which there is no distinct
boundary, we recognise a peculiar sexual element which gives
such a colour to the disease that it is known under the name
of ovarian, uterine, or hysterical insanity.

Its symptoms are well known, silly, childish manners and
actions, mischievous, purposeless, and irresolute conduct,
sometimes kleptomania, besides the frequent presence of
delusions connected with the sexual organs, together with a
certain lewdness and lasciviousness of speech and action.

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1883.] by D. G. Thomson, M.t>.

Dr. Savage points out that such cases, if moral treatment is
skilfully applied, get well, but if left to themselves in a
crowded asylum where no curb or individual care could be
enacted on their whims and propensities, being so plastic and
will-less, they fit into niches, so to speak, from which it is
impossible to move them. So, although the recovery-per¬
centages are high, it must not be supposed that all get
well.

.1 fear the good results obtained by the most modern treat¬
ment of hysteria by large magnets or plaques of metal, recom¬
mended by Prof. Charcot, and Dr. Muller of Graz, would not
avail much here where the vagaries of mental alienation are
superadded to a disease sufficiently irregular and strange in
itself.

On Large and Small Asylums. By T. Clave Shaw, M.D.,
F.R.C.P., Medical Superintendent of the Middlesex
Asylum, Banstead.

It seems to be generally assumed that asylums were built
large, either on the idea that they could be more cheaply con¬
structed or that they could be maintained at less average weekly
cost than small ones, but I doubt if such is the true reason of
the growth of large asylums, or of the development into
large of small ones. Convenience would appear more to have
determined the size than any other consideration, a thing
not to be wondered at if such large counties as Yorkshire,
Surrey, and Middlesex are regarded, where the visiting
committees of magistrates are largely taxed as to their time
in attending institutions placed often at long distances from
each other. But all these considerations of convenience ought
to, and no doubt would, disappear if it were abundantly mani¬
fest that the outcry raised against large asylums as causing
a higher death-rate, lower recovery rate, and heavier weekly
charge could be substantiated.

It is to be expected that those asylums that have most
unfavourable statistics, taken from the averages in the blue
book, should cost the most, because in proportion as the
population is more feeble, the expenses for attendance and
extra diet will be greater and the recoveries will be fewer;
and there can be no doubt that in proportion as an asylum
is large, so does it get filled with unfavourable cases in a
greater proportion than would have been the case had it been

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On Large and Small Asylums , [July,

of moderate size and more select in its receptions; but it
does not, therefore, follow that the large asylum is per se
more expensive than the small one, and that this is so is shown
by taking large asylums where the cases are selected, e.g.>
Prestwich and Hayward’s Heath, two asylums which receive
the approbation of the Lunacy Commissioners more than
any other asylum in the country, and also to some extent the
Hanwell Asylum. Herein lies, I think, the worst that can
be said against large asylums, especially where it happens
that there are several in a county—that from their size they
receive a number of broken-down and incurable cases that
would have been of necessity , in a county having only a small
or moderate sized asylum, kept in the workhouse. To my
certain knowledge there are county asylums which decline
to receive any cases complicated with epilepsy or paralysis,
or any infirmary patients ; in fact, that will scarcely take any
but curable cases. How then can these be used for
statistical tables, in a fair sense, on either one side or the
other ?

To take the average cost per head as the measure of
asylum efficiency is as absurd as to compare death and re¬
covery rates. It almost seems as if some argued that because
an asylum is a little higher than another in recovery rate
and lower in death-rate, and is also cheaper, that, therefore,
it is a better asylum. Such do not see that as death-rate
and expense rise together, so do high recovery-rate and
cheapness go hand-in-hand with low death-rate, and that
that is entirely due to the class of cases admitted; for look
at the various summaries of average cost per week in
different asylums and we shall see that it is not diet, not
quantity of drugs, not salaries and wages that lower the deaths
and inflate the recoveries, but that where these are largest
(whether the asylum is a large or a small one) the results are
least favourable. With the provision list in one asylum at
5s. 2d. per week per head the recoveries are not so numerous
per cent, as in another of nearly the same size at 4s. per
head per week, so that in the latter the diet can have had
nothing to do with recovery. In these asylums the drug
charge is identical, so that medicine cannot be credited with
the advantage; in the less favourable of the two the salaries
and wages bill is much larger, so that medical and general
attendance tell in the inverse ratio of their quantity. To
what then can the difference be attributed? Only to differ¬
ence in the nature of the asylum population.

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by T. Claye Shaw, M.D.

Dr. Chapman calls our statistics “ unfavourable,” but they
are not so, having regard to the number and nature of the
admissions. When our deatb-rate was bigb tbe provision
list was high, and it was so because the death-rate was high.
I was anxious to see that nothing in the way of extra diet
should be wanting to stay, if possible, the large mortality.
I do not think that the high diet very materially affected the
death-rate, but with a number of feeble people in the
population I should be sorry to see the diet-table reduced to
what seems sufficient for some asylum populations, and that
too in asylums averaging 600 to 700. During the last year
there were 634 persons admitted here, and yet the average
number resident during the year was only 133 more than the
year before. Of those admitted, so feeble was their condi¬
tion that 74 died, or nearly 11*7 per cent., a considerably
larger percentage than in the case of Hanwell and Colney
Hatch, because these two asylums, being nearer town than we
are, received the pick of cases. It is thus manifest that if
you have a feeble population, the vacancies in which are
rapidly filled up by feeble (though perhaps acute) cases, the
average number resident may remain about the same, but the
percentage of deaths on the average number resident may
be very large. Another thing to be taken into account in
estimating the deaths in an asylum is the proportion of men
to women in the population, and in the admissions; in pro¬
portion as the men are nearer in number to or beyond the
women so will the average death-rate be higher, although
the average number resident may be about the same; and it
is worth while to notice how uniform is the death-rate on
the female side (in established asylums), whilst the male rate
varies from year to year. None of these facts appear to me
to have been regarded by those who have lately compared
the statistics of asylums as if they were all placed on a com¬
mon basis, contained similar populations, and were built on
like principles. Now as to the cost of different asylums.
Primd facie an asylum for 1,000 or 1,500 patients ought, all
other conditions being equal, to be less costly than one for
600 or 700. If it is not there must be special reasons for
the extra expense. I contend that there are special reasons.
If anyone carefully examines the reports of the Lunacy Com¬
missioners, he must see that the small asylums err in want of
accommodation; either they have not a proper chapel or
recreation hall, or the wards are too small and overcrowded,
or the laundry arrangements are insufficient, whilst these

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On Large and Small Asylums , [July,

charges are not made against the newest and largest
asylums; in fact, as the large asylums are more expensive so
are they more complete. The old and small asylums are
also very deficient in the modem heating and electrical
appliances—expensive matters, but still considered necessary
nowadays. I grant that great care is required in the con¬
struction of a very large building, more so than in the case
of a moderate sized one; for if in the former any flagrant
error in the system of ventilation, warming or general con¬
struction is introduced, the cost of altering it will be greater
in proportion to the size of the building, and the expense of
it might become disastrous. This leads me to ask how
buildings can be compared as to expense of erection when
they are undertaken by different building committees holding
different views as to what is required, and how it should be done;
when, too, the very position of an asylum may be such as to
everlastingly knock it out from competition with others.
The administrative staff of asylums is scarcely similar in
any two instances, and from this alone it may be concluded
that the nature of the patients differs. In night attendance
I am inclined to think, from reading Reports, that the large
asylums are better off, and no doubt an additional reason
for the larger cost of provisions is due to the attention
necessarily given to feeble patients during the night, and to
the larger number of feeble patients that it is now generally
allowed the larger asylums contain. It has often been a
surprise to me how the paucity of night attendants does not
lead to more accidents or to greater distress. In this
particular we are, I think, in England much behind the
Americans, who in some asylums have a night medical
officer. What guarantee have we now, even with a lay night
inspector, that restless general paralytics are nursed as their
feverish condition requires ? I am not now comparing large
with small asylums so much in this particular, as I mean
that in none is it what might be desired; and I infer hence
that salaries cannot be compared, and the same may be
said of wages, for the number of attendants required depends
very much on the structure of the building. As a rule, the
larger the wards the fewer the number of attendants re¬
quired, relatively to the whole number of patients. As
regards the pay of the higher officials, there is no sort of
relationship between the number of patients and the conse¬
quent responsibility and the salaries—all is an arbitrary
arrangement settled by the views of different committees of

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209

1883.] by T. Claye Shaw, MJ).

visitors. Starting from my premiss that the larger the
asylum the greater the proportion of feeble cases it must
contain (unless in those where a selection is made), it goes
without saying that in large asylums the hospital accom¬
modation must be greater, the working bill larger, and the
proportion of attendants greater, whilst the diet must be of
a superior character and more in quantity, the stock of cloth¬
ing greater, and the statistics less satisfactory.

The treatment of the insane at county asylums is at pre¬
sent a compromise. It is not scientific beyond a limited
extent. It is a competitive system to try and show the best
results in the most moderate figures, the data being alike in
no particular except that the patients are paupers. Let us
be candid. Is not the expense too closely scrutinized with
regard to the interests of the ratepayers, who exclaim “ if
such an asylum is managed at so much per head per week,
why should notours be? ” The very little difference that
really exists between one county asylum and another (not
to take extreme cases) and the close approximation in their
statistics is a proof of this recognition of public criticism.
Taking the various statistics of any asylum over a course
of years, there will be found great diversities, but of late
those of cost have approximated more.

Where is the standard to which asylum regulation must be
referred ? What central authority regulates the diet, or the
amusements, or the supply of literature, or the quality of
the clothing, or the numberless other things that mean com¬
fort and probable cure, but which may be conveniently
dropped without being missed? Practically none. There
is no standard by which institutions may be compared. Is
there any superintendent bold enough to affirm that he is
not trammelled by considerations of the expense in the
treatment of his patients, and that his results would not be
greatly improved if he could put his hand more deeply into
the asylum pocket ? I quite acknowledge that there must be
always a restraint in this direction, but what I do object to
is that comparisons should be made between members of an
imperfect system, that imperfection being greater or less
according to the idiosyncracies of the individual who is at
the head of it. The statistics of county asylums must be
taken as showing merely what is done, not as correct esti¬
mates of what might be done. If lunacy is to be made a
matter of statistics let us have a uniform system by which
we can measure it. Why not have a definite dietary—at

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On Large and Small Asylums 9 [July,

least for the same county—a similar mode of keeping
accounts and registers ? Nothing to my mind is more un¬
satisfactory than the dietaries at different asylums—some
give* “slop” dinners for soup or stew, others milk and
potatoes, others preserved meat, others fish, &c. And there
is no doubt that though the food may be good, a great many
patients will not eat it. Of course, patients are fanciful and
some may say that like schoolboys they would object to any¬
thing given them, but there must be something wrong
when (as the Commissioners* Reports show) the dinner
if often left by a great many.

Again as to the number of patients in an asylum that can
be “ superintended ” successfully. Some say 600 and 700,
some say many less than this. Here again much license
must be accorded as to what is meant. If it means that the
superintendent must personally examine daily, and be
acquainted with all the particulars of the cases, the number
is far too large. If it means only a general supervision,
then he will scarcely have enough to do. The case is not
fairly put by those who divide the asylum population by the
number of medical men and accord so many to each, for in
many asylums the superintendent is occupied largely with
the steward’s business, and spends as much of his time
in looking after the farm, attending sales and buying stores,
as he does in attending medically to the patients. Take
the amusements, which are a great tax on the staff of an
asylum. In many asylums these figure as a large expense,
and there is no doubt of their value ; in others they appear
hardly at all. There is not even a settled plan of asylum
management. In some asylums the superintendent manages
the gas, farm, and patients, even down to signing
orders for pins ; in others he only occupies himself with the
patients. I do not say which of the two plans is the best,
but I do say that it is absurd to compare the medical atten¬
tion that patients must get in the two systems. Is there not
after all too much fuss made about the number of patients
a man has to attend to? There are, unfortunately, in
asylums, scores of cases that are better looked after by the
nurse than the physician, and I say, without fear of contra¬
diction that the present treatment of lunacy in this country
is rudimentary .

Except tonic treatment to improve the general health and
special treatment for cases of suspected syphilis, gout, or lead
poisoning, there is really very little that can be done. In most

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211

by T. Clave Shaw, M.D.

cases the time for treatment has passed when the patients
are admitted. So that the true way of keeping asylums empty
is an anticipatory treatment which shall prevent them from
getting full. Electrical apparatus, baths of various kinds
are conspicuous by their absence, and now^ that the use of
sedatives is generally discountenanced, it is easy to see why
the drug and surgical instrument account generally averages
£d. a week per head. Beyond good dietary, open air occupation
and protection, there seems little in the treatment of the
insane nowadays, and the reproach so constantly brought
against the medical men of this specialty for doing so little
to advance it, will not bear criticism. If lunatic asylums
were in large towns where libraries are easy of access, where
men could meet others and compare ideas or refer difficult
and disputed points, or if costly scientific apparatus could be
procured at the expense of the asylum, and specialists in
their use were at hand, there is no doubt more would be
done, but such is not the case. Asylums and their officers
are practically isolated. The functions of an asylum
physician are more those of a general practitioner, and com¬
petition prevents the expense that would be incurred by the
collection of scientific apparatus, library, &c.; whilst the
worry and anxiety inseparable from an asylum whether of
large or of small dimensions are such as to prevent (if a man
is to do his duty towards his patients) any great devotion of
time to scientific pursuits. I do not agree with those who
say that little is done by asylum physicians. My opinion is
that they go through a great deal of conscientious, harass¬
ing work, and it is only want of opportunity that prevents
them entering more fully into the arena of public medical
life. The treatment of insanity does not appeal so directly
to the attention as in the case of the operating surgeon or
the general physician, and, of course, the proportion of cases
is very much less; but as for the results of asylums, taking
40 per cent, as an average of cures, they may be said to
speak for the general efficiency. I contend, then, that whilst
in county asylums much is done for the cure and treatment
of the insane, it is an incomplete system, temporising only
with the subject, and too heavily weighted, by competition
and other considerations, to be taken as a standard of what
the treatment of the insane should be; that comparisons
between county asylums are impossible in the face of the
differences that exist in the characters of their populations,
the mode of their conduction, their situation, and their
xxix. 15

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212

On Large and Small Asylums. [July*

special completeness and aptitude for convenient treatment
and accommodation. Is there then no advantage in large
asylums? There is no doubt that they might if desired be built
more cheaply; that they are not always so simply arises from
the fact that building committees do not always feel bound to
keep within the strictest economical limits. When they do
so, as seen in the cost of the Metropolitan Imbecile Asylums,
they are successful. That they contain a larger proportion
of feeble cases than would be found in smaller asylums is, I
think, no disadvantage for the patient. The outcry at one
time was to remove all persons of unsound mind from the
workhouses and to place them in asylums. Now that these
u chronic ” cases are sent to asylums, and the demand has
arisen for more accommodation, the desire is expressed to
send back many of the harmless patients to the work-
houses, and to reserve the asylums for the violent and cur¬
able cases. It would be a pity to revert to the old system
of keeping great numbers of lunatics in workhouses, for there
is no doubt that they are far better looked after in asylums;
and, moreover, I doubt if there is one asylum in the country
(I am speaking of the county asylums) that could afford to
dispense with its harmless and quiet population, for this
reason, that the existing accommodation is not suited for the
treatment of any but a mixed class, and of a class too which
contains a preponderating element of harmless patients. If
acute and violent cases only are to have asylum treatment,
then the smaller the asylum the better; but Dr. Chapman
has shown that it is possible to have large asylums compar¬
ing in all respects more favourably in the results of manage¬
ment than small or medium-sized ones, mixed cases being
under treatment.

What would have been the expense for Middlesex if, in¬
stead of having three asylums, there had been six? It
might have been less, but almost certainly it would have been
much more , for the extra sum expended in land would have
reached many thousands of pounds, and it is difficult to be¬
lieve that the cost of building the six would not have cost
more than that of the three, whilst the charge for removal
of patients backwards and forwards would have been a last¬
ing source of expense, much greater than it now is.

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213

CLINICAL NOTES AND CASES.

Cases of Self-Mutilation by the Insane. By James Adam,
M.D., Medical Superintendent, Crichton Royal Institu¬
tion and Southern Counties Asylum.

Injuries to self, or rather attempts at their infliction, are
events of such frequent occurrence that in certain forms of
mental disease their probability is indicated by the symptoms,
and due precautions are usually adopted in asylums for their
prevention, although no previous overt act may have given
practical warning of the tendency.

It has, moreover, become the custom (so well are coming
events foreshadowed to close observation of the insane) with
regard to asylums, to consider that the greater or less number
of successful attempts may be taken as a pretty sure indication
of the character of their management and supervision, as well
as of the care and vigilance exercised by those who are respon¬
sible for the immediate charge of patients.

But although instances of attempted self-injury are not
infrequent, it will be found as a rule on inquiry that the in¬
tention in their infliction is suicidal in character-*-whereas
instances of wilful self-mutilation, for its own sake, are much
more rare, and an investigation into the various causes leading
to the act is attended with so much the greater interest on
that account.

The usual difficulty, however, presents itself in investigating
the origin of cases of this kind that occurs in the investigation
of many other forms of mental disease, or perhaps it exists even
in a greater degree, owing to the condition of mind to which
the patient is frequently reduced before being brought to an
asylum after the injury, or to the difficulty of obtaining reliable
evidence as to the mental condition of the patient before, at
the time of, and immediately subsequent to, its infliction; and
we are often baffled by obstinate and persistent taciturnity, or
by stupor, the associate of the melancholic condition.

The task of investigation becomes easier, however, when we
find the mutilative act the direct result of hallucination or de¬
lusion affecting the special senses; patients labouring under
these forms of disease being sometimes talkative and communi¬
cative. They will readily tell you that the act has been com¬
mitted owing to hearing a voice from heaven commanding them
to do it; or oy terror at seeing a vision, and in the frenzy pro-

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214

Clinical Notes and Cases.

[July,

duced thereby being impelled to self-mutilation or injury, or by
fear of loathsome disease produced by a perverted sense of
smell, or of poison by diseased sense of taste.

It thus becomes of importance when well authenticated facts
are ascertained with regard to cases of this kind that they
should be brought under the notice of the profession, and as it
happens that several cases of more than usual interest have
recently been under my own observation, I trust that a short
account of some of them may not prove unacceptable to the
members of our Association.

Before proceeding with the narrative of these cases, how¬
ever, I would briefly allude to the importance of the subject in
its general as well as its medico-legal aspect, and I would also,
with this object in view, call to remembrance two cases of this
kind which were published in the “ Journal of Mental Science”
for April, 1882.

In the first of these, reported by Dr. Howden, of Montrose,
a tendency to self-mutilation was shown to exist in several
members of the same family, and the injury inflicted was
similar in character in each member, although it does not
appear that one was even aware of the act which had been per¬
petrated by the other many years before.

The second case, that of a farmer named Brooks, is of
peculiar interest, medico-legally ; for this man, in whom insanity
does not seem even to have been suspected, not only inflicted
an injury upon his own person, but he succeeded in getting a
jury to believe the false story he told with regard to the manner
of its infliction, and was thus the means of causing two neigh¬
bouring farmers, who were perfectly innocent of the crime with
which they were charged by Brooks, to be sentenced each to
ten years’ penal servitude. What mental state he was in, or
what moral or other obliquity existed in Brooks to account for
his conduct, is not shown by this account.

In connection with the medico-legal aspect of this subject, I
would also briefly remark upon those curious cases sometimes
causing much anxiety which are occasionally met with,
especially among the more educated classes, where circum¬
stantial statements are made with regard to supposed injuries
said to be self-inflicted of which there is no evidence.
A remarkable, although extreme, instance of this kind
occurred many years ago in the case of an eminent
scientific man, who had been educated as a surgeon. He
laboured under occasional maniacal attacks, alternating with
extreme depression. This gentleman informed me, when

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Clinical Notes and Cases .

215

I went to visit him one morning in his bedroom, that in
the course of the night he had dislocated his ankle and hip
joints on one side, and broken both bones of the leg on the
other; as if this were not enough, he spoke also of a wound in
the temporal artery. He gave evidence of his own firm belief
in the existence of those injuries by having carefully and
accurately bandaged all the parts named for them respectively,
and for this purpose he had torn his sheets into bandages, and
he resisted with evident anxiety the removal of those bandages,
whereupon not the smallest sign of any injury was found to
exist.

I come now to record two remarkable cases of self-mutila¬
tion, one of them occurring in a male, the other in a female
patient, both having the same name, but I cannot trace that
they are related in any way.

With regard to the female patient, the first accounts I heard
of her were of a very unusual and alarming character, and they
were somewhat of the following tenor :—That if she were left
alone, or free from restraint for even a single instant, some dire
tragedy would certainly ensue ; that if her hands were allowed
to be free for one moment, she would gouge out her eyes
with her fingers, pull out her tongue, or do something else
equally dreadful. She was reported to have occupied a
“ locked bed 99 every night for a very lengthened period, and
to have seldom been without some form of restraint for many
days together. It was further reported concerning her that
self-injury was attempted at every possible moment, day and
night, in every possible way ; that she had an attendant day
and night for the whole time of her residence, whilst frequently
and for long periods she had required more than one. Full
details of the case, as recorded in the Case Book, would occupy
too much space. I therefore give only the following extracts
referring to her condition in each year of her residence :—

Case I.—Mrs. B. was admitted to the Crichton Institution on the
15th October, 1875 ; was then stated to be 45 years of age; married,
with a family; had previously been a governess ; and was one week
insane prior to admission. The cause was stated to be the climacteric
period. She had attempted self-violence by various means, and was
deluded on religious subjects.

Dec. 2nd, 1875.—There occurs the following entry in the Case
Book:—

“ This is a very bad case, in which little or no improvement has
taken place. The patient, an hour and a half after admission, gouged
out her right eye, which now presents a horrible wreck. She refuses

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216

Clinical Notes and Cases .

[Jnly,

her food, and has to be fed artificially three times a day. Restraint is
employed to prevent her gouging out the other eye, as she is on the
qui rive to get an opportunity of doing herself injury.”

Dec. 10th, 1876.—Is losing ground bodily; occasionally restraint
is necessary to prevent ber injuring herself, and she is constantly
watched by an attendant.

Oct, and Nov., 1877.—Still requires constant watching, and occa¬
sionally some form of restraint to prevent 6elf-mutilation.

Is worse again, refusing her food, trying to put her head into the
fire. She wears the camisole at present constantly, from the fear that
she may gouge out the remaining eye.

Sept., 1878.—Has not required feeding with the stomach pump for
some time. She still has delusions about “ spirits” and “ words,” or
rather hallucinations of vision.

Nov., 1879.—The camisole has been discontinued, its place being
taken by soft gloves of chamois leather, which are tied on during the
night. These are found to afford sufficient protection, without causing
the cramped position and interference with respiration, inseparable
from the use of the camisole.

1880.—The patient is in restraint by means of a straight waistcoat
by day and night. An attendant is always beside her, and for addi¬
tional safety by night she sleeps in a locked bed, which she has oc¬
cupied for several years. About this time an investigation reveals the
following physical and mental condition :—

A greatly reduced, exhausted, and emaciated frame—a cachectic,
hollow, and worn facial appearance, the right eye is wanting, the hair is
grizzled and grey,and there are marked facial lines; the cause of the re¬
peated mutilative attempts of which she has been guilty, and to which
she still has a determined tendency, is hallucination of the senses, both
of hearing and vision, whilst the other special senses are markedly dis¬
ordered as well. She hears voices commanding her to do the acts
referred to. She sees her children burning in the fire, shrieks with
terror, and tries to push in her head beside them. She says she feels
she is not worthy to live, because she is so diseased and wicked, that
she is a burden to herself, and she refuses her food because it is
poisoned. To repair defective nutrition is clearly indicated, and she
is ordered milk, eggs, beef-tea, port wine, &c. every two hours, with
directions to report if not partaken of.

May 10, 1880.—Has been walking out for some time regularly in
the grounds ; the depression is intense in the morning.

Oct. 1.—To-night, for the first time (for many years), slept in an
ordinary bed, and really did very well, restraint of all kinds had been
removed ; but an attendant is with her by day, and the night nurse
sits in the dormitory occupied by the patient by night.

March, 1881.— Has* continued to occupy an ordinary bed since last
date, and generally she sleeps well. She has also taken her food
well. Altogether there is very definite improvement in her case.

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1883.]

Clinical Notes ancl Cases .

217

1882-83.—From the time of the last entry to the present the im¬
provement then reported has been well maintained, and restraint of
any kind has never again been found necessary. Although still sub¬
ject to the same hallucinations and delusions, they are well under con¬
trol, and do not influence her conduct in the same manner as
previously. She is never without supervision, but she is allowed
a considerable amount of liberty to admit of her taking neces¬
sary exercise. She attends and enjoys the various amusements, and
she enters with spirit and animation at times into the dances. She
plays the piano, and altogether leads a life of as much composure
and comfort as can be expected in a case of the kind, in which recovery
cannot be hoped for.

The second case of self-mutilation referred to was quite
recently brought under my care in the Southern Counties
Asylum, and the following are the particulars with regard to
it:—

Case II.—W. B. : admitted 12th March, 1883. He is 18 years of
age, tall and handsome in feature, single, a farm servant, by religious
persuasion a Presbyterian. It is a first attack of mental disease; he
has been four days insane, the cause not known. He is stated to be
neither epileptic nor suicidal, but dangerous to others. No member
of the family is known to have been insane. The facts indicating
insanity, as given in the medical certificates for admission, are :
44 Violent in his conduct at times, has fixed delusions, prays that he
may be delivered from his enemies ; states that I, along with others,
am plotting against him.” His mother states he says he is the
44 Apostle Paul,” and’ that he is being persecuted; he refuses food from
her, saying that she wants to drug him, and deliver him to his enemies.

The following particulars with regard to the mutilated condition in
which he was found when admitted have been ascertained:—

On the sixth of March last, while employed fts a farm servant, he
told his fellow-servants, who were then at dinner, that he was going
home to his father's house, about two miles off; but it appears that,
instead of doing so, when alone in a field a short distance off, with a
sharp pen knife, he completely and cleanly removed the whole of the
penis. The haemorrhage ensuing from the wound was very great, and
feeling alarmed about it, he went to some running water near at hand
and bathed the wound ; the water being very cold at the time, it seems
to have assisted in arresting the haemorrhage.

The lad’s master soon after found him lying in a field with marks
of blood about him, and had him conveyed home, when he was
medically attended to.

I am indebted to Dr. Taylor Monteath, of New Abbey, who
attended him, for the following interesting particulars of the case

On the 6th March last I was called to see him, and found him in
bed ; he was quite rational at the time, but seemed much dejected in

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218

Clinical Notes and Cases.

[July,

spirits, and expressed his regret several times to both his mother and
myself for what he had done. The haemorrhage had ceased ; there
had been oozing from the cut surface before I arrived, but the lad’s
mother had applied cobwebs, which caused a clot to form, and arrested
the bleeding.

On questioning the lad I found he had been in rather low spirits
since Martinmas. His mother states that previously to Martinmas
he had always been of a cheerful disposition, but after that term she
began to notice a change in his disposition. He became dull and
moody, and endeavoured to eschew his friends as much as possible,
sometimes going a long way out of his road to avoid friends. He ad¬
mitted that he masturbated, and when asked why he cut off his penis,
he said that be considered he was only doing his duty, and following
out the Scriptural injunction that “ If thy right hand offend thee cut
it off.” He had been reading some quack publications on nervous
debility, and also Salvation Army publications.

The lad’s mother says, regarding him, " I cannot help thinking he
overtaxed his strength at the putting out of a fire at the other farm on
the 4th March. Everyone said he wrought like two men. That after
he went to bed on that night, and slept about two hours, he took it
into his head that someone was going to set fire to his master’s farm,
and he then took means to prevent them by watching all night and
putting things out of the way ; and next day he was at his work, but
that confusion came on him again all day and all night, and on the
Tuesday he was set to burn thorns, and while doing so he got worse,
and an impulse came upon him that he ought to do something. So he
got his Biblej and, happening to open it in Leviticus, he believed it
was his duty to do what he did; but he said if he had opened his
Bible at any other place, he would not have done so. He had also
some time previously, had serious thoughts about his soul.”

On admission this patient was in a greatly reduced condition, partly
from inanition, and partly from loss of blood previously; the pulse
was 60 per minute, weak and irregular ; the heart’s action weak, and
a tendency to lividity in the extremities indicated a weak general
circulation. There were several scratches and bruises about the
patient’s body, which are recorded in the a Physical Condition
Register ; ” but the most serious injury was the removal of the penis
near the root, leaving an unhealthy looking sore. The patient per¬
sistently shut his teeth against food, so he was fed twice with the
stomach pump on the day of admission. On each occasion, however,
most of the food was rejected by the stomach. He removed the dress¬
ings from the wound repeatedly, spat freely at everyone, prayed
frequently, when food was offered to him asked if it was God’s will, &c.
A special attendant was placed with him during the night.

13 March, 1883.—Patient fed with stomach pump, but took the
rest of his food ; he will not allow the dressings to remain on the
wound ; he slept seven hours at night.

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1883.]

Clinical Notes and Cases .

219

14 March, 1883.—Took plenty of food to-day, and with a little
management did not remove the dressings; he spent a quiet night,
sleeping three and a half hours; special attendant at night still
continued.

16 March, 1883.—Continues to take food well; patient was re¬
moved to Infirmary Gallery, and special attendant discontinued.

20 March, 1883.—Patient going on fairly well; occasionally he
removes the dressings from the wound; is very self-willed. Up till
to-day he has always passed his urine in bed, apparently wilfully ; to¬
day, however, he made an amendment in this way.

24 March, 1883.— W. B. continues to improve satisfactorily ; habits
improved ; has been visited by his friends, and seems the better of it;
wound healing kindly.

March 26,1883.—He has improved, but still has delusions, such as
that his relations are living in the asylum, and his bodily health and
condition are both much improved ; the cut surface is healing slowly
but satisfactorily.

Note. —For some time after admission there was mnch taciturnity, depres¬
sion, and stupor; this was followed by excitement, an exalted and religiously
exhilarated mental frame, during which he sang and repeated psalms and
hymns by night and day. This condition was succeeded by a gradual return
to his normal mental condition, in which he now remains, the wound having
healed by granulation over its entire surface.

Tubercular Meningitis in Insane Adults . By Wm. Julius
Mickle, M.D.

Some examples of tubercular meningitis occurring in adult
insane males will be briefly summarized.

In the first example (Case I.) the tubercular meningitis was,
as usual, mainly of the base of the brain, and it occurred in
a patient who had formerly recovered from symptoms of
phthisis with pleurisy, but in whom, long afterwards, pulmonary
tuberculosis came on, and, finally, tubercular meningitis, the
last occurring after some lowering of the general health by
intestinal disease, the traces of which were also found at the
necropsy; while the lungs showed trace of former, cured
phthisis.

In the second case (Case II.) meningitis, and chiefly of
the base, supervened on indications of pulmonary tuber¬
culosis ; and at the necropsy, besides the tubercular affection
of the cerebral meninges, there were found tuberculosis of the
lungs, of the pleura, of the old pleuritic pseudo-membranes
and adhesions, and of the peritoneum; also, enlarged indurated
and caseous bronchial glands, and tubercular nodules in the
spleen.

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220

Clinical Note* and Cases.

[Joiy,

The next two cases are of somewhat different character, for .
in them the tuberculosis was mainly of the meninges of the
cerebral convexity ; the inflammatory action had not advanced
beyond a very early stage.

In one of these (Case III.) the cerebral affection supervened
on chronic phthisis with much cavitation and tuberculosis of
lungs, tuberculosis and calcareous changes in the bronchial
glands, tubercular mesenteric glands, slight tubercular ulcera¬
tion of small intestines, and slight incipient tuberculosis of
kidneys, old perisplenitic adhesions, and adhesion of right
adrenal to the kidney. The only intra-cranial tubercles were
on the cerebral convexity, as minutely described below; but
the lateral ventricles were filled with a turbid serous fluid, and
the tissues around them were much softened, so that the
symptoms were perhaps partly due to disease in this situation,
which had not yet attained to the formation of visible
tubercles.

In (Case IV.) the other example of this latter group the
visible meningeal tubercles were confined to the right parietal,
occipital, and temporo-sphenoidal lobes ; thus chiefly following
the distribution of branches of the right posterior cerebral
artery, although found also in parts supplied by the anterior
and posterior parietal branches of the right middle cerebral
artery. An unilateral and localized distribution of the
tubercles of this kind, is not unique, however, although rare.
There were also slight indications of an irritative, or possibly
slightly inflammatory, process at the base. In the lungs were
cheesy masses, and sub-pleural tubercles; numerous large
yellow nodules in the spleen; one such*in the left kidney;
caseous abdominal glands, especially near the pancreas; and
old close perihepatitic adhesions.

In reference to the first group there is principally to note
that—as compared with similar examples of the usual patho¬
logical form of tubercular meningitis in sane adults—the
duration of the affection was in both cases unusually short,
and that in both coma came on rapidly; while in one there
was, throughout, no diminution of the pulse-frequency, which
on the contrary was high.

The latter group, or that in which the tuberculosis was,
mainly at least, of the convexity instead of mainly at the base,
differed in other respects from the former group chiefly in
this—that symptoms of thq tubercular cerebral affection'
occurred only when the patients already had somewhat advanced
pulmonary disease; and that the inflammatory action was only

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1883.]

Clmieal Notes and Gases .

221

so slight and incipient that it could scarcely be said that much
more than tuberculosis was present; and that, while the
cerebral symptoms were sufficiently marked, there was no
strictly localized paralysis observed in any part.

In the third case (Case III.) (a) the final cerebral symp¬
toms, though decided, were not distinctive, the tuberculosis
being of the convexity.

(b) The modified Cheyne-Stokes's respiration, or exaggera¬
tion of a respiratory condition sometimes found in basal
tubercular meningitis, was an interesting feature in this case
in which no tubercle was found at the base, and only slight
inflammatory indications.

(c) Here the so-called cortical motor zone was somewhat
affected, and yet without local spasm, convulsion, or paralysis
being observed, the inability to stand during the last two
days being apparently part of the general muscular relaxation
and asthenia then existent.

(d) The supposed cortical visual centres were considerably
affected, but without prominent visual symptoms. The
insidious formation of tubercle must, however, be kept in
mind.

In Case IV., wherein tubercle was limited to the posterior
part of the right cerebral convexity and base, (a) the cerebral
symptoms were of short duration, and motor symptoms were
absent.

(b) In this case, also, with vivid, long-continued auditory
and tactile hallucinations, coincided well-marked implication of
parts of the supposed right auditory cortical centre, and of
parts adjoining the supposed right tactile centre, while the
right angular gyrus also suffered without the production of
symptoms referable to the visual sense; and, without motor
symptoms arising, part of the right so-called cortical motor
zone was affected. Here, again, the mode of growth of
tubercles, and the tolerance of their presence sometimes
exhibited, must be kept in view.

Case I .—Tubercular Meningitis , basilar .—J. M. Private 77th
Regiment, admitted at the age of 30, died aged 38. First attack of
mental disease, of somewhat indefinite previous duration, and un¬
known cause. Offering to re-engage at the end of ten years’ ser¬
vice, he was rejected on account of “ varix.” Then, whilst returning
to England from India, he attempted suicide by jumping overboard
at sea, without having shown any previous symptoms of insanity, so
far as was recorded. After this, melancholia was marked; he
suffered from the delusions that he had committed an unpardonable

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Clinical Note* and Case*.

222

[July,

sin, as well as high-treason, by being in love with the Queen ; and
from great terror lest he should be beheaded on that acconnt.

For several years the melancholic depression continued to be ex¬
treme, and to the above delusions were added others, such as that he
wonld be hanged for the murder of a young girl at Aldershot, and
that he was guilty of various other unpardonable crimes. He was
clean,and at times industrious. Three years after admission indications
of pulmonary phthisis were observed, and cod liver oil was given.

More than three years later there was pleurisy on the left side,
apparently connected with the pulmonary disease. Recovery took
place nnder potassium iodide and bicarbonate, and subsequently tonics ;
but there were permanent indications of the past mischief, and the
right pleura was affected too.

About a year still later there was scrofulous cervical adenitis. These
swellings, he said, had been caused by the angels trying to strangle
him. They were incised, &c., and perchloride of iron and sulphide
of calcium were given internally, the former for several months.

After this he had delusions as to being importun^ nightly by pro¬
stitutes. Also an attack of severe and prolonged entero-colitis, from
which he entirely recovered ; but diarrhoea returned two months later,
or a fortnight before death. At the left apex were prolonged expira¬
tion, slightly bronchial character of breath-sounds, slightly increased
vocal resonance, fair percussion-note ; towards the nipple thin, feeble
inspiratory sound ; at the right apex somewhat blowing respiration ;
laterally rough breathing.

On Oct. 16th, the bowels being relaxed, he was put to bed, and
under treatment. Appetite gone.

On the morning of October 17th, restless and confused, he fell out
of bed, passed thin loose motions on the floor, but had no convulsions.
He took but little food. Temperature 98*3°; pulse 50, compressible,
feeble ; face somewhat flushed ; pupils rather wide and sluggish ; eye¬
lids slightly cedematous; urine free; over the right chest, sonorous
rales; some indistinct subcrepitant and other sounds at left front
apex ; some dulness over the lungs posteriorly. There were great
mental confusion and restlessness, lie was unable to answer questions,
and would not put out the tongue at request. Later in the same day
were stupor, and even coma, snoring respiration, and a small compres¬
sible pulse of 46 in the minute. By catheter 40 ozs. of urine were
drawn off, of high colour, uon-albuminous, containing abundant pale
urates, and detritus of bladder-mucus and epithelium. There was
palsy of the right third cranial nerve, producing dilatation of the right
pupil, ptosis, and external strabismus : both pupils were very sluggish,
the left was slightly dilated. The face was flushed, the body warm,
the abdomen tympanitic. The head was elevated, and an ice-cap was
applied to it. Ergot. Diuretics.

18th. Supported by nutritive enemata ; pulse small, 100; axillary
temperature 96°; respiration 36, mostly abdominal; abdomen still

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1883.]

Clinical Notes and Cases.

223

somewhat tympanitic; no vomiting ; had passed more than 30 ozs. of
urine since preceding day, and more was drawn, off by catheter. Later,
some resistance to passive motion, especially of the right limbs, and
some paresis of the left limbs were perceptible; coma continued ;
dorsal decubitus; death at 4 p.m.

Necropsy , 48 hours after death; medium height, spare and slender
build, rather thin. Scalp thick; cicatrices of strumous, cervical
ulcers.

Calvaria thin ; moderate amount of blood in sinuses; arachnoid
slightly opaque; inner meninges tough, not markedly hyperaemic,
not adherent to brain; no subarachnoid serum over cerebral convexity,
where, indeed, the gyri are closely packed ; cerebral grey cortex
slightly soft, thin, pale; white matter rather soft ; puncta cruenta
well-marked, clots drag from the vessels on section. At the base, in
the Sylvian fissure, opposite to the middle transverse diameter of the
insula, attached to the pia-mater, is a firm whitish tubercular nodule
of the size of a pea, indenting the left third frontal convolution. The
walls of the Sylvian fissures are adherent, and in both fissures abun¬
dant, soft, dirty-whitish, tubercular granulations are seen in the pia-
mater, particularly beside the branches of the middle cerebral artery.
The interpeduncular space and the parts immediately in front of it are
covered by whitish layers of lymph, and by turbid serum, which ex¬
tend to the entrances of the Sylvian fissures and encroach upon, or
compress, the nerves coursing through this area. The right third
nerve, however, does not seem to be more affected thereby than the
left, yet there is a small blood clot adjoining it in the cavernous
sinus. The basal grey cortex overlying the exudation is much
softened. Fornix very soft; basal ganglia sodden and rather soft.
Pons Varolii and medulla oblongata rather pale, the pia-mater cover¬
ing them contains a number of minute, transparent, almost colourless
granulations. Cerebrum 43£ ozs. ; cerebellum ozs.; pons and med.
obi. 1 oz.

Heart 10 ozs., fairly healthy; 2£ ozs. pericardial fluid. Right
lung 25 ozs., extensive tough old close pleuritic adhesions. Lung
congested, studded in parts with constellations of grey semi-transparent
granulations. Left lung 23 ozs., thick leathery old close universal
pleuritic adhesions. Lung everywhere thickly studded with grey or
dirty-whitish granulations, which are much more numerous and dif¬
fused than in the right lung. Diffuse hypostatic congestion and
pneumonia of base and posterior surface. At both apices are the
indications of former, cured phthisis.

Kidneys fairly healthy, cortices rather thin, 5£ and 6J ozs. Spleen,
7£ ozs. Liver soft, and of slightly yellowish hue. In the bowel are
a number of cicatrices of former healed ulcers.

Case II.— Tubercular Meningitis , basilar —S. B. 2nd battalion,
18th Regiment, single, admitted January 12th, 1872, then aged 28.
First attack of mental disease, and of one year’s previous duration ;

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224 Clinical Notes and Cases. [July?

prior treatment at Devonport and Netley; cause “ uncertain,” danger¬
ous, not epileptic or suicidal.

Like the former patient, this was a somewhat thin and spare man
of medium height, and nervous temperament. Mental disease was
first recognized when he was undergoing imprisonment at Millbank.

The dominant delusions then were that his food was poisoned, and
that he was acted on by galvanic batteries. He was often excited,
fiercely cursing and swearing at those in charge of him. After ad¬
mission here, the mental state was similar to that just described, and
he was extremely suspicious, and, when not abusive, was taciturn, un¬
social and exclusive. Subsequently he was less disagreeable, but was
satirical when jocose.

In 1874 a few crepitations were once observed over the lungs, and
slight arthritis affected the left knee.

In 1875 he had delusions as to lamps being put on his feet, and
women set to annoy him.—March. At the left apex-front were slight
dulness on percussion and increased vocal resonance and fremitus,
respiration slightly blowing; accentuation at the right apex-front of
the usual characters of the respiration there. Ordered cod-liver oil,
iron, compound tincture of camphor, quassia, and spirits of chloro¬
form ; frequent warm baths; and to continue on the extra diet pre¬
viously given.

May 9th. Had been ailing and feverish since May 7th, with pains
at the back of the head, quickened pulse, and occasional vomiting.
Pulse 98 ; tongue furred ; appetite fair ; bowels costive ; at left apex-
front some dulness and bronchial character of voice and respiration,
occasional musical rales ; in supra-clavicular region somewhat
bronchial breathing, and inspiratory clicks; bronchial rales posteriorly ;
signs less marked on right side ; cough only slight at any time ; no
thoracic pain. Subsequently, general bronchial rales, especially left
side.

After this there were pain about the head and back of neck, and
occasional vomiting, the latter especially occurring on the 10th and
11th, but being neither very frequent nor very urgent. He was
morbidly abrupt, quick and sharp in speech and in movements ; pulse
on 10th, 112, constipation continued, only slight cough.

On the 11th, delirium supervened, his replies were completely
incoherent and irrelevant, and then speech was reduced to a quiet
unintelligible muttering. Then he became semi-unconscious, and
finally comatose, with loud laboured frequent spasmodic respiration,
as if from diaphragmatic spasm. The decubitus was dorso-lateral,
and inclined towards the right side, the knees were flexed but not
drawn up, the abdominal muscles contracted on pressure, but before
becoming comatose he had denied any, except slight, abdominal pain
or tenderness. Pulse 120 and weak. He died on the 12th, the con¬
dition of stupor and prostration having steadily augmented since the
preceding day.

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Clinical Notes and Cases.

225

1883.]

Necropsy , 34 hours after death. The dura mater was slightly in¬
jected, it stripped off readily from the calvaria, as did also the pia-
arachnoid from the brain. The meningeal veins were moderately full.
Slight interlobar adhesions existed. On the convexity the sulci were
slightly wide and rounded in the frontal and parietal regions, and over
the latter and the posterior part of the former there was slight sub¬
arachnoid serosity. The cortical grey matter was of ordinary depth,
rather pale as a rule, but mottled in parts, rather soft; white sub¬
stance fairly vascular and softish. The fornix was soft, the lateral
ventricles contained a moderate amount of fluid, and their ependyma
was somewhat thickened and opaque ; basal ganglia slightly softened.
Foregoing characters alike in the two hemispheres. On the inferior
cerebral surface, and on the left side of the inferior cerebellar, were
tubercular granulations in the meninges, and turbid sero-fibrinous
effusion. Pons Yarolii and medulla oblongata rather soft, and the
meninges covering them slightly infiltrated; pons hypervascular.
Right cerebral hemisphere 22£ ozs., left do. 22£ ozs., cerebellum 5£
ozs., pons and. med. obi. 1 oz. ; fluid from cranial cavity 1 \ ozs.

Heart 10£ ozs., healthy save for febrile changes in its muscular
tissue,,pericardial fluid 1^ ozs. (

Right lung 35 ozs., nearly general old pleuritic adhesions, these
and the partially thickened pleura being highly tuberculous in many
parts ; 2^ ozs. of blood-stained serum in pleural cavity; much secretion
in bronchi. Firm minute tubercular granulations were scattered
throughout the three lobes of this lung, most were whitish and
opaque, a few were semi-transparent. The posterior surface and
apex were congested and oedematous. Left lung 20£ ozs., old, tough,
leathery, pleuritic false membranes, binding the lung to the chest-wall,
and enclosing collections of blood-stained serous effusion. Sub-
pleural, dense, firm, opaque and dirty-white tubercle in masses and
scattered nodules at the apex, and below the apex on the anterior
surface; a few semi-transparent granulations thickly scattered
throughout the rest of the upper lobe ; a few tubercular nodules in
the lower lobe. Bronchi congested and laden with secretions.
Bronchial lymphatic glands indurated and caseous, and one beneath
the left bronchus enormously enlarged.

Kidneys 4f- and 4£ ozs., cortices rather thin. Spleen 6£ ozs.,
firm, containing whitish tuberculous nodules. A few scattered
peritoneal tubercles, especially on the under surface of the liver.
Liver 50^ ozs., right lobe reddish-grey, left yellowish; healthy
adrenals ; irregular congestion of intestines.

Case III .—Meningeal tuberculosis of convexity . Incipient inflam¬
matory changes at base. —This and the fourth case have been published
elsewhere.

T. 0., 70th regiment, admitted May 16th, 1861 ; died August
15th, 1878, aged 41 years. This patient, at one time maniacal, with
hallucinations, and with extravagant notions as to his rank, and

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226

Clinical Notes and Cases.

[July,

latterly for many years fairly quiet, tractable, and somewhat
demented, became the subject of pulmonary phthisis of a somewhat
latent form, first noticed between three and four years prior to
his death. It was more advanced in the right lung, and was attended
with attacks of bronchitis, accompanied, or not, with symptoms of
the asthmatic order ; while, latterly, diarrhoea made appearance from
time to time.

Not until eleven days before death did he become permanently
bedridden. Four days before death he was very feeble, emaciated,
and his pulse was rather slow. Thus he remained, without any
marked alteration, until the day before death, when he was very pros¬
trate and feeble, and cerebral symptoms were first noticed.

For on this day he was mentally dull, heavy, apathetic, drowsy,
took little notice of his surroundings ; paid but little attention to
questions pot, or to his comforts, wants, or inconveniences; when ad¬
dressed was slow to understand, and brief, or even irrelevant, in his
replies. The act of swallowing was very slow and difficult, and some
hiccough was present. From fraction of minute to fraction of minute
the pulse-rate varied from 78 to 96 ; and the respiration, which was
26 on the average, also varied in frequency; in fact a modified
Cheyne-Stokes's respiration now existed. On some occasions there
was merely an ascending and descending respiratory rhythm; but at
others a distinct apnceal period, though only a brief one, was inter¬
polated. In the latter event the respiratory period consisted of five or
six respirations, gradually increasing in fulness and loudness, and it
alternated with a recurrent respiratory pause of about six seconds’
duration, which completed the respiratory cycle. At first the pulse
was rather slower during the respiratory period, but in some later
observations no difference in pulse-frequency was perceptible in the
two periods. Subsequently, respiration became more regular, and
varied from 28 to 30 per minute, the pulse simultaneously becoming
fuller than it had previously been. But again the modified Cheyne-
Stokes’s respiration returned later in the day. Temperature in left
axilla 98°. The left hand was swollen and cedematous, the feet were
slightly cedematous. The urine was free from albumen. There was
no perceptible spasm, convulsion, rigidity, or paralysis.

Next day I was absent, but was afterwards informed that the con¬
dition remained much the same, that the pulse was feeble, and
dysphagia persistent, that the patient became more dull, drowsy,
and inattentive to his surroundings, and incapable of replying to any
question. He died at 6.20 p.m.

Necropsy , 56 hours after death. Calvaria unsymmetrical, diploe
moderately vascular. A little fluid blood in arteries at base; slight
arachnoidal opacity over anterior half of inferior cerebral surface. The
general vascularity of the meninges was not extreme, but the meningeal
veins were turgid over the posterior half of the upper aspect of the
cerebrum. The arachnoidal villi were large at the vertex. There

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was patchy opacity of the arachnoid, and considerable pia-matral
oedema, both principally over the vertex. Slight old interlobar
adhesions.

Over the superior surface of the right cerebral hemisphere, and
partially embedded in the pia-mater, both in its free meshes and im¬
mediately beneath the arachnoid, were numerous minute, whitish,
tubercular granulations, many of which had formed cohesions with the
cortical grey substance, so that upon their removal with the meninges
the cortex was left in a slightly eroded state. This erosion especially
affected parts of the posterior half of the first and second frontal gyri,
the lower half of the ascending frontal, and parts of the supra¬
marginal, angular, and first and second annectant gyri. Some of the
slight adhesions seemed to occur independently of the presence of
tubercles at the very point of adherence. At several points the
granulations were collected into dense constellations, which, by their
coalescence, had formed tubercular nodules sunken in the anfractuo-
sities and attached to the subjacent grey cortex, portions of which
adhered to the nodules when they, with the pia-mater, were removed,
thus leaving erosions more considerable than those already named.
These nodules were highly vascular and hyperaemic, so much so that a
purplish background, formed by injected vessels permeating a cluster
between its constituent elements, was in vivid contrast with the
whitish sections of the soft, succulent granulations themselves. A
little yellowish softening also surrounded one of the nodules. One of
these nodular clusters was near the middle of the right second frontal
gyrus ; and connected with it was another which invaded sulci of the
third frontal gyrus. A third reposed in the interparietal fissure,
between the postero-parietal lobule and the supra-marginal gyrus.
Here, also, was a large, pervious, apparently atheromatous or indurated
vessel, surrounded by greyish and dirty-whitish tubercular infiltration,
and this by considerable hyperaemia.

Over the left cerebral hemisphere the condition was much the
same, but here the granulations were sparse and the nodules absent.
Here the cortical erosions, left on removal of the tubercular meninges,
were chiefly on the supra-marginal and angular gyri; to a less degree
on the second frontal, the two ascending, and the first and second
temporo-sphenoidal convolutions, and the postero-parietal lobule.

No tubercles were found on the internal, or on the inferior surface
of the cerebrum.

The whole brain was flabby ; the gyri were slightly wasted in the
frontal and parietal regions, and were somewhat softened. The grey
cortex was pale in front, but of considerable vascularity in the middle
region ; the orbital cortical substance was more healthy. The white
substance of the brain was of diminished consistence, slightly
hyperaemic, and spotted with numerous puncta cruenta.

The lateral ventricles contained turbid serosity. The fornix and
corpus callosum were extremely softened, as also were the basal
xxix. 16

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228 Clinical Notes and Cases. [July,

ganglia, and all the tissues immediately surrounding the lateral
ventricles.

The cerebellum was diminished in consistence, of no extreme
vascularity, and to its surface were slight adhesions of the pia-mater.
The pons Varolii and medulla oblongata were flabby. Right cerebral
hemisphere 19f ozs. ; left ditto, 19|ozs.; cerebellum, 4$ ozs. ; pons^
and med. obi. £ ozs.

As for the other parts, I may briefly summarize by saying that
there were—the general wasting of phthisis ; a small heart; a yellow,
flabby, soft and small liver 5 slight incipient tubercles of kidneys ;
slight tubercular ulceration of small bowel; enlarged and tubercular
mesenteric glands. Tubercular bronchial glands, one calcareous. In
left lung , extreme almost general tuberculosis, with numerous small
cavities, the tubercles for the most part were of dirty-white colour.
Right lung , much excavation, riddling the upper, middle, and part of
lower lobe; the cavities being mostly spread out horizontally. Old,
close, general, leathery, pleuritic adhesions, binding the lung and
thickened visceral pleura to the chest-wall. Right lung 50 ozs., left,
29 ozs. Liver 43^ ozs. Spleen 7 J ozs., capsule thickened, adherent to
surroundings. Left kidney 5 ^ ozs.; right 4^ ozs.; adrenal adherent to it.

Case IV.— Unilateral localized meningeal tuberculosis of cerebral
convexity . Slight inflammation .—J. S. Private 59 th Regiment, height
5 ft. 6 in., weight 1331bs., admitted June 6 th, 1877, died February
10 th, 1880, at the age of 34 years. There was a history of primary
syphilis, incurred in 1870 ; of jaundice, and of ague, in India, in
1872 ; of bronchitis, in India, in 1875 ; of being under medical obser¬
vation on account of suspected mental disease in 1876 ; of debility in
187^, and of mental aberration in the same year. Exposure to
tropical beat and climate was the cause assigned for the mental
disease. The delusions of annoyance, &c., and, later, of loss of organs,
were associated w.ith hallucinations of hearing and of touch ; listless¬
ness, failure of memory, and a tinge of depression accompanied them.
Pulmonary tuberculosis appeared and made progress, and onyxitis,
and, finally, slight pleurisy, succeeded to it. For two or three days
before death he complained of “ pain all over him,” and on the last day
of life .he was somewhat delirious, loquacious, and chattered and
muttered incoherently.

Necropsy (abstract of), 28 hours after death.

Dura mater unusually adherent to calvaria. Some arachnoidal
opacity, especially over the right cerebral hemisphere. Some wasting
of brain, and slight pia-matral oedema over the anterior three-fourths
of cerebral convexity.

Moderately firm, whitish, tubercular granulations over the posterior
part of the right angular convolution ; yellowish nodules over the
middle of the right ascending parietal convolution, partly embedded
in the grey substance, and partly projecting therefrom, some being
buried in the fissure of Rolando, and all being so connected that,

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while bringing away with them portions of the grey cortex (when
removed with the meninges), they separated conjointly as an irregular
mass formed by the fusion of several nodules, which were caseous
internally, and were connected one to another by firm fibroid tissue.
On the under surface of the right occipital lobe the membranes were
the seat of numerous, almost confluent, dirty-whitish granulations,
which appeared on section to be more or less caseous, and formed an
irregular layer, beneath which the convolutions were softened, pulpy,
and of dull-red hue. Scattered granulations existed over the posterior
part of the external surface of the right temporo-sphenoidal lobe, and
a softening and discolouration of the grey cortex such as just described.
Similar granulations, also, were seen in the sulci, on the under surface
of the right temporo-sphenoidal lobe, separating the occipito-temporal
gyri. Lateral ventricles large, containing an undue amount of serum,
their ependyma somewhat opaque. A small dirty-whitish-yellow
nodule embedded in the posterior part of the intraventricular nucleus
of the corpus striatum. Slightly roughened, sanded appearance of
ependyma of fourth ventricle. Thickening of arachnoid over the
pons Varolii. Soft, patchy, thickenings and infiltration of the
meninges about the basal aspect of the Sylvian fissures. Right
cerebral hemisphere 20 ozs.; left ditto, 20 j ozs.; cerebellum, ozs.;
pons and med. obi., £oz.; fluid from cranial cavity 1^ oz.

Left lung: thickly set, clustering, miliary granulations. Beneath
the pleura, yellowish cheesy masses. Old pleuritic adhesions.
Right lung : somewhat similar changes to those in left lung, but less
advanced. Pleura beset with granulations ; slight recent pleurisy.
Spleen studded through and through with large yellowish nodules ,•
also one such in left kidney. Caseous abdominal glands, especially
near pancreas. Old close adhesions of liver, enlarged glands in
portal fissure. Weights: Heart, 8|- ozs.; right lung, 26 ozs. ;• left
ditto, 30 ozs. ; spleen, 5^ ozs. ; kidneys each 4£ ozs. ; liver, 45 ozs.

In the following case of basilar meningitis the course was
extremely rapid, no tubercles were distinctly made out in the
meninges, there were some facts which told for a syphilitic
origin, and yet the existence of recent incipient pulmonary
tuberculosis around old foci suggested a possible tubercular
basis for the meningitis.

R. F. 1st battalion 19th Regiment, admitted April 13th, 1874;
died October 9th, 1875, at the stated age of 23, but he looked five or
ten years older. Hereditary predisposition to mental disease was be¬
lieved to exist. He suffered from chronic mania, was incoherent and
irrelevant in language, mischievous, destructive, and filthy in person
and habits. There were cicatrices of old venereal soft sore, and of
bubo, and a simple boss on the third right costal cartilage. Under
perchloride of iron the weight increased from 133 lbs. to 150 lbs. in
nine months.

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Clinical Notes and Cases.

[July,

October 8th. On rising the left arm was spasmodically jerking, the
bowels were loose, the patient did not speak. Shortly afterwards he
was unconscious; the pulse-rate varied from 80 to 90, the pulse was
compressible, rather quick, but not intermittent or irregular; the
cardiac second sound was feeble, the first rather dull and heavy ; the
pupils were equal, somewhat sluggish, and slightly or moderately
dilated; there were convulsive jerking and twitching, especially of the
left hand and arm, the former being drawn to the head ; the jerking
also affected the trunk and lower limbs, but the right arm only
slightly, and this limb offered some resistance to passive motion, the
other limbs were relaxed; face pale; temperature, right axilla,
104*4°; respiration 40, short and shallow. Ice to elevated head.—
K.Br.

12.30, coma ; pulse 84, of same characters as above; respiration
39, loud inspiration, slightly laboured; temperature, right axilla
104*9°, left 104*3°; still had jerking movements coming on from
moment to moment; frequent flexion movements of left fingers into
palm (thumb straight), forearm raised, face or shoulder clawed by
hand, left shoulder much jerked, right upper limb generally kept
straight, eyes and face very slightly to left, subsultus equally in two
lower limbs, slight lateral movements of jaw. 4 p.m., much the
same. 8.30 p.m., coma ; pulse 120, full, quick, fairly compressible ;
respiration 54, loud, laboured ; moaning expiration, mucous gurgling
in throat; pupils medium size and sluggish ; no subsultus ; right
limbs paralysed ; head and eyes very slightly to right; bowels open,
stools foptid ; has swallowed milk and medicine ; skin hot and
dryish; temperature right axilla, 106-3°, left 106*2°. Cold water
affusion and sheets ; a few minutes after this was begun, temp, right
axilla, 105*2°, reap. 51, less laboured, mucous oppression less.

12 midnight ; pupils and right-limb paralysis as in last note ;
slight twitching of left arm, which resisted passive motion ; temp,
right axilla 104*3°, left 103*9° ; respiration 44 to 52 ; continue cold
to head, and cold-water sheets at times.

9th. 9.30 a.m., temp, right axilla 101*2°, left 101*4°; pulse 117,
compressible ; respiration 57, not so laboured as before; pupils as in
last notes, eyes opened; slight indications of returning consciousness;
right limbs paralysed ; face symmetrical; resume bromide.

1 p.m., temp, right axilla 104*2°, 1 left 104*4°; respiration 57;
pulse 126, soft; no sweating (none throughout) ; pupils wider than
in a.m., quite sluggish ; loud, noisy inspiration, low moaning expira¬
tion with slight flapping of lips, nostrils dilated, and the extra¬
ordinary muscles of inspiration were in full play; much mucous
rattling about throat and chest; dysphagia ; dark slightly ammoniacal
urine drawn off by catheter; feet cold, purplish mottling of lower
limbs. Slight lividity of face and lips. Apply cold to head, sinapisms
and hot bottles to feet and legs.

4.40 p.m., temp. 105*6° in each axilla; pulse very feeble, frequent,

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1883.]

soft, small; respiration 45, laboured and loud; pupils wide, especially
the left one, and insensitive ; right arm more palsied than before.

Finally, respiration became slower and gasping, and still was
effected by aid of extraordinary muscles of respiration, both hands,
in the act of dying, were raised and fingered the chest. Died 5.25 p.m.

Necropsy , 46 hours after death.

Body well-nourished ; extreme rigor mortis; calvaria thin ; diploe
congested, sinuses gorged, dura-mater adherent and congested; fluid
blood in arteries at base; meningeal veins over cerebrum gorged.
Dura mater lining anterior fossae of skull-base abnormally thickened,
and opaque, and very adherent to the bone, whitish and slightly
yellowish in hue; dura mater slightly the same in the middle fossae.

Fibrinous effusion at and about the interpeduncular space, especially
on the under surface of the optic commissure and the left optic nerve,
some also about the third nerves. Also, symmetrically-placed
fibrinous effusion between the pia-mater and visceral arachnoid on the
under surface of the lateral hemispheres of the cerebellum ; also lymph-
patches at the outer angles of the Sylvian fissures. Pia-mater ex¬
tremely thickened, hyperaemic, red and swollen over the anterior
perforated space.

Old, slight, interlobar adhesions. Slight thickening and opacity
of arachnoid, even over anterior half of brain-base. Meninges of con¬
vexity rather thick and congested, not adherent, and not oedematous.
Grey cortex slightly pale anteriorly; white medullary substance of
faint lilac hue. Brain generally flabby, softish. Minute blood-clot
in white substance of left hemisphere, of cerebrum, 1 inch from upper
surface, inch from posterior tip. Congestive redness of temporo-
sphenoidal and occipital lobes at base. t Right hemisphere 22£ ozs.,
left 22^ ozs.; cerebellum 4J ozs.; pons and med. obi. 1 oz.

It need only be added that the apex of the left lung was adherent,
irregularly puckered by cicatricial/tissue dipping down to several old
calcareous nodules about half inch below the surface. The right
apex was also adherent, cicatrized, and puckered, and contained 12
or 14 masses of the size of peas, encapsuled, some only of the con¬
sistence of clotted cream, some firm elastic, some of horny or cartila-
ginoid consistence. Around them were clustered a number of
minute, whitish granulations. Posteriorly, were patches of incipient
lobular pneumonia. Both lungs were congested and oedematous
posteriorly, emphysematous anteriorly, and contained watery secretion
in the bronchial tubes. Slight patchy thickening and opacity of capsule
of spleen, and adhesions of it to surrounding parts.

Cases of Senile Insanity , with Remarks. By Geo. H. Savage,
M.D.

Admitting the difficulties that one has in the classification
of insanity, it seems to me, at all events, reasonable that we
should recognise classes associated with definite physical

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232 Clinical Notes and Cases . [July,

changes. Symptoms may be ever changing and decep¬
tive. A patient may to all appearances be weak-minded, but
on recovery it may be found that such patient's apparent
abstraction and mental weakness were merely the result of an
overbearing and overpowering sense of misery, so that, in
fact he was suffering distinctly from melancholia, and the
mental faculties were in abeyance through the assertion
of other painful sensations. A severe grief or an intense
occupation of any kind may make one forgetful of his
surroundings, regardless of the state of the weather, the time
of day, the condition of one's general health, and so on; and
so it is that in many cases of profound melancholy there is
an apparent arrest of function. This by the way. We have
to consider the fact that at certain periods of life there are
certain special tendencies to an intellectual breakdown. Any
serious affection of the brain in early childhood so afEects the
as yet undeveloped structure that it totters readily to its fall,
and, once having suffered a severe shock, it is with difficulty
restored. In the period of adolescence other functions of the
body are developed, and with them many stirring sensations
are aroused, which have a great tendency to upset the
highly nervous and unstable neurotic patient. As life pro¬
gresses some people exhibit marked tendencies to die out
through their nervous systems. Certain persons develope
phthisis late in life; others develop cancer, gout, chronic
rheumatism, or other constitutional vices. But the thing that
interests me most in this consideration is that there are
definite forms of disease seen in patients dying out from
exhaustion or wearing out of their nervous tissues. As has so
often been said, age is purely relative. A man may be a boy
at 70 or an old man at 35. Age, from the physician's side, is
a relative advance towards decay and destruction of the most
important of the vital tissues and organs. A man may have
all his organs slowly degenerating before he has reached
middle life, the degeneration being due to some constitutional
disease, or to some such condition as atheroma of the vessels.
In an asylum one constantly comes across patients
who have inherited insanity from their parents, and who have
inherited a special form of insanity, and even others who
have not inherited any special form, but have inherited
the tendency which produced the insanity; thus whereas
one person has atheroma of the vessels and dies of
apoplexy, another has atheroma of his vessels and dies of
aneurism, and another patient has atheroma of his vessels

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1883.]

and angina pectoris, so that the offspring of these
patients may have not only the atheroma of the artery, but
either the apoplexy, the aneurism, or the angina pectoris,
according to whether the parents had the one or the other.
I have seen many cases in which a parent has suffered from
mental disease only when he has become 60 or 70, and the
children have gone on very well until they reached a similar
age, and then have broken down under similar circumstances
in a very similar way. It would not be right always to say
that this has no relationship to mental effects and to predis¬
positions. One knows that suicide, for instance, is not only
associated with a family disposition to nervous disease, but is
in many cases also associated with a dominant idea which has
from early days been before the patient’s mind—that suicide
has been, as it were, the evil genius of the family; and so the
fact that a parent has died of nervous breakdown has been
reported to a patient, or has been remembered by him, and
when he comes to a like age he necessarily thinks more about
the fate of his parent, and this alone, in some temperaments,
might be a cause of producing insanity. In some families it
is very noteworthy that a certain age is looked upon as being
critical, and if that age be satisfactorily passed, the individual
may live to a considerable age beyond, but immediately before
this crucial period many members have begun with ailments
and have certainly worried themselves into their graves. But
what I would distinctly assert is that in certain families the
tendency is to die of some affection of the nervous system in
preference to dying by any other system; and it is interesting
to note that in some of these cases the tendency is not always
transmitted in exactly the same way, but that the offspring of
such parents, if they have not been placed in otherwise favour¬
able circumstances, may break down earlier in life; and
although I am not in a position to assert positively that such
is the case, many instances have inclined me to the belief
that the offspring of those parents who have broken down,
say at the climacteric or from advanced age, are more liable
than other insane patients to break down at special periods,
such as at adolescence and the climacteric. When one comes
to consider the changes that we mean by old age, I should say
that the mark I have used as the test as to atheromatous
condition of the arteries is seen by the tortuous temporal
arteries, and the rigid and rather high-tension in the
radial pulse. Other symptoms, such as capillary congestion
about the cheeks, white hair, and a tendency to leanness,

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284 Clinical Notes and Cases. [July,

have, of course, been considered, as well as the condition of
the eye called arcus senilis . Ail the patients to whom I shall
refer have the above characteristics, as well as years over 60.
They suffer either from progressive dementia, with or without
paralysis, or from melancholia of one form or another. As we
shall see presently, they suffered from hypochondriacal
symptoms, or in some cases exhibited maniacal excitement
with exaltation, and I shall have to refer specially to at least
one case in which these symptoms were so markedly like those
of general paralysis of the insane that I was constantly asking
myself in what the difference consisted between our typical
cases of general paralysis of the insane and cases such as the
one under consideration. We were obliged to confess that if
the patient had been brought before us, and that blindfold we
had been told that his age was 35, we should not have hesi¬
tated for a moment in saying that his was a typical case of
the disease. General paralysis does occur in old men some¬
times as well as in young men, but it is not nearly so common,
and when we meet with these cases we are obliged to consider
them as a special sub-variety of the disease, or else must look
upon them merely as cases of degradation of nerve tissue,
having somewhat similar symptoms to the symptoms seen in
general paralysis of the insane. I am rather fond of regarding
these cases as not truly those of general paralysis, but as
examples of progressive nerve degeneration, and I prefer to
look upon symptoms of general paralysis of the insane as
sjrmptoms that are produced solely by a steady and progres¬
sive degeneration of the highest nerve centres; and under these
circumstances I would expect that any disease which produced
steady, progressive degeneration of these highest centres
would also produce similar symptoms, just as in the lung,
whether it be a tubercle, a mass of smoke, or a piece of steel
or stone that sets up irritation, inflammation, degeneration,
and a cavity, the course and symptoms of the disease are the
same.

In considering some of these senile cases I would lay great
stress upon the observation of general physical diseases asso¬
ciated with the mental ones. We have constantly causes of
confusion and difficulty. One sees a large number of cases in
which an apoplexy is followed by more or less mental weak¬
ness, and also a certain number of cases in which athero¬
matous changes, or perhaps other arterial degenerations, are
associated with kidney disease, and with kidney disease there
may be marked alteration in mental character. Besides this.

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1883.]

one may have arterial disease, and I have at least once seen
aneurism in which the pressure on the pneumo-gastric seemed
to have set up enough irritation to cause insanity with delusion
as to food; and, again, valvular disease of the heart may also
be sufficient to set up mental disturbance. It is generally
looked upon as the most natural thing for persons who are
worn out, and who are dying by their brains, to become simply
weak-minded, and docile,as they enter upon their second child¬
hood. This is undoubtedly true in many cases, but we
shall have to notice cases in which every variety of mental
trouble may be seen in those cases whose diseases are attri¬
butable only to senile decay of the brain.

The first two cases which I shall report are those of senile
melancholia.

Case I.—Thomas P. I., admitted June, 1879, aged 69, married. His
father was insane, and since this report his son also has been a
patient in Bethlem. The cause of his attack was said to be over¬
work in business. He had been a collector, had been very sober,
and this was the first attack of insanity, and had lasted two months
before his admission. The first symptoms noticed were delusions.
He said that he struck against a lady unintentionally, but
he was accused of acting indecently, and expected every
moment to be taken up for it. He heard whisperings and people
in the house saying, “ Take him away.” His wife stated that he
considered his books were in a complicated state, and for that and
other reasons he expected to be arrested. He thought he was ruined.
He gradually became more quiet, dull, and unoccupied. He refused
his food, because he thought it was drugged. He thought he had
committed the unpardonable sin, that he must go to prison, and that
he would be put to death. His sleep had been broken, his bowels
were constipated, his general health was fair. On admission he was
full of delusions of the kind already mentioned, and these varied from
time to time, so that at one time he said he was sure he should have
to consent to be made naked, and at other times he would wring his
hands and mumble that he had been a great sinner. He lost flesh
steadily, between July and the following year losing two stone, and
18 months after admission he is described as a wasted, worn
old man, who sat crouched, with his head bent forward almost to his
knees, his eyes constantly turned to the ground, his hands clasped
together, his whole aspect unoccupied, untidy, and wretched. Nothing
6eemed to arouse him. He had to be fed and dressed, and was per¬
fectly regardless of decency and order, passing his water and faeces
wherever he might be. He seemed to have no power to change his
position, but remained exactly where he was put from morning to
evening. Now he takes little or no notice of his friends, and, when he

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does, merely quietly assents to what they say and do. He is still
losing flesh, his extremities are cold, the small vessels on his face are
marked, his hair is white, the arcus senilis is visible; in fact, he is a
typical old man, but suffering from a misery that is steadily leading
him to his grave, and he will probably become no more weak-minded
than at present before being seized with some attack of bronchitis or
other disease, which will prove fatal. It may be here mentioned
that his son, who was a patient in Bethlem, has been discharged re¬
lieved, but not recovered, he suffering from a form of hypochondriacal
insanity which rendered him able to live at home, but seemed to have
prevented his getting another situation. He had an idea that he
had cancer about his throat, and nothing could persuade him to the
contrary.

The next case is that of—

Cask II.—Lewis P., admitted June, 1880, married, 63. He had
been a railway collector, and his son and one brother had been insane.
The son recovered, but we have no knowledge of what became of the
brother. The cause of his insanity was said to have been business
worry, and was reported to have lasted 14 days before admission. He
had doubtless been greatly grieved and much worried by the insanity
of his son and the attempts at suicide which the son had made. His
mental disease began by a feeling of depression, which became
worse. He then would lie in bed without speaking or giving any
sign of his wants. He looked about him in a strange, bewildered
manner, and was suspicious. He would hardly reply to any
questions, and resisted any investigation as to his condition. He
was taciturn and incoherent, thought at one time he was on the
roof of the opposite houses, and was inconsequent generally.
From the first his case appeared to be hopeless. His age,
his white hairs, and his profound melancholia, with the knowledge
that his son had suffered and a brother also, pointed to a strong
family tendency, which, coming on at his age, must necessarily have a
very unfavourable outlook. A few months after admission he became
more dull, refused to speak, and was dirty and careless in his habits.
He would sit the whole day long looking in a vacant way before him,
neither dressing nor feeding himself, and requiring to be dressed,
washed, and tended like a child. His general health seemed to be
maintained till January, 1881, when, though he took his food fairly
well, his feet became swollen, and we had the greatest difficulty in
keeping them raised so as to allow the swelling to subside. His case,
like the last one, is one of progressive melancholia, in which the
patient, being worn out in body, is nearly worn out in mind, and some
physical disease or trouble will make an end of both.

The third case is one of senile dementia and hemiplegia.

Cask III.—John 8., admitted February 1881, single, 65, an

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1883.]

artist. Nothing known as to his family history. This is the first
attack of his insanity, which has lasted three months. There is no
known cause for his attack. He has always been more or less self-
willed, solitary, and eccentric, so that he often stood in his own way,
so far as his profession was concerned, by sticking to his own opinion
and declining to alter his work to suit the tastes of his clients. Up
to 12 months ago he was thought to be fairly well, and at this time
some difficulty in his articulation was noticed, which getting worse,
caused him to be treated for paralysis. He became more dull and
unoccupied, was unable, in fact, to follow his calling, and too indolent
and weak-minded to feel any distress or chagrin at not being able to
earn his living. Before admission it was noted that he had become
incapable of understanding ordinary things. He was irrational in his
answers, would strip himself naked, and sit quite regardless of the fact
that women might be present. He was very incoherent and childish
in his talk, maudlin and given to tears at times. He forgot more par¬
ticularly the facts or events that had recently happened, and had a
confused and dazed aspect. He was sleepy, and unable to occupy
himself continuously at anything, whether amusement or business.
His memory for more distant times was good, and his association of
ideas was very fairly correct, so that if he were started on the right
line of thought he would occasionally, quite automatically, come to
the right conclusion. For instance, on asking him about certain
engravings, and mentioning the fact that a certain artist had illus¬
trated the book, he at once said, “ Yes, with so-and-so,” another artist
who was associated with the former one in the illustrations. He had
never been violent, and the things that were most noteworthy were
that he seemed to have lost the idea of shame, that he was
unable to take care of himself, that he was likely to get
into mischief simply from his bodily and mental weakness. On admis¬
sion he is spoken of as a well-conditioned old man, with a pleasant,
agreeable look, and a very emotional disposition, easily given to tears,
rather incoherent in his talk, but fairly cheerful. There was a fulness
of capillaries on his cheeks, grizzled grey hair on his head, and arcus
senilis in his eye. His walk was tottering and unsteady ; tendon
reflex (patellar) greatly exaggerated, and when this was tried it
seemed to irritate and annoy him. He sat by himself, not asso¬
ciating with any of the other patients, and not taking any interest in
the games or amusements of the ward. Though his appetite was fair
and his general condition fairly satisfactory, he would forget the
hours of meals, and would even be uncertain whether be had had a
meal within half an hour after taking it. He complained about a
good deal of pain in his head, but it seemed doubtful if there was
anything more than a dull, uneasy feeling in that part of his body.
No great changes were noticed within the first few weeks after his
admission, but early one morning in April he had a slight fit affect¬
ing the right side, which left him somewhat weaker on his feet and

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distinctly weaker in his mind. The prospect is that he will slowly
lose both mental and bodily power, that there may be a recurrence of
these fits, or, more probably, that he will become bedridden, and from
bed-sores or bronchitis sink, and that on post-mortem we shall find a
wasted brain, atheromatous arteries, and one or more local softenings.

The next case of senile insanity is probably one of general
paralysis of the insane.

Case IV.—Richard James W., admitted March, 1881, married, 64,
architect by profession. His son suffered from melancholia. This is
the first attack of insanity, and is said to have come on three months
before admission, and to have been caused by anxiety about business
matters. The first recorded symptoms are exaltation of manner,
considerable excitement, rapid conversation, wandering from one
subject to another, willingness to unfold the whole of his family
history to anyone who would listen ; garrulity generally. He had
delusions of grandeur and importance, spoke of having purchased three
separate properties in’ the neighbourhood worth several thousand
pounds each, and said that he was about to engage a butler and
other servants. He sat up all one night writing his autobiography,
and on one occasion he rose at 5 a.m. and went to clear up the kitchen
and wash some oilcloths, a thing quite foreign to his usual habits. He
thought he was going to be Lord Chancellor and Chancellor of the
Exchequer. When admitted he had similar ideas, talked constantly
about his wealth and his general good position, and the state of his
affairs. He was a short, spare, elderly man, with curvature of the
spine, and over the whole of his body, on admission, was prurigo
senilis , which caused him a certain amount of trouble and uneasiness,
but not as much as might have been expected from the amount and
extent of the eruption. In his expression he was happy and contented.
He said he was worth any amount of money, and, like most paralytics,
was willing to give to each and all as much as they liked, and to play
the part of any character whose name might be suggested, so that he
would be a Lord Chancellor at one moment, Chancellor of the
Exchequer at another, a commander of a regiment at a third, or
simply a Lord Mayor and great entertainer at a fourth. He took his
food well, slept well, and was contented with all his surroundings. He
had hallucinations of hearing, and, one would say also, of sight, for if
one asked him for money he would for a moment turn on one side
and say, “ Oh, yes, I have told my clerks to get it all ready for you,**
and when further pressed he would say his clerks had it all right
“ down there.” This condition of exaltation, without any paralysis or
congestive seizures, has now gone on for a good many months, in
my own opinion he is more likely to be for a time depressed, and then
weak-minded, than to run through any course at all like general
paralysis of the insane as seen in younger patients.

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Clinical Notes and Casts.

239

It must not be supposed that all cases over 60 are incurable,
for I have seen, as have doubtless nearly all asylum superin¬
tendents, cases of recovery after 60, 70, and even 80 years of
age. My feeling, however, is that if a patient breaks down
for the first time without nervous inheritance at or over 60,
the chances of his recovery are small indeed.

The next case is one in which complete and, so far, per¬
manent recovery occurred in a patient over 60 years of age.

Cask V.—Joseph W. was admitted in March, 1880, aged 60. He
was married ; his brother had been insane before him, and there was
no known cause for his insanity unless it was the leaving a situation
that he had occupied for 26 years. The first symptoms noticed were
physical and mental depression, which became worse, so that he
would sit wringing his hands continually, saying, “ I have done
wrong, I have done very wrong; I feel I have done very wrong. I
have neglected prayer, and I have neglected my happiness; I havo
injured wife and family.” He said that he had been a thief all
his life, and that his house ought to be searched. He had to be
prevented from giving himself up to the magistrates. He thought
that he had committed many unlawful acts, and was generally des¬
ponding. There was loss of memory, and rambling and incoherence
in his talk. He attempted to cut his throat, and tried to
swallow a solution of cyanide of potassium. On admission he
had delusions that he was being followed, and that there were six
policemen ready to take him, that his ruin was impending, and that
he was eternally lost. He was a well-built man, rather above the
average height, had grey hair, and a serious, melancholic expression.
He was restless and feeble, and spoke slowly. He was suicidal, and
could not be trusted. For nearly the whole of the time that he was in
Bethlem he suffered from ideas that his body and soul were both
wrong, and he was very persistent in his belief that his bowels were
obstructed, and, if left to himself, would have taken purges daily. He
was tried with morphia, but with little apparent good. Glycerine
was given him in two-drachm doses before his food, and afterwards
large doses of bromide of potassium, but I am afraid that I cannot
attribute his improvement in any way to the drugs that he took.
By careful feeding and insisting on his taking regular exercise he
improved in general health, and was able to be treated at home,
and during the latter part of the time that he was on the books of
the hospital he became stronger in mind, lost his delusions, was less
emotional, and was discharged well enough to perform his ordinary
work.

Senile Melancholia .

Case VI.—Robert H. R., admitted July, 1880, single, 68. His
father was insane; two sisters were insane, and another was weak-

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minded. This is his first attack of insanity, and lasted six weeks
before his admission. It was said to be due to heavy losses through
speculating. The patient was said to be suicidal, and dangerous. He
refused his food, and had to be forced to go to bed. He thought that
he was ruined, and that he owed money where he did not ; that he
had no clothes on when he was properly dressed. He wandered about
at night, and thought people were waiting to kill himself and his
sister. He was in a state of melancholic depression and despair.
He repeated the same story, that had been contradicted and refuted,
over and over again. He thought that he was stuffed with food when
he had taken hardly any. On admission he thought there was a
design and plot to murder him and his sister. He was under the
impression that he owed a lot of money and could not pay it, and in
consequence he refused all food. The patient was a tall, thin man,
with the capillaries in his cheeks well marked. He was suffering
from melancholia; thought that he was choked up with food, and
that his bowels never acted. In this condition he remained, and, in
my opinion, will remain, as long as he lives. As long as he is fed,
tended, dressed, and looked after he lives on in a quiet, fairly orderly
way, because he finds himself too weak to resist, but beyond that there
will be no change, and, I believe, no improvement.

Cask VII.—Samuel P., admitted February, 1881, widower, 64.
No insane relations, but his mother died of paralysis. This was the
first attack of iusanity, and had lasted three weeks. It was said to
have been produced by money losses, which occurred during the last
two or three years, the last occurring about two months ago, after
which the mental symptoms became more marked. The earliest
symptoms were taciturnity, melancholia, sleeplessness, and slowness
of speech. These gradually and steadily became worse; he became
unconscious of his own identity and place of abode. There was
incoherency about his ideas, and complete inability to recollect the
simplest facts of recent occurrence. At times he would walk the
room at night, and in the morning say that he had been in bed all
the time. He was taken up by the police as wandering with¬
out being able to give a reason why. He was restless, and generally
weak. He refused food, and was very obstinate in some things. He
wandered or tried to get away from home, thinking that was not
where he lived. He heard voices, and people sawing the floor in
the house next to his own, and thought people were coming into his
room to him. On admission he was reported as a man of short
stature, thin, and worn-looking, hair and beard white ; seemed lost.
Was up, though feeble and weak. He was constantly and restlessly
moving about, and answered questions slowly and deliberately. His
speech was jerky, and his tongue and lips were tremulous during
speech ; his tongue, on protrusion, too, was very tremulous. The
pupils were contracted, but equal. The gait was fairly steady ; there
was no ataxy. He said that he was quite well, and he thought he

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1883.]

had been followed about before he came in. There was marked loss
of memory, and although he had been in the hospital only two days,
he said that he had been here for seven weeks. He walked with the
left side of his body lower than the right. There was undoubtedly
paralysis of this side. He was emotional, and memory was deficient.
So far there has been little or no gaiu, and in his case, as in the
other cases of melancholia, one would look for steady, degenerative
progress.

Case of General Paralysis in a Young Woman, Commencing at
the Age of Fifteen. By Joseph Wiglesworth, M.D.
Lond. Assistant Medical Officer, Rainhill Asylum.

I am indebted to Dr. Rogers for permission to publish the
notes of the following case:—

Elizabeth D., aet. 21, single. Admitted into Rainhill Asylum
November 18th, 1881.

Histol'y .—Father living ; mother died, ast. 43, of bronchitis ; mother
had six children born alive, and one miscarriage; four of these died
young, two living (including patient) ; a brother was consumptive.
No insanity or epilepsy in family. Father admits to having drunk a
good deal in his younger days ; he has been married a second time
about nine years, and patient has been neglected a good ‘deal by her
step-mother, and does not appear always to have had a sufficient
amount of food ; she is said not to have menstruated, or but very
slightly so. When about two years old she fell down stairs, and ever
since then has had a running from her ear. Father never noticed any
obtuseness in patient when a child, but his neighbours told him that
they observed she was always rather dull. She was, however, sent to
school, and learned to read and write ; was fond of singing hymns
and going to church. She always lived at home, and assisted in the
household duties. When patient was fifteen years of age, father
noticed that her memory was failing, and she was also observed to be
weak on her legs—often fell down in the street. She got gradually
childish, and was very slow at doing anything—at dressing herself,
for instance, would often let things fall, and break them ; was always
very quiet, speaking very little ; though gradually getting more and
more dull she did little odd jobs in her father’s house up to three or
four months ago. Three weeks before admission was found one morn¬
ing speechless, though she was able to mumble something unintelli¬
gible, and was unable to raise her left arm up ; the next day she
vomited her food, and this vomiting was repeated during several days
(she had never vomited before) ; in two or three days she recovered
her speech, and also power over her left arm, but was decidedly more
dull mentally, paying no attention to what was said to her, in which
state she continued till she was sent to the workhouse (a few days be¬
fore admission). Was never known to have any convulsions. She

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[July,

had been dirty in her habits occasionally as long ago as two years, but
latterly had got worse in this respect.

State on Admission .—A small, badly-developed girl, poorly
nourished, weight 104 lbs., expression decidedly fatuous, light-brown
hair, brown irides, pupils dilated, right decidedly the most so, scarcely
any appreciable action either to light or to accommodation, right
conjunctiva a little injected, left decidedly so, with a little puriform
secretion at angles of lids. Optic discs normal. Right eye =—15 D.
Left = — 18 D. No staphylomata. Tongue generally protruded
straight, but sometimes with a slight deflection to right, rolled about
at times, markedly tremulous, both as a whole and fibrillar. Distinct
tremor of lips whilst speaking, chiefly of upper lip. Speech very
hesitating and stuttering. Can give a firmer squeeze with left hand
than right. Sways a little from side to side whilst walking, and feet
are sometimes placed far apart, and brought down clumsily, but there
is no distinct ataxy; is very shaky when feet are placed together
even with eyes open—worse when these are shut. Knee jerk com¬
pletely absent on each side. Plantar reflex active. Lungs .—Respira¬
tory sounds generally feeble, but otherwise normal. Heart *—Normal.
Tongue moist and clean. Urine .—Clear, acid ; sp. gr. 1015; no
albumen, no sugar.

Her mental condition was pretty uniform for the first five weeks
after admission. She sat still most of the day with her head bent
a little forward, not attempting to move spontaneously, and did not
speak unless addressed ; she, however, answered simple questions
rationally, gave her name and former residence correctly, but said her
age was 16; stated also accurately one or two particulars in her
family history, repeated the days of the week correctly, and the
months of the year almost so. Memory was, however, much im¬
paired—said the day after her admission that she had been in the
asylum two weeks.

She slept well, and had a good appetite. On December 27th she
was noticed to be duller than usual, and there appearing to be general
loss of power she was put to bed. T. 99*8°, P. 106.—28th, T. 98°,
P. 80. Plantar reflex active. Knee jerk absent. Very dull mentally.
Cannot be got to *zive her name, or even to protrude her tongue.
—29th, Temporary conjugate deviation of eyes to right. Pays no
attention to questions. Urine and faeces passed in bed.—Jan. 1st,
’82, Lying with mouth half-open, tongue rolled about on floor of
mouth, eyeballs moved restlessly about, both pupils dilated, right the
most so; T. 100°, P. 112, small and weak. R. 40, somewhat shallow
and irregular. Tremor of hands when moved. Has not spoken at
all, and takes not the slightest notice of anything said to her ; has
several times made a peculiar noise compared by the nurse to the bark
of a dog; twice this evening had seizures which, according to the
report of the nurse, were of a tetanic nature, her head and neck get¬
ting very stiff, her neck being somewhat arched backwards, and her

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1883.]

arms and hands also becoming very rigid; each attack lasted from
four to five minutes.—2nd, Rolling her head at intervals from side
to side. T. 100*6, P. 120.—7th, In much the same condition, lying
quiet and taking no notice of questions. No convulsions of any kind.
A slough has formed at upper part of right buttock, close to fold.
—16th, Decidedly brighter, and can now answer simple questions
rationally.—25th, Bedsore above noted has increased in size, and a
small one has formed over crest of right ilium.—Feb. 3rd, Has
deteriorated again mentally, rarely speaks, and cannot be got to reply
to questions ; expression very fatuous, is restless, fidgeting with the
bedclothes, pulling out her hair, &c. Arms tremble very much on .
movement. The sores above mentioned have increased in size, and
others have formed.—11th, Has got much more feeble last few days.
Takes no notice of anything going on around her.—16th, Tempera¬
ture has been febrile last eight days, ranging from 100° to 101*2°.
The bedsores have much increased in size, and abrasions have appeared
about feet, ankles, and other parts of lower extremities. Is rapidly
sinking.—18th, 10.5 a.m., died.

Auto-psy. —1.30 p.m. (3^ hours after death).

Cranium. —Calvaria normal ; dura mater moderately adherent, a
little black and partially decolourised clot in posterior two-thirds of
longitudinal sinus, soft black clot in lateral sinuses ; here and there
attached to inner surface of dura-mater, a delicate reddish film,
easily detached, and not forming a coherent lamina; 5^- oz. of fluid
were collected from subdural space ; arachnoid everywhere very
opaque, it and pia mater considerably thickened, hemispheres firmly
adherent both in anterior part of median fissure, and in front of genu
of corpus callosum for about an inch; firm membrane also span¬
ning Sylvian fissure ; all these parts could, however, be separated
without tearing the brain; pia mater strips fairly well, and, though
obviously abnormally adherent in some parts, without much decortica¬
tion ; this, however, distinctly occurs (in right hemisphere) about
centre of middle temporo-sphenoidal gyrus, anterior part of angular
gyrus, posterior part of supra-marginal gyrus, and in one or two
places along gyrus fornicatus; in left hemisphere (which was not
stripped till following day, though kept moist—having been reserved
for microscopical examination) much more extensive decortication
occurred, viz., at posterior part of first frontal gyrus, lower ends of
anterior and posterior central gyri, anterior part of supra-marginal
gyrus, angular gyrus, and scattered patches over posterior two-thirds
of middle and inferior temporo-sphenoidal gyri. Large excess of
subarachnoid fluid. Gyri everywhere greatly wasted. Cortex every¬
where dark and much atrophied, especially in frontal region; striae
very indistinct. Grey matter of corpora striata dark, but basal
ganglia appear otherwise normal. Ventricles widely dilated—4 oz.*
fluid collected from them ; ependyma of fourth ventricle markedly
granular. Brain generally of firm consistence, that of upper part of
xxix. 17

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Clinical Notes and Cases.

[July,

medulla increased. Pons, wasted. Cerebellum, pretty firm. Weight
of brain (immediately after removal), 915 grammes.

Right Hemisphere
Left „
Cerebellum
Pons

Medulla Oblongata

332 grms. (stripped, 305 grms.)

333

123 „

11*5 „

6*5 „

805 10

Microscopical Examination .—Sections were obtained in the fresh
condition from the following gyri:—Sup. Front. Rectus, Angular,
Ant. Cent., and from the Cuneus ; they all showed distinct, though
moderate, increase of the neuroglia, with atrophy of nerve cells.

Spinal Cord .—Considerable excess of subdural fluid. Arachnoid
generally moderately thickened and opaque. Weight of cord, 26
grammes. Cervical region somewhat flattened antero-posteriorly.
Consistence about normal. Minute spots of reddish softening
situated here and there in grey matter of dorsal aud upper lumbar
regions, occupying posterior part of anterior horn, on right side in
dorsal, and left side in lumbar region.

Microscopical Examination .—Sections obtained from dorsal and
lumbar regions after hardening in Bichromate of ammonia, showed
the nerve cells of the anterior horns to be perfectly normal. There
was, perhaps, some increase of the neuroglia element.

The Thoracic and Abdominal Viscera presented nothing especially
noteworthy.

Remarks .—The interest of this case of course centres in the
unusually early age at which the disease commenced; this,
though stated at 15 years, was probably even earlier, since the
first symptoms noted, viz., loss of memory, and motor weak¬
ness, pointed to the probability of the disease having already
been in progress for some time. I am not aware of any case
having been published in which the affection began so soon
in life in one of the female sex; but in the “ Journal of
Mental Science” for October, 1877, a case will be found
recorded by Dr. Clouston occurring in a boy aet. 16, and in
the same Journal for October, 1881, Dr. Turnbull reports a
case, commencing at the still earlier age of 12—also in a boy.
It seems worthy of note with respect to these three cases
occurring in early life (1) That in none of them was there
any grandiose Mania, nor indeed any stage of excitement what¬
ever, but the mental characteristics were those of slow progres¬
sive Dementia. (2) The motor symptoms so typical of General
Paralysis were very well marked. (3) In two of the' cases at
least the course of the disease was unusually prolonged.

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Clinical Notes and Cases.

245

Two Cases of Rapid Death with Maniacal Symptoms . By

Geo. H. Savage, M.D.

The two cases can only be linked on account of the rapidly
fatal issue associated with actively violent mania. The first
was a case of acute general paralysis, and the second of
mania due to injury to the head.

Samuel B., aged 45, married. No insane inheritance; of tem¬
perate habits ; supposed cause, overwork.

The first symptoms were excitement and extravagance which ap¬
peared suddenly on Feb. 11th. He was admitted 11 days later.

On admission he was talkative, boastful, emotional, destructive,
and violent. He was extravagant in the wildest way. Pupils irre¬
gular. Tongue tremulous. Handwriting shaky. Reflexes normal.

He had had syphilis in youth, but there were no signs of con¬
stitutional disease.

The violence continued day and night, and he was dry packed on
several occasions. Nothing quieted him, and he appeared to get
weaker, but no serious symptoms appeared till April 4, when he
suddenly became quiet, and was dead in half-an-hour.

]f ost-moHem .—Dura-mater adherent to calvarium. No excess of
fluid ; the membranes peeled freely, save in one spot on left parietal
lobe, and over left first frontal the cortex was left rough.

Both lungs were intensely congested.

There was early atheroma in origin of the aorta.

So in this case we had death from exhaustion in the
earliest stage of general paralysis. The microscopic ex¬
amination has not yet been made.

S. S., aged 27, single. Admitted April 7, 1883. Some insanity
in the family. Teetotal and industrious.

Three months befpre admission he had a severe injury to his head
from a fall from his horse. He was stunned but soon recovered, but
from this time was not the same as before. His friends said he
became careless and indifferent, not taking the same interest in his
work, being lazy and sleepy.

He suddenly became excited and violent, attacking his attendants,
and talked incessantly and incoherently.

He ran out of the house in a semi-nude state.

Soon after admission he passed an ascaris, and was better for a day.
Tongue was dry and furred, and he refused food. Some scattered
papules occurred over his body.

Temp. 96*8. Stimulants and fluid food were given constantly, but
he continued excited and died on April 17,1883.

Post-mortem .—No signs of the injury were visible. There was

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246 Clinical Notes and Cases . [July,

excess of fluid, and the anterior lobes were mutually adherent along
the first third of the longitudiual fissure.

There were gangrenous patches on several toes.

Other organs healthy.

So in this case the patient died of acute mania following
an injury, and I believe due to it; and the only post-mortem
sign was cohesion of the frontal lobes. If the case was due
to a variety of cerebritis, it is of great interest, and must be
added as one more case in which we see the mortal nature
of a comparatively slight but sudden change in the brain in
a healthy man.

Symmetrical Tumours at Base of Brain. By Dr. Strahan,
Assistant Medical Officer, Northampton Asylum, Berry-
wood. (With Illustration.)*

T. P., an unmarried man, 28 years of age, was admitted a patient of
this asylum in October, 1880, suffering from a first attack of insanity.

On admission he was said to be suicidal, dangerous, and frequently
violent. The history received was : “ He had served as a soldier
several years in India: was of intemperate habits: had attempted ,
suicide by strangulation : had refused food and had been frequently
dirty. He had been noticed 4 strange ’ for about a month past.”

The medical certificate on which he was admitted was as follows
“ He is incoherent—much excited in his appearance and behaviour—
has a delusion that someone put a knife in his way that he might
injure himself; also that Jesus Christ was sent on earth to destroy
him.”

After the medical examination on admission the following note
was made:—

“ The attack appears to have come on slowly, and delusions been
gradually developed. He has a vacant expression, and his manner
is lost and confused.* Continually asking questions, but does not in
the least understand what is said to him in reply. There is almost
incessant incoherent muttering, and he seems to be talking to imagi¬
nary beings and looking for someone about the room.”

The paralysis must have been very slight, if at all perceptible at
this time, as there is no mention of such symptoms.

On the day following admission this note is made:—

“ He runs against tables, &c., and evidently cannot see much.”

The history of his case as recorded, gives little to note, except that
he gradually became completely blind, and that a year after his eyes
were examined by a specialist, who made the following note in the
Case Book :—“ Has atrophy of both optic nerves.”

* General asymmetry of brain is merely due to pressure, &c., post mortem.

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1883.]

Shortly after this time he came under my notice, when I found him
totally blind, very restless, frequently noisy, having many delusions,
and walking with a slightly rolling gait, the legs being separated to
some extent. At this time, and, in fact, up till three days before his
death, he could find his way about the ward so carefully that he
seldom or never stumbled, and always found his way back to his own
particular seat. He fed himself at meals, and attended to the calls of
nature. The only paralyses were blindness, deafness, the rolling gait,
and a slight want of co-ordination in the movements of the hands.
He had always been deaf, requiring to be spoken loudly to, but his
hearing gradually got worse, and he became totally deaf some month s
before his death.

On 27th August, 1882, having been in his usual condition up till
that time, he was found by the night attendant in an unconscioufe
state, with froth about the mouth, as though he had had a fit. The
pupils were equally dilated, breathing stertorous, face congested ; he
was unable to swallow. He remained in this state until the evening
of the 29th, about sixty hours after the appearance of coma, when
the coma deepened and he died.

The patient’s mother was averse to any examination of the body,
saying, “ she knew exactly what was the matter, as two others of her
children had died in almost the same way, and that the doctor had
told her it was * pressure on the brain.’ ” This statement led to
inquiry into the family history, when the following was elicited :—

“ She had had eight children by deceased’s father (her first husband)
of which T. P., our patient, was the last surviving, and eldest.
The first child, a female, died, aged 4^ months, of consumption. The
second, a male, died, aged seven months, of measles. The third and
fourth were still-born. The fifth, a female, lived to the age of 20
years. She was deaf, had been treated for St. Vitus’s dance at Guy’s
Hospital. She afterwards became insane, and died in ait asylum
after nine months’ residence ; certified cause of death, ‘Chronic
disease of the brain.’ The sixth, a male, had the left eye removed for
some affection when 18 years old, after which operation he became deaf.
He lived until 29 years of age, when he lost the sight of the other eye,
and died some six weeks later, ‘ after a severe fit.’ The seventh, a
male, lived to the age of 30 without any marked sign of disease, when
he ‘ dropped down dead.’ An inquest was held, and the jury brought
in the strange verdict (according to the mother) of death ‘ from
diseased heart and visitation of God.’ The eighth child was our patient,
T. P., who had been somewhat deaf since he was 10 years old, but not
sufficiently dull of hearing to prevent his reception into the army.”

On cross-examination, this woman stated that after the birth of
her first child her hair came out, that “she had a sore throat and lost
her voice some two years later ; ” while she became permanently deaf
of the left ear at some time subsequently, the date of which occur¬
rence she could not fix.

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Clinical Notes and Cases .

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Tho father of her children, she said, died aged 45, of “ asthma and
fistnla,” the doctors telling her that they would not cut the fistula as
he would die in any case. She further stated that he, her husband,
was “ quite insane for two days before his death.”

This woman has been married again, and has another large family.
Some of these children are over 20 years of age, and they are, she
says, “ all quite healthy, and have never had any fits nor any sickness
.of any kind to speak of.”

It will, I think, be generally admitted that this history points
directly to syphilis in the father. The first child died at 4^ months,
of consumption. This was in all probability the marasmus so often
seen in syphilitic children. The third and fourth being still-born
points strongly in the same direction, while the mother’s illness, as
given above, can hardly be referred to anything else.

No post-mortem examination was allowed, but the patient’s symp¬
toms and his family history being so interesting, I became possessed
of the brain on the 31st August, and soon after handed it to Dr.
G. H. Savage, who has made the following note :—

On each side of the medulla oblongata, lying against the under
surface of the cerebellum, is an irregularly rounded and nodulated
growth, firm and hard to the touch, about the size of a large walnut.
That on the left side is rather the larger.

Each tumour has caused depression of the under surface of the
cerebellum above it, of the posterior border of the pons varolii in
front of it, and of the medulla at its inner side. The growths have
no attachment to the cerebellum or pons or medulla, and are loosely
connected with the membranes about them—lying outside the visceral
layer of the arachnoid. Histologically, these growths are of. fibro-
cellular character .—(See Lithograph.)

OCCASIONAL NOTES OF THE QUARTER.

The Beer Dietary in Asylums .

There can be no doubt that there is a growing feeling on
the part of the Medical Superintendents of our large asylums
to take into consideration the question whether on the whole
the discontinuance of beer as a beverage is not a moral as
well as a financial advantage, and it is worth recording in
this Journal that at the present time, to our knowledge, there
are seven and twenty pauper asylums in England in which
the Committees, with the approval of the Superintendents,
have discontinued the use of beer as an article of ordinary
diet. The question, we need hardly say, is a practical one,
and has nothing whatever to do with “ teetotalism $ ” the

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Occasional Notes of the.Quarter.

249

course pursued should be determined by what is found to be
best for all concerned, and if beer at meals is useless—if it
can be shown that the health of the asylum population does
not suffer from its removal—and if, as alleged, there is a
moral gain not only among patients but attendants, then we
must acknowledge that common-sense and humanity would
alike sanction its discontinuance. For the Medical Superin¬
tendent, the health of the patients and the good order of the
household are the primary considerations ; we must not
allow the idea of saving money to interfere for a moment
with these objects. If, however, on these grounds we can
recommend this dietetic change, the saving to the ratepayers
is not a small matter. They are always entitled to con¬
sideration, but more especially are they so at the present
day. The Cumberland and Westmorland Asylum was, we
believe, the first to make the experiment, at its opening,
under the superintendency of Dr. Clouston, and the present
Superintendent, Dr. J. A. Campbell,* regards it with great
favour as an unquestionable success. When visiting the
Lenzie Asylum, last autumn, we enquired of Dr. Rutherford
what plan he adopted, and were informed that he did not
give his patients stimulants, although so many are employed
in out-of-door work. In December last, the Yisiting
Justices of the Devon County Asylum decided that at the
commencement of 1883 the daily supply of beer should be
entirely discontinued, and that in future neither it nor
spirits should be allowed unless ordered by the medical staff.
On going round the Derby County Asylum in October of
last year, we found the energetic Superintendent of that
institution had gradually diminished the use of beer, and
contemplated its entire discontinuance. This course has
now been adopted, and Dr. Lindsay is sanguine as to its
satisfactory working. We transcribe the remarks made by
him in his last Report:—“ In a few years it will probably be
found that in the majority of English pauper asylums, beer
will not be given as an article of ordinary diet; the minority
at present giving no beer will soon, I believe, be converted
into a majority. I am of opinion—an opinion, I believe,
shared by many Asylum Medical Superintendents—that the
small allowance (half-a-pint) of asylum beer of the quality

* Dr. Campbell writes :—“ I use really good liquor for those who need it,
and give it when I think it useful. I have always thought it foolish to give
dements, criminals and imbeciles, beer as an article of diet. If you do give it
call it by its proper name, a luxury.” (May 23, 1883.)

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250 Occasional Notes of the Quarter. [July,

(about 6d. per gallon) given to patients, contains so little
nutritive or stimulant property as not to be entitled to
serious consideration from a strictly medical point of view.
It cannot now-a-days be maintained that beer is necessary
for the purposes of health, nor can it be shown that beer
has formed part of the daily diet of most of the Derbyshire
patients prior to admission to the asylum, for, as far as my
enquiries have gone, it would appear that the large majority
of patients, especially females, had not been accustomed
to the daily use of beer prior to admission. The most,
therefore, that can be said in its favour is that it may be an
agreeable and so far wholesome beverage (certainly better
than bad or tainted drinking water), but a luxury that may
be done without. To my mind the chief objections against
its use are of a domestic and disciplinary nature connected
with the working of the establishment. It is frequently
wasted altogether, given away to or taken by other patients
of gluttonous and intemperate habits, who thus get more
than their allowance, and it is often the source of loss of
time and of diverse troubles from misuse and quarrelling.
In short, the supposed advantages from its use are not pro¬
portionate to its cost, and are more than counterbalanced
by the disadvantages attending its use and misuse. I am
not disposed to attach undue importance to the question of
the use of beer from a temperance point of view, although
I believe every Asylum Medical Officer of experience must
admit that even from this standpoint something can be said
against its use; for it is a practical and important point to
bear in mind that its abuse must also be considered, the
excessive use of even light beer being attended with dis¬
advantages, whilst its daily though moderate use no doubt
tends to keep up and encourage the drink-craving in those
of intemperate habits—the rock on which many have been
wrecked prior to their reception into the asylum, intemper¬
ance having been in a considerable proportion of cases a
partial factor, at least, in the causation of their insanity. The
financial or economic aspect of the question, although of
secondary importance to the health, welfare, and interests
of the patients, is also worthy of consideration. In carrying
out the new arrangement of the entire disuse of beer, I
was prepared to encounter some difficulties, but in reality I
have met with none, and it appears to work very smoothly
and satisfactorily; in fact, better than I had anticipated at so
early a stage, for I never had any doubt of its ultimate

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1883.] Occasional Notes of the Quarter .

success. In accordance with a growing conviction enter¬
tained by the Medical Officers, the use of stimulants in the
treatment of disease and of the sick in this asylum has been
greatly diminished for the last year or two, more reliance
being now placed on milk, arrowroot, beef-tea, and other
nutritious articles of food. The amount of stimulants has
now, I think, been reduced to a minimum.* On 31st
December there were no stimulants (beer, wine, or spirits)
on the sick diet lists for female patients, and for male
patients the quantity on sick diet lists was very moderate,
viz., four ounces port, four ounces brandy, and two ounces
gin. On the same day, at the morning visit of the
Medical Officer, there were no female patients confined to
bed, and in the male division six patients were in bed,
which shows the favourable state of the general health of
the inmates at that time.”

At the Wakefield Asylum the experiment began by beer
being given to men only. Recently, however, we find that a
clean sweep of the beer has been made throughout the estab¬
lishment. In his last Report Dr. Major says that water has
been substituted. It is too soon to express a definite opinion
on the experiment, but Dr. Major observes that <g so far I
have reason to feel satisfied with the change, which on my
recommendation you authorised, and its introduction has
been unattended with any practical difficulty whatever.”
Beer has not been included in the dietary of the new asylum
for the Borough of Birmingham, near Bromsgrave; and the
Committee of the Oxfordshire Asylum has the question under
consideration. Dr. Pringle, in his Report of the Glamorgan
County Asylum for 1881, stated that beer was never given as
a regular allowance to patients, but as a reward for work
to those who so earned it. Milk was substituted, and among
the attendants the females accepted a money equivalent, and
the males a uniform. Dr. Pringle observed, C€ several of the
more intelligent patients acknowledge the change with
gratitude, and seemed pleased that what had in many cases
proved their ruin should no longer tempt them here, and
keep up the craving which, on regaining their liberty, they
would be apt to indulge. In raising the tone and discipline
of the servants, generally, I believe much good will result.”
A year later Dr. Pringle wrote in his Report, (i The conduct
of the attendants and servants has been on the whole ex¬
cellent, and another year’s experience of the abolition of
beer as an article of diet for their daily use has strongly

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confirmed the view I formerly expressed as to the improved
tone and discipline likely to result. Nor have the patients
been in any way injuriously affected by the change made in
their dietary by the substitution of milk for beer to the
workers.” That the change must have been very great to
some on admission, is indicated by the fact that several ac¬
knowledged that they had been in the habit of drinking daily
fifteen or sixteen pints of beer, which was confirmed by their
friends. It is due to Dr. Pringle to add that he regards
alcohol as most useful as a medicine, and that he gives it to
the sick or the feeble as liberally as in an ordinary hospital.
A reference to the Reports of the Kent Asylum, Banning
Heath, shows that in 1878, Dr. Pritchard Davies allowed
less beer in the dietary, with the result that in his opinion
“ the patients certainly benefit by the alteration.” In the
Report for 1879, it is stated that the experiment has been
found to work so well of only issuing beer to workers, that
on Dr. Davies’s recommendation, beer had ceased to be an
article of ordinary diet from December 1st, 1879, being only
issued from the surgery as a €t medical extra.” Money
was allowed to the attendants and servants in lieu there¬
of. No extra diet was given to the patients. The
change had fully realized the Superintendent’s expecta¬
tions. In the next year’s Report Dr. Davies says, “ I
do not think any unprejudiced observer could question
the good results which have followed the total abolition
of beer as an article of ordinary diet. The wards are
much quieter than they have ever been before, the patients
are cheerful without being noisy, and they certainly work
better. Their general health has been good, and there
is a marked diminution in our death rate, to which,
however, I do not attribute much importance, as it
may be explained in other ways. However, for the im¬
proved condition of the patients generally—the diminu¬
tion of violence, destructiveness, and noise, I think the
abolition of the issue of beer is mainly to be credited.”
Dr. Davies says. “ although the abolition of beer as
an article of ordinary diet has been the means of
saving a large sum of money, I wish to state that it
was not with this object that I advised the step you
have sanctioned. From careful observation of the
effects of alcoholic stimulants upon the patients under my
care, as well as from a knowledge of the cause of a large
number of them being here, I became convinced that it was

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Occasional Notes of the Quarter.

253

not advisable to continue to supply exciting beverages to
them, which I felt sure had a tendency to prolong their
malady, and by keeping up a taste for intoxicants in those
inclined to over indulgence in them, directly conduce to a
speedy relapse after they were discharged.” In the Report
for 1882, Dr. Davies says that not a single patient has ob¬
jected to work in consequence of the change, and that the
general health has not suffered. Milk is not substituted.
Writing May 16,1883, Dr. Davies says, “ I cannot express my
satisfaction at the result of the change in language too
strong.”

Dr. Oassidy, in his Report of the Lancaster Asylum for
1881, states that he has abolished the use of beer as an
article of diet, and adds that he never took any step which
he afterwards saw less reason to regret. At the Monmouth
Asylum Dr. McCullough has discontinued beer entirely as
an article of diet. The dietary of the working patients has
been improved, and the attendants and servants receive a
money allowance. He reports favourably as to the effect of
the change. We observe that Dr. Wade, the lately
appointed Superintendent at the Somerset Asylum, says in
his annual Report, “ The experiment initiated by my pre¬
decessor of abolishing beer as an article of ordinary diet has
continued and worked well. I should not recommend any
return to the alcoholic beverage, nor should I propose any
more nutritious substitute for the beer than that already
given, as I consider the nutritive qualities of the ordinary
asylum beer to be almost nil , while your ordinary dietary is
at present most liberal, and amply sufficient for all ordinary
requirements of the patients.”

We shall watch with interest the movement which has
thus made so considerable a progress, and whatever may be
the final verdict, we consider that those who are making the
experiment ought to be encouraged to give it a fair trial.
If on the other hand there are any who have tried the ex¬
periment and found it in any way injurious, we should be
glad to be in possession of their views.

The Monasterio Case .

Although it is certainly no part of our duty to discuss
the charges brought against lunacy doctors abroad, while,
indeed, we think that as a general rule it is in much better
taste to mind our own business, there is the legitimate

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Occasional Notes of the Quarter.

[July,

motive which the discussion of such charges permits, of
endeavouring to learn the lesson taught by the failure, if
such it be, of laws enacted for the custody of the insane, and
thereby seeking to ascertain whether there is any corres¬
ponding defect or source of danger in the legislative enact¬
ments of our own country. It also behoves the critic of
foreign institutions, or of the scandals alleged to occur in
other countries, to remember that he may easily fall into the
error of forming an erroneous opinion or a harsh judgment
from an insufficient acquaintance with all the circumstances
of the case.

John Bull is disposed to be not a little Quixotic, and to
engage in attacks upon the doings and misfortunes of his
neighbours when he would be much better employed in
setting his own house in order. But a Journal like ours
can hardly pass over in silence an event which has caused so
much excitement at home and abroad, and been discussed in
all the newspapers.

The facts of the Monasterio affair are as follows :—

Much cannot, it seems, be said that is favourable to the
general character of the Monasterio family and its belong¬
ings. There is also, we believe, a large leaven of madness
among its members.

The allegation made is that a lady, Madame de Monas¬
terio, the widow of a Chilian merchant, and her natural son,
Carlos Lafit, wrongfully placed the daughter Fidelia in Dr.
Gonjon's Maison de Sante in Paris—the object being to
prevent her marriage and participate in her property.
Seven years ago she was a patient in the asylum at
Charenton, having become insane, so it is said, through
harsh treatment. She recovered, was again placed in the
same institution, and again recovered. On returning home,
she was so unkindly treated, it is asserted, that she escaped
to the house of Madame Chalenton, a former maid in the
family. It was sought to place her once again in confine¬
ment, and a doctor was induced to sign a certificate of her
insanity, which was endorsed by another physician, upon
which she was conveyed to the above-named private asylum.
In consequence of the representations of Madame Chalenton,
the case was taken in hand by the police, and Fidelia was
removed by Carlos Lafit within ten days, and was brought
to England. Madame de Monasterio and those who con¬
spired with her to deprive Fidelia of her liberty were
summoned before the Correctional Court; but on the ground

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Occasional Notes of the Quarter.

255

1883.]

that it had no . jurisdiction, they were discharged, and the
Court of Assize was stated to be the proper quarter in which
the case should be tried.

It should be added that when Dr. Ollivier, the physician
of the Prefecture of Police, visited Dr. Gonjon’s asylum
within three days of Fidelia’s admission, as the law directs,
he examined her, and did not see any reason for ordering
her discharge.

It appears clear that whether the action taken by the
several members of the family in reference to Fidelia was
actually criminal or not, it was unscrupulous. On the other
hand, it would appear to be indisputable that Fidelia had
had several attacks of insanity, and that she was weak-
minded when last placed in an asylum—-so weak-minded, in
fact, that her best friends, if she had any, might justly have
preferred her being in a well-conducted asylum to living in
the wretched menage of Madame de Monas ter io. It cannot,
however, be denied that there is too much evidence of un¬
worthy motives on the part of the mother and the son, in
depriving Fidelia of her liberty and, practically, of her
property. We are justified also in crediting the statement
that the medical man who signed the certificate was not a man
of any position in the profession—to speak mildly. He, unfor-i
tunately, bore the honoured name of Pinel, but we are glad
to record that he did not belong to his family. He appears
to have made a very superficial examination of Fidelia, and to
have hastily decided upon her mental condition. At the same
time the certificate itself was in accordance with the Statute,
and neither better nor worse than many others which are
never called in question. One certificate meets the require¬
ments of the French law, and the endorsement of the other
doctor was even more than the Act required. Again, the
proprietor of the asylum, M. Gonjon, had no alternative but
to receive Fidelia, the order and certificate being perfectly
en regie ; nor was he likely to have any suspicion as to her
family’s motive iu placing the patient under his care when
he knew she had already been confined several times at
Oharenton. He has been blamed for sending his attendants
for her. If, as stated in the papers, they were men, his
mode of proceeding was certainly contrary to our notions of
propriety; indeed, the event has shown that he acted un¬
wisely, though certainly not illegally. Formerly in France
it was usual for the police to agree to send, in difficult cases,
one or two of their number, who, we have reason to believe,

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Occasional Notes of the Quarter .

[July,

rendered the necessary assistance in a considerate and not
merely official manner. Recently, however, in consequence
of the attacks made by the newspapers upon the seques¬
tration of the insane, they have been forbidden to interfere
in all cases in which private asylums are concerned; but
nothing, as we have said, renders it illegal for the superin¬
tendent to send his attendants for a patient.

We confess we do not understand whv Dr. Gonjon is to be
blamed for having discharged Fidelia when he did, that is to
say when Madame de Monasterio, who ordered her admission,
demanded her discharge. At any rate, it is in accordance
with Art. 14 of the lunacy law of 1838, which confers this
right, whether the patient is cured or not, upon parents or
those who have signed the order. No other course, there¬
fore, was open to M. Gonjon; in fact, he would have laid
himself open to severe animadversion had he refused.

We know only too well how ready the Press in England is
to seize upon an asyluqa scandal, whether real or imaginary,
and exaggerate the circumstances in every possible way; and
we see indications of the same tendency in France. Certain
it is that in spite of the violent attacks made upon the pro¬
prietor of the Maison de Sante , he cannot be prosecuted.
The fault, if there be one, lies therefore at the door of the
law itself; and this remains true, however disreputable the
characters of those brought before the police-court in Paris
in this affair may be, and evidently are. The letter of the
law has not, it appears, been violated, and consequently no
condemnation is possible or justifiable.

That the law admits of revision on certain points is indi¬
cated by the projet de loi prepared by the Minister of the
Interior, M. A. Faillieres. It has been asserted in the
medical journals that this has been done in consequence of
the Monasterio affair. This is a mistake. The changes in
the law of lunacy referred to were prepared and presented
to the Senate in November, 1882, and have, therefore,
nothing to do with this scandal; although it is very likely
that necessary reforms will be facilitated by its occur¬
rence.

This proposed change in the law is characterised in the
preamble as a complete revision of the French lunacy law,
calculated to satisfy the demands, long expressed, of public
opinion, and to correct the imperfections and the “ lacunes
graves et nombreuses” of the very remarkable and creditable
law of 1838. It is the result of a Commission appointed in

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1883.] Occasional Notes of the Quarter.

March, 1881, consisting of a large number of eminent men,
including MM. Lasagne, Lunier, Foville, Motet, Ball,
Baillarger, Boumeville, Loiseau.

Among the modifications of the existing law proposed, is
the proposal, “ borrowed from English legislation,” to re¬
quire two medical certificates instead of one. The infor¬
mation supplied by the physician is also to be more detailed,
the date of the last examination of the patient being stated,
the symptoms and phases of the disorder, and the reason
why it is deemed necessary to confine the patient in an
asylum. The Superintendent must forward copies of this
certificate and the order to the Prefect of the department,
the procureur of the Republic of the arrondissement in which
the patient resides, and lastly to the procureur of the
arrondissement where the asylum is situated. Further, the
intervention of judicial authority is required for the con-,
tinued retention of a lunatic in an asylum after his pro¬
visional admission. “C’est, en effet, un principe de notre
droit que les questions d’ Etat, de capacity et de liberty
individuelle, ne peuvent 6tre tranchees que par l’autorite
judiciaire.”

This principle, it is maintained, was violated by the law
of 1838, by which a person could be confined in an asylum
on a medical certificate, or even in cases of urgency on the
production of a demand made by anyone whatever. The
object was, of course, to facilitate the early treatment of
the insane; but this intention, it is thought, will not be
frustrated by requiring judicial authority subsequent to pro¬
visional admission. This authority is to be based on the
examination of the patient by the procureur of the Republic,
accompanied by a physician chosen by himself—this visit
to be made within four days of the patient’s admission.
The procureur will be bound to forward instructions in
regard to the admission or discharge of the lunatic within
four weeks.

Various other measures of great importance are pro¬
posed in order to perfect the existing law, including the
legal care of the property of patients in private asylums;
but sufficient has been said to indicate the importance of the
proposed legislation *

* For details see “ Projet de loi portant revision de la loi du 30 Juin, 1838,
sur les ali6n£s, presents aa nom de M. Jules Gr6vy, President de la Republique
Francaise. Par M. A. Failli&res, Ministre de l’Interienr et des Cnltes, Paris,
1883.

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PART II-REVIEWS.

A History of the Criminal Law of England . By Sir Jambs
Fitzjames Stephen, K.C.S.I., D.C.L. 3 Vols. Mac¬
millan and Co., 1883.

Lawyers and mental physicians usually meet under con¬
ditions so unfavourable to the fair discussion of the questions
which are of gravest interest and importance to both, that it
is very satisfactory to find one of the most distinguished
members of the Bench carefully examining these questions
in the work at the head of this review, and approaching
them in a spirit of the utmost fairness and candour—qualities
too often conspicuous by their absence in the heated atmos¬
phere of the Law Court. Sir James Stephen, while noticing
with regret, and we must say not without some reason, the
“ often harsh and rude attacks ” made upon the lawyers,
admits that melical men “are sometimes (often?) treated
in courts of justice, and even by judges, in a manner which, I
think, they are entitled to resent. Sarcasm and ridicule are
out of place on the Bench in almost all conceivable cases, but
particularly when they are directed against a gentleman and
a man of science who, under circumstances which in them¬
selves are often found trying to the coolest nerves, is attempt¬
ing to state unfamiliar and in many cases unwelcome
doctrines, to which he attaches high importance ” (Vol. ii.,
p. 125).

Fully prepared as we are to grant that medical as well as
legal men may be one-sided and prejudiced, we heartily
reciprocate the sentiment, as admirable as the terms in
which it is expressed are felicitous, when the author says :—

“I think that in dealing with matters so obscure and
difficult, the two great professions of law and of medicine
ought rather to feel for each other’s difficulties than to speak
harshly of each other’s shortcomings” (p. 128).

At the outset of the chapter devoted to the subject under
discussion (Vol. ii., chapter xix), and which is entitled
“ Relation of Madness to Crime,” the observation made by
the author in complaining that medical writers for the most
part use the word “ responsible ” incorrectly, brings out
strongly the different standpoints from which lawyers and
ourselves view the matter; the different atmospheres, in fact.

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1883.]

which the two professions necessarily breathe. The lawyer,
we are reminded, has in view legal responsibility, while the
doctor is apt to confound it with his notions of moral re*
sponsibility, and to expect the judges to do the same. The
doctor, no doubt, is in fault when he does the latter, or if he
does not make it clear in what sense he is employing the
term. When, however, he is called upon to examine the
mental condition of a criminal with a view to ascertain his
responsibility, he is not bound to adopt the test which
appears to be at the time the legal one ; he may well
endeavour to discover whether the man before him is really
a responsible being in what he believes to be the true sense
of the term, although he should be prepared to give the
evidence sought by the lawyers who are bound by the tests
of responsibility determined by the judges in McNaughten’s
case in 1843. While, therefore, we agree with the author
that a mental expert ought to remember that with judge and
jury, “responsible” means “legally responsible,” and that he
should, in giving evidence, understand in what sense the
Court employs the term, and is legally justified in so
employing it, we hold that as a man of science, the physician
is not to blame for applying his own tests of responsibility
in examining the prisoner, and stating his opinion to the
Court, just as we should expect an engineer, employed to
ascertain the safety of a bridge, to employ his own tests of
safety, and to speak of the structure being safe or otherwise
in accordance therewith, and not in accordance with the
test which the law had laid down, although the latter must
be, or rather we should say, ought to be, followed, if the
law were always consistent with itself. No clearer proof
can be given of the importance of medical men attaching
their own sense to the term responsible, so long as they
make it clear in what sense they do use it—even though Sir
James Stephen may say that “ to allow a physician to give
evidence to show that a man who is legally responsible is
not morally responsible is admitting evidence which can
have no other effect than to persuade juries to break the
law” (p. 128)—no clearer proof, we say, can be given that
such a course is justifiable than the fact that medical men
by doing so have induced the judges themselves, in some
instances, to see the weakness of the legal test and the cruel
injustice which it would inflict upon the prisoner if adopted,
so strongly, that they have deliberately avoided doing that
which our author lays down as a fundamental principle
xxix. 18

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[July,

the^ ought to do, when he writes, “ one leading principle
which should never be lost sight of, as it runs tturough the
whole subject, is that judges when directing juries have to
do exclusively with the question—Is this person responsible,
in the sense of being liable, by the law of England as it is,
to be punished for the act which he has done ? ” Thus, to
give a recent example of what has now and again occurred.
At the trial of Joseph Gill at the Leeds Assizes in April last,
for attempting to murder Mrs. Fox-Strangways, the learned
judge, Mr. Justice Kay, said, in directing the jury—“The
most important question was, were they dealing with a sane
man? Judges had said over and over again that a man
could not be considered insane merely because he did a
criminal act, and the importance of that view could not be
over-estimated. Nevertheless, he did not agree with the
learned counsel who put it that ‘ it was necessary to prove
that a man did not know the difference between right and
wrong in order to show that he was insane.’ If a man’s
mind was in such a diseased condition that he was subject
to uncontrollable impulse, they would be justified in finding
him irresponsible for his actions. . . . What the jury had
to ask themselves was—Was the prisoner’s mind subject to
an uncontrollable impulse over which his Will had no
power? If so they must acquit him on the ground of
insanity.” This is not “ the law of England as it is.”

Sir James has been disappointed in finding so slight a
description of insanity, as a whole, in the text books, inde¬
pendently of its various forms; and this criticism is just,
where the broad features of insanity are not given, or a more
or less complete definition of the disease is not attempted,
but when that which is generally common to all cases of
insanity—loss of mental control, or whatever the character¬
istic fixed upon may be—has been stated, we cannot proceed
far without confounding specific forms in our description,
for there is no form of insanity which we can take as an
example of the whole, just as there is not any one inmate in
an asylum whom we could single out to show a stranger as a
representative lunatic. But this is no more exceptional or
surprising than the impossibility of describing a healthy
human character. A few words would have to suffice, for
to attempt the “ accurate picture ” our author covets, would
end in presenting an inaccurate picture of the very next
person met with. Even Shakespeare’s magnificent description
of the attributes common to man—and who can improve

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upon them ?—would fail to convey quite an accurate picture
of any of the members of the Salvation Army shouting in
Exeter Hall. In truth, to return from this digression, the
phases of insanity are so numerous and so opposite that
the characteristics common to all are comparatively few.
Pew as they are, however, they are given by Dr. Bucknill
under the head of the “ Diagnosis of Insanity ” in the
“ Manual of Psychological Medicine,”* After describing
the varieties of mental disorder, as derived from the text¬
books, and attempting a short summary of “the disease
of madness,” Sir James proceeds to the consideration of
the law as to insanity, and it will be convenient to present his
digest of it.

“ No act is a crime if the person who does it is at the time
when it is done, prevented [either by defective mental power
or] by any disease affecting his mind—

“ (a) Prom knowing the nature and quality of his act, or
“ (b) Prom knowing that the act is wrong [or
“ (c) Prom controlling his own conduct, unless the absence
of the power of control has been produced by his own
default].

“ But an act may be a crime although the mind of the
person who does it is affected by disease, if such disease does
not, in fact, produce upon his mind one or other of the
effects above-mentioned in reference to that act”f (p. 149).

Sir James Stephen observes in reference to the answers
given by the judges to the questions addressed them by
the House of Lords in 1843, after McNaughten's acquittal,
that although he has followed them, their authority is
questionable, and he candidly admits that “ when they are
carefully considered they leave untouched the most difficult
questions connected with the subject, and lay down propo¬
sitions liable to be misunderstood.” He, however, main¬
tains that they might, and thinks ought to be construed
“ in a way which would dispose satisfactorily of all cases
whatever.” It is to this daring task Sir James applies
his vigorous intellect, and the question of most interest to
us, is, whether he has succeeded.

All the points on which the law appears still doubtful,
notwithstanding these answers of the judges, may, in the
author's opinion, be reduced to one question—“ Is madness

* Page 402, Edit. 1879. It is to be regretted that in his references to this
. work the author has not consulted the last edition,
t “The parts included in brackets arc doubtful.'*

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to be regarded solely as a case of innocent ignorance or
mistake, or is it also to be regarded as a disease which may
affect the emotions and the will in such a manner that the
sufferer ought not to be punished for the acts which it
causes him to do ? ”

Sir James doubts, in the first place whether the answers
were meant to be exhaustive, and he shows that if they
were, they imply that the effect of insanity upon the
emotions and will is to be disregarded altogether—a
proposition so monstrous in its consequences that he shrinks
from admitting it to be part of the English law. We cannot
help thinking that in 1843 the judges did not shrink from
such a conclusion, and really meant what they said. In
1883 an enlightened judge sees things differently, and if he
induces others to interpret these words in accordance with
his own view, the mischief they have done for want of so
able an interpreter will not be repeated.

If Hadfield’s notion that he had received a command from
the Almighty to offer himself up as a sacrifice for the salva¬
tion of the world, had been a true one instead of being a delu¬
sion, would his act have been morally wrong ? for according to
the judges, a person must be considered in the same situation
as to his responsibility as if the facts with respect to which
the delusions exist were real, e.g., if under the influence of
his delusion he supposes another man to be in the act of
attempting to take away his life, and he kills that man,
as he supposes in self-defence, he would be exempt from
punishment. (Ans. iv.) Sir James Stephen replies that
a sane belief of this kind entertained by Hadfield would be
no excuse at all for crime, and he pertinently remarks that
if a special Divine order were given to a man to commit
murder, he (Sir James) should certainly hang him for it, unless
he got a special Divine order not to hang him. Hence,
although Hadfield ought to have been convicted according to
the natural sense of the rule enunciated by the judges, it is so
obvious to lawyer as well as doctor that he was rightly
acquitted that Sir James Stephen considers that the
existence of delusions must have some legal effect other
than those which the answers of the judges contemplate.
All we can say is, it is a pity that so vastly important a
document as the one in question should not have stated
clearly what was and what was not contemplated in its
scope and bearings; and that if we adopt the sensible
exegesis of our author, we are driven to understand some of

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the judges' phraseology in something very like a non-natural
sense. We cannot but agree with Sir James that “ every
judgment delivered since the year 1843 has been founded
upon an authority which deserves to be described as in many
ways doubtful” (p. 153), and that the propositions laid
down are “ liable to be misunderstood,” although it was of
vital importance that they should be lucidity itself. Mental
physicians may at any rate console themselves with the
reflection that this setting forth of the law of criminal
responsibility, which has been their bete noire for the last
forty years, and against which they have been constantly
waging war, has not been vilified by them without good cause,
and only becomes intelligible and reasonable when construed
by Sir James Stephen.

The learned author sees clearly enough, in reference to
the question, what effect an insane delusion can exert on a
man's conduct, except in relation to the matter to which it
relates, that it may indicate disease affecting the mind
otherwise than by merely causing a specific mistake, and
that it may evidence a mental condition which prevented
the person from knowing that his act was wrong. Thus it
is recognised that a delusion, which as such, is wholly un¬
important, may be highly so, from the indication it affords
of serious disturbance of the whole mind, and it is seen that
“ it is practically almost impossible to say what part of the
conduct of a person affected with a fixed insane delusion is
unaffected by it” (p. 162). Again, on the second point—
that a delusion may afford evidence that a person, in the lan¬
guage of the judges, was “labouring under such a defect of
reason from disease of the mind that he did not know that
what he was doing was wrong,” Sir James Stephen
observes that the word “ wrong ” is ambiguous, as well as
the word “know,” for it may signify either “illegal” or
“morally wrong” (p. 167). Anyone, says the author, would
fall within the above description “ who was deprived by disease
affecting the mind, of the power of passing a rational judg¬
ment on the moral character of the act which he meant to
do” (p. 163). Hadfield knew his act was illegal, and in
this sense knew it was wrong, but he believed it to be
morally right.

Sir James Stephen maintains, that even accepting the
answers of the judges, the law allows that a man who by
reason of mental disease is prevented from controlling his own
conduct , is not responsible for what he does (p. 167). Further,

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he holds that “ the existence of any delusion, impulse, or
other state which is commonly produced by madness, is a
fact relevaut to the question whether or not he can control
his conduct.” He grants, however, with his accustomed
fairness, that the judges' answers “are capable of being
construed so as to support the opposite conclusion”—but.
lie holds that it is a narrow interpretation, which forces us
to regard insanity as “ merely a possible cause of innocent
mistakes as to matter of fact and matters of common know¬
ledge.” With his own wide interpretation, “ the law” he
says, “ includes all that /, at all events , would wish it to in -
chide ” * (p. 1(38).

The sensation experienced when, after dreaming we are in
a state of hopeless confusion or lost in some inextricable
labyrinth, we suddenly wake and find to our intense relief
and surprise that we have escaped every difficulty, is not
more pleasurable than that which we experience when
painfully bewildered after looking in vain in the answers of .
the judges for a clue to the solution of the problem of
criminal responsibility, we are shown that it was there all
the time, and only wanted pointing out by the magic wand
of Sir James Stephen. We know now, on his high authority,
that the essential principle for which medical men have so
long been contending is the very one which, unseen by the
dim optics of our profession, is contained in the answers
referred to. Eemarkable indeed are ‘ the words of the
author:—

“ The proposition, then, which I have to maintain and
explain is that, if it is not, it ought to be the law of England
that no act is a crime if the person who does it is at the
time when it is done, prevented, either by defective mental
power, or by any disease affecting his mind, from controlling
his own conduct, unless the absence of the power to control
has been produced by his own default. . ..

“ No doubt there are cases in which madness interferes
with the power of self-control, and so leaves the sufferer at
the mercy of any temptation to which he may be exposed ;
and if this can be shown to be the case, I think the sufferer
ought to be excused ” (p. 168-70).

Sir James Stephen then asks—“Can it be said that a
person so situated knows that his act is wrong 9 ” And he
replies, “ I think not, for how does anyone know that any

* In every instance the italios are onr own.

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act is wrong, except by comparing it witb general rules of
conduct which forbid it, and if he is unable to appreciate
such rules, or to apply them to the particular case, how is
he to know that what he proposes to do is wrong P Should
the law upon this subject be codified, a question would no
doubt arise whether the article relating to madness should
refer in express terms to the possible destruction by madness
of the power of self-control or not” (p. 171).

We may refer here to Mr. Russell Gurney’s Bill of 1874,
which appeared to medical men to mark a vast stride in
advance of previous legislation, in the way in which it
recognised, among other things, the loss of self-control from
disease, as one of the proofs of irresponsibility. Now, this
Bill was drawn by Sir James Stephen, who at that time so
clearly saw the importance of this point that he introduced it
into this Bill for the amendment of the law relating to Homi¬
cide. Though it did not pass into law, it led to the appoint¬
ment of a Select Committee, when Sir James Stephen gave
valuable evidence, and maintained that it was eminently
desirable that we should have definitions, and that these
definitions should state plainly what the law is.

The opinion expressed in writing to this Committee by
the Lord Chief Justice (Cockburn) is well-known, but is so
remarkable that it can hardly be too frequently placed on
record. He said:—r-“As the law, as expounded by the
judges in the House of Lords, now stands, it is only when
mental disease produces incapacity to distinguish between
right and wrong, that immunity from the penal consequences
of crime is admitted. The present Bill introduces a new
element, the absence of the power of self-control.” The
Lord Chief Justice did not see, as Sir James Stephen now
sees, that the latter is involved in the former. Then he
added, in those emphatic, and it should seem unmistakable,
terms—“ I concur most cordially in the proposed alteration
of the law, having been always strongly of opinion that, as
the pathology of insanity abundantly establishes, there are
forms of mental disease in which, though the patient
is quite aware he is about to do wrong, the will becomes
overpowered by the force of irresistible impulse; the power
of self-control when destroyed or suspended by mental
disease becomes, I think, an essential element of (irresponsi¬
bility.”

In the Criminal Code Commission of 1878-9 the subject
of loss of self-control was discussed, but the Draft Code as

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settled made no reference to it. Sir James Stephen says
that his Bill of 1878, upon which this Draft Code was
founded, did refer to it. Sir James does not think this is
important, so long as the words “ know ” and “ wrong ” are
construed—we will not say in a non-natural sense, but—as
he would construe them. He takes much subtle pains to show
that the man who does not know that an act he commits is
wrong is incapable of self-control. In short, he would, after
all, be “fully satisfied with the insertion in a Code of
‘ knowledge that an act is wrong ’ as the best test of respon¬
sibility ”—adding once more the essential condition “ the
words being largely construed on the principles stated here ”
(P-171).

We cannot but regret that after the enlightened view
which the author really takes of the question, he should
seem to be in danger of falling again into the errors from
which we fondly hoped he had emancipated himself, for
when he says, as he proceeds to say, that if “power” is
“seriously impaired” “knowledge” is “disabled,” and
adds, “ It is as true that a man who cannot control himself
does not know the nature of his acts, as that a man who does
not know the nature of his acts is incapable of self-control ”
(p. 171), we think that he sails dangerously near the rock
on which the judges in their answers were shipwrecked.
In short, the legal and metaphysical principle thus formu¬
lated, however ingenious, .is at variance with the facts
daily witnessed in asylum life, and, as we have had occa¬
sion to point out, the late distinguished Lord Chief Justice
failed to perceive its validity.

We now approach the question of punishment, in some
instances, of the insane, and Sir James Stephen discusses it
with his usual ability. He does not think it expedient
that a person unable to control his conduct should be the
subject of legal punishment—perhaps he might have put it
a little more strongly ! He then opposes the notion that the
mere fact that an insane impulse is not resisted is to be
taken as proof that it is irresistible, and adduces the case
of the woman who felt impelled to kill the child she was
nursing with a knife, but had sufficient control to throw
away the knife and rush out of the room. Unfortunately
Griesinger terms this “ an irresistible desire to murder the
child,” and Sir James Stephen is obviously justified in
pointing out the illogicism involved in the remark. It is
pot, on the other hand, clear that the case which he

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adduces helps us much, for had the woman killed the child
there would have been no proof that she could have helped
it. Here is just the difficulty. If a person pressed by a
violent impulse is able to resist it, and does resist it, he is
not accused of crime, and the question of responsibility does
not arise. It is only when he yields that the question pre¬
sents itself; and then if it is shown to have been an insane
impulse, it seems to us that its irresistibility for legal
purposes must be assumed, although it is possible he might
have exercised more self-control. No one disputes that
among the inmates of a lunatic asylum there are different
degrees of uncontrollability. This must necessarily be the
case in the various stages and gradations through which
they pass from better to worse and from worse to better.
But the broad fact of mental disorder has to be taken at
every period as the proof of such an amount of practical
irresistibility as forbids the idea of punishment-«-except
that which is necessarily involved in the deprivation of
liberty. We cannot draw a hard line between those who
are insane in an asylum and those who are insane out
of it. And with the former, how delicate is the line, even
when it seems definite enough to the patient himself, which
separates the moment when he is and the moment when he
is not master of himself! We know a patient at the present
time in an admirably conducted asylum, who is allowed, and
advisedly allowed, to have deadly weapons in his room,
although a dangerous lunatic, because when conscious of
the on-coming desire to injure others, or himself, he desires
these instruments to be removed, or he locks them up himself.
Yet who would deem it just to punish him if he committed
a violent act in the interval between his paroxysms of
homicidal excitement ? The fact of mental disease would
constitute a legitimate presumption that he had lost his
power of control.

Sir James Stephen proposes that a jury should be allowed
to return three verdicts—(1) Guilty; (2) Guilty, but the
power of his self-control was diminished by insanity; (3)
Not Guilty on the ground of insanity.

At first sight, the second proposition seems fair enough.
It, no doubt, is the simple statement of a fact, and if the sen¬
tence to which the verdict led were only imprisonment, there
would in some cases be no serious ground for complaint
of a miscarriage of justice. Still, insanity is insanity, and
where, as here, it is admitted that the power of self-control

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is weakeued thereby, we cannot bring ourselves to consent
to any other course than protecting society by confining the
individual in a criminal asylum. See to what a conclu¬
sion the view advocated by the author conducts him. He
supposes the case of a man in a private asylum “ suffering
to some extent from insanity,” but the disease is going off.
He is also “ wicked,” and when his brother visits him he
deliberately poisons him in order to inherit his estate. He
recovers and does inherit it. Why, asks Sir James, should
he not be hanged, “ though he happened to be mad when
he did it 9 99 and he thinks such a course would be warrant¬
able. We doubt whether any medical superintendent of an
asylum would think so. The other illustration given by the
author is as little convincing. “ If,” he says, “ a lunatic
was proved to have committed a rape, and to have accom¬
plished his purpose by an attempt to strangle, would there
be any,cruelty in sentencing him to a severe flogging?
Would the execution of such a sentence have no effect on
other lunatics in the same asylum ? 99 (p. 176). We think
there ought to be but one answer to this question on the
part of medical men. -Nor would public sentiment sanction,
we are persuaded, any such proceeding.

There is another very interesting question discussed by
Sir James Stephen, on which, we think, his conclusion would
conduct him too far if logically carried out—although a final
judgment, declared by Omniscience, might be fairly supposed
to follow it. He holds that the rule—that a person should
not be punished when deprived by disease of the power of
self-control—should be qualified by the words “ unless the
absence of the power of control has been caused by his own
default” (p. 177). It is certain that such an exception
would allow of numbers who are now in asylums being
treated as responsible persons, and punished accordingly,
and we think this would be very cruel. ’Are we really
justified in punishing the epileptic maniac for killing his
attendant, because the attack under which he labours can
be distinctly traced to an immoral life ? If a man suffers
from general paralysis of the insane and in his mad delusions
commits a theft, is he to be punished because his insanity
is due to dissipation ? On such a principle it would be only
necessary to take the.causation-table of an asylum, and deter¬
mine which patients should be regarded as criminally
responsible for their actions by the character of the cause
assigned for their disorder. The result would be curious,
not to say startling.

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We must not quit this interesting and able disquisition
without observing that the author in referring to moral
insanity, allows that if the statements made by standard
authorities on the subject are correct, they may be taken
“to prove that disease in some cases has the specific effect
of destroying for a time, or diminishing in a greater or less
degree, those habitual feelings which are called, I think
unfortunately, the 6 moral souse,’ ” but he comments on the
fact, only too true, that many sane people possess but little
that resembles it. This, however, is rather a clever hit at
the general depravity of mankind than meant as a serious
objection to the admission of those peculiar cases which it
is intended to comprise under the term moral insanity, and
for which legal irresponsibility is claimed. Here, as else¬
where, Sir James Stephen is as fair as he is able. His fair¬
ness will, we hope, lead him to allow that there is, after all,
some reason why “many people, and, in particular, many
medical men, cannot be got to see the distinction between
an impulse which you cannot help feeling and an impulse
which you cannot resist” (p. 171). No doubt there is
a distinction in degree, but if, as we suppose, Sir James
means by “ an impulse which you cannot help feel¬
ing” an insane impulse, there is no difference in
kind. The two alike fall under the cognisance of medical
men as diseases which he has to treat; and if unden the
influence of an insane impulse the subject of it commits a
criminal act, his medical attendant would naturally be dis¬
posed to conclude that the impulse which he could not help
feeling had mastered his previous efforts to resist it. The
conclusion is not necessarily logical, but would generally
be true; while the opposite conclusion, would not neces¬
sarily be logical, and would generally be false.

The medical feeling is precisely in unison, it is important
to observe, with what Sir James Stephen acknowledges to
be the sentiment by which juries are guided. “ They are
reluctant to convict if they look upon the act itself as upon
the whole a mad one, and to acquit if they think it was an
ordinary crime.” In other words, they, like the physician,
find it hard to avoid making madness and loss of control
practically synonymous as regards the infliction of punish¬
ment. And when the science of doctors and the instinct of
juries lead to a common result, it is not difficult to see
what will be the fate of the lawyers in those cases in which
there is a difference of opinion.

In concluding this review, we would repeat that we regard

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it as of good omen that a distinguished lawyer should have
discussed one of the most important questions of the day,
affecting alike the lawyer, the physician, the criminal, and
society, with so much breadth of thought and so much good
feeling. With him the two constituent elements of legal re¬
sponsibility remain to be equally, knowledge and power; with
us the latter is infinitely the most important, as the one
which is more or less wanting in all cases of insanity’, and
which directly affects the efficiency of the penal code in pre¬
venting crime—the true test, according to Casper, of
responsibility.*

We heartily commend this work to our readers, and sin¬
cerely thank the learned author for the spirit in which he
has approached, and the manner in which he had treated the
medico-legal questions discussed in his pages, for nil molitur
inepte , although we do not always assent to his conclusions.

Injuries of the Spine and Spinal Cord without apparent Mecha¬
nical Lesion, and Nervous Shock in their Surgical and
Medico-Legal Aspects. By Herbert W. Page, M. A., &c.
J. & A. Churchill, 1883.

The scope of this work, sent to us for review, may seem
scarcely to fall within our province, but the medical psycho¬
logist will find cases recorded which are by no means with¬
out interest in their psychological bearings.

The serious mental symptoms, falling, in general, short of
actual insanity, which may arise from injury to the spinal
cord, are of great interest and importance, more especially
in relation to railway accidents. It must be evident, how¬
ever, that in such cases, it would be impossible to separate the
injurious shock to which the cord is subjected from that
which the brain suffers at the same time. Neither would it
be possible to determine, when mental symptoms supervene,
how much is due to the molecular disturbance, and how
much is the result of terror on the occurrence of an acci¬
dent. That there may be no “ apparent mechanical lesion ”
is very certain.

After an accident has taken place, another phase of ab¬
normal mental influence comes into play, and a very extensive

* Casper’s words are—“ Zurechnungsfahigheit in Strafrechtlichem Sinne
(Imputabilitat) ist die psychologische Moglichkeit der Wirksamkeit des Strafge-
setzes.” See his “ Practisches Handboch des gerichtlicben Medicin, Erster
Band,” p. 413, 1876.

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series of phenomena may here be studied, all more or less
directly resulting from the subtle influence of the direction
of the attention to the organs of the body.

We cannot doubt that Mr. Page is justified in insisting
upon the enormous influence exerted by mere mental shock
in the first instance, and by concentration of the mind, sub¬
sequently, upon motor and sensory phenomena, in order to
strengthen his leading contention that there is no proof that
the concussion consequent upon physical shock to the spine
without local injury will lead to organic changes in the cord
and its membranes. Mr. Page’s utilization of the recorded
facts of the influence of the mind upon the body, is an illus¬
tration of the important bearing and the practical utility of
researches in this direction—researches which at first sight
might seem to possess only a speculative interest, whereas
their far-reaching nature can hardly be exaggerated.

It would be entirely foreign to our purpose in thus briefly
noticing Mr. Page’s work, to enter into the consideration of
the. other bearings of the main question discussed by him,
and upon which his conclusion so widely differs from that of
a well-known surgeon of the present day. Our object is
simply to draw the attention of our readers to the psycho¬
logical aspects of a publication they might overlook, and
which they may study with advantage in the direction in¬
dicated.

A valuable tabular analysis of 243 cases is appended to
the work.

The Alternative: A Study in Psychology .—Macmillan, 1882.

This is certainly a curious and a remarkable book. On
the title page the anonymous author inscribes Hamlet’s
bitter text, “ We fools of nature.” The preface teems with
terse scorn of all philosophies, old and new, and claims that
the writer has for the first time not only justified what he
calls “the scientific method” against the riotous excesses
of induction, but that he has taught mankind a new gospel
that has more than all the moral merits of the old “ without
its supernaturalism and mysticism.” And throughout there
runs a heroic self-confidence, cropping out not merely in
terminology but in the whole tenor of the book, which pro¬
claims to this sceptical generation that it has to do with a
prophet.

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The first question that will occur to everyone is, what is
the “ Alternative ? ” Here it is, in the author's own words :
“ Either puppet, dupe, and victim of unconscious forces, or
self-denying conduct for the achievement of wisdom/* The
antithesis is not quite grammatical, and at the first glance is
not very intelligible either. But it carries a very important
meaning, which every page of the book is intended to enforce
by demonstration and illustration in every conceivable
way. The point is developed in the Third Book; for the
first consists of Definitions demanded by a new classification
of mental events and faculties—not the less new that the
classes are denoted by familiar names; and the second
treats of Reasoning. This Third Book, then, is to establish
first of all the existence of “unconscious mental event,’'
and, indeed, of an “ unconscious part of the tnind,” which
turns out to be “ the encephalon, &c.” The author begs
us to observe that unconscious cerebration and such things,
as far as has been hitherto shown, might have been only
unconscious conditions of mental events. Indeed, he roundly
rates Leibnitz and even Professor Bain for not considering
these phenomena as really “ mental ” at all; whereas he
is most positive upon that. But it would hardly seem a
very vital difference. The main point is the further proof
that in the history of humanity till now, man has been the
dupe, puppet, &c., of this “ unconscious part of himself.”

As might be expected, then, the author’s first concern is
the careful explanation and analysis of “ consciousness.” It
would be futile to follow him through a long series of
curiously worded subtleties, which merely lead up to the re¬
affirmation of the importance of “ latent forms of conscious¬
ness.” Inter alia, he gives us a new definition of “ con¬
sciousness,” whereby it includes not only “ discemment-con-
nected-with-apperception,” but also “ discernment-uncon-
nected-with-apperception.” What the latter, the latent
division, means is illustrated by. sundry examples, of which
one is so near akin to madness that as the author relates it
of himself, it will be wise to quote it in full, in his own odd
English:—

“ The following mental event was given to the writer as
having occurred while he was in a swoon: A discernment
void of self-consciousness seemed to have for object a figure
consisting of several luminous, variously-coloured concentric
rings, the largest about twelve feet in diameter. Time,
space, and the figure seemed to comprise all being. There

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was no spectator. After a while an impersonal wonder con¬
templating the figure obtained, and then after a while ‘ I ’*
was suddenly annexed to the wonder as subject to attribute :
for a moment I was aware of myself as gazing at the figure,
and with the vanishing of the figure I recovered.”

The importance or interest of the book, however, hardly
lies in the psychology of which this is a specimen. The author
does in reality good service by directing attention pointedly to
the immense proportion of our acts which are dominated by
forces and processes independent of consciousness. But this
has been insisted upon before. Neither will the book survive
because of the logical discussion of the nature of knowledge,
which, indeed, is sometimes very mystical and strange.
Take this refutation of Kant: “ Following Leibnitz, he
asserts, as though it were a self-evident truth, that what
all the world understands by the term experience, does not
give cognisance of the non-contingent, of what could not be.
He thereby implies, or seems to imply, that it is not com¬
petent to a latent encephalic event, consequent to a tactile
impression, to cause a discernment of both a solid and a non¬
contingent void.” This imposing statement leads up to a
demonstration of the error of Kant’s theory, by which Space
is an a 'priori framework into which the a posteriori data of
extended objects fall. But although the author is at most
elaborate pains to define all his terms as he goes along,
and frequently invents a new word or rebaptizes an old one
to serve his turn, yet he cannot escape a constant confusion
of ideas. In truth, this craze for new terms and indepen¬
dent definitions, which seems to beset each new psychologist
of our day, is a fatal snare. For the meaning of the terms
of our common mental experience, vague as these are to
the common man, is not a thing that can be altered at will.
“ Conscious ” has a true meaning, which by clear insight
and by just analysis of experience we may make definite.
So has perception, or will, or sensation. But to devise, for
the elucidation of a new hypothesis, some original definition
and then make an old and innocent word fast to it, and go
gaily on through endless arguments and theories, always
using, or professing to use, this well-known common term
as meaning not itself but bur new-fangled definition, is only
to deepen the darkness. You cannot in reality keep on con¬
sistently using a word which has its own hereditary asso¬
ciations in some arbitrary sense of your own. The old
associations creep in in spite of you—the more surely that

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Heinew*.

[July,

your own new definition must always be more or less mixed
up with the ordinary meaning to begin with. If a new

E hilosopher must have new terms to work out his theories
y, let him make up his definitions and then put * and y
for them. But do not let him say that “ mind denotes a
concrete, or a sum of concretes, that either is or involves
what lacks nothing essential to a subject of consciousness,”
and then suppose that whenever he speaks of “ mind 99
throughout 400 pages his readers will understand not mind
but “ a concrete or sum of concretes that either is or involves,
&c.” Psychology is not algebra : for while the latter deals
only with the analysis of a simple relation—that of space or
number—the former touches all the complex and interrelated
problems that lie within the touch of human experience.
But if a psychologist will commit the mistake of arguing on
an algebraic system, at least let him take for his counters
symbols that are not already saturated with vague and
varying import.

If the reader will penetrate, however, behind the curious
veil of twisted language, he will find that the tenor of this
part of the book is an interesting attempt to disprove the
“positivist” denial of the “ego” as “a concrete and durable
subject,” and of Cause as Power, and Life as “ a species of
power—a dynamic quality.” “ Blazoning the sovereignty of
experience,” he complains “ positivism behaves towards it as
a sort of Mayor of the Palace, discarding some of its most
important data.” His rehabilitation of the “ego” is so com¬
plicated by the pervading question of latent mental events
that an attempt to disentangle it here would lead this notice
to impossible lengths. But the argument as to cause is
worth noting, for it brings out an element in the problem
too apt to be ignored by the scientific school who take
Hume’s half-truths for gospel. The prophet of “The
Alternative” admits that he cannot disentangle the idea of
power from the many confusions that surround it; but he
thinks it is “ an embryo which culture is in process of matur¬
ing.” His argument is, that to say with Mill that “ cause
is the sum of the conditions ” is a meaningless phrase—for
in that case time and space, and, indeed, any and all the
infinitude of events simultaneous with or antecedent to a
given event, are included in its “ cause.” Everything is
the cause of everything else. And this, in a sense, is true.
Freewill apart, it is accurate to say that no natural
phenomenon would be what it is, if any of the infinite

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series of phenomena that have been, or that simultaneously
are, could be changed or taken away. But we make a dis¬
tinction between certain of these conditions which are
“ causes ” in a special sense, and others which are “ occa¬
sions ” or “ accessories.” Substitute twine for the wire of
an electric battery, and the current ceases. There is an
aptitude in the wire which might be called “a dynamic
condition.” Or, to take a better example, we start at a
shadow: the shadow is an essential condition, but it is not
a “ dynamic ” one. It was this conception of an element of
“ power ” of some sort, inherent in “ cause,” that Hume
overthrew, and that Hume’s opponents wished to use as a
basis for the conception of “ will ” as itself an “ uncaused
cause,” a power to bring into being a fact or state which all
the antecedents, minus my volition, would be powerless to
create.

On the question of volition, which, of course, is the main
point of the book, the author takes decided ground; and his
view is presented, as usual, under the bold form of a series of
definitions. “ Intention is a bent of the mind to act according
to a present guiding idea,” but choice is “ an intentional act
that consists of two acts—first, study of two opposite motives
intent upon a preference of one of them—second, a pre¬
ference.” The study is an effect of predetermining causes,
the preference is not; indeed, “ the idea of choice supposes
that the involved preference is not predetermined, and is
uncaused. He who affirms that an event presupposes a
cause, denies the possibility of choice.”

All this may seem very arbitrary, and it is. But the point
he wishes to lead up to is worth notice. It is that u the
greater 'part of perceptible human intentional actions are un-
optional .” For, as he assumes, it is essential to choice, or
volition, properly so-called, that the mind should refer to
what he is pleased to call “ a binary of opposite motives ”—
a motive to do and a motive to forbear from doing. Obviously,
it is true that no such “ practical alternative ” is in question
in the vast majority of human acts. But he insists that the
bulk of human intentions also are wanting in the same char¬
acter ; and for all u intentions or intentional actions uncon¬
nected with a practical alternative,” he adapts the misleading
term Instinct . This is a good instance of the vice of termin-
ology commented on just now—for instinct has a scientific
meaning of its own, which, whether it be hard to define or
not, cannot be swept away by an arbitrary definition invented
xxix. 19

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by a theorist. And, indeed, it is hard to see how much or
how little he proposes to include in his new class. The
examples he vouchsafes are meagre, e.g., “ quasi-attention
in spite of efforts to undo it,” or “anger breaking from control
of a man interested and strongly minded to dissemble.” It is
to be regretted that he did not spend more pains over the new
classification, for it is worth attending to. Habit, instinct,
and their allied conditions, are problems which students of
mind, and specially of mental pathology, have never suffi¬
ciently studied. We all see that there are thousands of acts,
including many of the highest importance, which we do at first
only by a distinct volitional effort or assent, but which in
time become all but automatic. And yet we do not really
take them .to be unintentional, or in any real sense
mechanical. When a choleric man, who has given the rein
to his temper, seems to be carried off bis feet by a trivial
annoyance, he knows, and we know, that he could stop him¬
self if he chose, and we hold him fully responsible for his
explosion. But, of course, the “ habit ” of breaking out in
that or any other form of passion has made acquiescence in
any new temptation easier, and resistance more difficult. And
the point at which the habit may merge in a moral madness
and become an uncontrollable necessity is apparently, in each
man’s case, a question only of degree. Is it really so ? Is
moral impotence a species of bad habit ? If that were proved
by mental science, it might be an interesting question for
the theologians to consider whether it did not provide a pos¬
sible theory of hell.

But we are deserting our author. He brings us next
to the startling proposition, which is in a way the key of
his whole position, that “ Will ” has very little to do with
the affairs of life. For the most part, the strongest motive
prevails—“ propensity ” does the ordinary business of the
world. Thus is “ our mind made up for us.” Only at rare
intervals does moral choice come in, but these occasions are
the valuable part of human conduct. It is when Wisdom
demands resistance to propensity that Will has its oppor¬
tunity. That opportunity is the opening for the introduction
of the improved form of Christianity which this anonymous
prophet has discovered—a revision in which, “ Wisdom and
the Christian spirit are identical,” and the ideas of reverence,
godliness, &c., are seen to be only u the scaffolding of the
temple.” It would be too long, and it would be out of place,
to sketch the extraordinary series of moral disquisitions, for

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the most part deeply interesting, by which this singular
writer developes his new ethical plan. St. Paul, the author of
the “ Imitation of Christ,” Hume, the Puritans, and many >
other ethical authorities not commonly found in company,
are all drawn in; and if the total result is a little hazy, it is
at least to be commended as a serious attempt to tackle
those moral problems which the prevalence of shallow
utilitarian shibboleths has lately tended to put out of sight.
The book ends with an odd abruptness. He has intimated
that there are difficulties in proving the freedom of the Will.
But instead of refuting statistical and other objections, he
contents himself with saying that even if it were apparently
drawn into doubt, we must rescue ourselves at all costs from
the moral paralysis which that involves. In the last resort,
we are therefore to take refuge in an “ arbitrium 99 a volun¬
tary determination to act as if free-will were proved, whether
we think so or not—a decree , in fact, that Will exists ! !
Having done this, a man may “ by ordinate self-denial (in
the way of volitional checks upon propensity) improve his
instincts, and make probable the possibility of man becoming
Christ-like.” And then afterwards we have an elaborate
diagnosis of the really Christ-like character, and even a
description of the “ Summum bonum.” But suddenly, when
we arrive at the last chapter, and, finding it duly headed
“Man, Puppet, Dupe, and Victim of Unconscious Force,” ex¬
pect a final blaze of luminous teaching on the relation of the
unconscious to the development of humanity, he stops in two
rambling pages and leaves us to draw the moral of the book
ourselves.

Probably, the moral which most of our readers will draw,
if they read this psychological curiosity, will be that the
author is somewhat eccentric at the least. But there are
among his disordered paragraphs not a few sound ideas. An
eccentric mind is of use somewhat as a wit is—because it is
struck by associations and connections of ideas which do not
suggest themselves to the too sane minds that work along
the highways of knowledge. The author of “The Alterna¬
tive 99 will do such service to the limited number who will be
at the pains to follow him. The philosophy of the unconscious,
if it has been too popular in Germany, has not been promi¬
nent enough in English psychology; and it is a fruitful field.
The distinction between propensity and will, and the extent
to which, by a kind of moral laziness, “ our minds are made
up for us ” perpetually, are subjects that involve infinite

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issues. Therefore, with all its obvious faults and follies, we
welcome this book ; and we venture to hope that it is one
among many signs that the tyranny of the lately dominant
English school of psychology is giving place to independent
thinking, even though that be, as it must be in the beginning,
a little wild and unprepared. It is high time that we pro¬
duced a new philosopher.

Die Alcoholischen OeUteskranhheitm im Bader Irrenhause , &c.

Vom damaligen Asristentarzte. Von Wilhelm von Speyr.

1882.

This dissertation consists of a valuable collection of actual
cases, well observed and thoughtfully classified. Dr. W. von
Speyr, possessing, as he does, a critical mind and a fine
perception of differences, approaches the subject of which
he treats with the'mental qualities so requisite for psycho¬
logical study. His treatise is dedicated to his teacher and
physician-in-cliief, the well-known and esteemed Professor
Wille, of whom he has proved himself to be an apt pupil
and loyal disciple.

Dr. W. von Speyr, after briefly discussing ©tiological clas¬
sifications of insanity, groups together the following specific
alcoholic psychoses:—

I. Pathological intoxication (Alcoholismus Acutus.) II.
Alcoholic Insanity, (a) Acute. (6) Chronic. III. Deli¬
rium Tremens. IV. Chronic Alcoholism.

Of the first, the delirious and maniacal attack resulting
from the abuse of alcohol, and developing itself not very
suddenly and completely, a typical example is given, viz.,
that of

A man who, having fallen down in the street, was admitted into the
Basle asylum. He had been unconscious, and violently convulsed,
and had bitten his tongue. The pupils were dilated and insensible,
the eyes red and dull, the body and limbs being still frequently con¬
vulsed. Although he could not stand alone he avoided everyone ; he
cried out loudly when the attempt was made to support his head.
He stammered out a few words, and had painful visual and auditory
hallucinations. A warm bath and cold affusion brought him round so
far as to be able to answer questions shouted into his ear ; after which
he slept the whole night. In the morning he was himself, and related
that when drunk he stumbled against some one in the street and fell

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down. After that the only thing he remembered was being carried to
the asylum and being put in a bath. The urine was normal; the
patient had never had epileptic fits. He had, however, been once in
a hospital for concussion of the spine arising out of a fight.

A case of transitory alcoholism follows, in which

A man recovering from a severe attack of typhus fever drank some
wine after being discharged from a hospital, and returned on the same
day apparently sober. Without being aware of it, he broke the rule
of the house in bringing with him some biscuits for another patient,
in consequence of which the others bantered him. He became at
once deadly pale, and gnashing his teeth stormed about the room
crying and gesticulating. He defended himself against imaginary
charges of theft, &c., and wished to fight them all as an old soldier.
He was with difficulty overpowered and dowsed with cold water and
conveyed to the asylum, on the way to which he vomited. His face
was pale, his pupils dilated and insensible; temperature normal, no
tremors or perspiration ; but there were still grinding of the teeth,
excited gestures, hallucinations, distress and confusion. He ejacu¬
lated broken threatening words, and laughed and sang, and bragged
meanwhile. He soon, however, became exhausted, and within twelve
hours came to himself, although still in trouble and very tired. He
slept the night without dreaming. In the morning the patient, an
intelligent joiner, was ashamed of himself. He knew he was beside
himself, but was oblivious of all that had happened. It should be
added that he had not suffered from epilepsy, and had had a similar,
only slighter, attack when he was a soldier.

This, then, was a very transitory state, and Dr. W. von
Speyr proceeds to contrast this with the previous case. In
that the symptoms of a heavy debauch were present, and
stood in direct relation to the craving for alcohol, and in
accordance with it, and the disorder developed gradually and
not in a sudden outbreak. In the second case, on the con¬
trary, the amount of alcohol taken was small. It did not
act in a specifically intoxicating manner, and no one simply
regarding the symptoms would have suspected drunkenness,
but only a sudden outbreak of excitement in consequence of
a little well-meaning banter, in a constitution rendered
morbidly susceptible through typhus fever. This is quite in
accordance with the parallel instance in which an anaemic
woman who has recently weaned her child, or who has been
weakened by a severe labour or puerperal fever, loses her
mental balance through slight inhibitions of alcohol; or
again, the woman with poor blood, who becomes maniacal

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in consequence of her husband returning home late and
quarrelsome while she is menstruating.

Passing on to Alcoholic Insanity, which Dr. von Speyr
describes as a mania of persecution with hallucinations, he
gives the usual divisions of the acute and chronic forms, and
very properly lays great stress upon the importance of the
distinction between delirium tremens and the first of these
divisions. The distinction, we need not say, is fully acknow¬
ledged in our own country. We cannot do better than take
the writer's own case of acute alcoholic insanity as an illus¬
tration of this distinction.

A young man deserted from the military service in which he had
been notorious for sexual and alcoholic excesses, including absinthe¬
drinking. He became one day suddenly insane, had hallucinations,
was anxious, and had tremors and loss of sleep. His symptoms were
aggravated at night. When admitted there was tremor of the tongue
and limbs; the pupils frequently unequal, the temperature normal,
the pulse weak and excitable. The appetite was bad, but there was
no fear of poison. Sleep was obtained on the first night with chloral
for only two hours, but afterwards it was good. He was rather
restless ; his memory was good ; his hallucinations lively, but some¬
times he acknowledged them. A wild beast, he said, was in his
body, burning his stomach and biting his back; while a ball pressed
upon his head. The birds sang in his ears, a demon mocked him,
he heard reproaches. He saw his dead parents, and he fancied a
bit of bread transformed into a monster. The pillow at night rose
up before him. The voices compelled him for three-quarters of
an hour to distort his mouth or to hold his hand to it and his ear.
He fancied he saw faces peeping at him out of crevices in the wall.

In about ten days the hallucinations vanished; the voices of
birds, however, remained longer. His physical state improved; the
tremors lessened. The anxiety gave way to the perception of humour,
and the patient left his cares to the future. He was discharged in a
month’s time.

The author tabulates 18 cases of typical acute alcoholic
insanity, occurring in 13 men. The more cultivated were
attacked, the reverse of what held good in delirium tremens.
The majority were unmarried, and between 25 and 35 years
of age, only one was above 50; he, however, had been de¬
ranged previously. The average age was 30. It was the
exception for the attack to last longer than a week. No
patient had had epileptic attacks. Heredity was indicated
in most cases by drunken or neurotic relations. All admitted
intemperance in drinking wine, beer, absinthe, or “ schnaps.”

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In some, sexual excesses were also acknowledged. The
exciting cause of the attacks was not very apparent. In one
case the attack followed a blow on the head. Some blamed
disappointment in their affairs, but there was in fact nothing
more than the consequence of frequent debauches. In no
case was the discontinuance of drink the cause. The physical
symptoms, though not wanting, fell into the background by
the side of the mental affection. They were transitory, and
were more marked in their early than the fully developed
stage. Most of the patients were well nourished, some
showing a tendency to be corpulent. The expression was
animated, mostly painful, only exceptionally expressionless
and dull. Pallor was frequently noted. Gastric disorders
were insignificant; the appetite and digestion as a rule were
good, diarrhoea rare, but a coated tongue and heartburn were
more frequent. Disease of the heart or vessels was not
observed, but vaso-motor disturbances, palpitation, conges¬
tion, change in the colour of the hair, buzzing in the ears,
dazzling and vertigo were common. In no case was there
collapse. In none was the presence of albumen recorded.

Tremors of the tongue and hands were noted in the large
majority of cases, although they were not excessive. In one
patient, in addition to muscular tremors, there was unequal
sweating on the two sides, and unsymmetrical growth of the
beard. Convulsions were but seldom observed, and then only
in the facial muscles. Inequality of pupils was noticed in a
third of the patients, but it did not last long.

The locomotive power of the patients was good, few being
weak in the legs. All movements were easily executed, and
there was neither cramp of the muscles nor grinding of the
teeth. When symptoms of mental stupor were observed
the form of disorder was either not altogether alcoholic or
there were indications of epilepsy. That the muscular
system participated but little is shown by the rarity of fatigue
on convalescence. Articulation was always good, only
sometimes hurried, never hesitating or thick.

Anmsthesia and analgesia were, when tested, not dis¬
covered. All the senses were marked by their acuteness.
The characteristic symptom of delirium tremens—hearing
evil things spoken—was observed only in one severe case,
in the oldest patient. Diplopia was not present in any
case.

The subjects of acute alcoholic insanity sleep remarkably
well, and if not are easily affected by hypnotics, even when

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they have been painfully excited in the evening. However,
all, sooner or later took doses of opium or chloral; in no
instance did the sleep prove critical, the patients being as
much hallucinated after as before; at the same time it always
exerted a beneficial influence on the course of the disorder.
During convalescence, there was not unfrequently loss of
sleep, partly owing to the suspension of narcotics, partly
in consequence of intercurrent disorders, and still more of
the chronic alcoholism which remained.

Severe headache was, on the whole, rare; there was usually
only a sense of pressure. Dizziness was frequent, and there
were epileptoid symptoms in two instances, and in one a
distinct epileptic attack after taking a bath. This seemed
to have no influence upon the general course of the
disorder.

Of psychical symptoms, the most important were the
illusions of the senses, with the exception of those of smell
and taste. Auditory hallucinations were most frequent,
being present in all the cases. The patients heard mock¬
ing expressions, warnings, reproaches, threatenings, judg¬
ments, orders, exclamations of woe from relations, God’s
voice, quarrels and disputes. In two-thirds of the cases
there were visual hallucinations. Patients saw their ac¬
quaintance, their enemies, ghosts, corpses, heads, forms,
beasts, then fire and smoke with pyrotechnic displays, judicial
proceedings, frightful heads and battles. In half the cases
hallucinations of feeling, mostly of a hypochondriacal
character, were present, e.g., an animal in the body, burn¬
ing and pricking sensations, nightmare, magnetism, &c. A
not uncommon delusion of those labouring under delirium
tremens, that of having snakes in the hair, was observed in
only one case.

The hallucinations were never of a pleasant character,
but the reverse, and often as dreadful as it is possible to
conceive. The patients would often see and hear their
relatives suffering; for example, a man saw his wife flayed
alive, and a dog feeding upon the mutilated body. The
hallucinations had seldom or never any connection with the
previous occupation of the patient. In the same case, they
were generally pretty uniform in their character.

The hallucinations did not always vanish at once, but
became indistinct, faint, and in their place there were sing¬
ing and whistling in the ear, and less frequently foggy vision
before the normal condition was restored.

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In Dr. von Speyr’s cases there was no tendency mani¬
fested to exalted ideas. No one gave himself out to be
greater than the reality. On the contrary, a patient main¬
tained how insignificant he was. There was especially a
marked absence of religious exaltation. If intercourse
with the Deity was maintained, and this happened only
twice, it assumed the form of being charged with sin, or of
doing certain acts as a penance. Not until convalescence
did there come, as with many alcoholic patients, along with
moral weakness, an optimistic valuation of their condition
and their capacity to enlighten others. All the patients
believed themselves pursued, without cause, and punished
illegally and with unjustifiable severity. Almost always
they were pursued by murderers. Death stared them in the
face in some form or other, least frequently by poison, often
by shooting or slaughter, generally with inconceivable
tortures. Several dreaded being vivisected, one being be¬
witched and changed into a dog. The forms of gipsies,
freemasons, judges, and executioners, presented themselves.
One-third of the cases were accused by the police of robbery,
arson, murder, and rape. The law will certainly punish
them; impeachments, judgments, and everything horrible
pass before the patient’s mental eye; nay, he reads at last
the indictment in which his particular sins are recorded.
Such a patient escapes, so to speak, from himself, to justify
himself before the police.

It is noteworthy that these patients do not suffer on their
own account only, but on account of the imaginary dangers
of their nearest friends, and some suffer the greatest anguish
because they cannot help them. This participation in the
sufferings of others is not confined to ' the married, though
naturally most striking with them. Nasse’s observation,
although referring more to chronic cases, is confirmed here.
The married underwent severe sufferings, through fits of
jealousy on account of the infidelity of their wives. With
the unmarried there were sexual delusions of a hypochon¬
driacal character which took the place of the foregoing.
Besides these there were others, as that a portion of the
lung was destroyed; that an animal was gnawing at the
vitals ; that the skin was covered with spots; that the bowels
could not act; and of course electricity and magnetism
played their part.

The anguish such patients suffer expresses itself differently
in different cases. With some it is manifested by excite-

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ment, with others by restlessness. They explain despair¬
ingly to all, especially to the physician, their unmerited
sufferings, and urgently implore protection. Others, who,
as a rule, sleep better, remain quiet and mope alone, are only
alive to their hallucinations; but their expression, distrust,
and disregard for the misfortune of others, betray their
condition.

{To be continued).

PART III.—PSYCHOLOGICAL RETROSPECT.

1. English Retrospect.

Asylum Reports for 1881.

Want of space compels us to deal this year in a somewhat sum¬
mary manner with these publications. We are not conscious that
anything really important has been omitted, but we have made the
extracts and the remarks thereon as short as possible ; indeed we have
avoided making the latter except where really necessary.

It is worthy of notice that at nearly every English asylum the
Commissioners made special enquiries as to the patients confined to
airing courts and those walking in or beyond the grounds. This is a
most important matter, and it is quite evident that it does not receive
sufficient attention in some places.

We would again gently urge the necessity of preparing the reports
with care. Printers’ errors are unnecessarily numerous, the style is
often just a little careless, so much so indeed as to leave the meaning
obscure; and, sometimes, the rules of Lindley Murray are, to the
slightest possible degree, ignored.

Argyll and Bute .—On account of continued overcrowding, the Dis¬
trict Board resolved that a separate building should be erected to
accommodate 126 industrial patients, 63 of each sex, at an estimated
cost of £7,500.

Dr. Cameron reports that the open-door system, which had been in
operation during the previous two years, was about to be extended to
the whole of the institution. Eighty-one per cent, of the men, and 54
per cent, of the women were on parole.

It is remarked in a report by a Commissioner that “ the asylum
furnishes accommodation to 40 private patients, paying low rates of
board, and in this matter it renders a very useful service to the
public. No other district asylum does so much in this direction.”
It would be well if all county asylums in Great Britain did the same.
The inferior class of private asylums would disappear.

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1888.]

(Report for 1882). Daring the last few years there has been a
remarkable increase in the demand for asylum accommodation in this
district. This subject is treated of at some length in the report by
Dr. Arthur Mitchell, who strongly recommends the boarding-out of
all harmless and incurable cases.

Barnwood House .—This hospital continues to exhibit signs of
energetic and successful management under, its able superintendent.
Extensive alterations and enlargements have been completed, thus
providing accommodation for 80 additional patients.

As the question of pensions is now engaging the serious attention
of asylum officers, the following paragraph may be interesting. The
proposed arrangement is a satisfactory evidence that the Committee
of Barnwood House appreciate the necessity of treating the officers
liberally. “ As the establishment increases in importance the num¬
ber of its officials must also increase, and the Committee consider
that the time has arrived when it would be expedient to make some
provision towards a retiring pension for old and faithful dependents.
They are not yet prepared with a complete scheme, but considering
the arduous and frequently repulsive duties which are discharged by
attendants, and the qualities of kindness,'firmness, and forbearance
which must be continually practised, it may be considered that good
attendants are rather exceptional persons, and, after long service,
demand special consideration from their employers.”

There is now an assistant medical officer, and three ladies act as
nurses. The Commissioners report that “ recently a gentleman, after
his discharge from this hospital on recovery, made complaint that his
letters, written during his insanity, had not been kept back from the
post. 1 ’ Surely the duties of a medical superintendent are beset by
difficulties.

Barony Parochial Asylum , Lenzie .—There is nothing new to notice
in this report. The system, now no longer peculiar to Lenzie, con¬
tinues to be developed in detail, and to produce satisfactory results.

The report by Dr. Arthur Mitchell, as the result of his official
inspection, is very interesting. We extract the following paragraph
referring to outdoor employment. His remarks may do good by
directing the attention of asylum officers to the subject. It is most
important that attendants in charge of working parties should work,
and not merely direct. Example is better than precept.

“ The employment of the men in active healthy work out of doors
continues to be a highly satisfactory feature of the management, and
is certainly productive of important benefits to the patients. It was
frequently observed during the visit that the patients do not engage
listlessly, but heartily, and with interest, in what they are doing,
which all of them see to be of a useful character. It is impossible
to estimate the value or extent of the work they perform ; but no one
can see them engaged in it without realising that both the value and.
extent must be great. All the attendants who are with working

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286 Psychological Retrospect • [July,

parties, join in the work, whatever it is, with as mnch energy and
interest as if they were paid for results. It appears, indeed, to be
essential to success that this should be the case. Even the head
outdoor attendant, who has a general direction of all working parties,
puts off his coat like patients and ordinary attendants, and joins
actively in the work. The patients are led to follow example rather
than precept, and it was manifest that a large number of them were
as much interested in the progress of the work in which they were
engaged as any labourers or artisans could be. Indeed, it is held
that unless this interest can be aroused and kept up, the value of the
work done by patients as a means of treatment is greatly reduced. In
other words, it is not always sufficient that a patient shall be in the
open air and doing work. This, of course, is good for him whatever
his condition may be, and for some patients perhaps it is the chief
good, but for others it is far from being so great a good as it becomes
when an interest in the work is developed, and when patients are led
to be industrious for a definite and manifest purpose, the accomplish¬
ment of which gives them a certain pleasure. There are many
patients, no doubt, in whom this interest cannot b$ roused, and who
simply perform in a listless way what they are asked to do; but in
this asylum an earnest effort is made to excite in all patients an
interest in their work, and it is done with much success as regards a
considerable number, among whom are the very patients most likely
to be benefited by it, those, namely, who are under the dominion of
ever present despondency or delusions, from which they escape tem¬
porarily and partially through this interest in their work, and it can¬
not be doubted that such recurring escapes are curative in their
tendency/ 1

Bedford, Hertford , and Huntingdon .—Some trouble appears to have
been caused by the employment of unsuitable attendants. The Com¬
mittee report:—

u Some cases of neglect of duty and of ill-treatment of patients were
reported to the Committee, and the parties complained of were dis¬
missed. One case in February last was of so serious a nature, it
being reported that four male attendants had severely beaten a
patient, that directions were given to take proceedings against them
at the Divisional Petty Sessions at Biggleswade ; they were convicted
and sentenced each to pay a fine of £10 and costs, or in default to
undergo two months* imprisonment with hard labour. Since that
time no further complaint has been made, and the attendants appear
to perform their duties with kindness and consideration/*

Mr. Swain refers to the same prosecution, and at the same time
speaks of the difficulty in securing suitable persons as attendants and
nurses. “ It has been found that some attendants engaged with
good characters, even from other asylums, have been quite unfitted
for the positions they sought to occupy/* It is not surprising that
the applicants from other asylums turned out badly. Good attendants

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1883.] Psychological Retrospect . 287

do not readily change their place of employment. So well is this
understood that not a few medical superintendents refuse all candi¬
dates who have already had asylum experience. In this they act
wisely.

Bethlem Royal Hospital .—In his report Dr. Savage touches briefly
on a variety of subjects, such as the reception of paying-patients, the
seeing of out-patients, &c., but we need only reproduce the following
paragraph relating to a most important subject, the clinical instruction
in mental diseases.

“ During the summer months the classes from Guy’s were in¬
structed four days a week in the wards, and Dr. Rayner used the
rich field of instructive cases for his class of St. Thomas’s men; and
once more I would say that the influence is altogether good, giving
the patients confidence that their cases are being thoroughly gone into,
and that they are medical cases, and not prisoners. As much as
possible other medical men have been encouraged to visit and study
in the wards, and I can say that no investigator, who has any real
interest to serve, has been prevented following his researches here.
The wards of an asylum cannot, in my opinion, be too open to the
medical and scientific world, as we have so much to learn that it be¬
hoves us to seek light from every source. Many new methods of
treatment have been tried, with varying success, the most novel being
a fair trial of the French method of prolonged baths of eighty-five
degrees continuously for eight or nine hours for days together, and in
some cases with some success ; other modes of bath treatment will be
tried, but I fear, until we have increased means, we cannot do it
justice.”

Berkshire , <J*c.—Important additions have been made to this
asylum. In order to utilise the surplus accommodation, and con¬
fer a benefit on the poor middle classes, the Committee very wisely
determined to admit a limited number of private patients. We regret
and are much surprised to learn that only three cases have been
brought to the asylum. It is difficult to explain such a condition of
affairs. It may be that the arrangement is not sufficiently known.
It would be well if every doctor, parish clergyman, clerk of the Guar¬
dians, and relieving officer were informed by circular that patients
of limited means can be received.

Some of the patients discharged “recovered” had been insane for
long periods, and were at one time considered incurable. One man
had been an inmate for four and a half years, another nearly nine
years, and one female close on ten years. She had been for many
years subject to epileptic seizures, but had been completely free from
them for two years,

Birmingham ( Winson Green ),—It cannot but be viewed as a serious
omission that the report by the Commissioners is not printed in this
report.

Bristol ,—A new church, described as an attractive ecclesiastical

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288 Psychological Retrospect. [July,

building, has been bnilt, and is in nse. It is proposed to add the
old chapel to the dining-hall.

The* Commissioner* strongly urge the adoption of continuous super¬
vision of epileptics at night. They even go so far as to say that they
44 mnst regard the neglect of such precaution as directly involving the
medical superintendent in personal responsibility for deaths, to &
certain extent preventive.” After that very strong hint, we would
advise Mr. Thompson to adopt the arrangement. He need not urge
expense as an objection. Most asylum physicians will admit that,
from a purely selfish point of view, continuous supervision is advan¬
tageous. When the best is done, no one can find fault, come what
will.

Amongst the cases admitted it was found that the mortality
amongst patients brought from workhouses was double that amongst
those brought from their own homes. Of 131 admissions, no fewer
than 46 came from the workhouse. Of these 46, 10 died in the year
of admission, that is at the rate of 20’4 per cent.; while those com¬
ing from other sources died in the same period at the rate of 10*6 per
cent.

Broadmoor Criminal Asylum .—Probably no asylum in England
publishes a report on which so much labour is expended. It is im¬
possible even to enumerate the subjects referred to in the 95 pages to
which it extends, but the reader is forced to conclude that the in¬
formation is most minute and accurate, and that the asylum is under
most judicious management and in excellent order. We are glad to
know that the grievous attack from which Dr. Orange suffered since
this report was issued has in a great measure been recovered from.
The following paragraph, referring to the re-admissions, is specially
interesting. It has always struck us as most pathetic that poor
creatures should show such consciousness of their condition that they
voluntarily seek rest and protection in an asylum. To be insane
is bad enough, God knows, but to be insane and know it, is probably
the perfection of misery.

“ Amongst the persons admitted during the year there were five
who had previously been inmates of the asylum. One of these had
been on the first occasion transferred to a county asylum, upon the
expiration of sentence ; another had been sent back to prison; leaving
three who had been discharged out of custody from this asylum. Of
these latter, one was re-admitted at the request of the relative to
whose care he had been discharged, in consequence of relapsing into
intemperate habits ; whilst the other two were re-admitted at their
own request. One of these was a man who in the first instance was
admitted in the year 1870, having been acquitted, on the ground of
insanity, of the murder of one of his grandchildren, and who was dis¬
charged conditionally in 1879 to the care of his sons. Early, how¬
ever, in 1880 he gave himself up to the police, stating that he did'not
feel well enough to remain any longer at large, and asking to be sent

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289

back. The other case was that of a woman who was acquitted, on
the ground of insanity, of the murder of her sister in the year 1861.
She was discharged conditionally in the year 1868, but after an
absence of twelve years she wrote a letter stating that she felt unable
to trust herself, and asking to be taken back. It is somewhat in¬
teresting to find that out of 11 persons who have, since the opening
of the asylum, been re-admitted after having been conditionally dis¬
charged, six of the number have themselves asked to be taken back,
having become aware of their relapsed condition before it was observed
by those around them.”

Cambridge , d*c.—To peruse this report is not pleasant reading. The
entry by the Commissioners is a continued growl; the report by the
visitors is unique for its length and painful minuteness; whilst that
from the late esteemed superintendent, Dr. Bacon, extends to only
two and a quarter pages of large print. There are constant refer¬
ences to sub-committees which appear to do everything except the
medical work.

The Commissioners say :—“ There is much that needs doing within
the asylum in the way of painting, plastering, &e., and in one or two
places a brick needs replacing ; but very much is left till the monthly
visit of the Committee, as we have had the ‘ emergencies 9 brought
before us since the last Committee day, and find the medical superin¬
tendent only puts down the veriest trifles, such as we should have
thought might have been done as a matter of course. We take the
two first and two last items out of the last entry as a sample of what
is entered :—(1) Mend chair ; (2) 2 panes of glass to be replaced ;
(16) Repair bedstead M 3 ; (17) 4 Kitchen tins to be mended.”

This is “red tape ” management with a vengeance, and is calcu¬
lated to excite nothing but derision in men who know how asylum
work should be done. The visitors no doubt believe they are doing
the best they can for the institution, but their best is not good, as the
actual weekly cost was 11s 2d, at least Is per week more than it
should be. Unless it be in Middlesex, we know of no asylum in Eng¬
land where the staff is so in danger of being paralysed by the inter¬
ference of the visitors as Cambridge. Dr. Bacon’s righteous soul
must have been often vexed with this state of things, though in
spite of it he managed to do so much good before he left this world.

Carmarthen .—When a patient in an asylum is found to have
sustained an injury, there is too much readiness shown in official and
non-official circles to blame the asylum authorities. It is too easily
forgotten that some injuries are difficult of detection in the sane, and
infinitely more so in the insane. We therefore direct special atten¬
tion to the following case reported by Dr. Hearder. He and his
officers are to be congratulated on escaping much undeserved blame.

“ In February a woman, aged 67, was admitted suffering from
acute mania, and so violent that no satisfactory examination of her
chest could be made. The following day she was again very violent,

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Psychological Retrospect . [July*

and the combined efforts of several nurses were required to restrain
her. On the third day she was more amenable to treatment, and it
was found she had at least one rib fractured; but even then the
efforts of four persons were necessary to hold her while a fifth applied
the requisite bandage. She fortunately improved mentally and was
able repeatedly to state that she had fallen downstairs about a week
before admission and hurt her side. She died after two months’ resi¬
dence. Had her death occurred before she could explain how her
injury had occurred, the nurses in charge, and with whom she had
struggled the day after her admission, would undoubtedly have
been credited with the injury. After death it was found that the 8th
and 9th ribs on the left side had been fractured. This case is
instructive and important.”

The weekly cost is very low in this asylum. In 1881 it was only
7s. 10^d.—a wonderfully small sum.

Cheshire, Upton .—A large dormitory, capable of accommodating 52
patients (females), has been built at a cost of £1,735. Ten acres of
land, specially suitable for sewage irrigation, have been purchased.

The wages of both male and female attendants have been raised.

A male patient, discharged on probation, committed suicide. Such
events have become so frequent, comparatively, that a superintendent
should pause before he loses sight and control of his patient, but con¬
tinues responsible for his life. There are so few advantages to be
gained by such a form of discharge, and such obvious risks, that it
should be adopted only in very exceptional cases.

Cheshire , Macclesfield .—A woman, whilst absent on trial, com¬
mitted suicide by poisoning.

Dr. Deas refers to the allowance of beer as an article of diet in
asylums, and says : “ Here, as in many asylums, those patients who
do not take beer or object to it are allowed milk instead ; and sup¬
posing beer were abolished, the logical result would be to give milk to
all.’’ That scarcely follows of necessity, for if the diet be ample
milk will not be absolutely required, though it may be given where
liked.

At considerable length Dr. Deas reviews the statistics of his asylum
during the past 10 years, the period during which it has been open.
He devotes special attention to the consideration of the effect of the
4s. grant upon the increase of the asylum population. Whilst many
asylum physicians will have some difficulty in agreeing with his first
conclusion, none will dissent from his last. He considers that the
following general conclusions may be fairly drawn from the figures
and considerations he has adduced :—

“ 1. There seems no reason to believe from the experience of this
district that the tendency of the 4s. grant has been to crowd the
asylum with patients not requiring asylum treatment, but proper to
be kept in a workhouse.

“2. In regard to two unions, while there has been a moderate in-

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1883.] Psychological Retrospect . 291

crease during the last seven years of the patients in the asylum, and
of the admissions, the numbers in the workhouses have remained
almost the same; in another, there has been a slight increase in the
workhouse, while those in the asylum are the same.

44 3. In regard to the union sending the largest number of patients,
while the total number in the asylum and the workhouse has remained
almost the same, there has been a steady alteration in the relative
numbers ; those in the asylum increasing every year, while pari passu
those in the workhouse have diminished.

44 4. The operation of the grant seems, on the whole, to have been
beneficial, by helping to lessen the temptation to detain recent and
possibly curable cases in the workhouses; the good thus effected being
much greater than any inconvenience resulting from the occasional
sending of cases which might have been kept in the workhouse.”

Cumberland and Westmorland .—The new buildings are approaching
completion, a portion being already occupied.

The Commissioners again refer with approbation to the quiet and
orderly conduct of the patients, and attribute it to the large amount
of out-door exercise given, and the avoidance of a too strict classifica¬
tion of noisy and troublesome cases.

44 The census taken during the year affords an accurate means of
finding whether there has been any change in the percentage of insane
chargeable to the rates in the population of these counties at the two
last periods of its being taken. In 1871, in Cumberland, there was
one insane person to every 500 of the population ; in 1881, there was
one insane person to every 523. This is an encouraging state of
matters—an increasing population and a decreasing percentage of
insanity, and this in spite of several adverse circumstances, which I
need not touch on here.

“In Westmorland, however, there has just been the opposite.
There was, in 1871, one insane person to each 520 of population; in
1881 there is one insane to each 414, and there has been a decrease of
826 in the population.”

The report presents a favourable picture of the condition of the
asylum, but not more so than the impression we have ourselves re¬
ceived from going over the asylum with Dr. Campbell some months
ago.

Crichton Royal Institution .—Many important improvements have
been carried out in this hospital and in the Southern Counties Asylum.

There is a seaside residence for the patients in the Crichton. It is
in use for five or six months in the year. During the season about
54 ladies and gentlemen enjoyed a three or four weeks’ stay there.
The house is an ordinary villa; there are no locked doors, and great
liberty is allowed to the patients. Distinct benefit to body and mind
is derived from this most valuable arrangement.

Denbigh .—Large additions have been made to this asylum. A
building for 160 male patients has been finished. A new dining-hall,
xxix. 20

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Psychological Retrospect.

[July,

capable ol eeating 400, is now iu use. A new chapel has been built,
and plans prepared for farm buildings. An excellent year’s work.
The larger portion of the original building is to be heated by hot
water.

Derby. —Dr. Lindsay explains the high death rate, 12*8 per cent.,
by pointing out the extremely unfavourable nature of the admissions,
in 21 of whom, over a third, the admission and death took place the
same year. In a third of the deaths the age was from 55 to 77.

The staff has been increased by the addition of an attendant and a
nurse.

The asylum continues to be in an excellent state, and we speak from
personal knowledge when we say that its efficiency is highly credit¬
able to the superintendent.

Dundee .—The new asylum is all but complete, and is already
occupied by a few quiet patients.

On the last day of the year an entertainment was held of too unique
a character to be passed over in silence. This consisted of a tea-
party, exhibition of dissolving views, followed by dancing, and a special
supper given by one of the private patients on the occasion of his
completing his fiftieth year of continuous residence in the present
building. The venerable host was admitted for the second time into
the asylum on the 31st December, 1831, and his jubilee thus appro¬
priately terminated the festivities of 1881.

We would recommend the publication of the Commissioners* re¬
ports as a part of the annual report by the Committee. Such an
arrangement is usual, and decidedly satisfactory. The Commissioners
may not always be correct in their applause or criticism. Still the
public like to know what they say.

Durham .—A detached chapel is urgently required. The present
chapel accommodation is neither satisfactory nor sufficient.

Twenty-seven cases of typhoid occurred in three months, with only
one death. It is reported that the cause of this outbreak was readily
detected and rectified.

Dr. Smith considers that the best attendants are those who have
been in the army as soldiers or bandsmen, and he attributes the diffi¬
culty of getting suitable persons very much to the length of time they
are daily on duty. Whilst we cordially agree with the latter portion
of Dr. Smith's opinion, and consider the time attendants are on duty
monstrously long, we think that few asylum superintendents will have
found, like him, that bandsmen are, as a rule, good attendants. For
one thing, they change at least three times as often as ordinary atten¬
dants. This, in itself, is a serious objection to their employment in
asylums. There can be no doubt that a good band is a most desir¬
able thing in an asylum, but its maintenance adds largely to the
anxieties of the medical superintendent.

The farm attached is large, extending to 326 acres. No fewer than
231 men work on it.

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Edinburgh Royal Asylum .—This is, as usual, a very carefully pre¬
pared report, and it records a great deal of work. It is the determina¬
tion of the management to greatly increase the accommodation for the
poorer middle classes. To do this about 170 paupers are to be handed
over to the District Board for care elsewhere, and not more than 400
parish patients are to be in residence at one time. It will then be
possible to admit a considerable number of patients paying from £30
to £45 per annum. This will be a great public boon.

Dr. Clouston makes some interesting remarks on periodicity in
insanity, but they are too long for reproduction. So also as to his
treatment of acute and feeble Cases. Instead of stimulants and drugs
he gives eggs and milk, sometimes in startling quantities. Eight
pints of milk and sixteen eggs every day for three months must be
considered heroic treatment. Cod-liver oil is very largely used; so
is quinine.

Amongst those discharged recovered, six patients had been insane
for five years, one for over seven, one over 11, and one over 21 years.

Many structural improvements have been effected, one of the most
important being a new infirmary for female patients. The arrange¬
ments proposed by Dr. Clouston for its administration are admirable,
and we reproduce his remarks in order that his example may be widely
followed.

“ In future it is to be the probationary ward and training school for
all the new female attendants. They are to be sent there for a time
at first to begin their work by learning to nurse the sick, and to look
on all mentally affected patients as really sick. If anything will pro¬
duce a habit of kindness and forbearance, this will be likely to do so,
and I anticipate much good to result to the patients from this training
and initiation of the attendants into their duties. To complete my
idea of the proper working of a combined sick and probationary
ward, we need annexed to it and worked along with it, and under the
charge of the head nurse, a small ward for a few newly admitted,
actively excited patients, not sick in the ordinary bodily sense, but,
from a medical point of view, brain-sick, and needing exactly the same
nursing, feeding, and attention. These patients will need single
sleeping rooms and a small corridor for a day room near, but apart
ffom, the bodily sick. We shall have a large staff to look after such
patients, who will be individually responsible for each patient. Most
such cases have quiet intervals, and then they will be sent to the sick
ward proper. When they would disturb the patients there, they will
be placed in this supplementary annexe. To have many such together,
they would irritate each other, and I could not carry out the principle
of individualization. Therefore six is the most I would wish provision
made for, and I anticipate only to have two or three very actively
excited recent cases. It fortunately happens that on the north side
of the same building we can get exactly the thing I want with small
and inexpensive structural change. The feeling, above all others, I

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would like to instil into our attendants, is that feeling of professional
interest in their work and pride in it, which a doctor has, and which
an educated trained nurse has.”

Fife and Kinross. —No fewer than 21 chronic cases were boarded
out during the year. This has afforded great relief to the asylum
accommodation, and shows what really can be done in this direction
when an effort is made.

Glamorgan. —The infirmary wards have been enlarged, thus greatly
facilitating the nursing and care of the sick. They are now brought
together into one large room, instead of being, as formerly, scattered
over the various wards. This is undoubtedly a great improvement.

The night attendance is good. There are four attendants on each
side. Two have the care of the suicidal and epileptic patients, one of
the sick, and one of the wards generally.

Glasgow Royal Asylum, Gartnavel .—It continues to be directed
with marked success. Pauper patients are being sent elsewhere, and
the accommodation thus obtained is used for the reception of private
patients paying low rates.

Now that the institution has escaped from its financial embarrass¬
ments, a fund is being collected for the providing of pensions to the
officers. This is a most important step in the right direction.

Hants. —Important enlargements are proposed at an estimated cost
of about £12,000.

This is one of the few English reports which do not include that by
the Commissioners. This is an omission it would be well to supply,
though it will be allowed by those who know this well-managed
asylum that official confirmation is not required.

Hereford. —Dr. Chapman reports that: “ Since the early spring
season, it has been the rule for every patient to walk daily (weather
permitting) round the asylum grounds. The only exceptions being
those whose employments involve abundant exercise, or whose bodily
health is such as to forbid it. This habit cannot but have a most
beneficial effect on the general health.”

Such an arrangement does good not only to the patients but to the
nurses and attendants.

Inverness .—Important structural alterations and additions are in
contemplation. These, when carried out, will relieve the over-crowding
of the wards, and remedy the other defects at present complained of.

During the ten years 1871-81, there has been a very marked
increase in the number of patients requiring asylum-treatment.

The sanitary state was anything but satisfactory. Dr. Aitken
reports that “ there was a tendency to the formation of abscesses, an
inclination to the slightest abrasion taking on an erysipelatous form,
and throughout the whole course of the year the establishment has
never been free from erysipelas and diarrhoea.”

We would urge the adoption of the statistical tables recommended
by our Association.

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1883 .] Psychological Retrospect . 295

Isle of Ma?i .—Improved arrangements for the extinction of fire
have been made, but not before a narrow escape from a very serious
disaster. A fire broke out in the female division. Fortunately the
night nurse was at hand and extinguished it before any damage was
done.

The proposed enlargement of the asylum, so urgently required, has
occasioned some difference of opinion between the asylum committee
and a committee of the House of Keys. It is suggested that the
Home Secretary should be asked to name a competent person to
advise as to the amount of accommodation needed, and the most
advantageous mode of providing it.

Kent . Chartham Downs .—In this case also the entry by the Com¬
missioners does not form part of the annual report. We think this
is a pity.

Killarney .—Dr. Woods reports that some much-needed improve¬
ments were effected during the year, but he also points out the abso¬
lute necessity of improving the heating of the building. He says
“ The heating of the asylum in winter has always given much trouble.
It is almost impossible to keep up a proper temperature; and, fre¬
quently, on the coldest days, the fires have to be put out to prevent
an accumulation of smoke through the house. Everything has been
tried to abate this nuisance, but nothing has been of any avail. The
Inspectors have recommended that the wards should be heated with
hot-water pipes ; and I hope, before long, to be able to lay before
you some plans on the subject. I should not be at all surprised if the
works could be carried out so as to effect a considerable saving. Our
present consumption of coal is very large, being three tons a week in
winter.’’

For an asylum containing some 310 patients, we cannot look upon
three tons of coal per week as excessive in amount; indeed, we can¬
not believe our eyes as we read the statement. In table 28 the annual
consumption of coal is given as 347 tons. If that represents the
total amount of fuel burnt, we do not wonder the wards are cold.
Surely peat must be largely used, but it does not appear as an item of
expenditure. We would strongly advise the adoption of the sugges¬
tion by the Inspectors that the wards should be heated by hot-water
pipes.

Lancashire. Lancaster .—A complete system of draining the whole
asylum is nearly completed.

It appears remarkable that when a patient required the performance
of the operation of ovariatomy, it should be necessary to send her to
Birmingham. Was there not in Lancashire one surgeon able and
willing to do it ?

Dr Cassidy reports a curious accident. A male patient was cross¬
ing an airing-court when his foot slipped and he fell. He was unable
to rise unassisted, and on being examined was found to have fractured
a rib, and the skin was crepitant from escape of air from the lung into

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296 Psychological Retrospect. [July*

the cellnlar tissue. He fell on a plane surface, and was said to have
fallen backwards.

Dr. Cassidy has made various changes, with the express object that
the patients may have more freedom, more out-door life, and more
work. His efforts could not be better directed.

Lancashire. Prestwick—We extract the following paragraph from
the Commissioners’ report on this asylum for the purpose of bringing
under the notice of all medical superintendents the importance of
ascertaining the character of the workhouse to which they consign
lunatics when they send them to the union. While we have always
maintained that there are workhouses where incurable lunatics may
very properly be placed, there are others which are totally unfit; and in
any case the greatest care must be taken in selection. We fear, how¬
ever, that patients will be spoilt for the most comfortable workhouse
when the accommodation they have had resembles the hall of a large
country house. The Commissioners say :—

“ We learn that out of the 88 patients who have been discharged
* relieved,’ 71 have been sent to their respective workhouses as fit
cases to be received in them ; but we are not astonished to learn that
many have to be sent back again, having become unmanageable in the
workhouse. A greater change can hardly be conceived than to the
ordinary workhouse day-room from these wards—in the one the rule
being whitewashed bare walls, stone floors, a hard bench to sit upon,
with only at the best a pauper help to look after their wants ; and in
the other well warmed, clean, bright, cheerful wards, filled with flowers,
plants, and ferns, the walls hung with pictures, stuffed benches and
chairs for their use, with attendants accustomed to deal with insane
patients, and able to understand their peculiarities. These remarks,
of course, apply to those workhouses which have no insane wards; and
we fear till marked improvement takes place in arrangements for the
care of the insane of the chronic class in workhouses, so long will they
be found impossible to be dealt with out of an Asylum, and remain at
an increased expense to the ratepayers. The wards and dormitories
here were in the best order, bright and cheerful, and No. 1 Ward on
each side has been completed since the last visit, and bears more the
appearance of the hall in a large country house than the ward of a
Lunatic Asylum. We are glad to observe attendants and patients at
work beginning alterations of a similar character in Wards 2 and 3
on the female side, and when these are finished, the corresponding
wards on the male side will be altered in like manner. It is satis¬
factory to add that all these great improvements are executed solely
by patients’ labour, superintended by skilled artizan attendants, whilst
all the furniture, fern cases, &c., are obtained by the same means, as
well as the busts and pottery which adorn the walls. We cannot too
highly express our gratification at the appearance the wards, even
those occupied by the destructive patients, presented; and we must add
that we are astonished to find that all this is done at a cost of no more

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1883.]

Psychological Retrospect .

297

than 8s. 2d. per week per head. We doubt if any other asylum in
the country has anything approaching to the comfort and even luxury
provided here at such a rate.”

Lancashire. Rainhill. —Dr. Rogers strongly urges upon his
Visitors the necessity of providing a suitably arranged reception ward
for each sex. The advantages to be derived from such an arrange¬
ment are self-evident.

Lancashire. Whittingham. —The annexe is already partly occupied,
and various important additions have been made to gas-works,
laundry, &c.

When some trifling defects have been made good it is expected that
the heating apparatus will suffice, aided by open fire places, to keep
the whole building at a comfortable temperature during even the
coldest weather.

Leicester and Rutland. —The proposal to remove this asylum to
another site has been for the present abandoned.

It appears that there is a difficulty in securing patients to benefit
by the charity fund. We therefore cordially agree with the Commis¬
sioners when they say that they think that if the separation between
the charity and pauper patients were more distinct, there would be no
vacant beds, as the class of applicants would be thereby much
enlarged, many now objecting to degrade themselves by associating
their insane relations with others far below them in social rank.

Limerick. —Important structural alterations continue to be made;
all tending to bring the asylum up to a high modern standard. One
of the Inspectors pays it a high compliment when he says : “ In no
similar institution in this country is there a better supply of clothing
of all descriptions—both personal and other.”

Lincoln. —Important additions have been made to the ward
accommodation, as it had been necessary for some time to board
about 40 patients in another asylum. Warned by a fatal case of
typhoid, the whole sewage arrangements have been modernised with
marked benefit.

Lincoln Lunatic Hospital. —It is reported by the chairman that the
Commissioners say that this Hospital only requires publicity to ensure
its filling. Of this we have no doubt.

It would be well if the trustees published the reports by the Com¬
missioners in full, and allowed the medical superintendent to be heard
in public as is done in all other lunatic’hospitals.

Middlesex. Hanwell. —The Visitors report that during the last
ten years the average increase of pauper lunatics in the county has been
343. Although a new asylum was built less than five years ago, many
applications for admission to Hanwell have to be refused, and the
Committee do not see any way of increasing the accommodation there
to any appreciable extent.

An additional medical officer has very properly been appointed.
There are now two superintendents, four assistant medical officers and

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298 Psychological Retrospect . [July,

an apothecary. Even this medical staff is too small. When the
number and character of the cases under treatment are considered, the
very onerous duties of the medical staff must be evident, especially if
any scientific work is to be done.

Dr. Rayner continues to make special and laudable efforts to employ
troublesome and destructive men. He says : —

“ The roller and pumping parties, at which those are employed who
are too destructive or excitable to be trusted with tools, have been
specially successful. In one instance which may be quoted as an
example, a patient, who for years had been constantly destructive and
violent, since his employment with the roller, has been destructive only
on the days when there has been no work.”

Middlesex „ Banstead .—Important additions have been completed
and others are contemplated for the accommodation of 200 male and
250 female patients.

At the time of the Commissioners’ visit there were 1,701 patients
on the books. The medical staff consisted of the medical superin¬
tendent and two assistant medical officers. We do not wonder at the
very strong expression of opinion by the Commissioners that another
medical officer should be appointed. It cannot be denied that one of
the blots on asylum administration in England is the insufficiency (not
inefficiency) of the medical staff.

Dr. Claye Shaw continues to speak favourably of his plan of asso¬
ciating a certain number of acute and suicidal cases with the chronic
and demented.

Monmouth , $c .—It is extremely creditable to Dr. McCullough that
he should succeed in maintaining his asylum in such a high state of
efficiency at so small a cost.

Tenders have been accepted for the erection of new buildings, and
the work is already in hand. The estimated cost is £42,000.

Montrose .—The following cases reported by Dr. Howden show that
asylum-physicians should never despair of their patients' recovery.
Although we often enough see patients recover after four or five years,
it is very seldom indeed that recovery occurs after 21 years’ residence
in an asylum. But let us live in hope; if we work as scientific physi¬
cians we may yet succeed in imitating the methods of nature and re¬
store to reason some apparently hopeless cases.

Dr. Howden says:—

44 The recoveries (54) are in the proportion of 44 per cent, to the
admissions, 45 had been less than a year under treatment, 6 two years,
1 four, 1 nine, and 1 no less than 21 years. The histories of the last
two cases are instructive. The first was that of a young woman who
laboured under violent mania on admission. She continued in a very
excited state for about six years and then gradually sunk into a con¬
dition of apparent imbecility, from which there seemed little prospect
of her ever emerging. Contrary to expectation, however, in about
eighteen months she began to waken up ; at first her conversation was

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1883.] Psychological Retrospect . 299

very limited and her capacity for work equally so; slowly, however,
her intelligence and former active habits returned, and eventually she
was discharged quite recovered. The variations in the weight of the
body at the various stages of illness in this patient were remarkable.
When admitted she weighed 109 lbs. ; during the first two months of
the excited period she Tost 5 lbs., and continued to lose weight for
long after; Cod liver oil and extra diet were administered, and as the
excitement passed off, and the apparently fatuous stage set in, she
became rapidly very stout, and continued so till her discharge, when
she weighed 1801bs., or over five stone more than when she was ad¬
mitted. The other case was that of a man admitted in 1860, labour¬
ing under deep melancholia accompanied by many delusions. Two
years after admission he was reported to be demented, and it is noted
that ‘ he rarely speaks in 1864 he is said to be ‘ quite demented and
dumb.* In 1868 he appeared to be in the same condition mentally,
but he had begun to assist the attendants in house work. In 1870,
when suffering from pain (as from toothache or colic) he spoke, but
when he got better he was again demented. In April, 1875, he began
to speak in a barely audible whisper, and continued to do so for several
months. His normal power of speech and intelligence were then
gradually restored, and in 1878 he was able to work at his trade in
the Asylum workshop. It was evidently an error to suppose that
during the dumb stage of his illness he was demented in the ordinary
acceptation of the term , for during the latter part of it at any rate, he
did intelligently what he was told, and though he did not speak, he ex¬
pressed his wants by signs and sometimes in writing. On recovery,
thirteen years seemed to have been a complete blank in his existence,
and on leaving, it appeared to him that he had been only six or seven
years in the asylum. His loss of speech did not seem to have arisen
from want of memory of words or their meaning, nor from paralysis
of the muscles employed in articulation, but from a nervous feeling that
he had not the power to give expression to his thoughts in articulate
sounds' 9

The extraordinary thing is that there should have been a complete
blank in the man’s existence ; as there would seem to have been a
state of “ mental stupor with melancholia ” rather than pure H mental
stupor ” alias (so called) acute dementia.

Norfolk .—A fire occurred in the laundry through the overheating
of a drying closet. It was extinguished in twenty minutes, thus
proving the efficiency of the fire arrangements.

The Commissioners comment upon the presence of a large number
of idiot lads in the male wards and express the wish that they could
see any prospect of pauper idiot-asylums being built, where children
might be sent and taught some useful trade.

Northampton .—Dr. Greene is to be congratulated on the very sub¬
stantial increase of his salary. It is unfortunately not every medical
superintendent who receives an advance of £250.

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300

Psychological Retrospect. [Jixly,

Northumberland .—In connection with impending changes in lunacy
legislation, Dr. McDowall makes the following remarks on private
asylums. With these remarks we cordially agree. Simply to ex¬
tinguish them by Act of Parliament would be a great mistake.

“ Important lunacy legislation will soon engage the attention of
Parliament; but as its scope is still unknown, I need not further refer
to it than by expressing a hope that the Lunacy Bill will make some
provision for the care and treatment of the insane of the poorer
middle classes. On them mental derangement falls as a crushing
calamity. The patient possibly loses his business or situation, and
his prospects in life may be permanently damaged. The relatives
necessarily suffer, though in a different way. During his illness their
income often disappears, yet, at the same time, they are called upon
to pay heavy charges for his maintenance in a private asylum.
There thus arises a degree of domestic affliction only to be understood
by those who have witnessed it. A private asylum is in one respect
a business speculation, and the proprietor, of course, does his best to
secure as good a return on his capital as is consistent with his duty to
his patient. To the rich this is no hardship, and it would be a mis¬
take to suppress those private institutions which receive patients from
the wealthy classes. For other reasons it would be a mistake to buy
out the proprietors of middle-class asylums, thereby securing their
extinction. What is wanted is competition. A public institution, if
well conducted, would speedily attract to it all cases in which, as it is
said, money is a consideration, and the inferior private asylums would
disappear. Were the three or four northern counties united into a
district, and an asylum for say 200 patients built at public cost, in
which the charges varied from £1 to £3 per week, the money in¬
vested would in the course of some 30 years be repaid with interest,
and an asylum would be provided which would relieve in various ways
the sufferings of a struggling class of the community

Norwich(City and Borough). —This is the first annual report. Nu¬
merous important and troublesome defects in construction and arrange¬
ment were discovered when the building came into use, but these have
been mostly made good or are in process of being made so.

The Commissioners in their report (1881) refer to twin sisters, one
in this, and the other in the County Asylum. As such cases attract
special interest at present, we should be glad to have their history
published in this Journal in the form of a clinical note.

Nottingham (Borough). —This new asylum is already full, and its
enlargement is under consideration. A detached hospital is to be
erected for the isolation of patients suffering from infectious diseases.

Nottingham Lunatic Hospital (The Coppice). —This admirable
charity continues to be administered most successfully. At the end,
of the year additional accommodation for the care of 20 patients of
each sex was nearly complete.

Oxford .—Although several resignations occurred during the year,

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1883.] Psychological Retrospect. 301

in only one instance is it stated that a retiring allowance was granted.
The head female attendant resigned after 18 years’ service, and the
head laundress after 31 years’ service, but no mention is made of a
pension having been granted to these persons.

Portsmouth .—The dormitories for epileptic and suicidal patients
are now under continuous supervision.

We agree with the Commissioners in considering the wages of the
attendants and nurses too low. Liberal wages, by securing the ser¬
vices of good servants, are, as a rule, true economy.

Richmond Asylum , Dublin .—In remarking on the changes in treat¬
ment which have been effected since his appointment in 1857, Dr.
Lalor congratulates himself on the total disuse of restraint, and that
seclusion and the use of single rooms have almost disappeared.

Contrary to the general opinion, he does not disapprove of the pre¬
sence of idiot children in a county asylum. In connection with his
system of education, and of industrial and recreative pursuits, he
says :—“ I think it right to state that they are carried out on the
same principles, and with the same details that are applied, and have
proved so successful in special idiot asylums, and which are
theoretically and practically suited to all forms of mental defect. The
association thus carried out of idiots with other classes of insane is
not found to have injurious effect on either class ; and I am con¬
vinced, from long experience, that, on the contrary, it is rather use¬
ful than otherwise, and, everything considered, it appears to me that
there is no necessity or advantage in having the treatment of the two
classes of the insane carried out in separate asylums, and the experi¬
ence of this Institution rather supports an opposite view.”

Though we venture to differ from Dr. Lalor in this point, we can¬
not too highly commend his continuous efforts to carry out his system
of teaching in the asylum. The interest of the Richmond Asylum
Schools does not consist so much in the education of idiots as in the
mental occupation of the insane.

Roxburgh , $c .—This asylum being full, it is proposed to discharge
the private patients to make room for paupers. To do this may be a
strictly legal proceeding, but it is to be commended for no other reason.
We, therefore, heartily sympathise with Dr. Grierson when he pleads
for the retention of these cases. He says :—“ At the risk of being
thought importunate, I would venture anew to bespeak a kindly con¬
sideration for this class of cases, for the twofold reason, firstly, that
the relief gained by their exclusion is largely illusory, as partly illus¬
trated in the preceding sentence, namely, that they, at best, are on the
verge of pauperism, and ready, without the threat of removal, to drop
thereto; and secondly, that the stigma of pauperism might be with¬
held as long as possible from the relations or friends who now, by the
exercise of a laudable self-denial, have kept themselves above the level
of their class. I say nothing of the benefit to the asylum arising from
the difference in the amount paid by the two classes, though that now,

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302 Psychological Retrospect . [July,

and in the past, as is well known to yon, has been not a little; and
equally, while it may not be so easily an estimated one, that of hay¬
ing a few of the better educated moving about among us is not with¬
out its influence upon both the directing and directed members of the
household, I have not any doubt.”

Royal Albert Asylum .—A hospital for the treatment of con¬
tagious diseases- is specially necessary in an idiot asylum. Such a
building is now nearly completed here through the munificence of a
gentleman who presented £4,000 for the purpose. The administra¬
tion of this institution continues to be highly creditable to Dr,
Shuttle worth.

St . Andrew's Hospital .—Important alterations have been effected
in the building ; and the asylum property has been added to at the
cost of several thousand pounds.

In his report Mr. Bayley points out that the institution runs the
risk of being diverted from its proper function. It is really intended
for the reception and treatment of acute and curable cases of brain
disease; but at the end of the year, out of 310 patients only seven
males and 16 females could be looked upon as curable. This is a very
remarkable state of affairs.

Salop and Montgomery. —Plans have at length been prepared for
the much needed enlargement and improvement of this asylum. It
is not often that a medical superintendent has to describe, as Dr.
Strange does, “ the machinery, workshops, and laundry in a state of
decay deplorable to behold.”

Great difficulty has been experienced in rearing good attendants,
and several were discharged as highly unsatisfactory. Dr. Strange
strongly condemns the short service men as being entirely unfit for
asylum work.

To relieve overcrowding, 30 patients, not recovered but “ relieved,”
were discharged to the custody of their friends.

Somerset and Bath .—Dr. Medlicott having ceased to be superin¬
tendent, his successor, Dr. Wade indicates in this, his first report,
various changes which he considers will add to the efficiency of the
asylum. His opinion of the effect of the discontinuance of beer is
referred to in “ Notes of the Quarter.”

Staffordshire . Bumtwood .—The supervision of epileptic and
suicidal patients has been improved. By slight structural alterations
it might be made quite satisfactory.

Staffordshire . Stafford .—Twenty-eight acres have been added to
the asylum property. Plans have been prepared for buildings to
accommodate 150 patients at an estimated cost of about £33,000.

Suffolk .—During 1881 the asylum was greatly overcrowded and
its sanitary condition most alarming. Twenty-one deaths occurred
from diarrhoea. This disease prevailed during the year to such an
extent as greatly to embarrass the ordinary working of the establish¬
ment. Effortshave been made to discover the causcof this and other pre-

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1883.] Psychological Retrospect, 303

ventible diseases, but, strange to say, with only partial success. From
the details given by Mr. Eager it seems, however, almost certain that
sewage is percolating into the well.

Plans for extensive enlargements have been prepared, but the
buildings will not be proceeded with so long as so much sickness pre¬
vails. In the opinion of Mr Eager, and we agree with him generally,
the proposed arrangements might be improved.

Surrey . BrooJcwood, —In this report Dr. Brush field takes leave of
his asylum, and briefly reviews his work therein during the 16 years
he held office. It is greatly to be regretted that impaired health has
compelled him to give up the direction of an asylum which reflects so
much credit on his management. His retirement was commented
upon at the time in this Journal.

Surrey . Wandsworth .—Several important alterations and
additions have been made. The chief of these is a chapel with 680
sittings.

Gratuities to attendants for good conduct continue to be, so far as
we know, peculiar to this asylum.

Sussex. —It would appear as if some steps must be taken to pro¬
vide further accommodation for the lunatics of this county. In Dr.
Williams's opinion the present asylum cannot with advantage be further
enlarged. Is Dr. Williams as sanguine as he once was, as to largely
relieving County Asylums by sending harmless cases back to their
friends, and so saving the rates ?

Five acres of land and five cottages have been added to the asylum
property.

In his remarks upon the employment of patients, Dr. Williams
shows that he at least does not neglect this, the chief form of reme¬
dial treatment. It is not improbable that as much as possible is made
of what is done in some Scotch (not to say some English) asylums,
but it does not admit of a doubt that lunacy administration in the
north has given a great impetus to the outdoor employment of the
insane. Were it not from a pretty well founded fear of incurring
official disfavour, some superintendents of English asylums would be
willing to incur greater risks than they do by employing both suicidal
and dangerous patients on the farm.

On the women's side two nurses are boarded by the Committee,
and paid for by a benevolent lady, to train them for attendance on
private mental cases elsewhere. This is a most admirable arrange¬
ment, which might advantageously be imitated in other county
asylums.

Warneford Asylum , Oxford. —This useful charity does not appear
to be as well known as it ought to be, else it would be impossible that
there should have been 15 vacancies at the date of one of the visits
by the Commissioners.

Warwick. —Any remarks by Dr. Parsey on asylum management
demand attention. His is now a long experience, and an eminently

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804

Psychological Retrospect . [July,

successful one. We therefore reproduce the following paragraph
relating to the open-door form of treatment. It is quite true that
the increased liability to serious accidents frightens many men who
theoretically approve of the method :—

“ I have watched with much interest the records of a system of
general treatment which at present finds ranch favour in the northern
division of this kingdom, the leading features of which consist in an
extreme extension of the personal liberty of the inmates of an asylum
by the removal of all locks, fenced airing courts, and other impedi¬
ments to their free movement throughout the establishment, and in
a possibly somewhat overstrained development of outdoor industrial
occupations among them. The results have proved the practicability
of this system; but two elements essential to its success appear to be
(1) an asylum of sufficiently moderate size to enable the chief officer
or his immediate subordinates to have an intimate personal know¬
ledge of the mental and physical idiosyncrasy of each individual
patient under his charge; and (2) a staff of assistants of exceptional
intelligence, vigilance, and trustworthiness. Many of the older
superintendents of English asylums must look back with regret to
the time when the numbers in their own asylums enabled them to
acquire this very desirable intimate knowledge of their charge, but
progressive enlargements, and in many counties to proportions utterly
beyond the possibility of such knowledge being attainable, would in
such institutions stamp with hopelessness the experiment carried to
the extremes attempted in some Scotch asylums.

“ Nor is it yet proved that even in these smaller asylums of Scot¬
land, where the success achieved is considered most marked, the
system is altogether in advance of that long in force in a large pro¬
portion of the English asylums, where, though a very great amount
of personal liberty and of industrial occupation are among the leading
features of management, it has not been deemed desirable to remove
all locks, nor to do away with airing courts as adjuncts to the more
extended exercise of the patients in the general grounds of the
asylum, or in the surrounding neighbourhood. Among the primary
considerations in the care of the insane a due regard for the personal
safety and safe-keeping of themselves, and of the safety and comfort
of their guardians, should be at least concurrent with any extraordi¬
nary extension of their personal liberty and freedom of action; but
in this most advanced movement in the progressive changes in asylum
life a weak point of some gravity is indicated by the much larger
proportion of escapes, accidents, and suicides that have been experi¬
enced than in the system out of which it has immediately sprung, and
of which it may be considered a somewhat advanced development.”

Waterford .—It is a very favourable indication of the system of
management of this asylum that during the year no change occurred
in the subordinate staff except in the case of one nurse, who resigned
on account of illness.

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1883.] Psychological Retrospect. 305

2. Danish Retrospect .

By Dr. T. W. McDowall, County Asylum, Morpeth.

1. Beretninger om den Kjobenhavnske, den Norrejyske, Ostifternes
og den Viborgske Sindssygeanstalt i 1880.

2. Om Sindssygeforplejningen Ude og Hjemme. Kristian Helweg.

3. Om Danmark’s Sindsygevaesen. red Dr. Vald. Steenberg.

1. This small pamphlet of 82 pages is the official statement of the
condition of the Danish asylums. There are no Lunacy Commis¬
sioners in Denmark, but three of the medical superintendents are
Government officials, and the fourth is responsible to the Copenhagen
Commune. The reports contain little but statistical information, and
are not of general interest.

The only fact worth noticing is that all the asylums are full, some
of them much overcrowded. In the report of the St. Hans Hospital,
prepared by Dr. Steenberg, it is noted that the admissions had been
very few, which had been a great comfort, as the block for recent
cases was overcrowded. This building, the Kurhus, is, of course, the
part of the asylum where the inconveniences of overcrowding are most
felt, as many of the patients required special care, and many cases,
although chronic, were suffering from recurrent attacks of acute ex¬
citement, so coi^d not be sent to the wards for chronics until the
symptoms had abated. Although the Kurhus was intended for only
63 males and 74 females, during the last eight years the daily
numbers have been 84 and 87*5 respectively. At the date of the
report a new block was nearly ready for occupation, but it is calcu¬
lated that it will be full in five years.

St. Hans Hospital is the largest asylum in Denmark. During
1880 there were 188 admissions, 116 discharges, and 61 deaths.

The following remarks by Dr. Steenberg on relapsed cases are
worthy of attention, though they may not command unconditional
assent : —

“ Nearly the half—that is, six—of these 13 relapses were caused
exclusively by their own drunkenness. One is rather apt to think
that all brain diseases, and especially all the forms of insanity, are
more apt to recur than diseases of other organs. This is an opinion
which is fraught with much harm and disadvantage to recovered
patients, as people so often fear to take them into their'homes and
service, dreading a sudden return of the illness, even when not the
slightest symptom remains from the former attack. Great attention
should therefore be paid to the fact, so clearly demonstrated year by
year at this hospital, that an acute case of insanity occurring in an
otherwise healthy person can, as a rule, be perfectly cured, so that the
patient is never afterwards attacked by a similar illness; nay, never
afterwards feels even the least reminder that he once was insane.
Further, a considerable proportion of the relapses which do occur are

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306

[Jaly,

Psychological Retrospect .

not caused by the nature of the disease, but by the patient himself,
either because he again finds himself involuntarily in the same
unfavourable circumstances—poverty, loss of work, household cares,
4c.—which produced the first attack, or because he voluntarily resigns
himself to his former evil habits, of which doubtless drunkenness is
the commonest. Of the 13 readmissions, six were, as already stated,
due to drunkenness ; four were hereditary (two of them very markedly
so) ; one was an epileptic ; one caused by love disappointments; one
a case of folie circulaire.”

Although it is undoubtedly advantageous to the patients that they
can be taken to the Commune Hospital in Copenhagen immediately
their illness necessitates their removal from home, and can then be
transferred to St. Hans when the necessary formalities have been
completed, it is distinctly disadvantageous to the asylum physicianSj
as they are compelled to take all information respecting the patient
from one of the hospital physicians, and cannot get it from his own
doctor.

Syphilis is a large factor in the production of insanity, chiefly
general paralysis. In no fewer than 30 of the admissions is this set
down as the cause.

A sad case of suicide occurred. The patient was discharged. When
his son came to remove him he complained of loss of appetite, and
begged to be allowed to remain until he felt better. This was granted.
Three days afterwards he seemed to be cheerful, and said he felt quite
well. An hour afterwards he jumped out of a window in his shirt,
and 11 days afterwards his body was recovered, he having hanged
himself.

There are two features of Danish asylums specially worthy of
notice. One is the presence of clinical clerks in all of them. These
appointments are eagerly sought after, as there are various Govern¬
ment appointments which cannot be held unless the candidate has
had some three or six months* asylum experience. The other feature
is the bathing of the patients in the sea. All the asylums are within
easy distance of the beach, being built close to one or other of those
beautiful fiords so numerous there. At St. Hans the bathing began
on the 27th May, and concluded on the 11th October. That gives 138
days, and in that time 17,404 sea-baths were taken in all—8,208 by
male patients, 7,196 by females, and 2,000 by attendants and others.

2. On the Treatment of the Insane at Home and Abroad .

Although the Commune of Copenhagen has provided adequate
asylum accommodation for its insane, there is great deficiency in this
respect throughout the rest of Denmark. Until 1877 there were
only other two asylums, but they were quite inadequate to the de¬
mands made on them, and though another asylum was opened at
Viborg in 1877 for 300 incurable cases, the relief was only temporary.

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1883.] Psychological Retrospect . 307

At Aarhus and Vordinborg, the two State asylums, only presumedly
curable cases can be admitted,-and these must wait until there is
room, to the great loss and annoyance of all concerned.

It is admitted that more asylum accommodation is required. The
question is, How shall it be arranged ? In this pamphlet it is dis¬
cussed at great length by Dr. Helweg. Much of what he says we
need not notice, as he writes not for specialists, but for the public, and
thus necessarily goes into details with which we are quite familiar.
He also necessarily devotes much attention to the financial aspect of
the question, for in a small and poor country it is highly important
that the buildings should be as cheap as possible, and the cost of
maintenance as low as is consistent with rational treatment; indeed,
Dr. Helweg seems to look for what, we fear, he will never find—a
system which will be self-supporting.

As many acute and troublesome cases are necessarily detained at
home, objectional forms of restraint and seclusion are employed for
the ease and comfort of those compelled to take care of them. So it
has been in all countries, not from any desire to be cruel, but simply
from ignorance and indolence.

•In his sketch of what Danish asylums are and ought to be, Dr.
Helweg, as a rule, confines himself to comparing them with German
ones. This is natural enough, as the races are in many points very
similar—indeed, closely related—so that what works well in one
country will probably succeed in the other. Besides, in Germany
there is now to be found one or more examples of all kinds of asylum
buildings and management.

The State-asylums in Denmark were built for curable cases only,
and the period of residence was limited to one or two years, when
unrecovered cases were discharged and kept in workhouses, gaols, or
any other place where they could be put. In building the asylums at
Aarhus and Vordingborg the idea was that lunatics were patients
whose brains required rest, so the asylums were divided into many
wards, through which the patient had to work his way during con?
valescence. Treatment began by seclusion in a single room; then
came smaller or larger wards, more or less locked up, when the
patient was under strict discipline and gradually re-accustomed to
work. Then came the really convalescent wards, with more liberty
and sane and healthy life and impulses. Such was theoretically, and
is still, the system of treatment pursued when I visited Vordingborg
in 1876, though chronic and incurable cases were allowed to remain,
and the asylums, so far as the population was concerned, had much
the appearance observed in other countries. As has occurred every¬
where, the chronic incurable cases gradually accumulated, and large
additions had to be made to the buildings from time to time. It was
found that the presence of chronic cases, far from being in any way
injurious, was really beneficial in all respects. It was economical,
convenient, and diminished excitement.

xxix. 21

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308 Psychotbgicat Retrospect. [July*

In discussing how to afford as much liberty as possible to the best
class of chronic cases, Gheel and Clenuont are described. The
advantages and disadvantages of these places are carefully pointed out,
but with these we are already familiar. A Russian, Dr. Cyon, is
quoted with evident approbation, who considers that for what they
get for the money, Gheel is two or three times dearer than the dearest
English asylum.

Dr. Helweg approves of the Scotch boarding-out system, and the
residence of harmless cases in attendants’ families, as is done in
some English asylums In speaking of the Scotch system, he
says :—

“ Prof. Jolly, of Strasburg, who has a great admiration for it, says
that as a rule the patients do hardly any work, just enough to pass
the time, and he thinks this an advantage, as those in charge are not
tempted to overwork them. But if we add this quality of idleness
to their other qualities of quietness and docility, and then seek in our
asylums for similar patients, we are in this difficulty, that we cannot
find them, for in all good asylums nearly every patient can be in¬
duced to work, and certainly all quiet, docile patients are very diligent.
I therefore think that if the 1,500 lunatics wandering about idle in
Scotch villages were in asylnms they would be diligent, useful persons,
and I further believe that if we sent our good workers to board in
private families they would deteriorate. If a State desires to do some¬
thing for all its lunatics, but cannot afford to build asylums for them,
then the Scotch system may be very good. In England, where it
met with some scepticism first, it is now spoken of with approbation ;
but in England people seem to have an exaggerated desire to let
patients at all times be as comfortable as possible, and to follow
their own will, be it a sound or an unsound one. In other countries
one seeks another goal—one wishes to keep up the higher faculties
as much as possible even in chronic lunatics, and one of our best
means for this is work, though it may be a medicine very distasteful
to the patients, and one which we must tempt or force him to use.”
Bee the opinions entertained about us abroad 1

The agricultural colonies in Germany are described, especially the
one at Colditz. Its arrangements are praised, and its financial success
much lauded.

The proposal that there should always be a division for recent
cases, where the arrangements are as nearly as possible those of an
ordinary hospital, is sensible, but some of the anticipated results are
too fanciful, and have not been obtainable where the method has been
tried.

The State-asylums remain essentially as they were arranged by.
Selmer in 1847. Dr. Helweg asks if they can be improved, and
answers that the portion for excited and dangerous patients is as
good as can be, but that improvement is possible in the arrange¬
ments for recently-admitted and for convalescent patients; The

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Psychological Retrospect .

condition of the insane in private dwellings also requires attention.
It is estimated that there are about 3,000.

It being admitted that more asylum accommodation is required,
the point at issue is, What form shall it assume ? Shall the old
asylums be enlarged or new ones built ? The latter plan is supported,
and we have the usual sermon about the necessity of small asylums,
so that the doctors may do scientific work. Is it not the fact that in
many cases the best scientific and other work has been done by physi¬
cians in charge of the largest asylums ?

If new asylums are to be built, where are they to be placed. Instead
of advising the country to be divided into districts and an asylum
built for each, it is recommended that asylums for different kinds of
patients should be built—for recent cases, able-bodied chronics, and
hopeless dements—and that an extensive system of transfer should be
carried on, in the belief that change of residence will in many cases
be beneficial. We think that Dr. Helweg greatly overrates the
possible advantages of this method. When Viborg Asylum was
opened he was appointed to it, and went there from Yordinborg
Asylum, where he had been one year. He therefore knew all the
patients, about 110, who were transferred from the one asylum to the
other, and he was much struck by the change it produced in many. The
effect was in general immediate. In some the improvement was
short-lived, but others continued to improve, and became useful
people, and two were discharged recovered. All these patients were
in the lowest stage of dementia.

The so-called extravagance of English and French asylums is con¬
demned, and an incredible story is told about the asylum at Cologne.
It is to the effect that so much was .wasted on a large dining-hall
and church that it has been necessary to restrict the patients’ food !

There are some other points we would have noticed, but space does
not permit. It is evident throughout the pamphlet that Dr. Helweg
has not visited any English or Scotch asylum. If he would do so,
he would find that in them the patients are as industrious as the
Danish, and that they are encouraged to work, not with the object
of saving money, but as the best way to recover their mental sound¬
ness and to maintain themselves in good bodily health. The decora¬
tion and other trifles which help to remove the bareness of a ward, so
conspicuous by their absence in Danish asylums, cost really very
little in English ones. They are largely carried on by patients’ labour,
and are of great benefit in many ways.

3. Danish Lunacy Administration. By Dr. Y. Steenberg.

This pamphlet may be considered as an answer to the preceding.
On many points he agrees with Dr. Helweg. but in others he argues
well, and, we think, successfully, for his own views. This pamphlet
is evidently the work of an able man, one who knows his own work

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810 Psychological Retrospect. [July?

thoroughly, and has used his eyes and ears when he was abroad in
foreign asylums. His views so thoroughly coincide with those pre¬
valent in Britain that we do not trouble to go into them in detail,
but content ourselves by reproducing the following about the open-
door system. It affords another proof of what an able man may do on
his own responsibility, without any official assistance and patronage,
as has occurred in Scotland. The only point in which we differ from
Dr. Steen berg is as to the position of his farm and auxiliary asylum.
One mile (that is, three English) is unnecessarily far away. A
quarter of an English mile is quite enough. Witness the detached
building at Wakefield, Ivy House. There the men enjoy as much
liberty as if they were 100 miles away from the parent asylum. We
cordially approve Dr. Steenberg’s system of detached blocks, though
we would not put a dining-hall in a sunk flat. It permits of
systematic classification, a point in which all asylums fail, to the great
curtailment of the amount of liberty accorded to many patients.

“ 1 Closed asylums are but gilded prisons for our patients.’ This
is perfectly true. I suppose that nowhere is so much misery congre¬
gated as in an asylum, and yet in all the years I have been connected
with asylums nothing has ever awakened my sympathies so much as
the daily sight of so many persons deprived of their liberty. For a
long time I could not reconcile myself to the thought of the justice,
the necessity, of depriving all these quiet, harmless people of their
liberty, and after experience had taught me that even the best
patients required a certain amount of supervision and control, I have
looked upon it as one of my life’s chief objects to let them feel this
control as little as possible, and to give them as much liberty as
possible. Owing to this division of curable and incurable I have been
able to give those patients most suited for it, the chronic, so much
liberty that I can say that St. Hans is not surpassed in this respect
by any other asylum in the world.

“ All mixed asylums consist of various wings, so constructed that
they form one continuous whole. They are cut off from the rest of
the world by enclosed gardens, so that no one can approach a ward
without permission. . . . All these arrangements are excellent for
acute cases, and are carried out in our * hospital,’ but are quite unne¬
cessary for chrorfic cases, increasing the prison-like appearance of their
dwelling. Therefore, in the annexes no gatekeeper is required, for
the gate is always open ; anyone can enter the grounds without being
questioned, and every Sunday during summer the hospital is passed
by many without being stopped by an attendant. The front of all the
annexes looks upon the high road, so that the patients can see, and
partly be seen by, all the passers, which to many patients is no small
pleasure. A foreigner once came up to me and told me that he only
knew asylums from descriptions in English novels, so he had been
under the impression that they were privileged gaols, which, of course,
contained some lunatics, but also a good many who were kept to con-

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Psychological Retrospect.

311

ceal some crime, but that now he was of a different opinion, at least
in regard ter St. Hans, because, without asking anyone’s leave, he had
walked about, and could have spoken to many patients if he had been
able to understand their language.

“ Dr. Helweg says :—‘ Here at Aarhus the industrious, quiet
patients, capital workmen, among whom escapes are rare, have to
pass through three or four locked doors to go to and from their work.’
Here in St. Hans the same class of patients (about 120) need not
go through a single locked door. These patients pass their leisure
in a large finely-wooded garden, surrounded by a low, light railing,
to which the doors are not locked, neither the one leading to the
ward, nor the one leading to the field. As to escapes ? Of course a
patient does escape occasionally, but not more frequently than from
the mixed asylum, and these escape from the wards which should be
the safest, by reason of locked doors and a large number of attendants.
It is well known that a lunatic’s cunning and perseverance render
him more difficult to guard than a sane man. I have had patients
whom I could not prevent from escaping, until, fairly wearied out, I
have transferred them to an open ward, where he had every oppor¬
tunity to escape, and this confidence formed a chain he never tried to
break. In England the open-door system is struggling to prevail;
indeed, one English superintendent demands that an asylum should
have no lock whatever, a proposition which only an Englishman could
make. A Danish physician (not in asylum-practice) advised me to
strive to attain so far that no lunatic should be sent to an asylum
against his wish, and only the absolutely dangerous lunatics should
be detained against their wish. We all agree that this would be very
desirable, and I do not doubt that in the not far distant future this
hope, somewhat modified, will be fulfilled. We all demand liberty
for ourselves and fellows, and, as far as possible our insane should
enjoy it.”

PART IV.—NOTES AND NEWS.

THE MEDICO-PSYCHOLOGICAL ASSOCIATION.

The Quarterly Meeting of the Medico-Psychological Association was held at
Bethlem Hospital, on Friday, 18th May, at 5 p.m. Dr. D. Hack Tuke presided,
and there were also present:—Drs. A. J. Alliott, D. Bower, T. J. Compton,. W.
Clement Daniel, Bonville Fox, S. Forrest, J. Fenton, G. G. Gardiner, W. R.
Haggard, O. Jepson, W. J. Mickle, F. Needham, H. H. Newington, W. Orange,
J. H. Paul, W. H. Platt, H. Rayner, W. H. Roots, G. H. Savage, H. Sutherland,
H. M. Sutherland, D. G. Thomson, C. M. Tuke, E. S. Willett, Ac.

The following gentlemen were elected members of the Association, viz.

J. Wiglesworth, M.D.Lond., of the Rainhill Asylum j W. H. Macfarlane,
M.B., Medl. Supt. of the New Norfolk Asylum, Tasmania j Robert Blair, M.D.,
Woodilee Asylum.

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312 Notes and News. [July,

Dr. Sutherland read a paper “ On Prognosis in Cases of Refusal of Food/'
(See Original Articles.)

Dr. Hack Turk, in inviting discussion upon the paper, remarked that
although the main subject was the prognosis in cases of refasal of food, yet
the other points to which Dr. Sutherland had referred—the mode of adminis¬
tration, the cases in which it should be given, Ac.—were points upon which
practical men present ought to be able to give most useful hints.

Dr. Gardiner said that the refusal of food might be from two causes—
from excessive obstinacy, or from some disordered condition of the stomach
itself. Of course, in the first case it was absolutely necessary that the patient
should be fed till he became better, and the obstinacy was overcome. As re¬
gards a disordered condition of the stomach, all nervous cases suffered more or
less from dyspepsia, which sometimes arose from the injudicious use of alkalies.
In certain cases the administration of alkalies was absolutely necessary, and
they had all experienced the value of alkalies; but they most be always con-
scions of the fact that in cases of low nerve-power, the administration of alkalies
would tend still further to lower the vitality. At the same time, they could
not do without them. In the treatment of feeding-caseB, he made it a great
point to determine whether there was flatulency in the stomach. They could
not always tell by touching the stomach, but there was an appearance which at
once determined the presence of flatus, viz., a distension of the stomach :
they would notice a kind of pyriform distension arising from the ensiform
cartilage, and extending three or four inches down. It was the object of every¬
one to avoid feeding cases. He had often contented himself with the passing
of a tube down, for the passing of the tube was frequently followed by a large
expulsion of wind, quite enough to blow out a candle. That was plain proof
that the stomach was pre-occupied—that it was so distended with flatulency
that the patient had lost all desire ; or even if he had the desire, his repug¬
nance to increasing his pain would be so great that he would refuse food on
that account. He would, therefore, strongly urge the passing of a tube three
times a day, and encouraging the patient to take simple food, such as milk.
And here he might say that he was in the habit of preparing his milk by sus¬
pending in it a lump of suet the size of an egg in a piece of muslin, and boil¬
ing it for ten minutes, which made the milk richer and more sustaining than
milk alone ; besides which the greasy nature of the milk would be more grate¬
ful. He had, in cases of acute dyspepsia, given milk of this kind with great
benefit. But, having ascertained that the intestines and the stomach were
loaded with flatus, what course was to be adopted ? Of course, there was
extract of belladonna, small doses of aloes or aloln, Ac. They had to increase
the peristaltic action of the intestine by which the flatus might be discharged.
The various mineral waters might be given with very great advantage, but
they were too strong—too gross a remedy—to be given in delicate cases. He
had found a single teaspoonful of carbonate of magnesia, given in a tumbler
of warm water, do much good.

Dr. H. H. Newington said that he had found the sex to be the greatest aid to
the prognosis. Many no;e incurable cases arose in the male than in the female.
It would seem that when a man did take to refusing bis food he did it with
some object, whereas a woman would do it with no object at all—perhaps
simply hysterically—and often after a time would give in. As regards the
administration of food, people were too prone to administer the old round of
beef tea, egg and milk, Ac., leaving out lime juice and other things.

Dr. Rayner considered that they ought to pay due attention to the mental
condition as well as to the mere physical state. They should endeavour, for
instance, to find out whether a man refused food simply in obedience to an
hallucination—as the result of an hallucination of taste—or whether he had
some illusion dependent upon the physical condition of his stomach—or whether
it was simply an abeyance of appetite as in melancholia—whether it had been

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Notes and News.

313

from actual anaesthesia of the nerves of the stomach—or whether it was the
refusal from hysteria or from senile causes. All those considerations appeared
to be of as much importance in forming prognosis as the physical conditions
which had been dwelt upon. In regard to Dr. Sutherland’s point as to the loss
of flesh, he (Dr. Rayner) had had several cases which had become emaoiated
to the last extremity, and yet recovered. He remembered a woman at Bethlem
who had been fed with the stomach pump for three years, and who for
eighteen months of the time had certainly been a mere walking skeleton, and
yet she recovered. Then again, where Dr. Sutherland had contended that the
prognosis was bad when the patients gained flesh under the treatment, he could
certainly call to mind cases of this kind which had recovered completely. Of
course, as regards those slight cases which give up their refusal after they have
been fed once, there could be no doubt that the prognosis would be good, and
that their refusal was not founded upon a very firm basis. Dr. Newington’s
suggestion that the refusal of men was more stubborn than that of women
was certainly borne out by his own experience. When he went from Bethlem
to Hanwell he could not help being struck by the difference in regard to the
food-refusal cases amongst the pauper insane, as oompared with what he had
been accustomed to at Bethlem. This difference was very striking, and he
had no doubt that it was due to some extent to the degree of education—the
more educated brain—when it did have a delusion—adhering to the delusion
more firmly. With reference to the treatment of cases of refusal of food, he
hid a very strong feeling that rest in bed was one of the most potent elements
of success in the early stages. He did not mean to say that if a patient had
been refusing food for a long time, and had established a thorough habit, that
this would have much effect; but in ordinary cases rest had a most important
influence. He always took it that mere refusal of food indicated rest; and he
had foimd the remedy so successful that he had been to a great extent able to
do without the stomach pump.

Dr. Hack Turk —How do you treat patients with acute excitement where
you cannot possibly get them to rest in bed ?

Dr. Rayner —In such cases we get the nearest approach to rest, by absenoe
of light and sound, and the use of a padded room.

Dr. Savage said that to give a prognosis from one symptom was scarcely a
scientific way of doing. In the case of a patient refusing food simply be¬
cause he was suffering from phthisis—if the refusal were associated with some
morbid feeling associated with phthisis, the prognosis would have nothing to
do with the refusal to take food. Taking, too, what he called “ aldermanic”
cases with “herring-gutted,” he should not like to say that one class of case
was more curable than the other. The point of giving alkalies was note¬
worthy. There were a great many cases who refused to be fed because they
could not, or would not, retain their food. No sooner was it passed into the
stomach than jt was returned. Immediately the operator passed the tube he
received in his face the vilest smells.. Their old attendants said, “ You oan
never do any good with that case. You should have smelt what came out of
their inside. They are rotten inside.” He would be inclined in such cases to
try some antiseptic, washing out the stomach first. In cases of prolonged
feeding, he thought that many of the hysterical cases, having been got up to a
certain weight, ought to be told that they would not be fed. Certainly,
good sometimes resulted from refusing to feed. There was a mathematical
master, a patient at Bethlem, who had got to like being fed, and actually
used at last to mix up his own food; till one day, when the patient had
got everything ready, Dr. Savage told him he should not be fed any longer,
and that he would have to wait until he could feed himself. The patient only
waited twenty-four hours. A great many patients were fed too lon^. At
Bethlem they made a point of varying the feeding as much as possible, feeding
sometimes by the nose, sometimes by the bowel, sometimes by the spoon, and

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Notes and News.

[Juiy ;

then neglecting them for a time. He was acre, that the insane were very

plastic, and got readily into habits. They would be very glad, as far as the

Journal was concerned, to have cases in which organic disease had been found
as the cause of the refusal to take food. They rarely got such cases.

Perhaps once a year one would get a case in which they might think they

oould trace the cause. He had only onoe seen cancerous disease in this con¬
nection. He had seen ulceration of the duodenum associated with gall stone.
It would be extremely important to get a well-marked case in which organic
disease, such as cancer, was the caqpe. He would also like to know whether
anyone there had tried the artificial foods—say peptonized foods.

Dr. Mickle said that the oonclasions Dr. Sutherland had drawn would be
borne ont by the experience of the majority of those present. There was one
point in the paper which he had particularly noticed. He had understood Dr.
Sutherland to say that the prognosis was bad if the patient increased fn
weight. He most say that that was not in accordance with his own particular
experience. He remembered one case in which a patient refused food, and
had to be fed. In three weeks the patient had gained eleven pounds in
weight (and in all these cases it was very important to frequently weigh the
patients). He (Dr. Mickle) said “I shall go on feeding you till you are so fat
you cannot move/’ The patient immediately ceased refusing his food, and got
on well. There was many a general paralytic who refused his food, but ceased
to do so immediately after a good aperient injection. The condition of functional
or of organic disease of the intestines or stomach was one that was not at all un¬
commonly present, whether in cases of general paralysis or in other cases. He
had met with several cases in which organic disease existed. This brought them
to a fresh point, viz., that in those cases where there was such functional or
organic disease, there was no use in putting a large quantity of food into the
stomach and expecting the damaged and diseased organs to do the usual
amount of work. The food should in those cases be extremely digestible. It
should be varied. Potatoes and lemon juice ought to be added to it. In his
own practice he was accustomed in all cases, where there was such functional
or organic disease, to peptonize part of the food by the method of Dr. Roberts,
of Manchester; not peptonizing all the food, but giving partly peptonized
and partly unpeptonized, thus giving the organs some work to do, and also
affording to the blood vessels and lacteals a sufficient supply of nourish,
ment.

Dr. Hack Tuke asked Dr. Mickle what form he was specially referring to in
the case of organic disease.

Dr. Micklk replied that he referred more especially to ulcerated and
inflammatory conditions.

Dr. B. Fox said he should like to know whether Dr. Sutherland had any ex¬
perience in regard to the presence of diarrhoea. As respects organic disease of
the stomach causing positive refusal of food, he supposed that the statement
might be almost received that nearly every lunatio was dyspeptic, which con¬
dition might in one case cause mere disinclination to the food, and in another
case absolute determination to resist all food at all, therefore it was a good
thing if they could adopt any plan by which this could be rectified. He had
occasionally seen instances in which it had been done. Sometimes the condi¬
tion had been one of chronic dyspepsia, in which the acids and nux vomica had
done good. As regards Dr. Sutherland's very interesting propositions, he
should like to know whether his cases were quoted as instances, or were they the
cases on which his propositions were founded ? He thought that the increase
in weight was not an ominous sign, but rather the contrary. Surely it was an
indication that absorption was taking place. He presumed Dr. Sutherland
meant superabundant gain; the extraordinary amount of fat that certainly did
become accumulated. He would like to ask Dr. Sutherland if he would not
modify his statement that mere gain of weight was bad.

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Notes and News.

315

1883 .]

Dr. Hubqabd quoted a case which had an important bearing upon the anb-
jeot under discussion, though it was of even greater interest from various other
points of view. A lady between 40 and 50 years of age had an attack of
melancholia, accompanied with cataleptic tendency. She refused her food
from the belief that it was poisoned, and on several occasions it was neces¬
sary to use the stomach-pump. At this time the speaker, impressed with Dr.
Hack Take’s paper on hypnotism, and Tamburini and Seppilli’s experiments on
the same subject, had recourse to this agent. The dangling of a bunch of keys
for a few minutes before the patient’s eyes brought on the hypnotic sleep.
While in this state any idea suggested was believed, and commands were
obeyed. She was ordered to eat, and she ate. She was ordered to drink, and
she drank. She was ordered to go through various quick movements, and she
did so. She was told that she was the happiest mortal in the world, and was
desired to laugh. Her face lighted up; an unaccustomed smile came upon
her lips; the croaking noise of unwonted and almost forgotten laughter was
heard, which soon, however, with practice, softened into more natural sounds.
Hypnotism was employed, off and on, for a week, and was then discontinued
lest a habit should be formed. But during the employment of this measure,
marked improvement was observed, which had since continued, and now the
lady was convalescent. In this case a new device was adopted to compel the
ingestion of food. But more than this, an opportunity was afforded of reach-
ing and exciting to action long disused nervous channels. Dr. Savage had
asked a question as .to the use of artificial foods. He (Dr. Huggard) had seen
an account given of peptonized foods by an Italian observer. That gentleman
found them very valuable for forced feeding, but expensive.

Dr. Mickle said there was no exceptional expense in peptonized food. It
could be obtained at very little expense. It only cost a few shillings beyond
the cost of the food. A few shillings’ worth of the material would last a good
many days.

Dr. Hack’ Tuke said that there was an article in the Journal several years
ago on nutrient enemata by Dr. Needham who was present, and he should like
to know whether he had still recourse to them frequently.

Dr. Needs am said that he had. It was a serious business to begin feeding.
In a considerable number of cases, however, the stomach was in that state that
it was extremely irritable, so that there was retching and ejection of the food j
or the stomach was in a filthy condition, and could not possibly digest it. In
such cases he thought it important to sustain the patient by nutritive enema,
4ozs. of strong beef tea, with a small quantity of whisky six times a day. He
had found no difficulty at all, the patient being held down, and using a short
Clastic tube and a 4oz. enema syringe.

Dr. Hack Tuke asked Dr. Needham if he found that mode of feeding more
or less easy than feeding by the mouth.

Dr. Needham said it was easier; but of course he would use it in those cases
in which there wae a difficulty in feeding by the mouth, and where retching
would take place which would not go off.

Dr. Hack Tuke said they had had a very interesting discussion. The remark
had been made that the lunatic was frequently dyspeptic. Unfortunately
dyspepsia was not confined to lunatics. In many of the cases in which there
was an excess of flatus in patients, that condition might have existed before
they became insane. Very likely in many sane persons if a tube were intro¬
duced into the stomach there would be considerable expulsion of wind. His
own impression of Dr. Sutherland’s paper was that the prognosis was too un¬
favourable. He could not but think that the patient who refnsed his food was
in rather a poor way. If he lost flesh, Dr. Sutherland told them the prognosis
was bad. If he gained it was also bad. So, what could the unfortunate
patient do ? However, the author’s remarks must not be taken too literally.
He quite agreed with Dr. Savage that they should not be guided, as regards

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316 Notes and News. [July,

prognosis, by one symptom only. He would now call upon Dr. Sutherland to
reply.

Dr. Sutherland said that, first with regard to Dr. Gardiner’s remarks, it
was quite true that refusal of food did very often arise from physical causes,
but they must not go to physical causes only. They must also take into con¬
sideration the mental causes of the refusal of food before they determined
whether they were to feed him or not. In reference to another physical point,
they might say that the patient’s breath was an indication. If the breath had
the peculiar smell indicating that the coats of the stomach were decaying,
there was no time to be lost. He himself always carefully watched them
for twenty-four hours. During that period he would be guided by the
condition of the pnlse, and by the previous history of the patient. Dr. Newing¬
ton had suggested that they were not to feed by routine. He thought that a
very power!al man blight be shamed by constantly feeding by the rectum. He
would, however, like to recommend pearl barley as being a good thing, through
the nasal tube. It dissolved in the hot beef tea, and in that way they might
get a good food. Dr. Kayner had told them that they ought to ascertain the
cause. He did not think that he could be accused of not having ascertained
the cause, as would appear from his investigation of the case where there was
the obstruction, but it was quite impossible in a paper like the present to take
every point. As regards Dr. Kayner’s case of emaciation which recovered,
that, he thought, must have been an exceptional one. Several speakers had
remarked upon his point that if a patient gained flesh it was unfavourable, but
it was only so with regard to the patient’s recovery of mental power. Of
course a fat patient was much more likely to live long than a thin one. As
regards Dr. Savage’s rather severe criticism with respect to his (Dr. Suther¬
land’s) taking the refusal of food as the one symptom only, he wished to say
that he took refusal of food as the subject of his paper because he wanted
to find out by prognosis whether such and such a course of treatment was
warranted or not. Of course, taken by itself, it was insufficient; but he
thought it was a good sort of peg or stand-point on which to found his re¬
marks. Dr. Savage and others must remember that private asylum pro¬
prietors were placed at a very great disadvantage with regard to statistics.
They had not so many patients to try their experiments on, and they had cases
of a different class to deal with. He would not say that one life was more
valuable than another, but it was quite certain that if a patient died in a
private asylum there was a great deal more said about it than in a public
asylum. Dr. Savage had spoken of a man who seemed rather to like being
fed and wished to be fed. He himself had a lady patient whom he had to feed
with the mouth tube, and she liked it very much. On the second oocasion he
attempted feeding with the nasal tube, but it did not succeed. He passed it
down, but could not get it to the stomach. However, it had such a good
effect upon the patient that she recovered. He quite agreed with Dr. Savage
as to varying the feeding. As to Dr. Needham’s remarks, undoubtedly injection
by the rectum sometimes had a good moral effect. With regard to Dr. Fox’s
cases of diarrhoea complicated by food refusal, he had himself had such a case
—a lady whom he had to feed artificially, but she died. He had used sulphate
of copper pills, a very good remedy. Dr. Fox had asked him whether the
propositions were taken from the cases or the cases from the propositions.
He might say that the propositions were taken from the cases, but they were
typical cases. As regards Dr. Huggard’s statements, he had a hysterical case
at the present time. Dr. Needham had said—Do not feed too soon. He quite
agreed with that. As to violent cases, that was a most difficult point. The
most violent case he had had was that of a general paralytic, complicated with
phthisis. He could not feed him by the nose. He tried by the reotum, but
the attendant got it in his face. Then Dr. Hack Tuke made some remarks
agreeing with those of some other speakers, that was to say, with regard to his

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Notes and News.

317

founding a paper upon one symptom. His object in so doing was to
find out, if he possibly oould, some indication for feeding, although, as he had
said before, it was impossible to take one point like refusal of food as either
indication for treatment or prognosis. However, he hoped, if only from the
discussion which had been elicited, that they had had some fresh light upon
the subjeot.

Dr. Hack Tuke having expressed the thanks of the meeting to Dr. Suther-
land for his interesting paper, informed the members present that arrange¬
ments had been made for their dining together at eight o’clock. He suggested
that it would be desirable that an opinion should be elicited as to the best
time of the day for having their quarterly meetings. Probably those who
were present would be more likely to give an opinion next time, but if there
was any gentleman present who thought there had been an error made in
fixing five o’clock as the time of meeting, and who wished to propose any other
time, he hoped he would do so. No member responding, the meeting adjourned,
Dr. Tuke remarking that the present occasion would be regarded as an
experiment.

A Quarterly Meeting of the Medico-Psychological Association was held in the
Hall of the Faculty of Physicians and Surgeons, Glasgow, on Wednesday, 18th
April. There were present Drs. W. W. Ireland (chairman), Clouston, Yellowlees,
Wallace (Greenock), Alexander Robertson, Carlyle Johnstone, Clark, Rutherford.

Dr. Clouston read a paper on “ Senile Insanity.”

Dr. Ireland said that it was needless to take up time in praising the paper
which had just been read. They all thought very highly of Dr. Clouston, and
this would add to his reputation. He had derived much instruction from the
paper ; but as their time was short enough for their programme, he would only
refer to a few points which seemed to him to have been passed over. He had
not Dr. Clouston’s opportunities for studying senile insanity, but like him he
took a kind of pathological interest in such forms of senile derangement as were
met with in the world. He wondered that there was no reference to the moral
degeneration of old age. It was long before he noticed this himself, having been
in early youth prepossessed in favour of senility by reading a paradox called
Cicero de Senectute. What first opened his eyes was a passage where Sir James
Paget, in his Hunterian Oration, spoke of “ those forms of senile degeneration
in morality against which all men growing old need to guard.” None of us liked
to go, and we could not stay here without becoming old, and so he had an un¬
easy feeling that he might pass into that mental stage which would render one
liable to having papers written upon him, but he would not suppress his convic¬
tion that Paget here spoke the truth. There was a saying “ that the good die
young.” However this might be, the verse of Burns sometimes occurred to
him—

O ! why has worth so short a date.

When villains ripen grey with time ?

Before that, he had been much perplexed by the behaviour of some old men, but
after reading the passage quoted, the truth dawned upon him. They all knew
that there were many good old men, but as years went by there were hardening
and demoralizing tendencies which made some worse in old age than they
were in youth and middle life, and which might culminate in insanity. He
thought senile derangement was often accompanied with well marked changes in
the handwriting, and he had collected and compared specimens of this kind of de¬
generation in the writing during several years. Dr. Clouston had referred to
some races who aged rapidly ; among these he would place the Ceylonese and
the Bengalis.

Dr. Robertson — I think the whole paper very instructive and valuable. Dr.
Clouston has brought out by his statistics, very forcibly, the striking fact that

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[July,

senile insanity is by no means so incurable as is by many supposed. The re¬
coveries were under 76 years of age, but there were cases even above that age.
This corresponds with my own observation. While he spoke I was reminded of
a case of mania which occurred last year in a man of 76; he was sent to
Greenock Asylum and brought back recovered after six weeks. He is now in a
state of ordinary senility, and is an inmate of the poorhouse. In reference to
the opinion that the occasional appearance of increased misery in certain aged
melancholiacs was indicative simply of organic uneasiness or pain, and did not
show that there was a corresponding mental state, I would venture to express a
doubt, especially as a tendency to suicide was stated to have been manifested.
It could not be easily established that there was not an actual increase of mental
suffering in these cases, while the paroxysm lasted, though it seemed to have
been of short duration.

Dr. Yellowlees —I have always felt interested in this type of insanity, as it
is one of those forms which can be definitely separated from the mass. Evidently
the vascular changes and the insufficient nourishment are the essence of it.
The recurrence of the attacks is specially interesting. I have under my care, at
present, a lady over 70, whose friends, by my advice, tried to manage her at
home, but utterly failed. She is extremely restless, refuses food, has delusions
of poisoning, and requires to be fed by the tube four times a day. She has been
twice insane since she was 60, and recovered on both occasions. This makes the
prognosis more hopeful in the present attack. [This patient, we learn, recovered
perfectly within a month.] Recovery in senile insanity is interesting from the
statistical side. I take a different view from Dr. Clouston of what constitutes
recovery. I must be able to certify patients sane before I class them as recovered.
Normal senility is surely different from normal mental health. The articulation
in some forms of senile insanity resembles that of general paralysis. The bone
compensation for brain-atrophy is unquestionable and very interesting.

Dr. Alex. Robertson read a paper “ Recovery from insanity of seven years*
standing ; treatment by electricity.”

Dr. Ireland was glad to listen to a paper on therapeutics which he regretted
was a rare thing at their meetings. It seemed most disappointing to think that
so little new was done in thiB direction, when they knew that the brain was
readily acted on by drugs, and that through the application of cold and heat as
well as electricity they could so readily influence the circulation within the
cranium. He remembered at a former meeting of the Association, held in the
same room, hearing the results of Dr. Robertson’s experience in the use of cold
and hot applications in nervous diseases. It had been proved by experiment that
we could, by passing the continued current through the brain, cause contraction
of the capillaries, and with a greater strength cause their dilatation. He thought
that this was owing to the direct action of galvanism upon the brain, though it
was possible that by acting upon the sympathetic nerves we could influence the
cerebral arteries. He had himself entertained great hopes of electricity as a
therapeutic agent in insanity, and had made some experiments both in imbecility
and insanity. He would have published his experiments, but they were incom¬
plete, and he never succeeded in achieving a success like that of Dr. Robertson.

Dr. Clouston said that his experience of the therapeutical value of electricity
had not been great. Dr. Inyasevsky, a Russian, medical officer of the asylum at
Kazan, in Eastern Russia, was recently at Momingside and spoke of his experi¬
ments. He had an apparatus for measuring the current. He found that the
weaker currents were most effective, and rarely used above five cells. He had
the greatest faith in the efficacy of this treatment, particularly in its stimulating
influence in cases of melancholia and stupor, as the result of his extensive ex¬
perience.

Dr. Robertson, in reply, said that he did not attempt to theorize on the v
action of the current, whether that were through the sympathetic on the vessels,
or directly on the tissue of the brain. He did not try to estimate the amount of
the electricity; this is tedious and difficult to do correctly. He simply increased

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1883 .]

the strength of the current till the patient felt it unpleasaut, her feelings being
his guide. He found that in the early stage of treatment a current from 15 to
20 cells could be home, but latterly one of ten cells was sufficient.

Dr. Campbell Clark read “ Notes (a) of a case of insanity following
alcoholic excess and lead poisoning, (2) of three cases of phthisical insanity.”

Dr. Robertson said—In reference to the first case I doubt if we can distinctly
attribute the mental symptoms to the presence of lead in the system. There
was no doubt a blue line on the gums. Perhaps the slight ptosis may have been
caused by the poisonous action of the lead, but even that, as well as the mental
symptoms; may have been due to alcohol, for it was,stated that the patient had
been of dissipated habits for years. Still possibly the lead may have had some¬
thing to do with the causation. In reference to the second group of cases it
seemed to him that the cases submitted by Dr. Clark did not correspond very
closely with Dr. Clouston’s descriptibn of the symptoms. He understood that
to be a stateof depression with delusions of suspicion and occasional outbursts
of irritability, but in Dr. Clark’s cases there was sometimes exaltation with
grandiose delusions, similar to those of general paralysis, and this was unlike
what Dr. Clouston had described. About this phthisical mania he felt still in a
state of uncertainty. He had certainly met with cases which quite corresponded
with Dr. Clouston’s description, as he understood it, associated with chronio
phthisis, but he had met with other mental disorders, and particularly acute
mania along with that condition, so that he did not feel sure that phthisical in¬
sanity could be regarded as a definite form of mental disease.

Dr. Clouston considered Dr. Clark’s three cases to be good examples of what
he had described as phthisical insanity in 1863. He had observed the exalta¬
tion described by Dr. Clark in some cases. There were the suspicion, the out¬
bursts of irritability, unsociability, dementia, and the pathological condition—
brain anaemia. It is essentially a brain anaemia, with a reflex disturbance of
constitutional function from the diseased lungs.

Dr. Yellowlees —The term phthisical insanity has been much misapplied
and greatly misunderstood. It must not be confounded with ordinary insanity
with phthisis. I have always restricted the term to a certain class of cases in
which the mental symptoms seem to be originated by the lung disease and to
vary with its progress. Such patients are whimsical, wayward, uncertain, irrit¬
able, unsocial, suspicious, and liable to impulsive outbreaks. Brain irritation,
rather than brain ansemia, I think the pathological condition.

Dr. Carlyle Johnstone read a paper “ Cases of exophthalmic goitre,” and
exhibited some interesting pathological specimens.

The members afterwards dined together at the Grand Hotel.

THE SENTENCE ON JOSEPH GILL.

At the Assizes at Leeds in April, Joseph Gill was tried before Mr. Justice
Kay on an indictment charging him with assaulting with intent to murder Mrs.
Fox-Strangways. Although the plea of insanity was not set up, strong medical
evidence was given to show that the prisoner was not fully responsible for
his actions, and that by reason of his mental condition he was entitled to
consideration in the verdict, and the sentence of the Court. It was, no doubt,
from this feeling that the jury found Gill guilty of only unlawfully wounding.
To the surprise of most, if not all, including, we have reason to believe, the jury,
Mr. Justice Kay sentenced him to penal servitude for five years.

Dr. Ball, of York, and Dr. Baker, the Medical Superintendent of the York
Retreat, had previously attended Gill on account of his mental state and gave
evidence at the trial; on two occasions he had attempted suicide. He formed a
foolish, but it would seem, not criminal attachment to the prosecutrix, and the
letters from her read in court showed how large a share she had in leading him

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[July,

to renew relations which had been broken off for five month*. The motive for
the assault was not proved. Probably some groundless ideas of jealousy entered
his mind, and in fact originated in its morbid condition. A petition has been
prepared and signed for presentation to the Secretary of State for the Home
Department, for the purpose of obtaining a substantial mitigation of his punish,
ment. Dr. Baker has addressed a letter to the “ York Herald,’* in which he says
“ Gill )iad in July, 1882, attempted suicide, was depressed and sleepless, and was
in such an unstable mental condition that we thought it necessary to engage the
services of a young doctor to live with him and watch over him. We pleaded
with him most earnestly to break off his connection with Mrs. Fox-Strangways,
insisting that we thought it necessary for the maintenance of his mental
stability that he should do so. A letter of piteous pleading was sent to the lady
to ask her to help us by ceasing all correspondence with him. For a time he
followed our advice, but then there came a time when Mrs. Fox-Strangways,
disregarding our appeal, found out Gill’s place of retirement, and soon had him
again travelling the certain road to mental and moral ruin. Then came the
sorrowful catAstrophe—this poor, weak, deluded, semi-insane man stabs the
woman who had lured him back again (after an absence of nearly six months)
from his retreat at Harrogate, to her own house at Scarborough. Surely, bear¬
ing in mind his mental instability and the provocation he had received, tha
verdict of the jury was a just and righteous one. But when the judge passed
sentence, his words were the personification of sternness ; verily, others besides
the medical witnesses, when they heard the terrible sentence of five years’ penal
servitude, went away exceedingly sorrowful. As a member of the priesthood of
medicine, whose mission in life it is to attempt to minister to minds diseased, I
ask, is it possible, in this enlightened nineteenth century, that this poor weak-
minded man is to work out this hard sentence ? ”

We hope that Sir Wm. Harcourt, after inquiry into this painful case, will
feel justified in advising Her Majesty to comply with the prayer of the
memorialists.

MEDICO-PSYCHOLOGICAL ASSOCIATION.

The Annual Meeting will be held at the Royal College of Physicians, Pall
Mall East, London, on the 27th of July, 1883, under the presidency of Dr.
Orange, at 10.30 o’clock. The Council will meet at 10.

H. Rayner, Hon. Sec.

Hanwell, June 15, 1883.

BRITISH MEDICAL ASSOCIATION.

Fiftt-Fibst Annual Meeting, Liverpool, Juirr 31st, August 1st, 2nd,

and 3rd, 1883.

Section—Psychology.

President . . . Thomas Lawes Rogers, M.D., Rainhill.

Vice-Presidents . . George Henry Savage, M.D., London.

David Yellowlees, M.D., Glasgow.

The next annual meeting of the British Medical Association will be held at
Liverpool, on Tuesday, July 31st, and the three following days. In the Section
of Psychology, in addition to the usual papers, the following special subjects
have been selected for discussion:—

1— The Employment of the Insane. Introduced by Dr. Yellowlees.

2— Bone Degeneration in the Insane. Introduced by Dr. J. Wiglesworth.

3— Cerebral Localization in relation to Psychological Medicine. Intro¬

duced by W. Bevan Lewis, L.R.C.P.

4— General Paralysis. Introduced (if time permit) by Dr. J. W. Mickle.

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It is necessary that abstracts of all papers to be read in the Section should
be sent to us before the 15th of July.

George E. Shuttle worth, M.D.,

Royal Albert Asylum, Lancaster.
Wm. Julius Mickle, M.D.,

Grove Hall, Bow, London, W.

N.B.—No Paper must occupy more than 15 minutes in reading, and-subse-
quent speeches are limited to 10 minutes.

AFTER-CARE.

The Association for the After-Care of Poor and Friendless Female
Convalescents on Leaving Asylums for the Insane.

The Anniversary Meeting for 1883 will be held, by the kind permission of
Lord Cottesloe, at 20, Eaton Place, on Thursday, 5th July, at Three p.m.

Rev. H. Hawkins,

Chaplain’s House, Colney Hatch, N.

Obituary.

M. LASHGUE.

The distinguished Professor of Clinical Medicine in the Faculty do
M5decine, in Paris, and Physician-in-Chief of the Insane Infirmary of the
Prefecture of Police, died March 20th, 1883, aged 67. He was an honorary
member of our Association. The memory of M. Lasfcgue must be fresh in the
memory of all who were present at the Section for Mental Diseases of the
International Congress in London two years ago. Everyone listened to his
discourse on epilepsy with pleasure, whether his original views carried convic¬
tion with them or not. With few Frenchmen did the flexibility and beauty of
their language appear to greater effect. His power of description, aided by
rapid and effective sketches on the black-board, was unsurpassed, and those who
had the pleasure of his acquaintance in Paris knew what an admirable
clinical teacher he was. A dash of humour would again and again relieve and
enliven his statement of scientific facts. On the occasion referred to it will be
remembered that M. Las&gue, in mentioning incidentally the fact that the
patient of whom he was speaking had nine children, laughingly exclaimed,
“ Fwmille Anglaise ! if At the annual dinner of our Association, 1881, he re¬
sponded to the toast proposed by the President, “ Our Foreign Guests.”

M. Las5gue was an accomplished physician ih all departments of medicine,
although especially distinguished in mental disorders, and was in 1870-71
President of the Societe-Medico-psycbologique of Paris, to which body M.
Motet, who now worthily fills that office, thus expressed himself at the seance of
the 9th April last “ From whatever side we study this truly remarkable man, we
are struck with the perfection of the qualities by which he was distinguished.
As Clinical Professor in the Facultd de Mddecine, he conducted his teaching
with the greatest care. His lessons which were not written, but which he had
long studied, were models of able exposition. Full of facts and clever insight
they were for the student a sort of initiation to unknown and even unsuspected
truths. For those who, more experienced, listened to the master, they were the
long-sought solution of questions previously unsolved. Lasdgue spoke and as
he proceeded to formulate his idea, it was a revelation for him who was able
and knew how to comprehend it. There was not a word, not a phrase, to which
our previous thoughts did not respond and which did not state in terms of
admirable precision the law of pathological conditions, glimpsed at before perhaps,

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but never determined as they were by him. . . For us, gentlemen, in whose midst
he took his place in 1867, too late according to our wishes, he was already known
as one of ourselves by the writings with which he had enriched your * Annales.’
From the first he was one of the collaboraieurt with his friend Morel. The his¬
torical studies on insanity, on its moral treatment, on certain asylums in Russia,
belong to the period of 1844-1848. And subsequently the * Archives G6n6rales de
M6decine,’ as well as your ( Annales * are full of these monographs, wherein
pages of vigorous brevity are condensed studies of the highest scientific value.
Need I recall to you that chef $ oeuvre of fine analysis called ‘ Le D61ire de
Persecution?’ Published in February, 1852, the original memoir of Las^gue has
circulated, we may say, throughout the scientific world. Everywhere this form,
the outlines of which have been traced with so forcible a pen, has been acoepted ;
nothing has been added to it, so precise was the description, the details of which
had all lieen supplied by clinical observation. It has been the same with all
Las&gue’s works, and you know that they are numerous. From predilection he
attached himself to Mental Medicine, into which he had been initiated by a
master, a friend, the elder Falret. . . . Las^gue was a high authority in medico¬
legal questions. He owed this not less to the recognised independence of his
character than to his great knowledge. He judged things from a height, with
a precision, a nicety, which carried conviction. His concise reports, in a form
sometimes aphoristic, expressed all that was necessary, and nothing more. We,
his former colleagues, shall recall the part which he took at our discussions ;
we shall never forget what he was during our Congress of 1878, where, side by
side with our venerated President, M. Baillarger, he appeared as one of the
most distinguished representatives of Mental Medicine in France.”

We regret that our space does not allow us to cite the whole of M. Motet’s
discourse, which is as true as it is eloquent.

Since the above was in type we have received from him a few particulars,
which we subjoin:—“ Charles Las£gue was born in Paris, Sept. 5,1816. It was
not intended he should follow Medicine, but forming a friendship with Claude
Bernard and Morel he acquired a taste for Medical Science,, and began to study
it in consequence. It was at the SalpStridre, in the wards of M. Falret ptre, that
be applied himself to mental alienation, for which he was prepared by his
psychological knowledge ; and he became the favourite pupil, and then the friend
of both Falret and Voisin. At the time of his death he was physician to the
Hospital of La Pitid (as well as holding the appointments mentioned above).
Las&gue died in the midst of his family, whom he so much loved. He was a
man of the warmest affections, and faithful in his friendships. I do not speak
of his superior intelligence ; you know that as well as I do. His loss is acutely
felt by all those who had the honour of his acquaintance.”

HERVEY B. WILBUR, M.D.

The death is announced of Dr. H. B. Wilbur, for upwards of 30 years Superin¬
tendent of the New York Btate Idiot Asylum. On May 1st he suffered from a
sudden attack of illness whilst writing at his desk, and after rallying for a short
time was seized with fatal syncope, the autopsy disclosing extensive fatty
degeneration of the heart.

Dr. Wilbur was born in 1820, and was educated at Amherst College. After
engaging for a time in the work of teaching, he studied civil engineering, but
soon abandoned this field in order to study medicine. He possessed qualities
that were admirably suited to this profession, in which he was successful from
the start, in Lowell first, and afterwards at Barre. He was one of the first in
America to turn attention to the care and rational treatment of idiots, and having
made vain efforts to enlist the support of gentlemen of means, he received pupils
in his house, and commenced in a humble way a work that was destined to com-

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mand the attention of the profession and the public. The establishment of this
school for idiots at Barre by Dr. Wilbur in 1848 seems to have preceded by a
few months that of the Massachussetts Institution with which the name of Dr.
S. G. Howe is so honourably connected. In 1851 the Legislature of New
York authorised the foundation of a State Idiot Asylum, ana Dr. Wilbur was
appointed its Superintendent. In this work, carried on first at Albany and
subsequently at Syracuse, he spent the remainder of his life, and his Reports
show that to the development of the various measures calculated to promote the
amelioration of idiots his best energies were devoted. Not only did he devise
methods of education specially adapted for the feeble-minded folk placed under
his charge, but he was ever ready to avail himself of opportunities of educating
the various Legislatures as to the necessity of establishing State institutions for
imbeciles. His zeal led him to make several tours to Europe to inspect kindred
institutions both in this country and on the Continent; and during his last visit
(in 1875) he seems to have devoted considerable attention to British modes of
management of asylums for the insane. “ Non-restraint ” and “ Employment for
the Insane” formed the subjects of various pamphlets which he subsequently
issued, and his enthusiasm in thisdirection sometimes carried him into controversy
with his confreres engaged in lunacy practice. Whatever may be thought of
his views as to the insane, it will be freely conceded that in all that concerned
the treatment and care of idiots Dr. Wilbur was an eminent authority. To
medical skill he added a thorough knowledge of educational methods. Resort¬
ing to specially-adapted modes of imparting instruction, he was able to work
wonders in developing the perception of those whose feeble intellects would
seem to the ordinary teacher to be beyond the reach of pedagogy. While his
thought was centred with rare devotion on his professional work, Dr. Wilbur
was at the same time a capable and careful administrator, and his management
of the New York State Idiot Asylum won him repeated commendations from
high official quarters. In addition to the Syracuse establishment, the character
of which was mainly educational, he had also, for several years preceding his
death, the supervision of a connected custodial Institution at Newark.*

Dr. Wilbur was a facile writer, and although he has not left behind any
large work, he was the author of numerous monographs, and of an able article
on 44 Idiocy ” in “Johnson’s Encyclopaedia.’* He was also a ready speaker, and
a frequent attendant at conferences relating to social and philanthropic matters.
In 1878 he filled the office of President of the Association of Medical Officers
of American Institutions for Idiotic and Feeble-Minded Persons.

The estimation in which Dr. Wilbur was held by his medical neighbours is
shown by the feeling terms in which his death was alluded to at a special
meeting of the Syracuse Medical Society. 4 ‘ It would certainly be the highest
pleasure that could be afforded to any of us,” said the President, Dr. Pease,
44 to manifest here, by personal tributes, our respect and friendship for the
honoured dead.” Those of his British confreres who had the privilege of Dr.
Wilbur’s acquaintance will not soon forget the handsome presence, the manly
outspokenness, and withal the courteous, genial manner which characterised
the subject of this notice.

G. E. S.

WILLIAM SAMUEL TUKE, M.R.C.S.

William Samuel Tuke, who passed away at Bournemouth on April 20th, at
the age of twenty-six years, was the eldest son of Dr. D. Hack Tuke, of London.
He was a student of University College, where he obtained the gold medal in
physiology, and the Filliter Exhibition in pathology. He also obtained the

* Described by Dr. Ireland, «* Journal of Mental Science,” Yol. xxvi., p. 216.

xxix. - 22

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[July,

gold medal in physiology at the Intermediate M.B. examination at the London
University. After holding the appointment of house-physician under Dr. Wilson
Fox, he took the M.R.C.S. diploma in 1878. Afterwards, he was for some
time in Egypt and the South of France, seeking in those more genial climes to
arrest the pulmonary mischief which had declared itself, and to which he
eventually succumbed. In 1881, the New Sydenham Society published an
excellent translation by him of Charcot’s “ Lectures on Senile Diseases.”

William Tuke was unquestionably a man of rare powers, and his early
removal is a keen disappointment to all who had the privilege of his acquaint¬
ance. It had been the hope of his friends to see him pursuing the specialty
with which his father’s name is so honourably associated, and he had already
contributed several papers on psychological subjects to the “ Journal of Mental
Science.”

His mental breadth and lucidity, which were known and recognised by
not a few of our leading men, gained for him a very high place in the esteem of
his teachers and fellow-students. But it was in the sweetness and strength
of his personal character that the charm of the man lay. Keen as was his
scientific interest in his hospital patients as ** cases,’’ he won their confidence
and affection in an exceptional degree, by the simple power of true sympathy.
His loss has left a sorrowful blank in the hearts of his many friends.—
British Medical Journal,

Correspondence.

THE NEW STATISTICAL TABLES.

To the Editors of The Journal of Mental Science.

Gentlemen,— In the Asylum Reports for the year 1882 most of the tables have been
framed on the old lines, but a considerable number are done on the new system,
and as the Superintendents of these Asylums do not complain of any great difficulty or
extra labour involved, it is to be hoped that their practice at the end of this year will become
general. Already they have been adopted in some of the American Asylums. There is no
doubt that the great feature of the tables, the introduction of the distinction between
reckoning “ persons” and “ cases” is very important indeed, and will go a long way towards
altering the views that many have with regard to the value of asylum treatment, notably,
in giving a proper appreciation of the small amount of real and permanent recovery. There
is, however, one table introduced which, however valuable it might be if sufficient informa¬
tion could be obtained, seems to me practically useless in the face of the fact that the diffi¬
culties in procuring exact knowledge are very great, that often no trustworthy details are
given, and that opinions as to what constitute different attacks vary among authorities. I
refer to Table I A. which is to show the “ number of previous attacks among those admitted
during a given year, distinguishing those attacks that have been treated to recovery (and
discharge) in this and in other asylums.” A person may be admitted for the first time to
an asylum who has been ill for a few months, or weeks, according to the certificates of ad¬
mission, but who has really during the time passed through a short attack and has
recovered previous to the one for which he is admitted to the asylum. Yet such a person
who is really in the second attack would be left out of the Table I A. altogether, because the
friends have not understood that the first illness, which lasted perhaps only a short time,
was an “ attackto all intents and purposes as much an attack as the one for which they
deem it necessary to put him under certificates. Numbers of instances of mania a potu
come under this head, a9 also insanity from sunstroke. I can quote cases of this kind that
have been treated in general hospitals to recovery or improvement, and where the patient
has afterwards, for a similar attack, been placed under certificates, with the result that his
«• attack ” is reckoned as a “ first” one, because he had never before been placed in an asylum.
Again, it occurs to many persons to have a lucid interval, the duration of which may vary,
being in some so long that one is justified in giving a discharge and reckoning it a recovery;
but this lucid interval may in another, though very decided, yet be very short in duration,
say two or three weeks, occurring perhaps twice or more before discharge can be recom¬
mended. In such a person woula the total number of attacks (which might be two, three,
or more) be reckoned as “all attacks ” in Table I A. ? They should be so counted, and then
the table would be correct for that patient; but suppose the patient to be discharged, and
after an interval of two or three weeks be sent to another asylum, would an account of the

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325

three or four previous attacks be known and reckoned ? Assuredly not; he would count to
his second asylum as a person who had had one previous attack, although, in truth, the case
was one of a regularly-recurring insanity, discharged in the lucid interval between his
perhaps fourth or fifth attack.

A few months ago a man was sent to this asylum in a state of suicidal melancholia, who
had been discharged “ cured ” from another asylum five days before his admission; he re¬
covered again in a short time, and for a month went on admirably, but he then had a short
though very decided relapse, after which he again worked here just as well as an ordinary
workman. His friends then wished to take him out on trial, but he had not been away
three days before he came back in a very insane state. Now, had this man been discharged
and re-admitted on fresh certificates, he would have appeared in Table I A. as having had
two previous attacks, whereas, to my knowledge, he has had four, and may have had many
more. If, in the case of this man, it be contended that these lucid intervals ought to be
counted as short periods of sanity occurring during the course of one attack, then his first
admission here ought to be considered as a prolongation of his stay in the other asylum,
and not as his “ second attack.” There is a girl here who, if Table I A. were adopted, would
figure as having “ had one previous attack,” but, in truth, she was discharged “ cured ”
from an asylum and sent here on the third day after her discharge. Since her admission
there have been several occasions when she might have been sent away “ cured,” but,
fortunately, the fear of another attack prevented my doing so, and the fear has been justified
by the occurrence of “ attacks,” for each of which she might have been again placed under
restraint, and the total of which would have been reckoned as many more than it now will
be. She has had many attacks, but has only been in two asylums; by right she should not
have left the first one. There is here an exceedingly troublesome patient, who, before
coming to London, was discharged from two asylums, in each of which, as far as I can make
out, she was counted as a “ recovery.” That she ever “ recovered ” is, I think, very doubt¬
ful, judging from what I have ascertained to be her acts directly after leaving these
asylums. There is no probability of her ever being discharged “ recovered” again ; but
should such an event happen, she would appear in &ble I A. as having had two previous
attacks, although in reality she is now in the process of evolution of her first attack.

It seems then, to me, that the introduction of this table is practically worthless, because
the information required cannot be properly supplied. All it shows is the number of times
a person has been in an asylum, a piece of information of little value. During the last few
years I have received here numbers of patients from other asylums, about whom, beyond a
copy of the original certificate upon which they were admitted, absolutely no information
has been given. Many of these have had distinct “attacks” since their admission, but the
interval between these attacks has been too short to warrant my discharging them; others,
after a certain period of waiting, have been discharged cured ; but to attempt to record the
number of “ attacks ” they hare had altogether is impossible. Borne of them may have been
admitted to some other asylum, in which case I have done wrong in counting them as
“ recovered,” and have helped to stultify a table such as the one in question. The informa¬
tion given in lunacy certificates is well known to be, as a rule, carelessly given, and may be
very damaging to the accuracy of such a Table as I A.; for instance, not long since a male
patient of a verv dangerous character was discharged from a county asylum to the care of
his friends. These friends soon found out that they could do nothing with the man, so he
was sent here on fresh certificates. All the information given about him was that he had
been “ discharged ” from another asylum sometime previously, leaving it to be inferred that
he was discharged cured, and crediting him with one previous attack, though it appeared
afterwards that he had not even had a lucid interval. Seeing then how different are the
views of Superintendents as to what constitutes an “attack” or a “recovery,” that on the
transfer of patients no history is given of the attacks they have had, and that certificates
are often untrustworthy, I would humbly suggest consideration by the Committee of the
Association as to the advisability of retaining tnis table.

I am, &c.,

Banstead,

June 6, 1883.

T. C. Shaw, M.D.

MILIARY SCLEROSIS.

To the Editors of The Journal of Mental Science.

Gentlemen,— Majr I be allowed to offer a few remarks upon the paper by Dr. Plaxton on
the above named subject in the current number of the “Journal of Mental Science.”

Dr. Plaxton asserts his belief, derived from his own observations, and the support of so
high an authority as Dr. Savage, that the above change is purely post-mortem—the result
of alcohol employed in the hardening of the tissues.

In reply to this criticism, I would beg permission to state that I derived my original
microscopical observations # from portions of brain and spinal cord that had never had

# “Journal of Mental Science,” 1870, and “ British and Foreign Med. Clin. Bev.,” 1874.

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826

[July,

nc*r them.rx* cpt that used to moisten the razor, in making the sections. I may add
that I have found the same lesion in perfectly fresh brain matter.

Of the series of pathological conditions enumerated in the contribution to the “Brit, and
For. M. C. R., M I am not able to affirm confidently, of all the specimens, that none had been
.placed in spirit before they reached my hand; but my own practice at that time was to use
exclusively chromic acid for hardening the substance.

I do not pretend to explain the difference of opinion—possibly the true explanation may
turn out to be humiliating to my self-esteem. I will, however, beg leave to wait the true
solution of the question, whether confirmatory or condemnatory of my own views, which,
moreover, I am quite ready to surrender on sufficient evidence.

1 remain,

Gentlemen,

Your obedient servant,

W. B. Khstkvkn, M.D.

[That many changes are produced by decomposition of the tissues in the hardening fluid
is certain, and observers ait over the world have about the same time arrived at the same
conclusion, which is confirmation in itself strong enough to convince most people.

Bpltzka, in America, deserves credit for being one of the earliest, if not the earliest, to
describe these changes; but many others quite independently had convinced themselves
that spirit was the great cause of the appearances described as miliary sclerosis. Dr. Kest-
even lias shown tissues in which bodies similar in appearance are produced without spirit.
We have seen such bodies, and would repeat that they are similar, but not the same, and
that they, too, are produced by decomposition.—G. H. 8.]

INDEX MEDICO-PSYCHOLOGICUS.

(Continued fromp. 146.)

ARTICLES IN JOURNALS.

See Index in " Journal of Mental Science ,” January , 1882, page 638.
MORPHIA (Insanity from)—

De la morphiomanie par M. Zambaoo. L'Encephale, No. 3, 26 Octobre, p.
443.

MORAL SHOCK—

Effect of a sadden explosion of aente alcoholism. Par M. Motet. Trans.

Internat. Med. Congress, 1881, iii„ 607.

MELANCHOLIA (suicidal)—

Swallowing knitting needles, See. By Mr. P. Bayley. Lancet, 1881, ii., 1041.
Melancholia , with left Hemiplegia, defective vision of left eye. By J. Shaw.

M.D. Brain, part xviii., July, 1882, p. 267.

MfiTALLOSCOPIE. Par Dr. R. Vigouroux. Archives de Nearologie, Janv.-
Fevrier, 1882, p. 87.

MYXCEDEMA—

De la cachexie pachydermiqne. Par M. Blaise. Archives de Neurologic,
Janv.-F6vrier, 1882, p. 60; Mars-Avril, 141.

MICROCEPHALISM (Notes et observations). Par MM. Boumeville et
WillaumS. L’Encfcphale, 1882, No. 1, p, 62.

NARCOLEPSIE—

Narcolepsie dans la demence. et i’epilepsie. Par Dr. Rousseau. L*En-
c^phale, No. 4, 1882, p. 709.

NATURE OF INSANITY. Charles Mercier, M.B. Journ. of Ment. Science,
Jan., 1882, p. 512.

OPEN-DOOR SYSTEM—

Journ. of Ment. Science, July, 1881, p. 221; Oct., 1881, p. 408, 477-80; Jan.,
1882, p. 665.

OVARES, Extirpation of, in Insanity. By Dr. Goodell. Amer. Joirni. of
Insanity, Nos. 3 and 4, 1882.

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327

ONANISM (iq two young children)— '

Onanism avec troubles nerveux, etc. Par Dr. Zambaco. L’Encephale, No. 1,
1882, p. 38.

PARALYSIS AGITANS (with Insanity)—

A case of paralysis agitans in which insanity occurred. Dr. Ringrose Atkins.

Journ. of Ment. Science, Jan., 1882, p. 534.

Paralysis Agitans (insanity withh De l insanite dans la paralysie agitante.

Par Professeur Ball. L’Enc6phale, No. 8, 1882, p. 22.

PATHOLOGICAL STATES OF THE BRAIN CORTEX—

Zur casuistik der Gehirnrinden-Verletzungen. Dr. Richter. Allg. Zeitsch. f.
Psych., xxviii., p. 327.

PSEUDO-PATHOLOGICAL APPEARANCES—

Certain Morbid Appearances produced by hardening nervous tissues. By Dr.

Savage. Trans. Internat. M. Congress, 1881, iii., 596.

PERCEPTION IN THE INSANE, Researches on the rapidity of. By Buccola
(Dr.). Trans. Internat. M. Congress, 1881, iii., 656.

PRESIDENTIAL ADDRESS delivered at the Annual Meeting of the Medico-
Psychological Association, London, August 2, 1881. Dr. D. Hack Tuke.
Journ. of Ment. Science, Oct., 1881, p. 305.

PRESIDENTIAL ADDRESS at the Annual Meeting of the Med. Psych. Assoc.

By Prof. Gairdner. Journ. Ment. Science, Oct., 1882, p. 321.

PROGNOSIS IN INSANITY (parti). Dr. D. G. Thomson. Journ. of Ment.

Science, July, 1882, p. 195.

PROSPERITY (effects of)—

On the effect of prosperity and adversity in the causation of insanity. Dr.

T. A. Chapman. Journ. of Ment. Science, July, 1882, p. 189.
PUNCTIFORM CEREBRAL HEMORRHAGE. Dr. Geo. H. Savage. Journ.

of Ment. Science, Jan., 1882, p. 539. (Case.)

REASONING MANIA, with especial reference to Guiteau. By Dr. Hammond.

Journ. of Nerv. and Ment. Dis., No. 1, 1882.

RESTRAINT (Philosophy of) in the management and treatment of the
Insane. Journ. Ment. Science, Oct., 1882.

Restraint . Etude sur le No-restraint. Dr. B^coulet. Ann. M6d. Psych., Janv.,
1882, p. 41.

RECOVERIES (retarded)—

Des guPrisons tardives chez les ali^nes. M. Rousseau dans PEncdphale, No. 3,
1882, p. 446.

Le Sabbat. Archives de Neurologic. Par MM. Bourneville et Teinturier.

Janv.-F6vrier, p. 115 ; Mars-Avril, 249.

RIEGER, liber die Beziehungen der Schadellehre zur Physiologic, Psychiatrie,
u. Ethnologie. Wurzburg. 1882.

SPIRITUALISM—

Illusionary and fraudulent aspects of spiritualism. Second letter from Mr.

Stuart C. Cumberland. Journ. of Ment. Science, Jan., 1882, p. 628.
SITIOPHOBIA—

Cas grave de sitiophobie. Par M. S. Mabit. L’Enc6phale, No. 2,1882, p.
282.

STUPOR—

Mental Stupor. By Dr. Hack Tuke. Trans. Internat. M. Congress, Lond.,
1881, iii., 624.

SYMPATHETIC INSANITY—

Note sur un cas de folie # sympathique. Par M. Pons. Annales M6d. Psych.,
tome viii., No. 2, p. 20i.

SUICIDE. Journal Psych. Med., Vol. viii., part 1, p. 82.

SEXUAL DISORDERS IN THE INSANE—

BechercheB cliniques sur la frequence des maladies sexuelles chez les attends,
par 8 . Archives de Neurol. Vol. iv., Numero 2, p. 171.

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' Notes and News.

SEXUAL FEELINGS (perversion of)—

Inversion du sens genital. Par MM. Charcot et Magnan. Archives de Neuro-
logie, Janv.-Fe'vrier, 1882, p. 53.

TEACHING OF. PSYCHIATRIC MEDICINE. By Dr. Clonston. Trans.

Internal M. Congress, 1881, iii., 596.

TEMPERATURE IN INSANITY—

Einige Beobachtangen iiber die Temperatnr bei periodiachen Geisteskranken.

Dr. Haase. Allg. Zeitsch. f. Psych., xxxix., p. 49.

TORPOR OF BRAIN. De la Torpeur c4r4brale. Par professenr Ball.

L’Enc£pha1e, No. 3, 1882, p. 369.

TRANSITORY INSANITY—

Ein Fall von transitorischer Bewusstseinsstorung bei einem elfjahrigen
Knaben. Dr. E. Engolhorn. ErlenmeyeFs Centralblatt, 1881, p. 481.
TRAUMATIC INSANITY—

Insanity from Tranmatism. By Dr. Verity. Amer. Journ. of Insanity and
Neurology, No 2, 1882.

Traumatic Insanity. Kopfverletzungen und Psychosen. Dr. Fiirstner. Allg.
Zeitsch. f. Psych., xxxviii., p. 682.

TUMEUR DU CERVEAU avec alienation mentale. • (Case.) Par Ph. Rey.

Ann. Med. Psych., Janv., 1882, p. 70.

VENTRICLES, Granulations in—

Das Ependyn der Hirnventrikel und die an demselben beimerkbaren granola-
tionen. Dr. F. Schnopfhagen. Jahrb. f. Psych., 1881, iii., 1 u. 2, p. 1.

Appointments.

Hewkley, F., M.R.C.S., appointed Assistant Medical Superintendent to the
Royal India Asylum, Ealing, W.

MacBryan, H. C., appointed Assistant Medical Officer to the Middlesex
County Asylum.

Moynan, W., M.D., appointed Assistant Medical Officer to the Wonford
House Hospital for the Insane, vice S. S. Noakes, L.R.C.P., resigned.

Hitchcock, Charles Knight, M.D., M.A., Cantab., appointed Medical
Superintendent of the Lunatic Hospital, Bootham, York.

Powell, John, L.R.C.P., appointed Junior Assistant Medical Officer to the
Joint Counties Asylum, vice A. D. Maitland, M.R.C.S., resigned.

Beatley, William Crump, M.B., Durham, M.R.C.S.Eng., L.S.A., late
Resident Medical Officer to Charing Cross Hospital, appointed Assistant
Medical Officer to the Somerset and Bath Lunatic Asylum.

Keay, John, M.B., C.M., appointed Junior Assistant Physician to the
Crichton Royal Institution, Dumfries.

Legge, Richard John, M.D., L.R.C.S.Ed., L.A.H.Dublin, appointed
.Assistant Medical Officer to the Derby County Asylum, vice W. Horton,
M.B., resigned.

Steell, G., M.D., appointed Honorary Assistant Physician to the Manchester
Royal Infirmary, Dispensary, and Lunatic Hospital, or Asylum, vice J.
Dreschfeld, M.D., promoted.

Blair, R., M.D., appointed Medical Superintendent of the Barony Parochial
Asylum at Lenzie, near Glasgow, vice J. Rutherford, M.B., resigned.

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tfo. 127. (New Series, No. 91.)

THE JOURNAL OP MENTAL SCIENCE, OCTOBER, 1883.

[Published by authority of the Medico*Psychological Association .]

CONTENTS.

PART I-ORIGINAL ARTICLES.

PAGE.

W. Orange, M.D.—Presidential Address, delivered at the Annual Meeting of
the Medico-Psychological Association, held at the Royal College of
Physicians, London, July 27th, 1883. ..... 329

J. Wiglesworth, M.D.—On the Pathology of Certain Cases of Melancholia

Attonita or Acute Dementia (with Illustration). , . . . 355

J. A. Campbell, M.D.—Remarks on Some Minor Matters of Management in

Asylums. . . . . . . ... . 373

Olinioal Notes and Cases.—Case of Murder during Temporary Insanity in¬
duced by Drinking. Epilepsy (?) Acquittal on the ground of Insanity;
by D. Yellowlees, M.D.—Note on a Case of Impulsive Insanity; by
Richard Greene, L.R.C.P.—Clinical Abstracts: (a) Three Cases of
Phthisical Insanity; ( b ) A Case of Insanity following on Alcoholic
Excess and Lead Poisoning; by A. Campbell Clark, M.B. -Uni¬
lateral Sweating: Note on Further Cases of; by W. Julius Mickle,
M.D.—Insanity of Twins; by A. F. Mickle, M.B. . . 382—401

Occasional Notes of the Quarter.—The Recent Lunacy Appointment.—The

Catastrophe at Southall Park. . . . . . 401—4i08

PART, II.—REVIEWS,

Lee Hyst6riques. Rtat Physique et Etat Mental. Actes Insolites, DSlectueux

et Criminels. Par Dr, Legrand Du Saulle. .... 408
A Regi&o Psychomotriz. Apontamentos para contribuir ao estudo du sua

Anatomia. Por Antonio de Sousa Magalhaes e Lemos. . .311

The Psychomotor Region. Remarks on the Study of its Anatomy. By

Antonio de Sousa Magalhaes e Lemos. . . . .411

Insanity; its Causes and Prevention. By H. P. Stearns, M.D. . . 412

Experimentelle und Kritische Untersuchungen zur Eleotrotherapie des Gehirns
insbesonders liber die Wirknngen der Galvanisation des Kopfes. Yon
Dr. Lowenfeld. . . . . . . . .415

CJeber die Bebandlung von Gehirn und Ruckenmarks Krankheiten vermittelst

des InduotionsstromeB. Von Dr. L. Lowenfeld. . . . 415

Behandlung der Psyohosen mit Elektricitat. Von Dr. Tiggrs. . . 415

PART III.—PSYCHOLOGICAL RETROSPECT.

1. German Retrospect. By William W. Ireland, M.D. . . . 425

i. English Retrospect. ........ 432

PART IV.-NOTES AND NEWS.

The Annual General Meeting of the Medico-Psychological Association held at
the Royal College of Physicians, London.—Annual Meeting of the British
Medical Association, held at Liverpool.—Asylum Benefit Club .—“ After
Care h Association.—The “ Open-Door ” System.—Changes in the
Lunacy Board.—Obituary.—Correspondence.—Appointments, &c. 435—458

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The Journal of Mental Science .

Original Papers, Correspondence, Ac., to be sent by Book-post direct to Dr.
Hack Tuki, Lyndon Lodge, Hanwell, W., or 4, Charlotte Street, Bedford
Square, W.C.

English books for review, pamphlets, exchange journals, Ac., to be sent
by book-post to the care of the publishers of the Journal, Messrs. J. and A.
Churchill, New Burlington Street. French, German, and American publica¬
tions should be forwarded to Messrs. Churchill, by foreign book-post, or by
booksellers’ parcel to Messrs. Williams and Norgate, Henrietta Street, Covont
Garden, to the care of their German, French, and American agentsMr.
Hartmann, Leipzig ; M. Borrari, 9, Rue des St. P&res, Paris ; Messrs. Wester-
mann and Co., Broadway, New York.

Authort of Original Papere receive three extra copies of the Journal by Book-
poet. 8hould they wish for Reprints for private circulation they can have
them on application to the Printer of the Journal, H. W. Wolff, Lewes,
at a fixed charge of 30s. per sheet per 100 copies, including a coloured wrapper
and title page.

The copies of The Journal of Mental Science are regularly sent by Book-poet
( prepaid ) to the Ordinary and Honorary Members of the Association, and the
Editors will be glad to be informed of any irregularity in their receipt or
overcharge in the Postage.

The following are the EXCHANGE JOURNALS :—

Zeitechrift fur Peychiatrie; Archiv fur Peychiatrie und Nerrenkrank -
heiten; Centralblatt fur Nervenheilkunde , Psychiatric, und gcrichtliche
Peychopatlwlogie ; Der Irrenfreund; Jahrbucher fur Peychiatrie, neuc Folge
dee peychiatriechen Centralblattee; Neurolog isches Centralblatt; Revue dee
Soiencee Mtdicales en Prance et a VEtranger ; Annales Mtdico-Psychologiques ;
Archiree de Neurologie ; Le Progree Medical; Annales de Dermatologic et de
Syphilographie ; Revue Philosophiqve de la France et de VEtranger , dirigde
par Th. Ribot; Revue Scientiflque de la France ct de VEtranger; L' Eticephale ;
Annales et Bulletin de la Societe de Mcdecine de Gand ; Bulletin de la Socittc
de Mcdecine Mentale de Belgique; Archiree Mcdicales Beiges; Archivio
Italiano per le Malattie Nervoee eper le Alienazioni Mentali; Archivio dipsioJiia•
tria , scienzepenali ed antropologia criminate : Direttori , Lombroso et Garofalo ;
Rivieta Clinica di Bologna , diretta dal Profeseore Luigi Concatoe redattadal
Dottore Et'cole Galvani; Rivieta Sperimentale di Freniatria e di Medicina
Legale , diretta dal Dr. A. Tamburini; Archivio ltal. de Biologie;
The American Journal of Insanity; Ihe Journal of Nervous and
Mental Disease; Archives of Medicine; The Quarterly Journal of
Inebriety , Hartford , Conn. ; Index Medicos, N. Y.; The Alienist and
Neurologist , St. Louis , Misso .; The American Journal of Neurology and
Psychiatry ; The Dublin Quarterly Journal; The Edinburgh Medical Journal;
The Lancet; Ihe Practitioner ; The Journal of Physiology , edited by Dr.
Michael Foster; Ihe Asylum Journal (BHtish Guiana); Brain; Mind;
Canada Medical and Surgical Journal.

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THE JOURNAL OF MENTAL SCIENCE. .

[Published by Authority of the Medico-Psychological Association]
No. 127. OCTOBER, 1883. Yol. XXIX.

PART 1-ORIGINAL ARTICLES,

Presidential Address , delivered at the Annual Meeting of the
Medico-Psychological Association , held at the Royal College
of Physicians , London , July 27th, 1883. By W. Orange,
M.D., F.R.C.P.

Gentlemen, —In doing me the honour to place me in the
position of your President to-day, in succession to the dis¬
tinguished Prof essor of Medicine in the University of Glasgow,
I cannot but be fully aware that you are prepared to accept
from me an address of a very different order from that with
which the Association was favoured ]ast year. Professor
Gairdner brought prominently to our notice the fundamental
principle that the profession of medicine, and the healing art on
which it rests, are one, and not manifold; and, in reminding
us that those whose special lot it is to minister to sufferers
from diseased mental function, proceed upon the same lines,
and pursue the same method, in the matters of diagnosis and of
treatment, as do those physicians who minister to other diseases
of the human frame, he chose a theme than which none could
have been more grateful to his audience ; whilst it is needless
to say that he clothed that theme in language, and embellished
it with illustration, the eloquence and wealth of which are of
too recent memory to permit of a successor venturing, for the
present, to place foot on the same ground.. Whilst, then, I
am sure that each and all of us would desire to keep the theme
of last year’s address very prominently in mind, and would,
perhaps, wish to say in a somewhat altered version of
Terence, “ Medicus sum; medici nihil a me alienum puto,” I
deem myself, on the present occasion, peculiarly fortunate that
xxix. 23

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Presidential Address ,

[Oct.,

the description of medical work that has fallen to my lot during
several years past has had relation to a somewhat special
matter; and it is upon this special matter, the relation of
. mental derangement to offences against the law of the land, that
I ask your indulgence for the few words which I offer to you to¬
day. Two incidents have occurred since the last annual meet¬
ing of this Association, which, if I had been in doubt as to the
choice of a subject, would have gone far towards removing that
doubt. I allude to the presentation to Parliament of the Report
of the Commission, appointed in 1880, to inquire into the sub¬
ject of criminal lunacy, and to the appearance of a new edition
of Mr. Justice Stephen’s work on the “ History of the Criminal
Law of England.” In attempting to give even the briefest
sketch of the progressive steps by which the measures for the
care and treatment of criminal lunatics have advanced during
recent years, the first question that naturally arises is, what is
a criminal lunatic ? The name appears, at first sight, to imply
a contradiction of terms, inasmuch as a person who is a lunatic
may be said to be incapable of committing what, in the strictest
sense of the word, can be called a crime. But, in spite of this
seeming inconsistencythe term has been in use for the last
eighty years, and it appears likely to continue to be used,
because it is, after all, really descriptive of the class of persons
to whom it is applied ; inasmuch as every criminal lunatic, of
whatever class, has not only been charged before a court of'
law with the commission of some crime, but is actually in cus¬
tody, so long as he remains in the class of criminal lunatics, on
account of such crime—the nature of the crime, and the cir¬
cumstances of its commission, determining whether the person
ever enters the class of criminal lunatics or not. If the crime
is not grave, the person accused is generally handed over to the
parish authorities or to friends, to be dealt with in accordance
with the provisions of the general lunacy laws; but if, on the
other hand, the crime is grave, or if the circumstances of its
commission are such as to give reason for believing that society
would be insufficiently protected by trusting to the operation
of the general lunacy laws, then the individual passes on into
the class of criminal lunatics, and becomes subject to special
statutes.

Insanity and crime may be combined in an infinite variety of
proportions; and if the term “ criminal lunatic” were ex¬
panded so as to be made to include, on the one hand, all insane
persons who had ever committed any act contrary to law, and,
on the other hand, every criminal whose mental organization

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33 1

1883.] by W. Orange, M.D.

falls short of an ideal standard of perfection, it might be, in
that way, made to embrace a very large proportion of the
inmates of the lunatic asylums and also of the prisons of the
country.

But it is a term which, though useful, cannot claim for itself
mathematical precision, and the intention is that no person who
has committed a crime shall become a criminal lunatic unless,
having regard to the nature of the crime, the protection of the
community requires this to be done; and also, that no criminal
whose mental organization is imperfect* shall be included, unless
the defect or derangement of mind be of such an extent or
degree as to prevent the application of the penal code from
being efficacious; or, in other words, such as to render the
person an unfit subject for penal discipline.

In a more ideal state # of society than that which now exists,
the class of criminal lunatics would disappear, because no one
would be sentenced to punishment without his mental state
being ascertained before sentence, instead of, as now so
generally happens, afterwards ; and, furthermore, because per¬
sons known to be insane would then be placed under proper
control before, and not, as now, after they have committed
some alarming act of homicide or violence.

But we are far from this ideal state, and, therefore, it happens
that the number of insane persons who are left to enjoy, as it
is termed, their freedom, until they have done some terrible
deed, is large; and society is thus constantly being called
upon to consider in what way it shall cover its own sins of
omission.-

The statutes relating to criminal lunatics have, therefore, as
might be imagined, been enacted piecemeal to meet the occasion
as it arose. I do not intend to weary you with anything
approaching to a minute and detailed account of those statutes,
which are to be found fully stated in the very useful works of
Archbold and of Fry, but I propose merely to glance at their
general tendency and scope. It is unnecessary to go very far
back into ancient history to make a beginning. There is no
record of the existence of a special asylum for criminal lunatics
in ancient Greece or Rome; nor need we linger with the view
of determining exactly what may have been Horace's opinion
with respect to the mental condition of Orestes, when he
wrote—

Quin ex quo est habitus male tutro mentis Orestes,

Nil sane fecit quod tu reprehendere possis.

But we may come at once to more modern times.

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332

Presidential Address ,

[Oct.,

It is estimated by Mr. Justice Stephen that, at the close of
the sixteenth century, the number of persons executed annually
in England and Wales for ordinary crimes was about 800 ; ana,
if regard be had to the difference of population between then
and now, it may easily be imagined that this summary mode of
dealing with so large a proportion of breakers of the law must
have cut short many difficulties, and must have removed, at
once and for ever, a large number of insane persons, inter¬
mingled with sane and responsible criminals. Indeed, long
after that time, the existence of mental derangement in per¬
sons accused of the commission of crime had little or no effect
upon the treatment accorded to them; because the existence of
insanity was not readily admitted, and also, further, because in
those times, when a whip and a dark house were regarded as
being the appropriate treatment of a lunatic, the lot of any
unfortunate being was not much ameliorated by being classed
in that category. Matters began to improve towards the close
of the last century ; and, at last, in the year 1800, the trial of
Hadfield for firing at George III., in Drury Lane Theatre, pro¬
duced a definite amendment both with regard to law and prac¬
tice. Hadfield had served his King and country in the wars—
he had been gravely wounded in the battle of Lincelles—and
he had given unmistakable proof of serious mental derangement
long before the commission of the act for which he was tried.
The evidence of his insanity, and of the connection existing
between his mental derangement and his attempt upon the life
of the King, was conclusive, but then the question arose as to
what was to be done with him; and, with reference to this
question, the presiding judge, Lord Kenyon, made use of the
following words, which have served as a guide from that time
to the present for the proper treatment of persons similarly
situated. Lord Kenyon said : “ For his own sake, and for the
sake of society at large, he must not be discharged, for this is
a case which concerns every man of every station, from the
King upon the throne to the beggar at the gate; people of both
sexes and of 'all ages may, in an unfortunate frantic hour, fall
a sacrifice to this man, who is not under the guidance of sound
reason, and, therefore, it is absolutely necessary for the safety
of society that he should be properly disposed of, all mercy and
humanity being shown to the unfortunate creature ; but, for
the sake of the community, he must somehow or other be taken
care of with all the attention and relief that can be afforded
him.”

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1883.]

by W. Obange, M.D.

333

Here, then, were two main principles clearly and humanely
set forth—the safety of society was to be secured, by not dis¬
charging the prisoner; but, at the same time, this afflicted man,
who was “ not under the guidance of sound reason,” was to be
taken care of with all the attention and relief possible.
Although more than eighty years have passed since those
words were uttered, they would afford but little room for
amendment if submitted to revision at the present day; and,
combining as they do the expression of humanity with that of
prudence, they remain as applicable to criminal lunatics of the
present day as they were to the person with reference to whom
they were spoken. The immediate result of the trial and
acquittal, oh the ground of insanity, of Hadfield, was the pass¬
ing of the “ Insane Offenders Bill,” which became law on the
28th July, 1800. This was the Act which made provision for
the detention of insane offenders, acquitted on the ground of
insanity, or found insane on arraignment, for whatever length
of time might be required by considerations of public safety.
This statute, however,, only applied to persons charged with
offences classed as treason, murder and felony; and it was not
until forty years later that, owing to the beneficial results of the
former statute, similar provisions were applied to persons
charged with misdemeanours.

In the meantime, very soon after the passing of the Act of
1800, the question began to press for settlement: What was to
be done with persons acquitted on the ground of insanity
under the provisions of that Act? As early as 1807, Mr.
Wynne, who did much in his day to improve the treatment of
the insane, obtained a Select Committee to inquire into the
state of criminal and pauper lunatics; and this is the first
appearance, so far as I know, of the term “ criminal lunatic ”
in official documents. The report of Mr. Wynne’s Committee
was ordered to be printed on the 15th of July, 1807; and this
report stated that, from the time of the passing of the Act in
1800, the number of persons detained under its provisions was
37, and the report went on to recommend that a building
should be erected for the separate confinement of these
persons, and of others who might in future come under the
provisions of that Act for offences committed during a state of
insanity. But, although this wise recommendation was made
so long ago, and although it was the natural corollary of the
statute by which a special class of insane persons was marked
out, more than fifty years elapsed before full effect was

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334

Presidential Address ,

[Oct.,

given to so obviously reasonable a recommendation. At first,
criminal lunatics had to remain in gaols, a plan, as Mr..
Wynne's Committee reported, equally destructive of all possi¬
bility of the recovery of the insane, and of the security and
comfort of the other prisoners.

In 1808 the House of Commons presented an address to
His Majesty, praying that a separate building might be
erected accordingly; but nothing was then done. When,
however, Bethlem was rebuilt, in the year 1816, on its present
site, a wing, which was called the criminal wing, was erected ;
but the amount of the provision made was quite inadequate,
and in a few years the extent of the accommodation for
criminal lunatics at Bethlem had to be doubled, and still
without keeping pace with the requirements. In 1835 a Com¬
mittee of the House of Lords, appointed to inquire into the
state of prisons, found therein many persons who had been
acquitted on the ground of insanity, and strongly recommended
that such persons should be removed from prisons to suitable
asylums. The Committee also extended*their recommendations
to other classes of insane prisoners, with the result that, in 1840,
an Act was passed making provision for the removal to
asylums of persons certified to be insane after sentence. The
effect of this statute was, as might naturally be expected, to
rapidly increase the number of criminal lunatics who were sent
to ordinary lunatic asylums, whilst a further cause of increase of
numbers was soon afterwards developed by the discontinuance
of transportation. As a result of this large increase of numbers,
an arrangement was entered into, in 1849, between the Secretary
of State and the proprietors of Fisherton House Asylum, near
Salisbury, under which arrangement accommodation was
provided at that asylum for the criminal lunatics who were in
excess of the number for whom provision existed at Bethlem;
but still, as ever, • the extent of the provision lagged behind
the requirements, and, to pass over minor details, at last the
matter was taken up vigorously, in the year 1852, by the Earl
of Shaftesbury, who thus added one more to the many benefits
already conferred by him on the most helpless and pitiable
members of the human race. Lord Shaftesbury,* after
presenting a petition on the 18th of March, 1852, to the
House of Lords, from the Chairman of the Visiting Magistrates
of the Lunatic Asylum for the County of Leicester, praying for

* Hansard, 3rd s„ Yol. cxix., p. 1230.

Digitized by CjOOQle

by W. Orange, M.D.

335

1883.]

an alteration of the law respecting criminal lunatics, proceeded
to move:—“That an humble address be presented to Her
Majesty, praying that Her Majesty will be graciously pleased
to take into her-consideration the expediency of establishing
a State Asylum for the care and custody of those who are
denominated criminal lunatics.”

His Lordship went on to say that the great care bestowed of
late on both our public and our private asylums had called
attention to the fact that the custody of these criminal lunatics
had been a great bar to the improvement of those institutions.
The Commissioners in Lunacy had reported in 1849, 1850, and
1851 to the Lord Chancellor on th,e annoyances, perils, and
injurious effects of the actual system, and had proposed
remedies for the system. They had also reported at various
times to the Secretary of State, and had prayed for relief,
setting forth such circumstances as these—that there was one
criminal lunatic who had escaped from Gateshead Fell four
times in a few months, and that there was another who had
escaped from Hoxton six times in the same period ; but all to
no purpose. His Lordship further said that the term
“ criminal lunatic ” seemed to him to involve something of
a contradiction ; nevertheless, it was the ordinary and
received term, and the ofily one that he could use on that
occasion.

This definite and vigorous expression of opinion on the part
of Lord Shaftesbury soon bore fruit; and, in the year 1856, a
site was selected, upon which Broadmoor Asylum was after¬
wards erected. That asylum was opened in 1863, and I have,
in the following tabular statements, attempted to give, in a
condensed form, some of the results of its operations during
twenty years, thinking that, although it is impossible for me
to read these figures to you now, some members of the Associa¬
tion may, perhaps, be interested in glancing over them after
they are printed:—

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Classification of the Crimes and Sentences of all Patients admitted (including re-admissions) from
the opening of the Asylum to the 31st December, 1882.

336

Presidential Address,

[Oct.,

Classification of the Crimes and Sentences of all Patients removed, on their recovery, to different prisons,
either for trial, or in order to complete their sentences, from the opening of the Asylum down to the 31st
December, 1882.

338

Presidential Address .

[Oct.,

Certified to
be Insane
whilst
undergoing
shorter
terms of
Imprison¬
ment.

i i I M I i i i i

Classified with reference to the Period at which Insanity was recognised.

i i i i i i M i I

* 1

1111111111

Certified to
be Insane
whilst
undergoing
Sentences of
Pena!
Servitude.

^ 1- 1 1 1 1

j | eo to •-« g ci ih ih i—i co

Reprieved
on the
ground of
Insanity.

ti | i i i i i i i i i i

1 1 1 1 1 1 1 1 II

1 II 1 1 1 II 1 1

Acquitted
on the ground
of Insanity.

1 1 1 II 1 1 1 1 1

1 1 1 1 1 1 1 1 1 1 •

1 1 1 1 1 1 1 1 1 1

Pound Insane
by Jury on
Arraignment.

1 1 1 1" 1 1 1 1 1

i 1 i i i i i i i 1

| | | | o | | | | |

Certified to be
Insane whilst
awaiting Trial
or

Judgment.

- 1- 1 1 1 1 1 1 1

1111111111

* I- 1 1 1 1 1 1 1

Total number
removed, on
recovery,to
Prisons, down to
31st December,
1882.

N«oohn«hhhco

1 ^ 1 1 1 1 1

a .

Crimes.

Murder

Attempt to murder, maim,. Ac....

Burglary and housebreaking ...

Sheep stealing ...

Larceny and petty theft

Arson and malicious burning ...

Forgery

Uttering counterfeit coin, coining, Ac....
Felony (not otherwise described)
Insubordination as soldiers

Total .

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339

Those included in these two columns
were transferred upon expiration of

Classification of Crimes and Sentences of Patients transferred to Perth or Fisherton, whilst still criminal
lunatics, from the opening of the Asylum down to the 31st of December, 1882.

340

Presidential Address,

[Oct.,

Total

Classification of the Crimes and Sentences of all Patients who died from the opening of the Asylum

down to the 31st of December, 1882.

342 -

Presidential Address.

[Oct.,

Classified with reference to the Period at which Insanity was recognised.

Certified to be
Insane whilst
undergoing
shorter terms of
Imprisonment.

l l M i I l M I i l l 00 1 I li l l I i i I

I t i 1 i l 1 I l li II 00 1 l 1 1 1 I I 1 l l

1 1 1 1 1 1 1 1 1 1! 1 1 1 1 1 1 1 1 1 II 1 1

Certified to be
Insane whilst
undergoing
sentences of
Penal Servitude.

o»

* l -1 I l 1 l l l l l l a i -1 I 1" l l l l

ph ph co eo | | ph | <«ph ph co jQCseopHp-i |esjosio j

Reprieved
on the
ground of
Insanity.

^ 1 1 1 1 II 1 1 1 ! II 1 II 1 1 1 1 1 1 1 1

111111111111111111111111!

-11111111111111111 i i ii 11

*-l

'S ® O ^

Sogi
<3 tW

1 1 l.l 1 1 1 1 1 1* 1 1 1 1 1 1 1 1

S IS—— 1- 1 1 1 1” 13 1 1"-" III

Found In¬
sane by Jury
on Arraign¬
ment.

1 ^ 1 1^1 1 l HC, i® 1 1 1 ^ I* i 1 ^

a i i ii i I I l I i i I M i" l i i ~ I 1 l l

COPH^J , |PH | | |PH^ 1*. | | | | | | |H

s’

Certified to be
Insane whilst
awaiting Trial
or Judgment.

3"® 1 1 1— 1 1 1 1 I" 1- 1 1 1“ 1 1 1 1

1 1 1 1 II 1 1 1 1 |- 1 1 1 1 1 1 1 1 1 1

a i® i i i m I i i i i rt \~ i i i- ii i i

Total Number
of Deaths down
to Dec. 31,1882.

tj-^^HfsoeoeorHcDpHpHeopHjgc^^PH’-irHi-.PHC'iiopH

1 1 I 1 1 1 1 1 1 IS 1 1 l w 1 1 1 1

g«Mg^<eoeocopH®pHpHCOpHj-ei*e«PHpHpHHjtpHCVi»opH

Crimes.

Murder

Manslaughter ...

Attempt to murder, maim, &c....

Rape ...

Assault, common

Do. with intent to ravish ...
Unnatural offences

Treasonable and seditious offences
Burglary and housebreaking ...
Robbery on the highway

Robbery with violence ...

Sheep-stealing...

Horse-stealing ...

Larceny and petty thefts

Receiving stolen goods...

Arson and malicious burning ...
Forgery

Uttering counterfeit coin, coining, Ac

Libel.

Felony (not otherwise described)
Threatening by letter ...

Deserters from the Army and Navy
Insubordination as soldiers

Other misdemeanours ...

Total .

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344 Presidential Address, [Oct.,

The following Figures, extracted from the Annual Volumes
of the Judicial Statistics for England and Wales, show
the Rate of Mortality which has prevailed amongst
Criminal Lunatics since the year 1856, and also show the
Extent to which the Rate of Mortality, and the Degree of
safe Custody, have been affected by the opening of Broad¬
moor Asylum.

In this table each year ends on the 29th of September.

(1.) Returns relating to the seven years immediately preceding
the opening of Broadmoor.

Year.

Total Number of Criminal
Lunatics under Detention
in England and Wales
during each Year.

Number
of Deaths in
each Year.

Number who escaped, and who
were not recaptured
before the end of each Year.

1856

686

1857

749

1858

798

1859

901

1860

957

1861 ■

970

1862

1,017

Totals ...

6,078

279

(2.) Returns relating to the period subsequent to the opening
of Broadmoor.

In all other Asylums in Exgland and
Wales excepting Broadmodr.

IN BROADMOOR.

Year.

Total

Number of
Criminal
Lunatics
under
Detention
during
each Year.

No. of
Deaths
in each
Year.

Number who
escaped, and who
were not
recaptured before
the end
of each Year.

Total |
Number of
Criminal
Lunatics
under
Detention
during
each Year.

No. of
Deaths
in each
Year.

Number who
escaped, and
who were not
recaptured
before the end
of each Year.

1863

1,050

1864

1,017

292

1865

860

446

—

1866

723

455

—

1867

767

477

—

1868

309

644

—

1869

250

497

1870

310

488

—

1871

338

524

—

1872

313

562

—

1873

278

559

1874

299

554

—

1875

319

544

—

1876

338

546

, — ■

1877

348

541

—

1878

341

526

—

1879

323

528

—

1880

316

532

—

1881

318

554

—

Totals...

8,811

502

9,367

| * 235

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345

1883.] by W. Orange, M.D.

The foregoing figures, reduced to percentages for the sake
of more ready comparison, give the following results :—

Description of Asylums.

Rate per cent, of
Deaths calculated
upon the aggregate
of the Yearly Totals
of Numbers of Cri¬
minal Lunatics under
Treatment during
the Periods specified.

Rate per cent, of
Instances in which
Criminal Lunatics
escaped and were
not recaptured
before the end of
each year during
the Periods specified.

In all the Asylums in England and Walks,

taken together, in which criminal lunatics
were confined during the seven years

4-59

0*62

immediately preceding the opening of
Broadmoor, from 1856 to 1862 inclusive ...
In all the Asylums in England and Wales,
taken together, in which criminal lunatics

5*69

0*87

were confined from 1863 to 1881 inclusive,
with the Exception of Broadmoor

In Broadmoor, from the date of its opening

I' 250

0*05

in 1,863 to the 29th of September, 1881

The following Tabular Statement shows every instance of
Escape that has taken place, from the opening of the
Asylum, in 1863, up to the 31st of December, 1882, toge¬
ther with . the date of recapture, where recapture has been
effected.

Under
Detention
during Her
Majesty's
pleasure.

Under current
Sentences of
Penal

Servitude or
Imprisonment.

Date of escape.

Date of recapture.

6th October, 1863

6th October, 1863.

—

8th June, 1864 ...

9th June, 1864.

—

19tli September, 1864

8th November, 1864.

—

29th October, 1864

29th October, 1864.

—

25th November, 1864

25th November, 1864.

—

8th April, 1865 .

9th April, 1865.

—

8th „

9th „

—

21st May, 1865 ...

21st May, 1865.

—

26th July, 1867 .

26th July, 1867.

—

29th September, 1868

2nd October, 1868.

—

4th November, 1868

9th February, 1869.

—

8th

30th November, 1868.

—

8th

6th January, 1869.

—

25th December, 1868

Not recaptured.

—

27th July, 1869 .

Not recaptured.

—

11th January, 1871

16th January, 1871.

—

— -

—

14th August, 1871

20th August, 1871.

, _

10th December, 1872

10th December, 1872.

—

26th May, 1873 .

26th May, 1873.

—

12th July, 1873 .

Not recaptured.

—

7th August, 1873

29th September, 1878.

—

12th November, 1873

13th November, 1873.

—

6th December, 1874

6th December, 1874.

—

12th October, 1878

13th October, 1878.

XXIX.

Digitized by LjOOQle

346 Presidential Address , [Oct.,

If time had permitted, it would have been interesting to note
the steps which, in the meantime, had been taken in the
sister island.

Long after the date at which provision was made, in con¬
nection with Bethlem Hospital, for some of the criminal
lunatics of England, the criminal lunatics of Ireland were still
detained in gaols; and their pitiable state, in 1843, is
graphically recorded in the report of a Parliamentary Commis¬
sion. Those who then pleaded for the Irish criminal lunatics
asked for arrangements similar to those existing in England,
or, if that was impossible, prayed that the criminal lunatics
of Ireland might be sent over to England to be accommodated
at Bethlem. Something much better than that was, however,
done for them, by providing the separate asylum at Dundrum,
which thus became, in 1850, the first separate and distinct
asylum set apart especially and entirely for criminal lunatics.

Broadmoor Asylum was not actually finished and opened
until 1863; and it may be observed, in passing, that, inasmuch
as Dundrum is one-third of the size of Broadmoor, whilst the

portionate amount of accommodation than England.

I had prepared a short analysis of the Report, already alluded
to, of the Commission recently appointed to inquire into the
whole question of criminal lunacy, but time warns me to pass
on; and this I do the more readily as the Report itself is ac¬
cessible to all.

I have no doubt that most of the members of this Association
have read that report, although I cannot of course pretend to
form any opinion as to what conclusions those members who
have read it may have arrived at.

Probably one of the chief points upon which a difference' of
opinion may have arisen has been the question of the removal
to county asylums of persons whose sentences have expired,
and who are no longer " criminal lunatics,” as the term is
defined by statute; but upon this point I think that some
amount of misunderstanding exists.

The idea seems to be prevalent that the removal of such
persons is an arrangement applicable only to Broadmoor; but
this is not so. At the expiration of the sentence the patient
ceases to be ranked as a criminal, not only in England, but also
in Ireland and in Scotland; and, therefore, at Dundrum those
whose sentences have expired are then removed. The same
plan is employed in Scotland; and in the ninth report of the

Digitized by LjOOQle

347

1883.] by W. Orange, M.D.

General Board of Commissioners in Lunacy for Scotland the
following passage occurs :—

“ Criminals who become insane in prisons are removed at the
expiration of their sentences to the local prison from which
they were received, in order to be liberated. As a rule, they
are, on liberation, immediately taken in charge by the police,
or by the inspector of the poor, and placed in the asylum of
their district as ordinary patients. In this way the accumula¬
tion of criminal lunatics in the lunatic department of the prison
is, in some degree, prevented, as well as the growth of their
numbers as a distinct class of the insane. This procedure helps
to account for the comparatively small number of so-called
criminal lunatics in Scotland.”

An opposite plan would multiply the number so enormously
that three or four establishments would be required; and,
besides this, if a large class of criminal lunatics were created in
that way, it would be necessary to provide for them specially.
One chief point that increases the expense of the care of
criminal lunatics is the necessity of making greater provision
for their safe custody. Those who are not familiar with the
working of an establishment for criminal lunatics can scarcely
realise how much that element increases the actual cost of
maintenance. It is, therefore, in the interests of the State,
very desirable that no larger number should be included in
the class of criminal lunatics than is absolutely necessary.
The person who has come to the end of his sentence has
actually paid the penalty, and there is a natural feeling against
making anyone pay a penalty twice over. Many of these
patients were really lunatics at the time of being sentenced,
and, if the matter be regarded from every point, it will
probably be found that the greatest hardship lay in sentencing
them.

The evils of sentencing persons who are really insane to
penal servitude or imprisonment, are much graver than is
commonly supposed. If the punishment is to be carried out in
its entirety it necessarily involves much suffering; indeed,
penal servitude has been spoken of by one of the most eminent
judges as “ white slaverywhilst if the sentence is not to be
carried out thoroughly, but if the understanding is that it is to
be modified in its severity, so as to suit the mental condition
of the prisoner, it were surely better, in doubtful cases, not to
pass sentence until after a satisfactory examination of the
mental condition of the prisoner had been made. To sentence
an insane person to the same punishment as would have been

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incurred by him if he had been sane, acts as an encouragement
to the practice of allowing insane persons to remain at large
until after the commission by them of some act seriously hurtful
to the community ; whilst, on the other hand, every instance
in which a prisoner is found, on his trial, to be insane acts as a
reminder to the community that, little or much, it has failed in
its duty in not having prevented the commission of the crime
by placing the prisoner under proper care at an earlier date.

Those who may chance to have to endeavour to arrive at
a decision as to whether a prisoner should be treated as a
rational being, and be subjected to the ordinary punishment of
his crime, or whether he should be treated as irrational, and be
detained as a criminal lunatic—a question often involving much
doubt and difficulty even when, as rarely happens, all the facts
of the case can be clearly made out—will hail with gratification
the recent work of Mr. Justice Stephen, a review of which has
already appeared in the Journal.

Mr. Justice Stephen writes that he regrets to be unable to
attend this meeting to-day, being compelled to be absent from
London on circuit. He adds, in his letter to me, that he is
pleased to find that so much interest is taken in his work, and
goes on to say that the part of it which relates to madness was
written with a sincere desire to conciliate the medical profes¬
sion on a point upon which there has been much misunder¬
standing.

A reference to Mr. Justice Stephen's work will show that
the intention thus expressed in his letter has been fully carried
out. Before writing his chapter on the “ Relation of Madness
to Crime," the learned judge read the works of some of the
leading medical writers upon insanity in this country and in
Germany, including those of Drs. Bucknill, Hack Tuke, Mauds-
ley and Griesinger; and that he has fully mastered the subject-
matter of those works will, I am sure, be most fully admitted
by any medical witness who may in the future be called to
give evidence before him on the subject of insanity. The fol¬
lowing extract gives a good indication of the manner in which
he handles his subject:—

“ What then is the meaning of a maniac * labouring under
such a defect of reason that he does not know that he is doing
what is wrong ? ’ It may be said that this description would
apply only to a person in whom madness took the form of
ignorance of the opinions of mankind in general as to the
wickedness of particular crimes, murder, for instance, and such
a state of mind would, I suppose, be so rare as to be practically

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349

unknown. This seems to me to be a narrow view of the sub¬
ject, not supported by the language of the judges. I think
that anyone would fall within the description in question who
Was deprived by disease affecting the mind of the power of
passing a rational judgment on the moral character of the act
which he meant to do. Suppose, for instance, that by reason
of disease of the brain a man's mind is filled with delusions
which, if true, would not justify or excuse his proposed act,
but which in themselves are so wild and astonishing as to make
it impossible for him to reason about them calmly, or to reason
calmly on matters connected with them. Suppose, too, that
the succession of insane thoughts of one kind and another is so
rapid as to confuse him, and finally, suppose that his will is
weakened by his disease, that he is unequal to the effort of calm
sustained thought upon any subject, and especially upon sub¬
jects connected with his delusion, can he be said to know, or
have a capacity of knowing, that the act which he proposes to
do is wrong ? I should say he could not." *

A little further on the learned judge writes :—

“ The proposition, then, which I have to maintain and ex¬
plain is that, if it is not, it ought to be the law of England, that
no act is a crime if the person who does it, is at the time when
it is done, prevented either by defective mental power or by any
disease affecting his mind from controlling his own conduct,
unless the absence of the power of control has been produced
by his own default." +

Here, then, we have a very true and admirable explanation of
words which have so often proved a stumbling block; and we
have also an explicit statement to the effect that the presence or
absence of the power of control is a matter to be taken into con-,
sideration, with reference to the question of legal responsibility.

It is well to be reminded of this latter point, because there
is danger, perhaps, of its being occasionally overlooked. But
in the Lumleian Lectures given in this College by a distinguished
Fellow, in 1878, 1 find the case of Dove referred to, which
occurred thirty years ago. Lord Bramwell, then Baron Bram-
well, was the presiding judge, and tried the case. In charging
the jury, he said :—

“ No doubt insanity is strong evidence of innocence, but it
is not conclusive evidence; and the question whether or not its
existence rebuts the presumption of guilt in any particular case
is entirely for the jury. The questions which by the law had

* “ Hiat. Crim. Law of England.” Stephen. Vol. ii., p % 163.
t Vol. ii. t p. 168, op. cit .

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to be left to the jury were these : Did he know he was doing’
wrong ? Could he help it ? ” That was the direction to the
jnry of one of the judges more than thirty years ago. It was
not very long after the debate in the House of Lords on the
celebrated McNaughten case; and it is, therefore, certain that
the recognition by the law of England of power of control as
an element in the case is not an innovation. “ Could he
help it?” were the words of the question left by Lord
Bramwell to the jury, but the learned judge explained care¬
fully that what he meant by the question was this: “ If
somebody had been standing over Dove with a pistol, and
would have shot him if he poisoned his wife, would he have
done it r This is certainly a very forcible mode of putting the
question; but, if it were settled that Dove knew at the time of
its commission that his act was wrong, in the sense in which
Mr. Justice Stephen takes the words, it is a mode of putting
it for which much could doubtless be said.

tt ^posing w , e were to ask the same question with regard to
Hadfield, when he fired at King George III., the answer might,
possibly, also be in the negative, because Hadfield wished to be
hanged, and if he had been shot, one of his objects would have
been defeated; but then Hadfield is regarded by Mr. Justice
Stephen,* and in that view of the matter I entirely concur,
as a person who did not know, when he committed his act, that
it was wrong. 7

Where premeditation is shown by an insane person in the
commission of an insane act, the loss of control is not a loss
of control over action, but a loss of control over the train of
thought which appears to the individual to make the action
desirable. The question as it presents itself to the mind of
the medical man must ever be: Is the accused insane, and is
the act for which he is being tried the product, or result, of his
insanity r If this question be decided affirmatively in any
particular case, it is practically equivalent to deciding that the
accused did not know right from wrong with respect to the act
in question; because an insane man can no more be said to
know right from wrong with regard to an act done by him, as
the result of his delusions or mental derangement, than he can
be expected to estimate rightly the character of his delusions
themselves. Insane persons who commit murder do not
usually commit the act as the result of sudden impulse. It is
commonly a matter they have thought over and intended to
do tor a considerable time, insane though they may be.

* Vol. ii., p. 167, op . oit .

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A very interesting case, from which much may be learned,
is recorded by Lord Blackburn in his evidence given before the
Homicide Law Amendment Committee.

Lord Blackburn, before relating the case, made these observa¬
tions : “ I have read every definition (of insanity) which I ever
could meet with, and never was satisfied with one of them,
and have endeavoured in vain to make one satisfactory to
myself. I verily believe that it is not in human power to do
it. You must take it that in every individual case you must
look at the circumstances and do the best you can to say
whether it was the disease of the mind which was the cause
of the crime or the party’s criminal will. But this I am clear
about: Whatever definition you give of insanity, it should
apply to all crimes. 55 And I should like to say, in passing, that
this last point is one which cannot too often be urged.

Lord Blackburn then goes on to relate the case to which I
refer, of a woman who had cut the throats of her infant and of
an older child, aged 15, killing the former, and who would have
killed another of her children if she had not been diverted from
her intention.

I cannot omit here to say that this case has also been
referred to by a veteran member of this Association in the
Lumleian Lectures delivered by him in this College in 1878,
and to express the fervent hope that those most instructive
and valuable lectures may soon be reprinted in a permanent
form.

Lord Blackburn says :—“ The facts were these : The woman
had more than once been insane, the insanity being principally
brought on by suckling her child too long; that was the cause
that had produced it before. She was living with her husband,
and had the charge of this girl, a girl of about 15, an impotent
girl, who lay in her bed all day. She was very kind to her,
and treated her very well. They were miserably poor, and,
very much owing to that, she continued to nurse her boy till
he was nearly two years old; and suddenly, when in this state,
she one morning, about 11 o’clock, went to the child, lying
there in bed, aged 15, and deliberately cut her throat. Then
she went toward her own child, a girl of five or six years of
age, of whom she was exceedingly fond, and the girl, hearing
a noise, looked up and said, ‘ What are you doing ? ’ ‘I have
killed Olivia, and I am going to kill you,’ was the answer.
The child, fortunately, instead of screaming threw her arms
round her mother’s neck and said, ( No, I know you would
not hurt your darling little Mopsy.’ The woman dropped the

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child, went downstairs, and went into a neighbour’s house,
told her what she had done, that she had killed Olivia and
was going to kill Mary, ‘ but when the darling threw its arms
round my neck I had not the heart to do it.’ ”

Lord Blackburn continues : “ She clearly knew right from
wrong, and knew the character of her act; for some little
time after that she talked rationally enough, but before night
she was sent to a lunatic asylum, raving mad, and, having
recovered, she was brought to be tried before me at a subse¬
quent assizes. On the definition in McNaughten’s case, she
did know right from wrong. She did know the quality of her
act, and was quite aware of what she had done; but I feel it
impossible to say that she should be punished. If I had read
the definition in McNaughten’s case and said, ‘ Do you bring
her within that ? ’ the jury would have taken the bit in their
own teeth and said, ‘ Not guilty on the ground of insanity/
I did not do that; I told them that there were exceptional
cases, and on that the jury found her not guilty on the
ground of insanity, and I think rightly/’

My present object in referring to this case is to point out that
the word “ suddenly/’ used to express the manner in which the
poor woman killed her child, is liable to be misleading. The
woman became an inmate of Broadmoor, and told me all about
the matter. She said that she was very much depressed and
weakened by suckling her infant, and that the catamenia had
returned, and she had suffered a great deal from haemorrhage,
and, on the previous day, Sunday, she knew she was “ getting
bad again”—to use her own phrase. Two years before she
committed this murder, she had attempted to drown herself and
her child, but was rescued. She says she could not accurately
describe what she felt, but she remembers that she did not
want to live, and she felt it to be a right thing to kill the
children before she killed herself. She says also, and this is
the point to which I wish to call your attention, that she lay
awake the whole of the Sunday night harbouring and pondering
over her intention. She says that when her husband got up in
the morning he said, “ How are you ? ” She said, “ Better,”
in order to induce him to go to his work and leave her; and
then, after her husband had gone, she committed the murder.
This is the history of all the cases of this kind of which I have
been able to ascertain the real facts. The acts, in. the absence
of delirium, or sudden provocation, are commonly premeditated,
and are the result of delusion, or, what comes to be same thing,
of an insane train of thought; and these cases must, therefore.

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353

be ranked in the same category as the case of Hadfield. The
poor woman, whose case is so graphically related by Lord
Blackburn, was unquestionably insane, and unable to rightly
estimate the moral character of her act ; but we must not over¬
look the lesson to be learned from the fact that the act was
premeditated, and that the opportunity was carefully planned.
The premeditated act was dwelt upon and thought over during
the whole night; and the question arises as to what is under¬
stood when it is said that she could not control her conduct.
She controlled herself the whole night. She controlled herself
when she said to her husband that she was better. But,
suppose we go deeper, and find that her reason was deranged,
and that she was indeed in that condition which Mr. Justice
Stephen says is really what he thinks the law means, when
speaking of incapacity of knowing that the act was wrong. We
find then truly a want of power of control, but it is a want of
power of controlling the mental operations that lead to action.
We are all of us familiar with the strange things that a
patient, in an early stage of mania, does, that cannot by any
possibility be of any advantage to him to do. Can we say that
he knows clearly that those things are wrong ? If so, why does
he do them ? The instances in which an insane person does
things that are detrimental to him, whilst thinking that he is
right in doing them, are so common as to run the risk of pass¬
ing unheeded, and, therefore, I would ask your indulgence
whilst I attempt to illustrate the point in question by alluding
to a case now under my care. It is that of a soldier who shot a
comrade, some fifteen years ago, in the hope that he might be
hanged, wishing, in fact, to commit suicide in an indirect
manner. After a time he recovered, to a great extent, and, for
many years, he was comparatively well. He wrote many
petitions to the Home Office, praying to be discharged, and so
sensible were his letters that they were often referred to me for
my report as to whether it would be safe to discharge him.
My opinion was, however, that he was not a safe person to be
at large. Recently he has had another acute attack of mania;
and, whilst this attack was coming on, but before it had
declared itself by any very well-marked signs, he wrote to the
Secretary of State a petition praying for his discharge, and then
wound up the petition, which was, in other respects, properly
worded, as follows:—“And pardon me for saying, may the
Devil sweat the hindmost.” Now, did he realise that he was
doing wrong when he wrote those words ? I told him the next
day that I had kept the petition on account of its strange

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354 Presidential Address . [Oct.,

ending, upon which he said, “ I wish you had sent it all the
same. The Secretary of State will understand that.”

This expression of opinion on the patient’s part must
have been the result of a condition of mind in which he
was not capable of realizing the true character of the words
that he had used. Two days later, he asked me to strangle
one of the attendants, saying that he would have done bo
himself, and saved me the trouble, if he had had the oppor¬
tunity. Supposing that he had succeeded in killing some one,
would it have been right to consider the act as being the
result of a want of control over conduct, or as being indicative
of a sudden and uncontrollable impulse, or as being due to a
mental condition in which, to use Mr. Justice Stephen’s words,
the man was “ incapacitated from forming a calm estimate of
the moral character of his act, in other words, had not a
capacity of knowing that it was wrong ? ” *

I have ventured to occupy some of your time this afternoon
with the consideration of this exposition by Mr. Justice
Stephen of the criminal law in relation to madness, because
the matter certainly is one upon which there has, as the
learned judge says, been much misunderstanding. I feel con¬
vinced, however, that this misunderstanding has been due en¬
tirely to the inherent difficulties of the problem. It is possible
that some of my hearers may not agree with the interpretation
given by Mr. Justice Stephen, but I feel very strongly
persuaded that a careful perusal of his chapter on madness will
well repay all who may be called upon to give evidence with
respect to the mental condition of persons accused of crime.

In conclusion, I have very much to thank you for, on
account of the patient manner in which you have listened to
these very imperfect remarks ; and it is unnecessary to say that,
in offering them, no attempt has been made to do more than
to raise a few points which I now ask you to do me the
favour of discussing.

* Vol. ii., p. 162, op , tit .

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355

On the Pathology of Certain Cases of Melancholia Attonita or
Acute Dementia .* By Joseph Wiglesworth, M.D. Lond.,
Assistant Medical Officer, Barnhill Asylum. ( With
Illustration .)

Since a knowledge of the Physiology of Mind is essential to
a clear comprehension of its Pathology, we may fitly introduce
a paper purporting to deal with one form of abnormal mental
action, with a few considerations concerning mental action in
general.

A nervous system is an apparatus for registering the impres¬
sions received from the external world—an apparatus through
which the environment acts upon the organism, and is itself
re-acted upon by it. In ultimate structure such a system
consists of nerve vesicles, and nerve fibres connecting these.
The nervous arc, consisting of afferent and efferent fibres, and
intervening corpuscle, which subserves reflex action, introduces
us to the primitive form of nervous action—shows us the unit
out of which the nervous system is built up ; by the combina¬
tion of two or more such nervous arcs, fibres from which meet
in a common centre, a nervous system in its simplest form is
produced, and it is by the combination and re-combination of
an infinite number of such simple nervous systems, that the
highest nervous systems are elaborated.

The co-ordination of a number of inferior centres by a
superior centre, implies not only that all these inferior centres
are there brought into union, but that they are subject to the
influence of this higher centre—are controlled or inhibited by
it. A number of such superior centres are themselves co-ordi¬
nated or controlled by still higher centres, and so on to the
latest stages of evolution. We might, therefore, roughly
divide nerve vesicles into those which register impressions, and
those which co-ordinate the impressions thus registered. This
is, of course, but a rough subdivision; during the gradual
evolution of the nervous system, registration of impressions,
and co-ordination of these have gone hand in hand. Never¬
theless, we are justified in assuming that in the highest nervous
system hitherto evolved—the human brain—an enormous
number of plexuses of cells and fibres, which we may call
lower centres, are controlled and co-ordinated by a smaller
number of plexuses which we may call higher.

* Essay to which the Prize of the Medico-Psychological Association has been
awarded. (See report of the Annual Meeting in this number).— Eds.

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Melancholia Attonita or Acute Dementia , [Oct.,

Dividing Mind into Feelings, and .Relations between Feel¬
ings, we see that the former correspond to the physical excita¬
tion of nerve vesicles, and the latter to that of the fibres
connecting them. The nerve vesicles, therefore, in which
impressions have been organically registered, form the raw
material of intelligence, and it is by the combination and re¬
combination of these in an infinite number of ways, that all
manifestations of intelligence result.

What is called a knowledge of any object, however small, is
a synthesis of a number of impressions—is a synthesis of
physical changes in a group (large or small) of nerve vesicles,
and of the fibres connecting these. For the object to be
recognized as a whole, all these impressions must be brought to
one centre—must be co-ordinated in one centre. Such centres
of co-ordination are themselves combined and re-combined in
endless variety. The final groups of vesicles, through which
all the original groups are brought into relation, are the highest
centres—the “ highest co-ordinating centres,” and are of
course the latest developed.

Arrest of the function of these highest centres permits the
lower centres to act without restraint, and excess of action,
coupled with incoherence of action, is the result, as we see in
mania. The due performance of the function of the highest
co-ordinating centres is essential to consciousness in its highest
form, and in proportion as the function of these is abrogated, the
individual is dethroned from a higher to a lower phase of con¬
sciousness. It may well be doubted whether a patient, the
subject of a severe attack of mania, has ideas in the strict
sense of the term. The so-called random ideas, of which his
incoherent talk is the expression, are merely due to the un¬
controlled action of certain lower nervous plexuses, which, not
being brought to one centre, cannot by their action form part
of one consciousness. But if, in place of a disease which
attacks primarily the highest co-ordinating centres, we have
one which affects the nerve vesicles constituting the lower
plexuses—those which have directly received the impressions
stamped on them by the external world, and which thus form
the raw material of intelligence—the result would be different;
for whatever might be the ideas excited by irritative action
going on in these centres, they would be capable of being to a
greater or less extent co-ordinated in a common centre, and of
thus forming part of one consciousness; that is, the individual
would be conscious of the ideas excited, however incoherent
they might be.

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Jourhai. or Mental Science
Oct 1883.

J Wi glee worth, del . R Mintem.Uth.

Mint era. Bros. imp

TO ILLUSTRATE D R WLGLESWpRTH’S ESSAY

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1883.]

by Joseph Wiglesworth, M.D. 357

What would be the result of an irritative action, say of an
inflammatory kind, going on in these vesicles ? Whatever
might be the special function of any individual cell attacked,
it probably would be speedily annulled, for inflammatory action
in a nerve cell could not long continue without seriously
damaging the delicate protoplasmic substance of which it is
composed; but though quoad its own direct function, i.e ., as
regards the representation of an impression formerly registered
in it, it might be practically obsolete, it would still, however,
functionate indirectly, by calling into activity the numberless
nerve vesicles with which it is in organic connection, for as
long as any inflammatory action was proceeding in it, so long
would it act as a permanent source of irritation, and be per¬
petually drafting stimuli along the plexuses with which it was
in connection, thus calling into activity the impressions with
which it had been associated in experience. But since for the
harmonious working of a whole, the integrity of every part is
necessary, and since, according to the hypothesis, the injured
cell forms part of a whole, the impressions thus re-presented
lacking some element which existed on their original presenta¬
tion, will give rise to ideas which are more or less incoherent—
more or less, according to the greater or less number of
vesicles, the direct functions of which are in abeyance. But
the highest co-ordinating centres not being involved, the ideas
thus aroused are capable of being brought to one centre—of
forming a consciousness.

I have now to describe two cases, in each of which a definite
assemblage of clinical symptoms was associated with a definite
microscopical lesion discovered in the brain after death. An
attempt will then be made to explain the former by the latter,
and to draw some conclusions.

Case I.— Elizabeth G., was 48 years of age when she was admitted
into an asylum. Her family history disclosed no evidence of insanity,
epilepsy, or phthisis. Her parents were said to have been temperate,
but two of her sisters were stated to have been very intemperate—
were described, indeed, as having drunk themselves to death. Patient
had been married upwards of 25 years, but had been separated from
her husband for about 12 years. Since that time she had kept a
lodging house, and had lived with one of her male lodgers as his wife.
During the last few years she had been gradually getting intemperate,
and had drunk a good deal during the last year or two, chiefly gin, it
was said. Some eight months previous to admission she got a fancy
that the man with whom she cohabited had designs on her life, and
two months subsequently, when staying with a friend, she thought

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Melancholia Attonita or Acute Dementia, [Oct.,

people were going to poison her. It did not appear, however, that her
friends considered her mind affected at that time, and it was only
about a week before admission that distinct evidence of mental
alienation, was observed. She then took to her bed, and could scarcely
be got to speak at all.

On admission she was noted to be a woman of short stature, bat
otherwise fairly well developed ; she was fairly nourished, but appeared
to have lost flesh ; her height was 4ft. ll^in., and her weight (taken
a fortnight after admission) was 98lbs. Complexion muddy, and
capillaries of cheeks dilated ; hair brown and matted, full of pediculi.
Temp., 99*2; pulse, 92, weak; respirations, 24. There was no
evidence of visceral disease. The urine was normal.

She appeared very feeble, and could not be got to walk, but had to
be carried into the ward. She had a stolid expression, and was
perfectly sileut—could not be got to answer a single question.

1st week.—On the following day she had the same stolid expression,
and preserved the same obstinate silence. She took no notice of any
question put; sometimes, indeed, she stared at questioner, but at
others, even when spoken to loudly, did not even turn her eyes, nor
could she be got to protrude her tongue. She resisted all attempts at
the administration of food, and took very little. She remained much
in the same condition for about a week, but was a trifle brighter, for
she occasionally answered simple questions shortly, and in a whisper;
more often, however, she was obstinately silent. She had to be
dressed and fed, but took a fair amount of food with pressing. She
sat very quiet, taking very little notice of surrounding things, though
she at times looked about her a little. Appeared shaky when walking.-
Slept on the whole fairly well, but was wakeful at times. Tongue
moist. Slightly furred. Bowels confined.

2nd week.—During the following week she still continued dull,
though was on the whole a little brighter; though keeping very
taciturn she answered questions somewhat more readily, and on one
occasion stated correctly one or two incidents in her past life. Her mind,
however, was clearly much confused. She took food pretty well, and
fed herself. Bowels still confined ; breath offensive, and tongue
furred. Right pupil slightly contracted, left normal size; both
regular, and acted to light. Kept decidedly feeble.

3rd week.—During the third week she still continued to get a little
brighter, and once or twice did some needlework. She kept, how¬
ever, very feeble; hands trembled on movement, and she on one
occasion fell down ; tongue could only be protruded for a very short
distance, and was distinctly tremulous. She was a little restless, at
times wandering about. There was still difficulty in getting her to
answer questions, and-she rarely spoke spontaneously. She appeared,
however, to have some confused idea as to where she was, and on one
occasion asked for her bill, saying she wished to settle it. Was some¬
what wakeful at night. Took food better.

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1883.] by Joseph Wiglesworth, M.D.

4th week.—Towards the end of the fourth week, she was one even¬
ing restless and excited. She spoke to medical officer in a rapid
nervous way, appearing to have vague, incoherent thoughts, to which
she could only inadequately give expression. She continued restless
during that night, and on the following morning rolled on the floor,
pulling at the carpets and screaming. She said she was sad at heart
—that nobody cared for her—and putting her hand to the top of her
head, said she had a child there.

5th week.—She continued somewhat more restless during the fifth
week, and was again on one occasion observed to roll on the floor, and to
endeavour to wrap the carpet round her head. She continued feeble,
and there was still tremor of hands when moved, and of tongue when
protruded.

6th week.—During the sixth week her condition varied, she being
at times very dull, scarcely speaking at all, and at others talking a
little in a rapid nervous way.

7th week.—At the beginning of the seventh week an attack of diar¬
rhoea came on, which confined her to bed, and she rapidly became more
feeble. There were occasional twitchings of tendons. Temp, varied
from 98° to 101*2°. Breath exhaled a peculiar sickening odour.
Examination of thorax showed respiratory sounds to be normal, with
the exception of being a little harsh anteriorly, there was no dulness
anywhere. She became very morose, and could scarcely be got to
say a single word.

8th week.—At the beginning of the eighth week she lay on her
back low down in bed ; arms rigid ; tendons twitching a little. The
diarrhoea had been arrested. She took no notice of her friends who
visited her. From this time to her death, which took place three
days later, she exhibited much the same symptoms; she lay very
quiet with a fixed expression, taking no notice of surrounding things,
and could not be got to speak. Anns kept very rigid ; occasional
slight jerkings of tendons.

Temp, was normal.

She died on the 52nd day after her admission into the Asylum.

Autopsy (24 hours after death).

Cranium .—Calvaria somewhat thin ; dura mater not abnormally
adherent, somewhat flaccid over each frontal lobe ; about an ounce of
fluid in subdural space (arachnoid cavity) ; arachnoid and pia-mater
not appreciably thickened, strip readily. Distinct wasting of frontal
lobes, and wasting, to a less extent, of parietal ; the widening of the
sulci being in some places greater than others, gave something of the
appearance of cysts ; this was the case in both prae-central sulci;
posterior part of left third frontal gyrus distinctly wasted. Occipital
and tempero-sphenoidal lobes appeared perfectly healthy. Cortex
somewhat dark, but not markedly wasted. Brain generally very
soft and wet. Ganglia at base especially soft. Ventricles slightly
dilated, containing excess of clear fluid. A few atheromatous patches
on vessels at base of brain.

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Melancholia Attonita or Acute Dementia , [Oct.,

Weight of different portions of brain .

Right Hemisphere ...
Left „

Cerebellum ..

Pons .

Medulla Oblongata ...

... 563*5 grammes
... 565 „ )

... 133*8

... 12*5 „

... 51 „

Stripped of
membranes.

1279*9

Right.

Left.

Frontal Lobe .

98*2 grammes

104-7

Parietal Lobe

... 305

302

Temp. Sphen. Lobe

... 114*5

114*8

Occipital Lobe.

... 45

43*5

f»

562*7

565

(The posterior boundary of the frontal lobe here taken, was the
ascending limb of the Sylvian fissure.)

Thorax .— Costal cartilages partially ossified.

Diaphragm reaches to fifth rib on right side, to fifth space on left.

Pleurae empty. A few old adhesions easily broken down at
posterior and upper part of each.

Lungs. —Right, 16ozs. ; left, 14ozs. Somewhat emphysematous.
Both lower lobes congested.

Pericardium .—External layer of parietal pericardium thickened,
and adherent to each lung by two or three fibrous bands; visceral
pericardium healthy.

Hearty 8ozs. A little black fluid blood in auricles. Mitral valve a
little thickened and contracted, with a few atheromatous patches on
anterior flap. Aortic valves a little thickened, and several athero¬
matous patches encircling lower portion of aorta. Muscular sub¬
stance of left ventricle showed numerous pale streaks.

Abdomen. — Liver , 37^ozs. Right lobe extends two inches below
ribs, is marked by a broad tranverse depression, and connected with
right lateral region of abdomen by a few fibrous bands. On section
pale, fatty, patches irregularly distributed. Gall bladder adherent
to tissue around right supra-renal capsule.

Spleen normal. Pancreas normal.

Kidneys each weighed 4^ozs.; hypersemic; capsules a little
adherent; cortices a little diminished and somewhat mottled in parts.
A few small cysts.

Supra-renal Capsules .—Left enlarged to three times its natural
size, and destroyed for the greater portion of its extent by fibroid
overgrowth, studded with caseous and calcareous nodules; at left
lower corner, proper substance of capsule remained nearly intact.
Right very slightly, if at all enlarged, and fairly healthy, but showed
here and there caseous nodules the size of a pin’s head.

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1883,] by Joseph Wiglesworth, M.D.

Fatty tissue round each capsule much condensed, and appeared at
first incorporated with the capsule, requiring careful dissection off.

Semi-lunar ganglia appeared free and healthy.

Stomach .— Mucous membrane somewhat injected.

Intestines appeared healthy (not opened).

Uterus .—Very small ; weighed one ounce. Somewhat un-
symmetrically developed towards right side.

Ovaries. — Right small and puckered ; left contained a cyst size of
pea, enclosing glairy fluid.

Microscopical examination of Brain .—Sections were obtained from
the brain in the fresh condition, on the ether-freezing microtome,
treated with osmic acid, and stained with aniline blue-black; they
were taken from the following gyri:—

Posterior Central Gyrus (Upper part. Left Hem.).—Great swelling
of nerve cells, in some cases producing almost complete sphericity of
outline; eccentricity of nucleus; comparative scarcity of yellow pig¬
ment, this, however, distinct in some cells. The contents of many of the
larger cells have, independently of pigmentation, or at times associated
with it, a coarse granular appearance; at other times the cell is smoothly
and uniformly stained with the aniline, the nucleus being, however, in
almost all cases distinct. These changes best marked in the large
cells of the fourth layer, but are well marked in third, and distinct in
many of the larger cells of the second layer. Slight pigmentation
also occurs in some of the larger cells of the second, apd smaller cells
of the third layer, without any distinct swelling or nuclear displace¬
ment being apparent. Some of the spindle cells also appear a little
swollen, ancf some are distinctly, thoughly slightly pigmented.
Occasional little patches of bright yellow pigment occur which can¬
not be distinctly connected with anything.

Posterior fart of Third Frontal Gyrus (Left Hem.).—Second and
third layers: pigmentation very common, in some fields scarcely a cell
being altogether free from it. Occasional patches of yellow pigment
not obviously connected with anything; greater or less displacement of
nucleus common; in some cells distinct tendency to sphericity of outline;
this quite clear and distinct in a minority of cases, more especially of the
larger cells, and probably occurs to a slight extent in the majority.
Swelling probably somewhat more marked, and pigmentation less
marked in the larger cells of the fourth layer. A few of the spindle
cells show slight swelling and pigmentation, but the majority
appear quite normal. Many of the nuclei have a white dot in the
centre.

Tip of First Frontal Gyrus (Left Hem.).—Similar conditions to
those above described, but less marked. Some cells quite typical.
Pigmentation very marked in some parts of the section.

Tip of Tempero-Sphenoidal Lobe (Right Hem.).—Many of the
cells present previously described characters typically, but the majority,
probably, were not so affected. Comparative scarcity of pigment.

xxix. 25

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Melancholia Attonita or Acute Dementia, [Oct.,

Tip of Occipital Lobe (Left Hem.).—Some of the larger cells of
the deeper layers distinctly swollen with displacement of nucleus.

In all the above sections the neuroglia appeared normal.

Note .—The type of lamination followed ,in the above descriptions
has been the five laminated, which comprises an outer (1st) non-
nervous layer, a 2nd layer of small pyramidal cells, a 3rd of large
pyramids, a 4th of small angular cells, which contains nests of giant
pyramidal cells in some parts, and a 5th (deepest) of spindle cells.

It must be admitted that there were certain features in this
case which gave it a little resemblance to one of general
paralysis; the muscdlar feebleness and tremors especially called
this to mind, as also the slight inequality of the pupils, though
these acted well to light. The mode of death might perhaps
be said to favour this view, but, in emphasising these points, the
marks of resemblance to this disease are exhausted. It was
contradicted by every other clinical feature, and during the
patient's life was, after due consideration, decidedly rejected.
The pathological evidence was altogether opposed to it, and,
therefore, while considering it advisable to call attention to the
above points of likeness to general paralysis, I think a possible
view of the case, which might include it under this heading,
cannot be entertained.

On admission this patient presented the appearance of a
typical case of melancholia attonita; deep mental stupor was
the predominating feature then, as it formed a striking element
in the closing scene. During the middle period of the case the
mental characters varied somewhat, but throughout a greater
or lesser degree of self absorption was dominant; there always
appearedmore or less of this. Combined with this mental picture,
we have noteworthy physical characteristics, muscular weakness,
muscular tremors, and (for a few days before death) muscular
rigidity. The case, indeed, appeared to run a definite clinical
course, the cause of death appearing a mystery which was not
elucidated by a naked eye sectio cadaveris; though the
patient’s tissues generally were not in a perfectly healthy con¬
dition ; the only organ distinctly diseased was the left supra¬
renal capsule, but it is well known that one capsule may be
destroyed and produce no recognisable symptoms, nor in this
case were there any clinical signs of affections of these
organs (there was no bronzing of the skin). I do not myself
think that this lesion had anything to do with the patient’s
death ; at best it could but have been considered accessory.

It has been said that no naked-eye lesions were discovered
which could account for death. It has now to be admitted

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by Joseph Wiglesworth, M.D.

363

that this point has not been completely elucidated by micro¬
scopical examination ; nevertheless the demonstration of what
must in all probability be regarded as inflammatory swelling of
the nerve cells of the cortex cerebri is a fact of much import¬
ance. The difficulty is not in supposing that inflammation of
nerve cells may cause death, but the association of death with
affections of nerve cells in parts not ordinarily considered
vital. It must, however, be remembered that the limits of the
morbid process were not accurately defined, nor was it possible
to do this, for no one individual can make even an approach
to a complete examination of a brain in a fresh condition,
and for the appreciation of delicate lesions in nerve cells
it is imperative that the brain should be examined whilst
fresh. It is possible that a lesion similar to that above
described had spread beyond the cortex, and had involved
nerve cells in the basal ganglia or medulla oblongata, but,
independently of this suggestion, we are by no means in a
position to affirm that inflammatory changes in nerve cells of
the cortex cerebri are not alone sufficient to account for death.

The concurrence of a distinct affection of the muscular
system—tremors, rigidity, &c., with a demonstrated lesion in
nerve cells of the cortex cerebri, in parts now ordinarily con¬
sidered as subserving a motor function, is a fact of much
significance. The cells here more particularly referred to are
the nests of giant cells of the 4th layer of the cortex, found
mainly in the anterior and posterior, central gyri, paracentral
lobule, and posterior part of the three frontal gyri; but cells
identical with these in position and grouping are found in
many—probably most—other regions of the cortex, and, though
not equalling the former in size, not improbably subserve a
substantially similar function. For considering the first named
cells to be motor, we have the analogy between size of cell
and motor functions, which is suggested by the now clearly
demonstrated fact of association of motor functions with the
large cells of the anterior cornua of the spinal cord; but the
fact more particularly to be relied upon is the demonstration by
Hitzig and Ferrier, of the connection between electric excita¬
tion of certain definite arese of the cerebral cortex and sequent
muscular movements of a well-defined character,’ the giant
cells in question being proved to correspond in distribution
with this excitable area. It must be noted, however, that
though the morbid process in the case described was best
marked in the above cells, it was by no means confined to these.

In talking of motor cells, and motor centres, stimulation of

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Melancholia Attonita or Acute Dementia , [Oct.,

which produces definite movements, the tendency in some
quarters seems to be to regard such motor centres as something
apart from—outside of—mind ; that is, to look upon mind as
an entity, which in acting upon the external world acts through
these motor centres—uses them in the production of move¬
ments. Nevertheless such'a conception is opposed to funda¬
mental views of the structure of the nervous system; we can¬
not talk of mind and motor centres any more than we can talk
of mind and sensory centres; the two are mutually inclusive.
What we know as mind is made up of these motor and sensory
centres, that is of the functional activities of these ; from the
simplest reflex act up to the highest generalization of science,
the nervous system sensori-motor at the beginning, is sensori¬
motor to the end. This view, elaborated in the works of
Herbert Spencer, has been ably advocated for many years by
Dr. Hughlings Jackson; nevertheless it is doubtful whether it
yet receives by any means universal recognition; a full appre¬
ciation of it is, however, necessary to a clear conception of the
complicated phenomena of mind.

The application here to be made is, that inflammatory irrita¬
tion of nerve cells, considered motor, will produce not merely
affections of those muscles, with which their action is
ordinarily associated, but also distinct mental manifestations,
not yet specifically recognizable, which are nevertheless neces¬
sarily to be inferred.

Case II. —Eliza R. was 30 years of age when she was admitted
into an asylum; she was a married woman living with her husband.
Her family history was unimportant, her father was said to have died
at 50 of a “ stroke,” but no evidence was forthcoming of insanity,
epilepsy, or phthisis ; her mother, who gave these particulars, ap¬
peared to be of a decidedly emotional temperament. Patient’s
personal history was to the effect that she had been married ten years,
but had had no children, nor any miscarriages; she herself was the
only child in the family, and had always been delicate; for some
months previous to admission she had been under treatment for
uterine disease ; her condition of ill-health seemed to prey upon her
husband’s mind, who, a week before her admission, attempted to
commit suicide by jumping into the river ; this escapade of her
husband’s was a great shock to her, and she almost immediately
showed signs of insanity. It was impossible to obtain from the
mother a coherent account of the symptoms patient then presented,
but she was said to have been excited for two days ; previous to this
she had never shown any signs of insanity.

On admission, she was noted to be a woman somewhat below
medium height, of spare habit, but fairly nourished, features thin,
brown hair, grey hides, pupils 4 mm., equal, regular, appeared to act

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1883.]

by Joseph Wiglesworth, M.D.

365

to light, but it was difficult to examine them properly; teeth much
decayed, tongue protruded straight, but rapidly withdrawn, dry and
somewhat brown; lips and teeth dry. Temp., 99 2°, pulse 108.

Lungs , normal. Heart , normal. Urine, clear, amber-coloured,
acid ; sp. gr., 1032 ; no albumen, no sugar.

She was restless and out of bed most of night, the first night after
admission, and the following day was reported to have appeared in a
greater or less condition of panic since her admission, clutching hold
of everybody who came near her, and muttering at times disjointed
words, such as “ judgment , 191 in a hurried, nervous way. She could
not on this morning be got to answer a single question, but the even¬
ing previous had given one or two rational replies to simple questions
—thus, gave her name correctly, her age as 20 (really 30); stated
that she had been married 8 years (really 10), and had had no
children (correct). She now had a nervous, frightened manner. Her
arms and the upper part of her body trembled at times, and she at
times moved her right arm rapidly to and fro, with what appeared to
be voluntary movements.

The following night, being put to sleep in a single room, she was
out of bed all night, and at 4 a.m. was reported as screaming, and
knocking at the shutter and door of her room. Her bowels were
moved during the night, and her bed was soiled. On the morning of
the next day she was in much the same condition as above described,
but in the afternoon went to sleep, and slept almost continuously until
the following morning ; on this (4th) morning she was sitting up in
bed with a wild, somewhat absent expression. She was very quiet,
but could not be got to answer a single question. She was got up,
and for the next three days continued restless and wakeful during the
night, and during the day wandered about in a lost sort of way, but
could not be got to speak. Right arm was frequently agitated with
tremor. On the morning of the 8th day she was still restless, stand¬
ing with one arm behind her back, and the other crossed in front of
her abdomen ; fingers of each hand bent into palm, right arm not
unfrequently agitated with more or less rhythmical jerks, which
appeared to be under the control of the will; her expression was
absent, though she looked about her. She wandered at times about
the room, but did not speak ; the only question she could be got to
answer was to say “ yes,” when asked if she was better. Was taking
food well.

Bowels rather confined.

She continued quiet, scarcely speaking at all, but occasionally
muttering a few unintelligible words. Expression continued absent.
She was on one occasion detected eating her faeces. On the morning
of the 14th day, appearing more feeble, she was kept in bed. She
lay quiet, mouth half open, eyes moving about restlessly, expression
distinctly blank, though she appeared to regard surrounding objects;
occasional slight twitchings of upper lip observed, arms trembled on
movement, and there was also very slight quivering of muscles of

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866

Melancholia Ationita or Acute Dementia, [Oct.,

loft side of arm and hand, when arm was apparently at rest. Arms
were kept rigid when attempts were made to move them. Temp., 102 - 2°.
Pulse, 116, pretty full and regular. Respirations, 24. Reflexes ,
plantar very active; abdominal very slightly marked. Knee-jerk
very active. An opthalmoscopic examination showed both discs to be
very red, but the edges were perfectly clear and defined. Could not
be got to protrude tongue, and the only word she could be got to say
was “ better,” in reply to a question as t > how she was, and this
answer was only elicited after the question had been frequently re¬
peated. She had to be fed, and kept food a long time in mouth before
swallowing it, but took a fair amount of it. Hhe slept well the next
night, and on the following day (15th day) temp, was 99*8°; pulse,
124. 8he still lay quiet in bed, with her mouth half open, but there
was no escape of saliva; she screamed when moved; she did not
speak spontaneously, nor could she be got to take any notice of
questions, neither would she protrude tongue when told. She con¬
tinued much the same for the next two or three days, but appeared
getting gradually weaker. Temp, varied from 97*2° to 99*2°;
pulse from 120 to 128. On the 18th day she was lying very quiet,
taking no notice of anything; could not be got to speak at all.
Muscles of extremities were rigid when attempts were made to move
them. An examination of thorax showed general slight hyper-
resonance, and expiration was somewhat abnormally distinct; these
signs, of course, pointed to some slight pulmonary emphysema, but
beyond this no evidence was forthcoming of any visceral disease,
either thoracic or abdominal. On the morning of the 19th day some
swelling and induration of both parotid regions was observed, and
patient was obviously sinking ; she died on that day, at 9.50 p.m.

Autopsy (18 hours after death).

Cranium. —Calvaria normal. Dura mater somewhat too adherent,
bags in frontal region ; about two ounces of fluid in subdural space ;
arachnoid not opaque ; it and pia-mater not thickened ; pia-mater
strips fairly readily—no adhesions ; sub-pia-matral tissue cedematous ;
considerable wasting of gyri over convexity, with corresponding excess
of sub-arachnoid fluid ; this wasting as well marked posteriorly as
anteriorly ; surface of cortex pale, becoming slightly pink on exposure
to the air; brain generally rather pale, wet, and slightly soft. Cortex
of normal depth—pale grey; striae generally indistinct, but fairly well
marked in occipital regions. About half an ’ounce of fluid in ven¬
tricles ; basal ganglia normal; cerebellum normal; pons and medulla
normal; basal vessels healthy.

Weight of brain immediately after removal, 1,365 grammes.

Right hemisphere

.. 582 grammes.

Left „

.. 578 „ (stripped = 558)

Cerebellum...

... ... ... 158 ,,

Pons .

• •• . 12

Medulla oblongata

... ... ... 75 ,,

1337-5

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1888.] by Joseph Wiglesworth, M.D. 867

Thorax. —Diaphragm reaches to 4th rib on right side, to 4th space
on left.

Pleurae empty ; no adhesions.

Lungs. —Right, 13ozs. Left, ll^ozs. Upper lobes emphysema¬
tous ; lower moderately hypersemic, fully crepitant.

Pericardium empty.

Heart , 6^-ozs. Small amount of subpericardial fat. A little par¬
tially discoloured clot in right cavities. Valves competent and healthy.
Muscle a little soft, but apparently healthy.

Abdomen. — Liver , 33ozs. A little pale.

Spleen , lfoz. Normal.

Kidneys , right, 3fozs.; left, 4^ozs.

Capsules strip readily. Structure apparently normal.

Pancreas , normal. Adrenals , normal.

Uterus , 2oza. Fundus a little large ; lips of os somewhat hyperasmic ;
cervix contains a slight amount of glairy fluid.

Ovaries , left contained a recent corpus luteum. Right appeared
abnormally tough, as if containing an excess of fibrous tissue, chiefly
in centre.

Microscopical Examination of Brain .—Sections were prepared, as in
the former case, from the fresh brain; they were taken from the
following parts. (Right hemisphere) :—

Tip of Middle Frontal Gyrus .—Of the larger cells of the 3rd
layer, the majority presented eccentricity of the nucleus ; 18 cells
showing this character were readily counted in one field (^inch), most
of them also showed slight swelling—slight tendency to sphericity,
one or two showed small whitish spots in centre of nucleus ; scarcely
any showed nucleus absolutely central; a few cells showed slight
yellow pigmentation ; the above-mentioned points were most marked
in many of the larger cells of the 4th layer; some, however, appeared
quite normal. At one spot two large cells were observed close to¬
gether; one presented distinct swelling and distinct eccentricity of
nucleus; in the other the outline was sharp and angular, but the
nucleus was not exactly central, and had a white dot in the centre.
Free nuclei very distinct about many of the cells (? nuclei of lymphatic
sheath). In the spindle-celled layer the nucleus appeared slightly
eccentric in some cells, and in others the nucleus seemed large, almost
filling the cell, but the majority looked normal or almost so.

Tip of Anterior Central Gyrus .—Many of the larger cells of the
2nd layer showed distinct tendency to sphericity, with eccentricity of
nucleus; a few were pigmented ; these characters got more distinct
in passing from the 2nd to the 3rd layer, and in many of the large
cells of the 4th layer, the swelling and eccentricity of nucleus were
exceedingly clear, but slightly or doubtfully visible in the layer of
spindle cells.

Angular Gyms. —Same conditions, but less marked; a considerably
larger number of the larger cells, as compared with those from pre¬
ceding sections, appeared normal; many of them, however, showed

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308 Melancholia Attonita or Acuie Dementia, [Oct.,

very distinctly tlie tendency to sphericity of outline, with eccentricity
of nucleus.

Third Temfyoro-sphenoidal Gyms .—Same conditions, but probably
less marked than in preceding sections—quite distinct, however, in
some cells.

Tip of Orcipitnl Lobe .—A few of the cells appeared to present the
above described characters in a slight degree.

In all the sections the neuroglia appeared normal.

The exact position of this case in psychological nomen¬
clature, might perhaps be considered to admit of some question;
nevertheless it can hardly be doubted that it would have been
included by all, or nearly all, under the class of mental affec¬
tions, which form the heading of this paper. There was, indeed,
an early stage of excitement in the case, but the symptoms
soon passed into those of self-absorption and vacuity. The
case indeed was regarded by a thoroughly competent authority
(the superintendent of the asylum in which the patient was
confined) as one of acute dementia.

We have in this case, as in the last, an affection running a
perfectly definite clinical course, and ending fatally, without
any objective signs of disease being observed during life to
account for the termination, nor indeed did a naked eye exami¬
nation of the body after death throw much light on the case.
A microscopical examination of the brain, however, showed
lesions similar to those of the case first recorded, though they
did not appear to have advanced to quite the same extent.

These lesions have already been described as inflation of nerve
cells, with displacement of nucleus. As regards the inflation,
when it has progressed to the extent here recorded, it cannot
but be regarded as distinctly pathological, though we must not
shut our eyes to the probability that some degree of distension
of nerve cells may occur under conditions physiological, or but
slightly removed from these; the very marked displacement of
the nucleus, moreover—pushed in some cases up to the apex, or
to one corner of the cell—appears indicative of a decidedly
abnormal process.

The changes are probably analogous to those described by
Charcot, as occurring in the large nerve-cells of the anterior
cornua of the spinal cord in so-called ‘ r infantile paralysis/’

As regards the pigmentation, this is such a common lesion in
all forms of insanity (and moreover appears to occur to a slight
extent as a physiological condition) that no special notice of it
is requisite.

On comparing these two cases together, we find, in spite of

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369

1883.] by Joseph Wiglesworth, M.D.

some differences, some striking points of contact. They were
both recent cases of insanity, running a definite course to death
which could not be accounted for by any symptoms observed
during life, nor by a sectio cadaveris conducted in the ordinary
manner; it is important to observe that there was no maniacal
excitement which might have permitted of death being attri¬
buted to exhaustion. But there was a definite association of a
mental condition, broadly characterized by more or less self¬
absorption passing into vacuity, with a distinct affection of the
muscular system—in the first instance, tremors—in the second,
rigidity. Let me emphasise the fact that there was well-marked
rigidity of the arms for a few days before death, for this is not
a sign very commonly observed at the termination of a case of
insanity.

In each case, though muscular quiescence predominated,
there were intercalated periods, more or less transitory, of mus¬
cular activity ; in the second case there appeared to have been
a stage of excitement prior to admission, and after admission
there were periods, more especially at night, in which the
patient was restless; whilst in the first case it will have been
noted that the patient, during the middle period of the case,
was at times restless, wandering about and rolling on the floor;
but in neither case was the restlessness at all comparable to that
of a maniacal patient, and there was none of the loquacity
observed here; the restlessness had an aimless random cha¬
racter, such as might be supposed would result from diffused,
moderate excitation of the nervous centres governing muscular
movements in general. Finally, it has to be noted that similar
microscopical lesions were discovered in the cerebral cortex. In
estimating the significance of these changes, it must be re¬
membered that affections of nerve cells clearly identical with
those here observed, have been previously described under the
names of (i inflation,” “ hypertrophy,” &c.; they have, I be¬
lieve, been chiefly noted in cases of general paralysis and epi¬
leptic idiocy; in the former case the lesion is probably secondary
to overgrowth of interstitial connective tissue, and in the latter
it must be looked upon more as a congenital malformation than
as an acquired affection; but I am not aware of any cases of
recent insanity in which this change has been the sole or the
chief morbid lesion found after death; nor am I acquainted
with any attempts to correlate this change with a definite assem¬
blage of clinical symptoms. But though, as above-mentioned,
this lesion of nerve cells has been described as an isolated phe¬
nomenon and though I have myself met with it occasionally in

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370

Melancholia Atlonita or Acute Dementia , [Oct.,

cases of general paralysis, it has not in my experience been a
lesion by any means commonly met with; patting aside general
paralysis, out of a series of 32 cases of acate and chronic in¬
sanity (other than those here recorded) of which I have sec¬
tions prepared from brain in the fresh condition, I do not think
that I have been able satisfactorily to demonstrate its presence
once.

And now calling to mind the few considerations with regard
to nerve function with which this thesis set out, we may endea¬
vour to harmonise the facts observed clinically, with those
afforded by pathological investigation.

An initial inflammatory affection of nerve cells would account
for the preliminary stage of excitement in the Becond case,
whilst its absence in the first (if it were altogether absent—for
the history was imperfect) might be associated with a slower
onset of the malady; the occasional restlessness subsequently
noted in each case might be attributed to a spread of the morbid
process, fresh series of cells becoming involved, and by their
discharge giving off a transitory energy. But it was concluded
that inflammatory affection of a nerve cell would quickly suspend
itsown proper function, whilst still permitting it to act as a source
of irritation, and of thus calling into action the plexuses with
which it had been previously functionally associated; and if
such inflammatory action is proceeding in a multitude of nerve
cel^s, a multitude of plexuses must be simultaneously called into
activity, and the manifestations of their activity will be more
or less enduring; that is to say, in the mind of an individual
thus affected (to use ordinary language) a multitude of vague
and incoherent thoughts will be aroused over which he will
have no control; the ego indeed for the time being will consist
of this mass of ill- defined reminiscences; but in proportion to
the activity of this process, will the individual be absorbed in
the contemplation of his thoughts, and will be, in proportionate
degree, insensible to external stimuli: in one word, the indi¬
vidual will be self-absorbed, which condition we founcl to be
the prominent clinical feature in each case.

But it is manifest that, according as a larger number of nerve
cells become functionless, quoad their own proper function,
there will be a smaller proportion of cells capable, by being
indirectly excited, of arousing mental action ; but to say that an
individual has a large number of his nerve cells rendered func¬
tionless is to say that the individual is demented, just in pro¬
portion to the number of cells involved ; and since, by the
hypothesis, the lesion here spoken of is a progressive one, the

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371

1883.] by Joseph Wigleswobth, M.X).

symptoms of self-absorption will pass into those of dementia
by imperceptible degrees, which was just what we found to be
clinically the case.

The correlation between a lesion of motor nerve cells and a
definite affection of the muscular system, has been already
dwelt upon.

From the foregoing considerations, the following conclusions
emerge:—

(1.) That from the ill-defined assemblage of cases commonly
called “ Melancholia,” “ Melancholia Attonita,” and 66 Acute
Dementia,” a group has to be distinguished which constitutes
a definite clinical and pathological entity.

(2.) That this group is clinically characterised by the asso¬
ciation of more or less of self-absorption passing into vacuity,
with a definite affection of the muscular system, to wit, muscular
tremors and muscular rigidity.

(3.) That the pathological basis of the same is a primary
inflammatory affection of nerve cells, best marked in the so-
called “ motor cells,” and possibly originating in these, but
showing a decided tendency to spread beyond their area.

In saying that from the above class of cases this group has
to be eliminated, it is also said .that this group is not coequal
with the series; but, to prevent any misunderstanding, I must
express my opinion that, under these names are confounded
mental affections, the pathology of which is altogether distinct,
and the present is merely an attempt to define the pathology
of one group of these. The limits of this group require,
indeed, much more working out before they can be considered
to be accurately defined. Since the two cases which form the
groundwork of this paper terminated fatally, they must be
looked upon as cases of unusual severity, and it is probable
that many cases which own a similar pathology, but of a milder
character, occur, and are recovered from, or maybe lapse into
dementia, and have thus far escaped specific recognition.

Some such cases have, I think, come under my notice, but
in the absence of pathological details, I have not thought it
advisable to encumber this thesis with an account of them.

Whilst formulating the conclusions reached in the above
specific way, this is done to put clearly forward the issue raised,
for 1 am fully sensible that, as the matter at present stands, the
induction is based upon too small a number of cases to be ad¬
mitted without further question ; more observations are urgently
needed, but cases of this kind terminating fatally are not very
numerous, and may not occur very plentifully in the experience

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372

Melancholia Attonita or Acute Dementia . [Oct.,

of any one individual; I am therefore tempted to hazard these
observations sooner than I might otherwise have been disposed
to do, in the hope that the attention of others being directed to
the question, opportunities may be afforded for deciding the
matter, which can only be done by the joint action of several
independent workers in the field of cerebral pathology.

DESCRIPTION OP THE PLATE.

Cask L

Drawings or Cells from thi Posterior.

Central Qteus ( x about 350.)

L Deep part of the 3rd layer.

2. 4th layer.

8 and 4. Large {motor) cells from the 4th layer.

All these oelU show swelling with eccentricity of the nucleus, and these
characters are very well marked in the lower two figures. There is almost
entire absence of yellow pigmentation.

Drawings or Cells from Posterior Part of 8rd.

Frontal Qtrus ( x about 350).

6. 3rd layer.

6. 4th layer.

All these cells show more or less swelling and eccentricity of the nuoleus ;
there is a little yellow pigmentation in several of them.

Tif or Temporo-Sphenoidal Gtrus.

7. General swelling t without pigmentation ; no appearance of nucleus.

Cask II.

Drawings of Cells from Tip of Anterior Central Gtrus
( x about 350).

8. 4th layer.

Marked swelling and displacement of nucleus.

Nerve Cells from Middle Frontal Gtrus (x 350.)

9. Deep part of 4th layer; moderate inflation with displacement of nucleus.

In one cell slight yellowish pigmentation.

10. 4th layer, (a) Displacement of nucleus; (b) the same t with swelling;

Nerve Cells from Angular Gtrus ( x 350.)

11. 8rd layer. Moderate inflation t with displacement of nucleus : slight

yellow pigmentation.

12. 4th layer. Moderate inflation , with displacement of nucleus.

Nerve Cells from 8rd Temporo-Sphenoidal Gtrus (on Level with
Posterior Ek'd of Stlvian Fissure) ( x 350.)

13. Deep part- of 3rd layer. Moderate swelling ; marked displacement of
nucleus; slight yellow pigmentation.

Digitized by ijOOQle

1883.]

373

BemarTcs on some Minor Matters of Management in Asylums.

By J. A. Campbell, M.D., F.R.S.E.

At the annual meeting for 1880, one of the Editors of our
Journal asked the members present for contributions on the
subject of practical details in asylum management, pointed out
the value of improvements in such directions, and expressed
the opinion that such topics came most properly within the scope
of a good asylum physician.

The prospectus of our Journal in 1853 clearly included such
subjects, among others, as being suitable for discussion in its
pages.

Dr. Urquhart’s paper iC On the Decoration and Furnishing of
Asylums,” and Dr. Bower's contribution, “ Employment in the
Treatment of Mental Diseases in the Upper Classes,” were
acceptable and worthy responses to the appeal of our Editor.

It cannot be questioned that whatever is essential to the
safety, comfort and happiness of those under our charge is
well worthy of our attention; that improvements or advances
in this direction are to be welcomed. To many patients minor
discomforts, which may easily be produced by official -neglect
or oversight, seem, in their distorted fancy, wrongs of the
greatest magnitude, sins of the deepest dye. Slight and inex¬
pensive improvements are capable of being made in most
asylums, which would greatly add to the comfort of our charges.
Most of us know that patients in certain asylums have not only
more of the solid comforts of life, but also more of the amenities
than in other asylums where the cost is identical, or almost so,
and we are also fully aware that this disparity is the result of
special knowledge or aptitude for improvement on the part of
the superintendent or one of the higher officials.

Visits to other asylums usually enable one to pick up im¬
proved ideas and methods, and I am sure if we could tap the
proper fountains many of us would benefit largely.

The large amount of routine inspection, the hundred and one
minor worries of medical work and management, not to speak
of continual asylum enlargements, are apt to produce a frame
of mind unfavourable either to scientific work, or even to
marked advance in details of management. A freer absence
from the asylum and its cares, a more frequent exchange of
opinion on medical and other subjects would be beneficial to
the superintendents of most public asylums.

In the remarks that follow, I have no intention of willingly

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374 Minor Matters of Management in Asylums , [Oct.,

disparaging* what are supposed to be improvements in
certain modes of asylum treatment or management. I think
a generous rivalry between asylums as to results of the right
kind, and an open discussion on the modes adopted to arrive at
these results, whether by medical or other treatment, shows a
healthy state of matters.

What I would deprecate is a tendency to refrain from ex¬
position of anything which would be useful to us as a pro¬
fession, if conveyed in the precise and exhaustive manner, in
which it should be treated in the pages of our Journal, or in
any medical paper, while there exists a tendency to deal in
generalities on such subjects in reports. Even lay communica¬
tions, pitched in highly laudatory terms, occasionally startle
us with accounts of marked advances in treatment of the
insane.

Details of management have scarcely been sufficiently
attended to at Garlands, and I am therefore the more anxious
to receive all the information and asylum tips that I can on the
subject. In a late “ Lancet ” I noticed that Dr. Clarke, of the
Bothwell Asylum, intends to communicate a paper on the sub¬
ject of asylum attendants. His experience will enable him to
treat the subject well. I hope he will touch on the question of
uniforms for attendants—is it an advantage or otherwise ?

The slight contribution which I submit of some minor matters
in use here, I offer not so much on account of their value, as in
the hope that, by doing this, I may elicit in return useful
hints from many sources. I know that there are not a few
among us who have the rare gift of excellence in management,
and who, if we could get them to open out, would give us quite
a flood of useful knowledge.

So far as I have been able to gather in my intercourse with
medical superintendents of experience, knowledge and standing*
in the profession, a high recovery rate, a low death rate, an im¬
munity from accidents, and an exemption from preventible
diseases in the inhabitants of any asylum is what ought to be
aimed at, and it might be quite fairly granted, I think, that if
these aims are arrived at, with anything like an average ex¬
penditure, the management of the asylum must be considered
successful in the highest sense.

The general tenor of some of the Scotch asylum reports has
latterly almost convinced me that the occupation of patients is
a new discovery, that the employment of pauper patients in
farm work is only properly carried on in certain portions even of
the northern kingdom ! However, on second thoughts, and

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1883.]

375

by J. A. Campbell, M.D.

without going further back, I find that when I became assistant
at the Durham Asylum in 1866, a very large proportion of the
patients at that asylum were employed on the farm and garden,
and the value of industrial occupation was strongly expressed
to me by Dr. Smith. When I came to this asylum as assistant
to Dr. Clouston, I found that he held the same views. I have,
out of curiosity, looked up the Returns of this asylum, and I
fifid that on June 1st, 1867, of 165 male patients 119 were in¬
dustrially employed (72 per cent.), 47 per cent, of the total
worked on the farm and garden. On June 1st, 1883, with a
male population of 249, 186 or 74 per cent, were usefully em¬
ployed; 146 of these were employed on the farm and garden
(59 per cent). Taking, at the latter period, the number of
patients in bed from physical ailment, the aged, the feeble, and
the number of acute recent cases who require special treatment
and attendance, and are totally unfit for work, I am convinced
that, in the interests of the patients, our percentage of working
patients is quite high enough. During the cold months the
percentage from the same cause is considerably lower.

I may add that on the last day of June, with a male popula¬
tion of 250, I find 15 between 65 and 70 years of age, eight
between 70 and 80, and two between 80 and 90 : in all, ten per
cent, of the male patients unfitted by age alone for exposure or
work.

As I have already stated, the general impression which must
necessarily result from what we have been hearing of late years
is that, in building asylums, the acquisition of land for the
proper employment of the male patients was not at all con¬
sidered.

Now I find by inquiry that in the older asylums in the north
of England this was not the case. The following shows the
truth of the matter, and I may say that in some of these
asylums, as additions were built, so the farm was extended, and
this before laudation of farm work came so prominently before
us in reports :—

No. of

Date of

males

Name.

opening.

built for.

Acres.

Lancaster County

... 1816

Freehold

North Riding, Yorks..

... 1847

do.

Durham

... 1858

150

do.

Northumberland

. 1859

100

do.

Cumberland and Westmoreland 1862

100

108

do.

I think these facts

clearly show that the utility of farm work

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376

Minor Matters of Management in Asylums, [Oct.,

in the curative treatment of insanity is not of such extremely
modern origin as some might wish us to believe, from the great
amount of what is vulgarly but expressively termed blow , which
for the last few years has been expended on the subject.

I agree that a certain amount of farm connected with an asylum
is useful as a curative agent, and profitable from an economic
point of view, and that the experience of the older asylums,
especially some of the English asylums, bears this well out. I
also, however, am certain that a medical superintendent, who
still believes in medical treatment, who is active in mind and
body, and fertile in resource, who can devise various modes of
occupation, exercise, and amusement, not merely throw shoals
of patients (some of whom are probably mechanics) on an
already overstocked farm, may quite well arrive at higher re¬
sults in every way than another whose sole panacea for all mental
ills is farm work.

I quote the following definite statement regarding the
recovery rate from the 1879 report of the Royal Edinburgh
Asylum, an asylum where medical treatment is still recognised
as useful and is carefully carried out; an asylum which is not
worked on the open-door system, which has over 400 male
patients, and only 115 acres of ground attached : “ Compared
with our own recovery rate for the past ten years, it was this
year 6 per cent. more. Compared with the Scotch public
asylums for the same time, 10£ per cent, more.” The following
as regards the death rate : “ It is about 2 per cent, lower than
the average rate of the previous sixteen years. It is *6 less than
the rate in all the Scotch public asylums for the past ten
years.”

It is said that visionary and unpractical authorities hold the
idea that immense farms are the ideal of the asylum treatment
of the future. It is well, however, to recollect that one may
have too much even of a good thing—that the acquisition of
territory in connection with an asylum, instead of such a reason¬
able amount of ground as would profitably absorb the patients 5
labour, may change humane and kindly directors into keen,
grasping and unfeeling speculators, who recognise the risks
that they have entered on, and act accordingly. The super¬
intendent must necessarily either sink his profession and
assume the farmer, or else separate management, with all the
evils of divided authority, and responsibility, must ensue.

The patients by whom the gains are to be made must work
fair weather or foul, and will have a tendency to become more
like the serfs so recently emancipated even in Russia than

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377

1883.] by J. A. Campbell, M.t).

patients sent to a hospital for the treatment of a disease which
in most cases is recognised to have a physical origin.

I do not wish to be misunderstood. I quite agree as to the
value of having a farm attached to an asylum, but my opinion,
founded on my own experience and the deductions I have
drawn from what I have seen elsewhere, is that from half an
acre to an acre of tillable ground per male patient will suffi¬
ciently absorb the labour power, and that a very large farm
may become a serious disadvantage, cause a deterioration in
articles of diet, and interfere both with the health and recovery
rate of the patients. I do not think that even the most severe
or enthusiastic advocate of farm labour for lunatics, or rather
lunatics for farm labour, be he Medical Superintendent or even
Commissioner, can altogether get rid of his early medical
training.

Shivering shopmen, miserable mealy-faced mechanics and
timid tailors, must surely be subjected to some slight hardening
process, before anyone that has still a glimmering of medical
knowledge left can consign them in winter weather to dig, to
drain, or to do such duties as necessarily devolve on farm
labourers to the manner born.

I perused with pleasure the 23rd Report of the Scotch Com¬
missioners in Lunacy, especially the portion which refers to
recent changes in modes of administering asylums, and think
(with the exception of the part which refers to airing-courts,
and which may be due to an imperfect knowledge of the prac¬
tical value of a sheltered and properly laid-out airing-court in
the treatment of certain classes of cases) few can take exception
to the general tenor of the remarks. It is, of course, written
from an Inspector’s point of view, but still it is more enthusi¬
astic, and less judicial than one would expect, and it might have
been none the worse for some counter-balancing precautionary
advices. It is just possible—I do not at all, however, say that it
has done so—that such a style of report may tend to make
young and inexperienced, or even old and enthusiastic Superin¬
tendents too eager for the commendations which aid to pro¬
motion. Patients may have to work . Freedom at unwarrant¬
able risk, both to patients and their relatives, may be accorded.

A spade, a hoe, or a wheelbarrow is surely not to be the
whole sum of the asylum treatment of the future.

There are certain patients who must be isolated for their own
safety and that of others, and we know that there still exist
patients in asylums, who, if they can, will place their heads on
rails, or do other things equally injurious to their health; and
xxix. 26

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378

Minor Matters of Management in Asylums , [Oct.,

w© need not blink the fact that they must be specially guarded.
Fatalism is not as yet accepted as an asylum doctrine.

I was much pleased with Dr. Needham's questions as regards
the “ open-door system," so called; and I read with great
interest the replies by Drs. Tuke, Dunlop and Cameron, in the
July and October numbers of the Journal for 1882. The
subject has been touched upon in official reports on asylums
and in the reports of the asylums, and has been generally
lauded. I think, as a profession, we should now have the
matter in both its aspects, as a curative agent and also as a ques¬
tion of management, brought distinctly before us in a direct
communication which would deal with the following points of
the asylums in which it is, and has been, in use :—

1st. What is the proportion of epileptic, general paralytic,
and actively suicidal in the asylum ?

2nd. The number of escapes per year to the population ?

3rd. The number of suicides per year ?

4th. Does it increase the real liberty of the patient ?

5th. Has it a beneficial action on the recovery rate ?

6th. Does it produce a state of security or the reverse in the
minds of relatives who might be liable to sustain injury from
patients labouring under delusional insanity ?

7th. Have pregnancies occurred among patients in asylums
worked on the open door system f

8th. If an escaped patient commits suicide or is accidentally
killed, what public inquiry, if any, takes place ?

In the Argyll Asylum report for 1881, 81 per cent, of the
men and 54 per cent, of the women are stated to be on parole.
Now, during the time I have been at Garlands Asylum, I am
certain that no medical man, with the class of patients here,
could have granted parole to this per centage; so that I think
it highly likely that if we get, as really is properly due to us,
a careful and complete paper or papers on this subject, we may
find certain lines of indication for the proper use of the open-
door system. Even in medicine, with drugs, new remedies are
usually made use of with an indiscriminativeness which after¬
wards astonishes ourselves.

There are two other subjects which I trust will also be
brought before us in a specific and accurate shape. The one is
asylum farming as a remedial agent, and from a pecuniary point
of view. To anyone who will contribute a paper on the subject,
I shall gladly give such information as to the results here,
more especially the monetary results, as lies in my power; and
the report of Garlands Asylum for 1882 contains an analysis

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379

1883.] by J. A. Campbell, M.D.

of the results of 10 years’ treatment, which could be easily
used for comparisons. The other subject is asylum night¬
nursing in the North. In England, of late years, much atten¬
tion has been devoted to continuous supervision of the
epileptics and the actively suicidal, and also to the proper nurs¬
ing of the sick. In several of the Scotch Asylums, attendants
sleep in the dormitories with the patients. Now, I think it
would be most interesting and instructive to have an expression
of views on this subject. Of course, I can ask only for the
latter—the other two subjects really now demand treatment
other than by laymen, or in Asylum or Commissioner reports
which deal in generalities.

With these remarks, suggestions and queries, I now offer my
mite to what, I trust, will be a rapidly increasing fund.

Admission Card. —For some years I have sent with each
admission a parchment slip, on which the name, age, and certain
noteworthy particulars about each new case are given, and which
is passed on with the patient when he is shifted from ward to
ward. I know that this is in use in several asylums. I believe,
so far as my memory goes, that I introduced it after seeing it
at Morpeth Asylum. 1, however, consider it such a useful safe¬
guard that I call attention to it.

Lists of Working Patients. —Each attendant who works a
party of patients has a list of names given to him, with those
suicidally disposed, likely to escape or to be dangerous, speci¬
ally marked on the list; and these lists are from time to time
altered as necessary.

l)irections of a Specific Nature to the Higher Officials , as far
as possible, are given in writing on a specially prepared form,
with counterfoil.

Orders to Head Attendants are written in a daily order-
book, which is carried round at the visit by the head attendants
of either side. The assistant medical officer makes the entries
in the order-book for the male side, and previous to their being
put in force they are, as a rule, read by me, so that I may be
thoroughly cognisant of matters in the division which is not so
directly under my observation, as, at present, I take charge of
the female division.

It may, I acknowledge, be said by some that too much writing,
too many rules and directions are the bane of asylums; but we
must have safeguards. Hitherto, I am certain, more than
their proper share of anxiety, care, and responsibility has
fallen on the medical staff; and if matters go wrong, they in¬
dividually suffer most. A properly divided responsibility, and

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380 Minor Matters of Management in Asylums, [Oct.,

a means of clearly proving it, should exist in all asylums.
Many accidents, escapes, and other evil occurrences, are just
the result of sheer carelessness, neglect, positive disobedience,
or want of thought, and a medical officer cannot be ubi¬
quitous ; so that system, routine, safeguard, and wholesome
preventive measures have to be largely substituted for what in
some may be intuitive knowledge, foresight, and caution. As
to the mode of givingdirections to head attendants in writing,
I am convinced of its good results. Few memories are so
perfect as to recollect all the small things noticed at a visit to
500 or 600 patients in a three-storey asylum, ^-mile long. It
also enables the head attendant to go and read any special entry
to any attendant without unnecessary unpleasantness either to
the one or other.

Dietary .—I have been trying to do what most of us aim at,
viz., to combine nutrition, pleasant variety, and economy. I
have increased the changes of vegetables in winter, dealing
largely in onions, which are said to have a specially beneficial
effect on nerve tissue, and turnips, which are said to promote
good nature—a much wanted requisite in an asylum. In the
summer months, as far as possible, the patients here get two fruit
dinners a week instead of animal food. Rhubarb, green goose¬
berry tart, black and red currant tarts or apple tart, with a
ration of bread and cheese after it; and on two nights a week,
lettuces at tea. I certainly think there should be a difference
in the amount of animal food given in winter and summer. I
have lately substituted what is called golden syrup • for butter
with the bread at tea for two nights in the week. I gave it ten¬
tatively at first, and the patients, as a body, were so clear that the
change was agreeable to them, that I have now made it per¬
manent. With our numbers of 500 it saves over £50 a year,
as compared with butter. In many asylums less animal food,
more broth, fish, eggs, vegetables and fruit would conduce to
the individual good as regards health and longevity of the
patients. I hope shortly to arrange a more satisfactory sick
diet than I have.

The question of the dietary of large public institutions has,
I think, scarcely received its meed of attention. Instead of
such a passing allusion as I make, the subject is so important
that it merits exhaustive discussion. I certainly should like to
have dietary scales, dealing more especially with dinners, dis¬
cussed in our Journal—the article, quantity, and cost dealt
with. A sick diet for each day in a week, dealt with in this
manner, might appear among the notes of our Journal, and

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381

1883.] by J. A. Campbell, M.D.

perhaps be as valuable as some of the subjects frequently
touched on. The subject of beer in asylum dietaries has been
well threshed out lately. I gave the experience of this asylum
in the “ Lancet/’ of May 14th, 1881. The days have long passed
when it was considered that a physician’s principal and only
duties were to prescribe medicines ; a surgeon’s, to remove
portions of human structure. Dress, diet, recreations, internal
and external surroundings, are all within our province; and
those who can include in their survey the widest view of all
that relates to their patient must necessarily be the most
successful practitioners.

Dress . Men’s Ties .—Those in use here were not very nice-
looking, and were all the same—black stocks buttoned at the
back. I have had in use for a considerable time, and am
satisfied with, ties like sailors’ knots, or the shape as at present
considered fashionable, made in different sizes, and buttoning
at the back; the material Turkey red, and different colours of
printed cotton. Such ties can be made at a cost for material of
about a penny each; and from their brightness, tidiness and
variety, very much improve the general appearance of the male
patients. They cost so little that when dirty they are done
away with.

Clogs .—The farm-working male patients, and women in the
laundry, always were shod with clogs when at work. Some
years ago I introduced the wear of clogs when out of doors
for all the patients, and I am satisfied with the result, as regards
keeping the feet warm and dry, diminishing the dirt brought
into the house, and decreasing the expenditure in shoe leather.
Among the working classes on the Border the use of clogs is
very common, and I am rather astonished that a custom con¬
ducive to health and economy has not been introduced into
other asylums, especially those asylums where farm work is a
chief feature—asylums situated where the climate is exception¬
ally wet, and the ground under foot is almost always damp.
Comfortable, well-fitting clogs can easily be obtained; and
very few of my patients, even those who previously had not
worn them, complain in any way of their use.

Structural .—Acting on a proposal of mine, Mr. Cory, the
architect of this county, has fitted up the water-closet blocks of
the recently-built extensions of this asylum in a manner which
appears to me, from its simplicity and from the material used,
to be an improvement on any mode I have seen. The w.c.’s
and lavatories are in a block separated from the asylum by a
narrow neck, with opposite windows in the neck. The w.c.’s

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382 Minor Matter s of Management in Asylums. [Oct.,

on each flat, and on the three flats, have water supplied from
one cisteim by a small main. The flushing of the individual
w.c/s is effected by a weighted handle at the side of the seat,
which is self-adjusting, the water only flowing while the handle
is pressed. The w.c. cistern has a small pipe entering into it
from the hot water cistern, properly stopped by valves to pre¬
vent return; so that in extreme frost sufficient hot water can
be turned on to prevent any risk of the w.c. freezing. During
the severe frosts, some winters ago, I believe much discomfort
was experienced in many asylums from the w.c.’s freezing.
Such an arrangement as tnis prevents such a contingency. -All
the pipes connected with the w.c.’s are of galvanised iron.

Lavatories .—I had been much troubled by the old lavatories
in this asylum always getting out of order—the lead pipes ex¬
panding and giving way from the action of the hot water. I
had the following carried out in the new lavatories. The waste
pipe under the basins, and its downright communication with
the basins, are both made of galvanised iron ; the longitudinal
waste pipe, of 3-inch diameter, has a large screw-plug fixed in
it at intervals, so as to allow of its being cleaned out if it gets
stopped, as frequently happens in asylum lavatories. The
waste pipe has a fall of an inch in nine feet.

Bath Rooms .—All the pipes in the bath-rooms are placed
together in an iron-covered box, with provision for a ruhaway
in the event of a burst, so that neither the floor of the bath¬
room nor the ceiling below may be injured.

CLINICAL NOTES AND CASES.

Case of Murder during Temporary Insanity induced by
Drinking. Epilepsy (?) Acquittal on the ground of
Insanity .—By D. Yellowlees, M.D., Glasgow Royal
Asylum.

George Miller, a private in the 74th Highlanders, returned from
the Egyptian war to the depot of his regiment at Hamilton, on 28th
December, 1882, and two days later he was discharged to the Army
Reserve, from which he had been summoned for active service.

He had been drinking freely each day since his return. On the
evening of December 30th, he left Hamilton by train for his home in
Glasgow, but before reaching his house he was found drunk and in¬
capable on the street and was taken by the police to the Southern
Police Office, Glasgow, about 8.15 p.m. Although obviously intoxi-

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1883.]

cated, he was perfectly quiet when received there, was able to give his
name, age and residence, and to walk upstairs with little assistance.

In reply to his questions he was told that he would get out when
he was sober. He was placed in a cell which had already a helplessly
drunk inmate, there being great demand for such accommodation on
the last nights of the year.

The cell was visited every half-hour by the turnkey who on each
occasion found the men soundly asleep side by side on the wooden
bed of the cell.

This was their condition at 10.45 p.m., no noise or quarrelling had
meanwhile been heard, although the cell was immediately over the
waiting-room, but at 11.10 when the turnkey again opened the door
he found the first occupant of the cell lying in the middle of the floor
covered with blood and apparently dead, while Miller was sitting
quietly by the fire with his arms folded. When asked how the man
came to be in this state, Miller said he knew nothing about it, but the
blood on his hands, clothes and boots showed, what post-mortem ex¬
amination confirmed, that he had kicked his neighbour to death.

Being at once charged with the crime by the officer on duty, he
repeated that he knew nothing about it. As to his condition when so
charged, the officer testifies: “ He appeared to be quite sober and
answered all the questions about his age, name, nativity and residence
distinctly and promptly ; he was very cool and collected.” The turnkey
similarly testifies •: “ If nothing had occurred I would have let him go
out as sober.”

Dr. James Chalmers, Police Surgeon of the District, was fortunately
on the spot, and saw Miller immediately. His evidence is : u The
prisoner was very calm and collected when the charge was preferred
against him ; he did not appear to be drunk, but seemed to be dazed.
I thought his mind was affected. I thought it probable that his
insanity might have been produced by drink, and that it might pass
away when he got sober. I have seen him repeatedly since, and he
seems to be well enough now. There might have been disease of the
brain, but I could not discern any symptoms of it. I think he was
suffering from insanity when charged with the murder, but he was all
right next forenoon. His insanity might have commenced during a
drunken sleep.”

This evidence was given at the Glasgow Circuit Court, on the 16th
February, 1883, when Miller was tried before Lord Deas, on the charge
of murder.

Dr. Robertson of the City Parochial Asylum and the Reporter
gave evidence for the CroWn, as to the prisoner’s mental condition.
Their opinion was founded largely on Miller’s previous history as
obtained from himself and from the precognitions of witnesses. It is
as follows :—

George Miller, age 27, is a native of the North of Ireland, and
was employed as a labourer until he enlisted about seven years ago.

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He has taken to drinking since he joined the army. He has never
had venereal disease. His education is poor, he cannot read nor write
farther than in signing his name. His intelligence is below the
average; althongh he has just returned from Egypt he cannot recall
the name of any place except Tel-el-Kebir, Cairo afid Alexandria, nor
does he know the name of the one-armed General who commanded
the Highland Brigade of which his regiment was a part. Some of
his comrades in the regiment appear to have regarded Miller as
peculiar, self-centred and rather weak-minded ; others saw nothing
strange about him.

In answer to special enquiries Miller said that before he enlisted
and when quite sober he frequently had short turns of “ dizziness ”
in his head, when everything appeared to be whirling round, and he
felt queer and giddy, and seemed to lose himself. These turns
usually lasted some minutes and they were preceded and followed by
very severe headache. He has had similar turns while in the army
and has repeatedly been obliged to fall out of the ranks on account of
them, or to take hold of someone to save himself from falling.

These turns have occurred both at home and abroad, but chiefly in
hot weather. They were never reported to the surgeon of the regi¬
ment. It was alleged that a comrade had seen Miller in a convulsion
fit, but this man did not come forward. Miller says that he never
had a fit so far as he knows, nor have there been fits or insanity in his
family. Enquiry elicited that he had frequently wetted his bed when
asleep after a bout of drinking, and that he had done this perhaps a
dozen times in his life when he had not been drinking at all; also
that at home, when quite a grown-up lad and almost as tall as he is
now, he frequently wetted his bed, perhaps once a week or oftener.

Soon after enlisting he volunteered into a regiment that was going
abroad. At Penang in 1877 he drank a great deal of the native
spirit. When confined in the guard-room there for drinking, a
comrade says that he was desperately violent, and flung himself
against the bars of his cell so that he had to be tied. On a like oc¬
casion he broke his spoon and tried to cut his throat with it, but of
this suicidal attempt he was entirely ignorant until told of it after¬
wards.

In 1880, his regiment was stationed at Mary hill, near Glasgow, and
on one occasion when he had been drinking and was late in returning
to barracks, he flung himself over a bridge in Glasgow into the river
Kelvin; he was much bruised by the fall, had some ribs broken, and
was some months in the regimental hospital in consequence. To the
gentleman who assisted him out of the bed of the river and asked him
why he had done this, he said in a calm and rational manner that he
had overstayed his leave through drinking, and did not like to go back
to the barracks. When taken to the hospital he seemed to have
completely forgotten what he had done, and he solemnly declares now
that he has not, and never has had, the very faintest remembrance of

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Clinical Notes and Cases .

385

having leapt from the bridge. From what he has been told, he does
not doubt that he did so, he perfectly remembers walking along the
bridge on his way to the barracks, and remembers finding himself in
the hospital, but all that intervened seems a blank; he can recall
nothing whatever either about the fall or the. assistance rendered him
or his reply to the person who helped him.

In 1881, when he had again been drinking, he suddenly and with¬
out the slightest provocation or excuse, assaulted and struck with a
stick a woman, quite unknown to him, who was quietly passing in
the street in Anderston, Glasgow. For this offence he was tried
before a magistrate and sent to prison for 30 days. He declares that
he never struck a woman in his life, and has no remembrance of being
accused of such an offence. He knew that he was drunk, and imagined
that he was sent to prison on that account.

In the spring of 1882 , at Aldershot, he was wildly excited after
drinking, jumping about the room, and wishing to leap over the
verandah.

Referring to the present occasion, he says that he reached Hamil¬
ton on Thursday, December 28th, and that he drank freely on that
and the two following days. On Saturday evening he went, accom¬
panied by some comrades with whom he had been drinking, to the
railway station in Hamilton, to enquire as to his train for Glasgow.
Finding there was no train for some time they returned to the public
house for more liquor, and from that point he remembers absolutely
nothing until he found himself in a cell in the daylight and saw that
his hands were stained with blood. He supposed that the blood had
come from his cheek where a small abcess had been recently opened.
A man who was standing near the door of the cell asked him if he
knew what he was there for, he said “ no,” and was then told that he
had killed a man. He could not understand or believe that statement,
but could recall nothing that had occurred. This intervening period is
still an absolute blank. He remembers nothing about the railway
journey, nothing about being taken to the police office, nothing about
any quarrel, nothing about assaulting or kicking anyone. His whole
manner gave the impression of entire truthfulness ; when pointing to
the wall of his cell he said that he remembered “ no more nor that
wall ” what had occurred between returning to the public house in
Hamilton on the Saturday evening and coming to himself in the police
cell in Glasgow late on the Sunday morning.

Judging from this history the medical witnesses were of
opinion that the deed was committed during a temporary
attack of insanity. The jury returned a verdict of acquittal
on that ground, and the prisoner was ordered to be confined
during Her Majesty’s pleasure.

There can be little doubt as to the correctness of this
opinion, though some may demur to the complete exculpation

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Clinical Notes and Cases .

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of a man who wilfully drank to excess after so many warn¬
ings as to the dangerous condition which drinking induced.

Hallucinations or delusions leading to dangerous violence
are of course frequent in the insanity of intemperance.

Transient delusions of a like kind may follow even a single
carouse.

Taylor, in his “ Medical Jurisprudence,” mentions a case
tried at the Norfolk Assizes in 1840, where two friends got
drunk together, and the one killed the other under the idea
that he was a person who had come to attack him.

He quotes a similar case from Marc, where the one killed
the other under the belief that he was an evil spirit.

An interesting case of a parallel kind, though less tragic
in its result, occurred near Airdrie. A young farm servant,
in sound health and of sober habits, had spent the day in
Airdrie, and had drunk freely. When on his way home in
the evening, he was overtaken by some acquaintances, who
found him fiercely fighting with a milestone on the roadside.
His knuckles were bruised, peeled and bleeding, and they
had difficulty in getting him to leave his supposed antagonist.
When he came to himself in the morning he could not imagine
how his hands had been injured, he could recall no such occur¬
rence, and would not believe the explanation given him until
he went to the milestone and found it stained with his own
blood.

The degree of obliviousness as to what occurs during in¬
toxication varies greatly in different subjects, and subsequent
obliviousness does not necessarily imply unconsciousness
while intoxicated. The tendency to violence under liquor
also varies greatly, and the violence may be unprovoked or
may be merely the result of a quarrel.

The absence of witnesses must leave the exact occurrences
doubtful, but in Miller’s case the cell was so situated that
anything like an altercation or a fight must have been over¬
heard. Probably Miller was suddenly awakened by some
movement of his drunken neighbour, and finding a man
beside him, imagined that he was being assaulted or that a
stranger had come into his bed; whereupon he dragged the
intruder off the wooden bed, stunned him by the first kick,
and' then completed his fatal assault on an unresisting
victim.

If this.be the true history of the deed then the case was
parallel to those cited, and the violence was the result of a
temporary delusion induced by an excessive dose of alcohol.

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1883.]

There is however another explanation of the condition
which the history very strongly suggests.

The incontinence of urine in youth and even in early
manhood, the recurrent attacks of giddiness during his
whole life, the desperate but meaningless violence, the
sudden leap from the bridge, and the total oblivion of all
that had occurred during the attacks undoubtedly point to
epilepsy as the explanation of the case.

The fierce and fatal violence occurring suddenly on
awaking recalls the case of murder by a somnambulist *
and, like it, certainly suggests an epileptic seizure occurring
during sleep.

It is the fashion to call every seizure which we do not
understand “ epileptic,” and we are apt to think that we
know more about a seizure when we give it a Greek name,
but the term does not seem misapplied in this case.

If the attack was really epileptic, it is very interesting to
find that the alcoholic epileptic convulsion can be replaced
by an explosion of violence, just as ordinary epilepsy oc¬
casionally takes the form of mental excitement instead of
physical convulsion.

Note on a Case of Impulsive Insanity. By Bichard Greene,
L.R.C.P., Medical Superintendent, County Asylum,
Northampton.

At the Northampton Winter Assizes, T.L., a clerk, was
tried for a homicidal attack on his mother. Shortly before
the trial, but several months after the attack, I was asked by
the solicitor for the defence to examine the prisoner, with a
view to forming an opinion as to his probable mental state
at the time of the assault, a difficult, if not impossible, task
to have assigned to me.

The prisoner was a somewhat sparely formed youth of 19 years of
age; his features regular, and expression not unpleasing; his face
pale, and his temperament bordering on the nervous. He seemed
fairly well educated for his station, and answered all my questions
willingly, and with but little if any reserve. As far as I could judge,
he made no attempt to deceive me in anything, and altogether it
would be hardly possible to imagine anyone in manner, appearance, or

* “ Journal of Mental Science,” October, 1878.

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388 Clinical Notes and Cases . [Oct.,

behaviour further removed from our conceptions of a criminal than
he was.

He told me that for a year or mqre he had suffered from almost
constant headache, and he referred the pain to the parts corresponding
to the longitudinal fissure. His memory was good. He talked about
his school days, about his work in the office, about his companions,
his pursuits, his family, and finally about the horrid deed for which he
was in a few days to be placed at the bar. When talking about the
assault he was as unmoved and apparently as indifferent as when he
spoke of his invoices and his ledgers. He said he tried his utmost to
resist the impulse, but found it uncontrollable. After the act,
“ something told him he had done wrong, and he felt as though his
brain were on fire.*’

This was all that I made out for myself—all that I could have
stated in a witness-box: probably more than I should have been
allowed to state ; and when asked the question, “ In what state did
you find the prisoner ? ” I was bound to answer that I detected no
conclusive evidence of insanity, and it was ruled that I could not state
my opinion of the prisoner’s mental condition at the time of the
assault.

I stayed in Court throughout the whole of the trial; I made
notes of the evidence, and through the kindness of the prisoner’s
solicitor I was allowed to read not only the depositions, but also
private letters bearing on the prisoner’s previous history. I am thus
able to lay before the readers of the “ Journal of Mental Science” an
account of a case of a somewhat rare form of insanity—rare at least
as compared with the other forms which are met with within the
walls of our county asylums. I may premise my account by saying
that T.L.’s relatives bear a highly respectable name ; no stain of
crime or insanity had hitherto darkened the annals of the family, and
the young man himself was universally described as a most affec¬
tionate son and steady in his habits. The first paper I shall refer to
is a letter written by the head of the school which T.L. attended
when a boy of twelve. He writes that periodical fits of moroseness
occurred, and during these times it was impossible to elicit answers
to questions put to him. Sometimes his conversation was rambling,
incoherent and vague, and he would break in with a remark not
having the least bearing on the subject matter. At other times he
was led away by an exuberance of spirits far from natural. He
would lay his hand on his teacher’s arm, look fixedly in his face,
administer a severe pinch or kick, then laugh and run away. Shortly
he would return and express sorrow for what he had done. Here is
evidently described the first glimmering of that terrible disease which
ultimately led the poor youth to the committing of an awful act,
placing him at the bar on a grave charge which would have been a
capital one but for the almost miraculous recovery of his victim.
After leaving school he spent some time in a lawyer’s office. Sub-

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Clinical Notes and Cases.

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1883.]

sequently he took the post of clerk in a merchants office, and for
some years the sypmtoms of a disordered mind seem to have been in
abeyance. Beyond a certain amount of reserve, unusual in anyone
of his age, nothing seems to have been remarked about his mental
state until we come to March, 1882. On the 24th of that month, he
was sent to the railway station with a parcel which he was to
despatch to Birmingham. Without the slightest preparation he went
to Liverpool, where he stayed a fortnight. He said nothing about
his intended journey to anyone, and although the day was a bitterly
cold one, he left his great-coat in the office. This journey seems to
have been made in obedience to some sudden unaccountable impulse,
and on returning he could give no explanation of it. There was not
the faintest suspicion that he had been behaving improperly either in
Northampton previous to his journey or in Liverpool during his stay
there. This freak caused his friends much anxiety, and he seems to
have had some remorse for the grief he caused his mother. He was
more than usually kind and attentive to her afterwards. He went
back to his office work, which he performed satisfactorily and
punctually; but soon further symptoms of insanity showed them¬
selves. One of his fellow-clerks stated that he often noticed him
staring vacantly out of the window. At other times he seemed
absorbed in contemplation ; he would knit his brows and grind his
teeth, or remain for hours without speaking. All these symptoms
were more pronounced a few days before the assault, and the clerk
remarked to a friend that “ something ought to be done about
Thomas.’ , But, of course, nothing was done, and it so happened
that on the fatal day he was brighter and more cheerful than he had
been for some time. In the morning, on the 4th October, he ordered
a present for his mother, took his meals as usual, and in the evening
went to a young men’s meeting connected with the church he
attended, returning home about nine o’clock ; had supper, and read a
religious book, entitled the “ Pathway to Heaven.” He then said
good-night; kissed his mother, and went off to bed. Shortly after¬
wards his mother went to her room. He lay down in bed, but could
not sleep. The awful impulse had seized him. In vain he tried to
shake it off. He got out of bed, went down to the coal-cellar, laid
hold of the coal-pick, which, although in the dark, he found at once
without search or fumbling, and returned upstairs with it to his
mother’s room. The door creaked as he pushed it open, and he
hoped the noise would awake her; but alas! there was no such result,
and in an instant the pick was buried in the sleeping woman’s neck.
A second and a third blow followed : one with the sharp end of the
hammer and one with the blunt end. Jt was then he felt as though
his brain were on fire. He left the house, wandering purposelessly
and aimlessly in the neighbourhood of Kettering. He slept either
in the fields or in barns, and for food he had one or two meals from
cottagers, but fed for the most part on wild fruit for three days, and

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Clinical Notes and Cases.

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then, having come to himself, as lie expressed it, walked back to
Northampton to his mother’s house. He asked if she were dead, and
on being told she was not, said he was glad to hear it, and offered to
give himself up to the police. In the morning he was taken into
custodj.

Such is an epitome of the evidence given in Court, and it
is amply sufficient to convince any medical man, and almost
any layman, that the prisoner was unquestionably insane. He
was ably defended, and his counsel, Mr. Attenborough, in a
forcible and eloquent speech laid before the jury the grounds
on which he raised the plea of insanity. He pointed out that
there was absolutely no motive for the act; no preparation
for it; no concealment of the weapon; no attempt to escape
the consequences ; but an apparent indifference as to what
became of him.

The Judge, in addressing the jury, said that to acquit
the prisoner on the ground of insanity they must not only be
satisfied that he was insane, but that in consequence of his
insanity he did not know the act he was doing was wrong .

The jury, without leaving the box, returned a verdict of
not guilty on the ground of insanity, and the Judge ordered
the prisoner to be detained during her Majesty’s pleasure.

In reviewing this case, one cannot help being once more
struck with the strange state of the law relating to insanity.
It had an odd sound in medical ears to hear a judge lay it
down that the fact of insanity ivas not sufficient to sustain the plea
of insanity. In civil courts a very slight trace of mental disease
may be enough to nullify a contract or set aside a will, but
when the life or liberty of a fellow creature is concerned,
insanity of any degree is inadequate to obtain acquittal, and
it needs the absence of knowledge of right and wrong to
sustain the plea. So at least it seems. By the French code
it is enough to show that the crime is a product of insanity.
“There is no crime nor offence,” says Article 64 of the
French Penal Code, “ where the accused was in a state of
madness at the time of the action.” To alienist physicians
this will almost justify the prediction of a living author that
Napoleon will be remembered as a law-giver long after he is
forgotten as a general. How differently will the clumsily
expressed opinions of the English Judges of 1843, be re¬
membered !

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Clinical Notes and Cases.

391

Clinical Abstracts* — (a) Three Cases of Phthisical Insanity;
(b) A Case of Insanity following on Alcoholic Excess and
Lead Poisoning. By A. Campbell Clark, M.B.Edin.,
Medical Superintendent Glasgow District Asylum,
Bothwell.

(a) Three Cases of Phthisical Insanity.

Whatever diversity of opinion may exist as to the name
phthisical insanity , there can be no doubt of this—that we
frequently find associated with phthisis pulmonalis a group
of mental symptoms which strikingly individualise such
cases, and which embrace, in whole or in part, the features
delineated by Dr. Clouston in his description of the disease.

Three well-marked illustrations are at present under my
care, and I propose to describe them collectively, in order
that you may the more easily grasp points of resemblance
and difference.

They are all men, ages respectively 38, 34, and 32. They are all
dark, delicate complexioned, with well-chiselled features, the phthisical
habit and countenance well marked ; an intelligent but nervous ex¬
pression, and physical signs of lung disease. We shall distinguish
them as A., 13., and C. In all three incipient lung disease was
observed on admission, and only the left lung affected ; no moist
sounds were audible. Owing to the absence of symptoms, consump¬
tion had not been suspected by the relatives. A. has beeh nearly two
years in the asylum, 13. has been 13 months, and C. seven months.
Phthisical symptoms are now evident in all the cases, but they are
not serious, and their development has been slow. Wasting has not
been a prominent symptom, and this is not surprising, for they are all
men of spare habit, and could scarcely afford to do muoh in the way of
atrophy. Their weights are recorded as follows since their admission :
A , on admission, 9st. 131bs. ; highest, lOst. 61bs. ; present 9st. 1 libs.
B., 8st. 31bs.; present and highest, 8st. 61bs. C., 9st. 41bs. ; present
and, highest, 9st. 1 libs.

They cough little. The cough is chiefly mucous in character, but
in A.’s case it is muco-purulent. Cough is most frequent in C.’s case.
A, and C. exhibit a hectic flush ; B. has slight night-sweats. They
agree in suffering from constipation, which is most obstinate in A.,
who also suffers from piles, and they all, in spite of good appetites,
are capricious regarding their food. When the appetite is most

* Read at the quarterly meeting of Medico-Psychological Association, held
in Glasgow, April, 1883.

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392 Clinical Notes and Cases . [Oct.,

capricious I have noticed tbe mental excitement very pronounced.
The average pulse and temperature are :—

M. E. M. E. M. E. M. E. M. E. M. E.

A., 70 84; 88*3 98 5 ... B„ 76 84 97*8 08'3 ... C., 65 67; 981 98'2

Both lungs are now affected in A., B., and C.

The insanity in A.’s case has existed for several years, and is said
to have arisen from sunstroke when abroad. I have been able to trace
an insane and phthisical heredity in C.’s case only, but the history
of the others has not yet been fully elucidated. They are all dangerous
patients, but not suicidal. They agree in several respects regarding
their mental state, and these I propose now briefly to describe. Firstly ,
they are all subject to spurts of excitement coupled with mental
exaltation, during which ideas or delusions of self-importance are
peculiarly prominent.

A. ’s state is best described by saying that he has “ a mighty
opinion of himself.” He affects to look with contempt, and from a
superior eminence, on those who have nibbed against him in the
course of life. His language towards such is one of unmeasured abuse.
They are always wrong; he must of necessity be right. He is a man
of average education, and a grocer by trade.

B. and C. exhibit exaltation in a more decisive way, and not only
in religion, but in secular matters. B., by his own showing, exercises
a very important influence on the course of political events and the
deliberations of the Bank of England Directors. He, moreover, con¬
siders himself an authority on theological matters. C. is decidedly
vain, and seems to derive immense satisfaction from his attempts at
literary composition. To his mind Shakespeare is nobody ; he could
write greater plays himself. He considers himself qualified to under¬
take any architectural commission, and he is, moreover, an authority
on the interpretation of Scripture.

In the second place, they agree in being a prey to strong suspicions,
which appear to me often to arise out of a necessary snubbing of their'
exalted notions. B. works himself into a violent passion on finding
that his letter to the Bank of England had not been forwarded, and
the muscles of his face quiver with excitement. He threatens ven¬
geance, and looks it every bit, but in a few minutes he lapses into a
state of gloom, which gradually deepens, and for days his expression
and manner are those of deep suspicion, sullen defiance and violent
hatred, the evidence of which may come out more forcibly after weeks
or months of dismal brooding, and be wakened into a flame of actual
violence by the stimulus of some very trivial incident which per se
would scarcely cause disturbance at all. This was well seen in the
case of A., who, having for months proved amenable and sociable,
though nursing a dangerous grudge against outsiders, suddenly
stopped work because a proposal for his release could not be enter¬
tained. He then and thereafter nourished in moody silence a grudge
against myself for months, and only burst out into actual violence

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1883.]

long after, when in most minds the memory of the initial circum¬
stance would have been obliterated. He made a complaint about his
food the occasion for such an attack, and yet his appetite has been so
good that he never missed a meal, nor previously hesitated over any
article of diet. A few weeks later, when this attack had spent itself,
he frankly stated that the only grudge he had against me was the old
grudge about his liberation. This man, it may be stated, was sent as
a “dangerous lunatic ” to the asylum. He had broken a man’s arm
with a poker, had attempted his wife’s life with a knife, and had
threatened the lives of several lawyers and doctors. C. is less suspi¬
cious, and less moody, but it is only a difference in degree. He
believes that he was decoyed to the asylum by a conspiracy on the
part of his relations, and at times he gets excited and threatening on
what appears a trivial provocation. Suspicion with A. and B. is an
overruling disease. It is warped into their natures. C. is less a
slave to it as yet. In A. and B. I have been at a loss to determine
whether delusions or some unhappy experience have begotten the
suspicious habit, or whether the suspicious habit has first begotten
delusions. Suspicion and jealousy did not appear in the case of B.
till a year after mental derangement had shown itself, and, so far as
I can learn, delusions preceded them. C. only gives expression to
suspicions when excited, and was for some years insane without the
co-existence of morbid suspicion. A. accused a lawyer of improper
intimacy with A.’s wife. The lawyer was his agent. This proved a
delusion, but it is a fact that his wife was not very circumspect in her
conduct. B. looks on me as an enemy who has designs against him,
and a few days ago he interrupted a conversation I had with his wife,
and insisted on being present at the interview because he mistrusted
me. I am unable at present to go back sufficiently far into their his¬
tories to be able to trace the inception and development of the first
delusion or morbid suspicion.

A. and B. are frequently seen laughing to themselves, and A.
mutters a good deal at night when awake. Of late he has been
very noisy at night, frequently yells out “ Murder” and “ I’ll do for
the devils yet.” B. and C. sleep well.

As their disease developes they work less and less, brood more, and
become more threatening and dangerous. Excitement exhausts them
very quickly, and they get very pale, and seem to feel this them¬
selves. Their life is one long unremitting warfare with the powers
that be, and by their own showing every man’s hand is against them.
A. and C. have attempted escape, both by breaking parole, which was
tried as an experiment. They fought most doggedly, kicked and
scratched most viciously, rather than come back. B. was allowed on
parole to his child’s funeral, and came back of his own accord. Their
one cry is to get out. For this purpose they exhaust much steam
in writing to my “ lord ” this and my “ lord ” that, and the disap¬
pointments which necessarily follow tell very sorely upon them. C.

xxix. 27

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is the only one who chances at times to give you a smile. A. need
to be more genial and sociable. B. has not been so in my experi¬
ence. They are all tending more and more to make for themselves
an isolated position in the house, which is assailed unavailingly by
kind attentions and various conciliatory endeavours. Their attitude
is one of bitter animosity. Nothing pleases them ; medicine or
extras prescribed to suit their caprice are indignantly tossed aside
as useless ; what is fancied in the morning is called “ disgusting ”
in the afternoon. And so their weary, miserable lives roll on ; the
lung disease progresses slowly, and their misery seems to deepen with
its progress.

The duration of the mental disease is in A.’s case over ten years,
but he was many years of that time engaged actively in business,
and made money. The duration in B.'s case is over three years. C.
had an attack 6ix years ago. The present attack has lasted a year.
I look upon them as cases of nervous constitution combined with a
strumous diathesis. The spurts of excitement and exaltation are
unusual, but the irritability, suspicion, caprice, and fits of sullen,
moody abstraction, combined with unmistakable phthisis pulmonalis,
clearly indicate their appropriate classification.

(£) A Case of Insanity , following Alcoholic Excess and Lead -

poisoning.

J. M., admitted 21st September, 1882, set. 45, married, a foreman
painter, insane a few days, first attack, assigned cause intemperance.

History .—No heredity known ; he has been addicted to intemper¬
ance for some years, and six months before admission received (while
intoxicated) a severe scalp wound of vertex. For two years prior to "
admission hair has been falling off in small areas at a time, leaving
bald spots on head and face. He has for years been very costive and
occasionally suffered from colic, but had no wrist drop or other symp¬
tom of plumbism except gum line. As a foreman painter he has
worked a good deal with lead.

Mental State as given by Certificate .—Nervous and excited ; has
no ideas of his whereabouts. Is under the delusion that he is pur¬
sued by enemies.

State on Admission .—Very shaky and tremulous, pupils of natural
size, but slightly irregular outline; hands tremulous, tongue tremu¬
lous, slight ptosis of left eyelid. In a state of quiet coherent delirium,
imagines he is in his own house in Glasgow. He thinks he has some beer
in a cupboard, and endeavours to open it for a drink ; has delusions of
identity, mistakes the name of every one he comes in contact with. He
is of sallow complexion, stout build, muscular system fairly developed,
no evidence of bodily disease." Has a small abrasion over right
olecranon. Temperature on admission 100*6 ; no sign of baldness.

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1883.]

Course of Case .—September 23rd. The abrasion of right elbow
has given rise to an erysipelatous inflammation, and his temperature
has risen to 102*6. He is very restless and sleeps very little, appetite
fair, but his bowels are confined. Ordered lotion for arm and a dose
of sulphate of magnesia.

September 26th. The inflammation of arm is passing into suppura¬
tion. Has had one draught of bromide of potassium and chloral
hydrate, owing to severe excitement his delirious state having been
more pronounced, and great difficulty being experienced in keeping
him in bed. The temperature rose to 103°.

October 1st. Abscess opened and counter opened ; a free drainage
of healthy looking pus took place, temperature has considerably fallen,
and the mental excitement is more subdued ; he is still, however,
delirious, and has delusions of identity.

October 7th. Since last report the abscess has almost ceased to
discharge, and the drainage tube has been removed ; delusions of
identity as to persons, time and place still continue; he is quite
coherent, understands quickly what is said to him, and answers with¬
out hesitation, but often incorrectly. This is evidently due to an
erratic memory, which is continually tripping him up. Attention has
been directed to the probability of lead-poisoning having had its share
in the production of his insanity ; and it is observed that there is a
well marked blue line round the gums. At present he looks pale and
somewhat exhausted. There is still tremor of hands, and ptosis of
left eye-lid. His walk is unsteady, and he is apt to fall when turning
quickly round. No spinal myosis; tendon reflex normal. His
memory is fairly good as regards events prior to his illness, e.g n he
states what is true when he says that he took advantage of his wife
being from home to get on the “ spree but he cannot remember
events of half-an-hour ago. His sight and hearing are good. There
has not been noticed any visual or other hallucination ; pupils, as on
admission, active, but irregular in outline.

October 18th. Was at a conjuring entertainment last night; had
a vague consciousness of what was going on, and when he came out
of the hall remarked that the people were mesmerised (there was no
mesmerism). This morning has no recollection whatever of the enter¬
tainment delusions of identity are still present, but not so prominently
as at first. To have purgatives of Epsom salts twice or thrice a
week.

November 20th. Saw two friends yesterday, recognised them, and
at once called them by name, but could not tell them my name. To¬
day has no recollection of having visitors yesterday. Delusions of
identity are disappearing, but slow to remember the days of the week.
Is less docile and more touchy and emotional; walks more steadily.
Put on iodide of potassium 15 gr. dose thrice daily.

November 24th. Nervous, tremulous, excited, and crying a great
deal, wishes to go home, and is anxious about his wife, who is soon

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396 Clinical Notes and Cases . [Oct.,

to be confined. Still, however, he is easily appeased, apt to mistake
his bed, and lose his way in the ward.

December 28th. There is no very appreciable progress since last
report, except that he is learning the names of officials and patients
better. He is apt to have fits of depression, and prefers to keep out of
sight at the doctor’s visit, because the doctor tests his memory, which
makes him nervous. Was at Christmas tree last night, and received
a comical present from the tree. This morning he has a dim recol¬
lection of getting something, but he cannot tell what it was. He is
often witty, and banters the attendants and patients a good deal.

The course of the case from this date onward was one of steady im¬
provement, the memory became more retentive, but he often forgot
instructions received. As regards all details connected with his trade
his memory was almost from the first quite good, but for a lopg time
it was evidently incapable of retaining and reviving at will new im¬
pressions. In the beginning of February he made himself useful in
the sick ward, and on the 24th was discharged recovered. The points
of interest in this case are these :— First: Mental excitement before
admission, such as might be expected after a fit of drinking. Second :
Delusions of identity of long duration, showing themselves after the
alcoholic effects might reasonably be expected to have disappeared.
Third: A decided weakness of memory, an inability to register and
recall at will new impressions (this was exaggerated by nervousness).
This peculiar affection of memory is, I understand, not unknown. It
may, in fact, be common in cases of mental disorder from lead¬
poisoning, and may be less frequent in asylums than in ordinary
hospitals, seeing that per se it cannot technically be considered a
symptom of insanity. Lastly : Certain disorders of the motor system,
such as hand tremor, and an unsteadiness of gait, a difficulty in turn¬
ing sharply round and an irregularity in shape of the pupils. With
the exception of the last, these had disappeared as he got stronger.

Subsequent Note .—This man reported himself two months after
discharge. His memory had improved very little. He was able to
resume work, but required a memory-aid occasionally in the shape of
an overseer; and when he got instructions was at first confused,
until fairly started with the job in hand. Blue line is still present,
but less marked than on admission. Complains of weight over vertex,
and of bad taste in mouth. Is now a journeyman, and not able for a
foreman’s work as previously.

Unilateral Sweating: Note on Further Cases of. By Wm.

Julius Mickle, M.D.

In the “ Journal of Mental Science” for July, 1877, p.
196, I placed on record some examples of unilaterally in¬
creased sweating, or hyperidrosis, particularly three cases
occurring in general paralysis. In one of these cases of

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Clinical Notes and Cases .

397

1883.]

general paralysis, the unilateral excessive sweating affect¬
ing one side of the face and head was not associated with
any local convulsion or paralysis, but the eyeball of the same
side was sightless, and completely withered and shrunken, as
the result of disease following an injury incurred long before
he came under care. In the second case, convulsion and paraly¬
sis affected the same side of the body as that on which the
accompanying unilateral facial sweating occurred; and in
the third case the first appearance of the sweating followed
the onset of hypochondriacal symptoms, and was contempo¬
raneous with slight transitory unilateral facial paralysis of
the same side, although the tendency to this sweating
remained for a time after the local paresis had cleared up.
In the first and third of these cases the right was the side of
the face affected, and the left in the second. Full details of
all these cases were given in the paper.

In that part of the above-mentioned paper which treats of
the pathology of the symptom, p. 206, loc. tit., I discussed
the question whether the sweating was due to some disorder
or lesion of the vaso-motor system, or to a morbid excitation
of nerves which may be supposed to more directly control
secretion, and I suggested that there might be sweat-secretory
nerves, which exercise an immediate control over the per¬
spiratory function analogous to that which certain secretory
nerves were at that date believed to exercise over some other
secretions, as, for example, the salivary. Since that time
views similar to those thus theoretically suggested in my
paper have resulted from the experiments of Luchsinger,
Nawrocki, Adamkiewicz, and Vulpian.

The fourth case mentioned in the same paper, p. 201, loc .
tit., was that of an agitated melancholiac, who became
phthisical, and in whom, after death, the greater part of the
left supra-marginal gyrus was found to have been destroyed
and absorbed; while a branched calculus filled the pelvis of
the right kidney, which organ was much wasted. The
phthisical changes were more advanced in the left lung. The
hyperidrosis was of the left side of the face, and was rather
less marked than in the preceding patients.

To the above I now add brief notes of two other cases
observed since the publication of my paper in 1877. One of
these examples occurred in a general paralytic whose
symptoms were somewhat obscure and ambiguous; the other
was seen in chronic melancholia.

Cask I.—J. H. M., Royal Engineers, admitted July 12th, 1879,

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398

Clinical Notes and Cases.

[Oct.,

aged 34. Recognized mental disease had existed for six months
previous to admission, but the affection had come on insidiously; over¬
strain and anxiety about military office work, and about his change of
religious profession were the causes assigned for the mental disease.
At first there was gradual failure of memory and increasing feebleness
of intellect. He was silent but mischievous, restless, and destructive.
It was necessary to feed him ; the habits became filthy; he passed
urine and faeces in bed. Bedsores made their appearance, and only
healed to recur. This was before admission here.

On admission he was emaciated, feeble, helpless, of wet and dirty
habits, melancholic, and rarely spoke.

Vomiting became rather troublesome. The mental condition for a
time approximated to melancholia attonita.

Later on there was diarrhoea. The tongue also was tremulous, the
speech shaky ; the pupils were slightly irregular, sluggish, and often
unequal, the left being usually the larger.

At last, besides local spasms there were epileptiform seizures,
especially affecting the right side and followed by right hemiplegia.
These recurred frequently, and in the intervals sweating confined to
the right side of the face was often noted. Thus, to take one note
only, on January 12th, 1880, he had four epileptiform convulsions,
mainly of the right side. Chloral enema. The right lower face
and right upper limb were somewhat paretic, and the right side of the
face bedewed with perspiration. At times the profuse sweating was
limited to the right side of the visage, with a very little on the left
side of the nose ; at others there was more general and more equalized
sweating. The left pupil was the larger : blebs formed on the right
hand. 60ozs., and, again, 20 ozs. of pleuritic fluid were removed
from the left side by the aspirator. Death months after admis¬
sion.

As to the necropsy, only the following points need be mentioned
here. The olfactory bulbs and tracts were somewhat wasted. There
was some atrophy of brain convolutions with oedema of meninges
and opacity in fronto-parietal regions. Adhesion and decortication
slight, affecting the first and second frontal gyri on both sides,
and the left ascending frontal very slightly, also slight cerebellar
adhesions. White medullary substance rather pale, and slightly
firmer in frontal region than elsewhere. 3 V. serosity in the large
lateral ventricles. Faint granulation of ependyma of lateral ventricles.
Left hemisphere -^oz. less than right. No very special naked-eye
changes in pons Varolii or medulla oblongata. Fluids from cranial
cavity 4^ozs.

Case II.—J. C., soldier, «et. 40. Chronic melancholia, with various
delusions, formerly suicidal. Thin and pale, he at one time had
slight morbid signs at the lung-apices. One morning in November,
1881, he complained of severe abdominal pain, looked ill, was quickly

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Clinical Notes and Cases.

399

1883.]

purged, and became faint, and as if threatened with syncope. I found
him pale, with dilated pupils, and the right side of the face beaded
with large drops of perspiration, which if removed readily re-accumu¬
lated, whereas the left side of the face was only of a greasy-looking,
clammy, slight moistness, with no beads.

As to his customary state, the following may be mentioned:—

Hair of head and face partly and prematurely grey, slight yellowish
pigmentation of forehead, skin everywhere rough and slightly scaly,
central line of features slightly convex towards right side. Tongue
flabby, indented, protruded slightly towards the left side; many of
the teeth, especially the back ones, carious, broken-down, or missing,
and this in both jaws, especially on the right side. Pupils equal,
act fairly to light and in accommodation ; patch of slight left corneal
opacity (following disease about 20 years ago, he said) ; a scar on
right temple, of which he recollected no history. No present indica¬
tions of syphilis, and he denied having had any venereal disease except
gonorrhoea. Heart fairly healthy.

Note .—After the above was written this patient made a suicidal
attempt; had delusions as to torture, persecution, and intestinal in¬
action ; haemoptysis, phthisis, iritis, and keratitis. Then came on
indications of pulmonary gangrene. On several occasions was
observed unilateral sweating of the right temple and upper part of
cheek, there being none above the level of the ala nasi , and none on
the left side. The hair, also, was damp on the right side of the head,
and the right side of the nape wasmoister and more clammy than the
left. On these occasions there was no sweat on the lower neck or on
the chest. At times general sweats occurred.

Necropsy (briefly expressed).—Brain flabby. Cerebral cortex slightly
atrophied, pale, but mottled. Greenish discoloration and early
decomposition of anterior half of basal aspect of cerebrum. Small
foul abscess in left second frontal gyrus, and surrounding greenish
discoloration. Eight fifth cranial nerve somewhat softened, and
easily separating from its insertion. In left lung, caseous nodules ;
patches of decomposition, lower lobe. Eight lung adherent; gan¬
grenous patches in upper part, hepatized portions below. Spleen
12 £ozs., dark, firm, capsule thickened ; containing a small portion
broken down into foetid, ashen grey, semi-fluid material. Liver
51^ozs. ; deep-green hue, partially decomposed, and spongy from
disappearance of parts of parenchyma.

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400

Clinical Notes and Cases.

[Oct.,

Insanity of Twins.

Twins in Similar States of Imbecility. By Arthur Fflintoff
Mickle, M.B., Kirklington.

Case I.—A. D., aged 40. Single. The elder of twins. He is a
very short and strongly-built man ; has a bullet-shaped head and
narrow forehead, high cheek bones, a largely developed lower jaw and
big mouth. He has brown hair, prominent and shaggy eyebrows,
small grey eyes, and is of sanguine temperament. The facial expres¬
sion is that of a weak-minded, cunning and mischievous person, but
frequently he indulges in a broad grin, and then looks rather good-
natured.

The only history I can gather, and which relates equally to this
patient and his twin brother, is as follows :—Their father was insane,
but there is no history of insanity on their mother’s side ; other
members of the family, viz., a brother, and especially a sister, are of
weak intellect. No definite history of phthisis or any constitutional
disease could be obtained. This patient has always been weak-minded,
has had no serious illness, and has enjoyed good bodily health.

Present Mental State .—He is very childish in manner, is easily led
and induced by others to do wrong; he is very cunning, mischievous,
and takes great delight in committing petty acts of theft. His memory
and judgment are very defective, and he cannot form an opinion on
any subject with which he is not familiar, nor has he any idea of his
age; he can, however, converse a little, and perform many of the ordi¬
nary duties of life ; knows the people with whom he associates daily,
has some affection for his friends, and can take care of himself. When
not allowed to do as he wishes he frequently becomes very passionate,
and can scarcely control himself; usually he is quiet and fairly well
behaved.

Case II.—W. D., aged 40. Single. The younger of twins. This
man is the same height and very similar in build and appearance to his
twin brother. He has the same coloured hair, similar eyes and eye¬
brows, and is of the same temperament, but his lower jaw is very
largely developed and protrudes slightly, and he has a sulky and more
cunning facial expression than the other twin. He was never so weak-
minded as his twin brother, but of a more passionate, quarrelsome and
depraved nature. He was always weak-minded, has had no serious
illness, and enjoys good bodily health.

Present Mental State .—He is not so childish in manner nor so good-
natured as his twin brother, but often sulks, is very depraved and
vicious, and frequently commits petty acts of theft. His memory is
weak, and his judgment defective, and he cannot give an opinion on a
subject with which he is not familiar, nor does he know his age, but
he can converse in a simple way, and knows the people with whom he

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Clinical Notes and Cases .

401

1883.]

associates. He can, like his twin brother, perforin many of the ordi¬
nary duties of life, and is able to take care of himself, but he is
irritable and much more passionate, and occasionally when thwarted
gives way to fits of ungovernable rage, amounting nearly to short
maniacal attacks. He is, however, usually fairly well behaved.

From the foregoing notes it will be seen that there is a
marked resemblance in the twin brothers. Thus—both men
are imbecile, and the degree of mental weakness is almost
equal in the two, and corresponds, I think, to the first of the
three classes into which Hoffbauer divided imbecility. Both
are very passionate, liable to paroxysms of anger, very de¬
praved and prone to commit petty acts of theft. They are
also of the same height, and are very much alike in build
and appearance, but there is a difference in the facial expres¬
sion, for whilst the younger has usually a sulky countenance,
the elder twin's face is frequently brightened by a broad grin
or imbecile smile.

OCCASIONAL NOTES OF THE QUARTER.

The Recent Lunacy Appointment.

One feature of this Journal is to comment upon the topic or
topics of the Quarter possessing most interest to the special
branch of medicine, of which it is the accredited organ. In
accordance with this practice we should have offered some ob¬
servations on an event which has aroused so much feeling as
the appointment recently made in the Lunacy Board conse¬
quent upon the resignation of Dr. Nairne.

When a similar appointment was made many years ago, Mr.
Cairns raised his voice in Parliament against it, but in vain;
and equally fruitless was the eloquent appeal made by the then
Editor of the Journal, Dr. Bucknill, who acknowledged that he
“ would fain have avoided the invidious task of commenting upon
it, but that the indignant letters he had received from members
of the Association made it his imperative duty to express his
entire disapproval of the principle or want of principle upon
which the choice of the Government had been made; ” being, as
he continued, a heavy blow and great discouragement to all
medical men practising in lunacy, whether in or out of asylums.
“ How can men instruct who have never learnt ? How can
men direct the most difficult of labour who have never sub*

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402

Occasional Notes of the Quarter .

[Oct. (

mitted to work ? ” Referring to those who, in undertaking the
duties of this appointment, “ take great credit to themselves
for bringing to the Commission a freedom from prejudice
derived from primitive innocence in all that relates to asylums
and the insane,” Dr. Bucknill incisively adds “ as if ignorance
were the parent of impartiality ! ”

There are various ways, however, of marking the feeling
which has arisen in our ranks. It would be easy to write a hot
and bitter article; it would also be easy to state forcibly, though
in the baldest terms, the obvious reasons why this appointment
has caused widespread disapproval, we were about to say, in¬
dignation succeeding to astonishment; but instead of pursuing
either course, we shall follow the example of the Annual
Meeting of the Association itself. The members felt, and, as
individuals, were not slow to assert, that a glaring injustice had
been committed, but they deemed it more dignified, as an
Association, to exercise self-restraint, though smarting under
the sense of the wrong which had been done their members,
and to maintain absolute silence, satisfied that it would be under¬
stood that while silence meant assent to the protest contained
in the letter addressed to them by Dr. Clouston, it did not
mean assent to the justice of the appointment. If, then, we
err in thinking that on this occasion silence is golden, we do so
in the good company of the Association, by whose “ authority ”
this Journal is published. Speech is indeed but silvern, when
protest, however just, would be futile. Now, as in the days of
Homer—

“The man who suffers, loudly may complain,

And rage he may, but he shall rage in Tain.”

The Catastrophe at Southall Park.

It is rarely indeed that so sad and fatal an occurrence as the
calamity at the Southall Private Asylum occurs to bring home
to those who have the charge of the helpless and insane the
added risk they incur of loss of life in the event of fire. Little
is known of the circumstances immediately attending the fate
of the victims of this fire, but it redounds to Dr. Boyd's credit
that when he perished in the flames in the early morning of the
14th of August, he was returning to look after the security of
his patients, after having seen his daughters to a place of safety,
by which they escaped from the house. Much has been said
as to the deficient precautions taken against fire in this and

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1883.]

Occasional Notes of the Quarter.

403

other Private Asylums, including the means of escape.
Although in the present instance it would seem that these pre¬
cautions were insufficient, it is doubtful whether, had they been
otherwise, the result would have been different, for such was
the rapidity of the conflagration, and the character of the
building, that we believe nothing would have saved it from
destruction. Of this we are assured by a member of the Fire
Brigade who was present, and by a medical man who, among
others, hastened to the scene from the neighbourhood. Few of
the partitions between the rooms of the house were of brick,
and they therefore burnt rapidly. Many private asylums are,
we suspect, similarly constructed, being old mansions, chosen, in
part, for the attractive appearance they present, as well as for
their general comfort. In view of such a catastrophe, it be¬
comes incumbent on the proprietors of asylums to take every
possible precaution against fire, and we are glad that the jury
at the coroner’s inquest demanded an adjournment in order to
ascertain whether the Lunacy Commissioners had had their at¬
tention directed to so important a matter.* Nothing is known
as to the origin of the fire at Southall Park. The kitchenmaid
stated at the inquest that she was awakened by some one
screaming, and by the cook calling “ Fire ! ” On going down¬
stairs she found the place full of smoke. Dr. Boyd’s room was
on the second floor. To this she proceeded, and aroused him,
and he immediately inquired after his family and the patients.
At that time the fire was chiefly in the lower part of the house
and under the dining-room. There had been a fire in the grate
in the servants’ hall, but when the servants retired to bed it was
very low. The cook was left to shut up the store-room, but
she would not require to carry a candle for that purpose. The
above witness had been nine years in the establishment, and
she was not aware of any alteration in the heating apparatus.
The cause of the conflagration is therefore a mystery, and will
no doubt remain so. In addition to the death of Dr. Boyd, his
second son, Mr. William Boyd, two patients and the cook lost
their lives. It is fortunate that two of Dr. Boyd’s daughters were

* Since this article was in type the following verdict of the jury at the
adjourned inquest has been given, after hearing Mr. Frere as a witness for the
Commissioners:—“Death from injuries received in jumping from the roof of
the building during the fire,” with the following rider:—“The jury unani¬
mously record their opinion that the laws which give power to confine lunatics
should provide sufficient means for their protection from fire, and that the
Commissioners in Lunacy should have exercised greater vigilance in causing
adequate provisions to be made at Southall Park.” Is it possible that the
author of “ Gehenna” was on this jury ?

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404 Occasional Notes of the Quarter . [Oct.,

from home, and that some of the patients were having a change
at the seaside.

The sympathy of all, more especially of every member of the
Association, has been excited, and the deepest regret ex¬
perienced, in consequence of this terrible event.

Dr. Boyd was esteemed by all who knew him. His kindness
of heart and his evident sincerity of expression made him many
friends, and we should not suppose he could have had any
enemies. He would often go out of his way to render a service to
those who had no claim upon him. He was not a showy man;
his abilities were not of the kind which are regarded as brilliant; .
but he was a hardworking, plodding man, having a definite aim
before him. Hence his studies and writings are united by a
common bond, and are not mere disjointed essays. His contri¬
butions to the pathology of insanity are well known; and his
statistics of the insane, derived chiefly from the Somerset
County Asylum, are of lasting value, on account of the large
number of cases he had at his command, and the scrupulous
accuracy with which they were prepared.

Dr. Boyd contributed a paper (on Cholera) to the first
number of this Journal; to the second and third volumes,
articles on Convulsions, Cretinism, and Epilepsy; to the fifth
one, on the Necessity of the Study of Insanity; to the seventh,
a contribution on the Causes of Death in Male Patients; to the
ninth, the Results of 2,000 Cases at the Somerset Asylum; to
the tenth. Cases of 1,000 Female Patients ; to the sixteenth, his
Presidential Address on the Care and Treatment of the Insane
Poor, as also a paper on Puerperal Insanity; to the seventeenth,
the Statistics of Pauper Insanity, and Observations on
General Paralysis and the Spinal Cord; to the nineteenth, a
paper on Tumours of the Brain; to the twenty-sixth, a short
paper on the Cure and Care of the Insane, read before the
Annual Meeting of the Association in 1880. In the first and
second Reports of the Somerset Asylum he insisted on the
presence of lesions of the spinal cord in general paralysis, as
well as those in the brain itself. H e studied the relations of
general paralysis and glosso-pharyngeal paralysis, pointing out
their pathology.

Among contributions from his active pen to other journals
may be enumerated the following :— t( On the Weight of the
Brain at Different Ages and in Various Diseases,” read at the
British Medical Association, 1875; “ Tables of the Weights of
the Human Body and Internal Organs ; 99 “ Vital Statistics; ”
and on “ The Pauper Lunacy Laws.”

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1883.]

Occasional Notes of the Quarter .

405

When President of the Association in 1870, the Address he
delivered was of the practical character which might have
been expected from him. In it he strongly advocated the
greater use of workhouses (as at present conducted) for the
insane.

It was, no doubt, as the resident medical officer in the
Marylebone Infirmary, that he first acquired the extensive
knowledge he possessed of morbid anatomy. He was, indeed,
never weary of referring to this period of his life, and the lessons
there learnt, both in pathology and the treatment of the insane
in workhouses.

We are indebted to a former colleague of Dr. Boyd (Dr.
Culpeper) for the following reminiscences :—“ He was the
Lecturer on the Practice of Medicine at the old Charlotte Street
(W.C.) School of Medicine, and at that time the Resident
House Physician, Marylebone Infirmary. The School had but
a very short existence, and when I became a resident pupil of
Dr. Boyd's at the Infirmary, June, 1842, the School had
terminated its existence. Dr. Boyd held no appointment in
England after he left Dublin till he was appointed an out-door
assistant medical officer to the Marylebone Infirmary, which he
held for some time; his colleague was Dr. Bernard. He suc¬
ceeded Dr. Clay as resident house physician. Dr. Boyd was so
modest and retiring in his nature that he was almost passed by
in public; and I suppose those who are writing about him knew
but little of the inner man, but I can say from the most
intimate acquaintance with him since June, 1842, that he was
unselfish by nature, entirely free from jealousy, envy, or affecta¬
tion, steady to the good old lines of his Dublin and Edinburgh
teachers, but always ready and willing to listen to his juniors,
of any degree, in any matter for the advancement of practical
knowledge. His post-mortem rooms, wards of the infirmary and
workhouse were always open to medical men, and in those old
and sleepy days of professional inertia, he was not slow in seeing
what would in time bring forth fruit. I may be permitted to
say that in August, 1842, a youth of 18 years, of fair and slender
build, was admitted into the Infirmary, and for want of a bed
in the medical wards he was sent to the surgical ward till a
place could be provided for him. On examination I found that
he had a very severe attack of malignant scarlet fever, and so
hot and parched was his skin that I thought it must be some¬
thing quite unusual, and with that impression on my mind I
determined to see how the case would terminate, and began by
taking the temperature of the body (106°). I need not say that

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clinical thermometers were not then in vogue, nor in use, as a
means of diagnosis. He kindly cautioned me against the risk
of contagion; but when he saw that I was engaged with his
room-thermometer, he went into the matter as earnestly as I
had begun, and when I gave him my crude and ready views of
the subject he readily embraced them, and the next few days
we were devising all sorts of plans for. a grand course of re¬
searches on the temperature of healthy and diseased conditions
of those that we had to treat. We, after some consideration,
devised that we would make three series of observations—(1)
physiological, (2) pathological, (3) chronic cases, the usual
residents of such establishments. Such was our determination,
and then our troubles began as regards the kind of thermo¬
meter to be used. After numerous trials, mishaps from crying
babies and restless children, we had them made by Negretti
and Zambra, and we set to work upon the above plan, beginning
from the nursery, mother and child, about 14 days old, and
carrying it up to the infants’, boys’, and girls’ school, to about
seven years of age, finishing up with our first series. We
made conjointly 700 observations, consisting of temperature in
two places, pulse, respirations, and all other states of the indi¬
vidual, which we called the general state or condition. All these
were done in spare time, and a most careful registry made of
every case. We did not do very much in our other series, for our
time did not permit; one of the cases Dr. Boyd has pub¬
lished, and no later than last July 9th, 1882—the last day
that I spent with him—he put the report of the case before me.
I left the Infirmary soon after these cases were finished, and I
believe he did not proceed with the research. On his coming
to London from Somerset he renewed the request that we should
finish up the matter, but want of time and other matters pre¬
vented me from doing so, and I considered that our crude and
imperfect set of experiments were not in accordance with the
scientific instruments now in use. I did not see that our
labours would be appreciated. He did not see that the present
system of thermometers, made specially for the purpose of
clinical observation, would clash with our imperfect beginnings.
If time had not been in the way, on my part, I should have
gladly helped in the second part of the matter, namely, the
condition of health, &c. of 700 children, from birth up to seven
or eight years, in an aver-crowded workhouse under the most
unfavourable hygienic conditions. This I could have carried
out well, for he gave me the entire management of the three
grades of schools in the establishment, so that the record

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would have been most correct. I fear these papers are con¬
sumed, unless he may have left them in the archives of the
Marylebone Infirmary. Such is a short and imperfect account
of the doings of an earnest and hard-worker in the profession.
I, the last of his pupils, and, I believe, the last but one of his
numerous colleagues, have only to lament the loss of my first
patron and my first friend, from whom I always received ready
support, and many kind proofs of his interest in my welfare.
His conduct through life deserved the hearty commendation of
all those with whom he had to do. One word more. I, who
have done so much work with him, and know so much about
his quiet professional ways and views, so far as it is possible for
one person to know another, must say that it reflects no great
credit on the disposers of State benefits, who do not appear to
be guided in their appointments by the fitness of the individual,
that he should not have been long ago put into a place which
he could have filled with advantage to those for whom he had
laboured so long and so arduously. This would have been a
fitting place for him, and would have suited the bent of his
inclinations, which were studious and official, rather than those
of the ready man of the world. With this I conclude a hurried
note of a man with whom I so much regret, I shall never have
the pleasure of recurring to those old times which he always
delighted to talk over with me. 55

In the capacity of Medical Superintendent of the Somerset
Asylum for twenty years, from its opening in 1848, he was
beloved by the patients and officers of the asylum, and implicitly
trusted by the Committee, the management of the institution
being very successful. He opposed lavish expenditure, and
we have heard him lament that so extravagant a sum should
have been spent upon the asylum chapel after he left.

In their 20th Annual Eeport the Committee thus refer to
Dr. Boyd's resignation :—“ The Committee will part with him
under the recollection of twenty years of uninterrupted
harmony and entire confidence, during which they have
observed his thoughtful care of the patients and for the
improvement and enlargement of the asylum, whereby the
county property has been much increased in value, while the
expenditure has been kept below the average of other asylums.”

Dr. Boyd was an unobtrusive man, and it was sometimes
difficult to induce him to express his opinions in public even
on subjects upon which he was well qualified to speak. This
was not in consequence of his holding his own opinions lightly.
He had very decided views, as, for instance, in regard to the

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treatment of lunatics in our large county asylums. In visiting
him very shortly before his death, the conversation turned on
the recoveries of insane patients when he was a young man and.
at the present time. He stoutly maintained that Lord Ashley's
Act of 1845 had proved a curse instead of a blessing, and that
the percentage of cures had declined in consequence.

In the melancholy death of Dr. Boyd, our specialty has lost
an admirable example of devotion to the arduous work of his
profession; and his career has shown, once more, the possi¬
bility of pursuing to an advanced period of life, with unabated
interest, if with diminished vigor, the investigations under¬
taken in early manhood.

To the surviving members of his family we offer our pro¬
found sympathy, and doubt not that at the next quarterly
meeting of the Association—if not before—the feelings of the
members will be embodied in an appropriate resolution,
followed, we should hope, by some lasting memorial to one
who was beloved in life and lamented in death.

PART II.—REVIEWS.

Lee Hysteriques . ktat Physique et ktat Mental . Actes
InsolUes , Delectueux et Oriminels. Par Dr. Legrand Du
Saulle. 1883.

It is an easy and pleasant task to review a book in which
there are few, if any, faults to expose, but wherfe all that is said
is in the way of praise and commendation. Such, on the
whole, is the case in the present instance. This large book, of
more than 600 pages, records the experience and observation
of 30 years, and it is not surprising that Dr. Du Saulle ex¬
presses considerable satisfaction at the great advance of know¬
ledge which has occurred in that time. He must remember
very well the hopeless ignorance of the profession in former
years as to the true nature of hysteria, and it has been largely
through the work of French physicians, notably M. Charcot and
M. Richer, and now through Dr. Du Saulle, that this ignorance
has in great measure been dissipated, and that we now possess
some rational ideas as to the disease. He by no means would
suggest that we have yet learned all that can be discovered as
to its nature, but he believes that we are now on the right
track, and that by perseverance in our present methods of re-

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search we may hope to disentangle the phenomena which have
for ages puzzled the profession.

The book is a perfect mine of clinical work ; anyone work¬
ing at the same subject can scarcely fail to find here the record
of a case somewhat resembling any other that might come
under observation. So true, indeed, is this that Dr. Du Saulle
is quite justified when he says : “ Although in any future time
a hysterical woman should exhibit functional disorders sur¬
passing the previsions of physiology and pathology; though
she sleep an indefinite time; though her sensibility be increased,
diminished, or extinct; though her personality be doubled;
though her memory suddenly cease; though she be addicted to
eccentricities which frighten, deceive or excite the compassion
of the most careful and least credulous men ; though she give
way to the most inexplicable vagaries; though she be, if you
like, a sort of sham, indecipherable sphynx, yet she will find
her twin sister in the gallery which I now exhibit.”

Besides the eight chapters into which the book is divided,
there is an appendix which discusses nymphomania. The author
has made this addition in order that the two diseases may be
compared and their essential differences demonstrated. By a
generally credited and most mischievous error, hysterical
patients are generally believed to possess tendencies and habits
which cause them to be worse thought of than they really
merit. Hysterical women are sufficiently badly regarded
without unfounded prejudices reducing them lower than they
deserve; and it cannot be doubted that the belief that they are
all immoral in thought, word or deed, has mightily influenced
the profession against them. These unfortunate women have
suffered much cruel treatment, unintentionally cruel no doubt,
at the hands of physicians in days gone by. They *were
literally tortured by nauseous medicines being so administered
that the taste was never out of their mouths; and when, unable
longer to endure such treatment, they declared themselves well
or ran away, they were denounced as impostors and cheats,
deserving only the tread-wheel and the whip. Dr. Du Saulle
is right when he fears that a long time must elapse before such
patients are treated with due consideration, and their state and
conduct correctly understood.

It cannot be said that hysteria is a disease generally mis¬
understood because of the rarity of cases in which it can be
studied. Can it be believed that it is estimated that in Paris
alone there are 50,000 hysterical women, of whom 10,000 have
attacks ? Yet Dr. Du Saulle says so.

xxix. 28

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In an exhaustive treatise of this kind, where knowledge is
brought up to the day of publication, it is really unnecessary
to recapitulate the various expressions of opinion, and to indi¬
cate the methods of treatment advanced. To do so would be
to give an epitome of the work. But we may say that to all
men engaged in the study of nervous and mental diseases, the
whole book is of the highest interest and importance. In the
third chapter we have discussed some of the most interesting
phenomena of life, the manifestations of hypnotism in hysterical
women. These phenomena are almost incredible. Although
they have been studied but a very short time, the results are
great and the prospects immense. Hysteria will not have been
an unmixed evil to humanity, if through it we succeed in
unravelling some of the most difficult problems of nervous
action.

The portions most interesting to asylum physicians are un¬
doubtedly chapters 4, 5 and 6, but the others may be read by
them with great profit ; indeed, must be read by them if they
pretend to the character of scientific physicians and not that of
mere specialists. In county asylums it is rare to admit a
genuine, well-marked case of hysterical insanity, but when re¬
ceived it is deserving of the closest attention and study. In
an asylum almost exclusive attention is paid to the mental
symptoms, whilst in a general hospital they are not adequately
appreciated or observed—greatly to the loss of the physician,
who at best gains but an imperfect idea of perhaps the most
interesting disease which can come under his notice.

We are accustomed to talk of hysteria—what is it? Who
has defined it ? It is not exclusively a cerebral disease ; neither
is it purely spinal, but a combination of the two. We may
safely say that it consists physiologically in a diminution of cer¬
tain of the cerebral faculties (will), having as a correlative or
parallel effect the exaggeration of other faculties (affective),
and approaching the rupture of equilibrium which normally ^
exists between the cerebral and spinal functions. We have to
do with, we may say, a cerebrospinal ataxy (Jaccoud), or
adopting an expression quite recently proposed by M. Huchard
—a neurataxy* But we must not forget that hysteria has
never been defined, and probably never will be.

The Medico-legal aspect of the disease receives exhaustive
treatment at the hands of Dr. Du Saulle. The cases illustrate
every form of perversity and wickedness, and convey one solemn
lesson at least, viz., that any statement made by hysterical
women, affecting the character of men should be received

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with great caution, and abundantly confirmed before received
as true. It is heart-rending to read the accounts of perfectly
innocent men being imprisoned during many years, the victims
of hysterical women, who seemed possessed of an ingenuity
perfectly devilish. We are reminded by these cases of a remark
by Serjeant Ballantine, in Kis “ Recollections/ 5 to the effect
that he never knew of innocent persons being condemned to
punishment except in such cases as we have referred to.
Members of our own profession and clergymen are peculiarly
liable to such accusations, and they run great risks of condem¬
nation if the woman be good-looking and affectedly-modest.
Juries are notoriously subject to such influences, and even
judges do not appear to be proof against the wiles of the wicked
ones.

In concluding this imperfect notice of a very good book, we
would desire to make amends for our own shortcomings by
praising Dr. Du Saulle’s work. It is the best treatise on the
subject in any language so far as we know; it should be in the
possession of all asylum physicians, and of those interested in
the scientific investigation of nervous diseases. We can assure
anyone who will read it carefully that he will be greatly in¬
terested, and that his knowledge of hysteria cannot fail to be
much expanded and brought up to date.

T. W. McD.

A Regido Psyckomotriz. Apontamentos para contribuir ao
estudo da sua Anatomia . Por Antonio de Sousa

Magalhaes e Lemos. Porto: 1882.

The Psychomotor Region. Remarks on the Study of its
Anatomy . By Antonio de Sousa Magalhaes e Lemos.

Oporto: 1882.

This work is at least evidence that Portugal is not without
her earnest workers in science; and it is with pleasure we
find that the author is not only acquainted with the writings
of foreign neurologists, English, Erench, and German, but
has himself investigated the anatomy and the functions of
the nervous system from various points of view. The work
before us is ah inaugural dissertation with some additions.
It deals almost wholly with the intimate structure of the
motor portion of the cortex, and of the motor tract connected
therewith; and it is illustrated by some very good original
wood-cuts.

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The subject is examined under three aspects. It is
successively viewed in the light of the facts of development,
of pathology, and of comparative anatomy. The one con¬
clusion to which all these lines of study converge is this : that
the motor regions of the brain are characterised histologically
by giant cells, either pyramidal (cerebral type) or rounded
(medullar type).

Some experiments on the electrical excitation of the cortex
are recorded in an appendix.

It may not be out of place to remark that Dr. Herbert
Major and also Bevan Lewis and H. Clarke are frequently
quoted; as a rule, with warm approval, but sometimes with
critical dissent.

In conclusion, we may say that this work would seem to
indicate a spread, rather than an advance, of neurological
research. Nevertheless, as a spread of knowledge forecasts
an advance, the book deserves a cordial welcome.

W. R. H.

Insanity ; Its Causes and Prevention . By. Henry Putnam
Stearns, M.D. New York : 1882.

This is a book containing much practical counsel, the out¬
come of the author’s experience as Superintendent of the
Hartford Retreat (Conn.), and elsewhere. Dr. Stearns is
satisfied that there is an actual as well as an apparent in¬
crease of insanity. Unfortunately he cannot contribute any
fresh statistics towards the determination of the question.
He only gives figures obtained from the British Lunacy Blue
Books, because we have greater facilities for accurately de¬
termining the number of insane persons living at any one
time than is possible in the United States. It would have
been interesting to the English reader of Dr. Stearns’s book,
to know whatever can be known of the numbers of the
insane in the different States, so as to form something like
an approximate estimate of the proportion of lunatics to the
general population. The author has no doubt that when the
statistics of the insane in the United States for 1880 have
been published, they will strongly confirm the conclusion
which he draws from our own Blue Books. Among the causes
for the increase of mental disease, he dwells much upon the
difference between present and past times in regard to fresh
air. “ The thousands who are in the present immersed in
the dense atmosphere of cities, large towns, manufacturing’

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establishments and mines of various kinds, were accustomed
in former times to live largely out of doors, and were engaged
in such pursuits as tended to develope and strengthen the
whole system ” (p. 14). On the other hand Dr. Stearns very
properly points out that the very.extensive emigration of able-
bodied men from Britain during recent years, must leave the
proportion of the weakly and insane to the population higher
than it otherwise would have been without a corresponding
actual increase of insanity. This is true; at the same time
it must not be overlooked that a considerable number of
emigrants leave their native shores because poverty stares
them in the face, and would, in some instances, be likely to
find their home eventually in an asylum. In all these con¬
siderations the grand difficulty is to gauge the contending or
opposing factors accurately, and, therefore, when our author
employs the expression “ having made due allowance for this
and other considerations/’ the reader must be warned that
neither Dr. Steams nor anybody else is able to ascertain
what allowance ought really to be considered as “due.” We
fear that so long as the conclusion arrived at in regard to
the increase of mental disorders must be largely influenced
by the personal equation of the inquirer, so long will wide
differences of opinion obtain on the subject—varying possibly
from the belief in the alarming spread of insanity under
modern civilization, to the denial of any increase at all. It
is simply impossible to reduce the various considerations in
question to figures; they refuse to be appraised like so much
furniture or farm stock by the valuer. Vital statistics'proudly
defy our laudable attempts to compress them within the
columns of tables; but for all that we must continue to tabu¬
late, and, in truth, with the greater care and accuracy. It
is no excuse for shirking them. Summing up the relation
between civilization and the liability to insanity, we believe
it is but too true that as the author says, “ in the degree in
which nations have passed from those conditions which per¬
tain to life in the savage state, upward towards those which
abound in civilized life, in that measure has the sum total of
diseased conditions, in both body and mind, increased; in
this measure have there resulted degenerations of nerve ele¬
ment, and consequent failure to attain to and live in har¬
mony with those artificial arrangements and conditions with
which society in the civil state has thus far in its history
uniformly surrounded itself ”(p. 37).

Dr. Stearns vigorously denounces the present preposterous

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excess of education of our boys and girls, and we endorse
all he says. Whether medical protests will avail aught we
do not know. We rather fear that the masters and ex¬
aminers of schools will reply, “ Physician, heal thyself,”
seeing that the English medical curriculum and the practices
of the examiners in our own profession are just as absurd and
wilfully mischievous as those of other people. They cannot
expect their advice to be followed when they deliberately
break every principle of cerebral physiology themselves. We
are at one with the author when he says there are two great
points to aim at in order to lessen the present crying evil,
viz., “a larger measure of individuality , smaller schools and
fewer pupils for each teacher, that each may have more
special assistance and special training; and secondly, a less
number of subjects of study. Let there be fewer subjects studied
and let what is studied be more thoroughly mastered. Have
fewer half-understood problems and half-remembered lessons,
and I believe we shall have more stable brains and stronger
intellects in after-life ” (p. 92).

Much stress is laid upon the importance and utility of
industrial labour, and it is very truly observed that the lack
of this kind of employment tends to produce too much self¬
distrust and introspection.

Moral education is not overlooked by Dr. Stearns. A
child must acquire self-control and self-denial, but now-a-
days the danger consists in letting him have his own way
and gratifying every wish. To repress by too stern an educa¬
tion is alike cruel and mischievous ; but no less true, perhaps
more true, is it that the freedom of youth, which is now per¬
mitted and encouraged, is in danger, as the writer says, of
degenerating into mere license. Parental respect, the au¬
thority of school and of State, thus become disregarded, and
indeed despised. The warning note must be obedience, not
license.

Dr. Stearns, when speaking of heredity, remarks that the
day will come when the first question asked in the education
of a child will be as to its inheritance. This is all very well,
but we shall find that the educator must, after all, study
the child’s own character rather than that of his progenitors.
He may follow after his paternal or his maternal ancestors;
he may resemble neither. Without for a moment calling in
question the importance of this aspect of the subject, we
would observe that although after a careful study of ancestral
proclivities, we may know something of the original elements

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which went to form the character, we are sadly out when we
attempt to forecast the compound. A dwarf may have had
parents remarkable for their physical endowments, as we
have known to be the case. Dr. Stearns points out five
obvious groups of children, and he might have added more.
These are the Precocious ; the Passionate and Cruel; the
Timid; the Wilful; and the Lonely; and it is no doubt very
desirable that the parent and educator should be alive to
these different forms. Passing over “ Consanguineous Mar¬
riages ” and “ Alcohol ” (from which he counsels all parents
as well as the young to abstain) we observe that the writer
takes a serious view of the influence of tobacco as a predis¬
posing cause of insanity. He is inclined to regard the
excessive use of this favourite weed as inducing in the off¬
spring “ a lower grade of intellectual and moral character,
though to a less extent than alcohol” (p. 183).

Our space does not allow us to follow the author in his
reflections upon the influences of Sex, Poverty, Religion, and
Insufficient Sleep, in disordering the mental functions. His
observations close in recommending that on all State Boards
of Health there should be one or more physicians appointed
“ whose duty it would be to ascertain and make public, reports
upon the prevalence of such conditions as conduce to the
production of mental disease ” (p. 248). This might be very
desirable if we could ensure suitable appointments. Per¬
haps they can in America.

Experimentelle und Kritische TJnter suchungen zur Electro -
therapie des Gehirns insbesonders uber die Wirkungen der
Galvanisation des Kopfes . Yon Dr. Lowenfeld. Miin-
chen: 1881.

Ueber die Behandlung von Gehim und Ruchenmarhs Krank-
heiten vermittelst des Inductionsstromes. Yon Dr. L.
Lowenfeld. Miinchen: 1881.

Behandlung der Psychosen mit EleJctricitdt, Von Dr. Tioges,
in Sachsenberg (Zeitschrift fur Psychiatrie, xxxiv..
Band, 6 Heft.)

The study of these productions affords a favourable oppor¬
tunity for the consideration of the treatment of diseases of
the brain and nervous system, and electricity.

Whilst Dr. Tigges goes no farther than to record his

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own experience, Dr. Lowenf eld's pamphlet of 138 pages
takes the form of a comprehensive treatise on the physio¬
logical and therapeutic effects of electricity upon diseases of
the nervous system, with 242 citations from the literature of
the subject in German, French, English, and Italian. We
have all the diligence and thoroughness characteristic of
the German scientific observer, and, what is also too often
characteristic, the neglect of the art of writing. In Dr.
Lowenfeld's pamphlet there is a want of grace and point;
and though it is full of repetitions, the sense is often ob¬
scure.

In the German Retrospect of this Journal (April, 1874),
in giving a resume of Dr. Tigges' communication on
“ Cases of Giddiness with Double Vision and their Treatment
with the Constant Current,” we ventured to complain of the
want of clearness in the style of this able experimenter, and
the difficulty of guessing at his abbreviations. In the pre¬
sent article Dr. Tigges gives some definitions of his prin¬
cipal abbreviations and symbols which the reader must
learn by heart in order to wade through a paper of 41
pages. His difficulties are not then over. A profusion of
remarks carelessly worded are heaped one on the other, and
sometimes needlessly repeated. Apparently Dr. Tigges has
even grudged the labour of correcting his proof sheets.
Nevertheless the paper is valuable on account of the
numerous observations it contains, which seem to have been
made with care.

Dr. Lowenfeld’s own experience in electro-therapeutics
seems to be extensive. He has repeated many former experi¬
ments and originated new ones. Unhappily, in spite of
hard work and many careful observations, the conclusions
are undecided, not to say discordant; and the juxtaposition
of varying views on many points only serves to show that
the subject has not passed out of the stage of experiment
and debate. There is plenty of guess-work, merely empirical
observations, and contradictory assertions. It is, therefore,
extremely difficult to give the pith of these papers. Their
importance seems in great part to consist in the hopes they
hold out of the influence upon disease of that mysterious
fluid whose presence is everywhere in nature; but whose
method of action is so difficult to follow, describe, and
formulate. For some years back most of the great scientific
discoveries and inventions have been made by tentative ex-

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plorations in the domain of electricity. One step has often
been attended with most unexpected results, and as our
area of investigation, and the fineness of adaptation of our
instruments for experiments are always increasing, it may
be hoped that our methods will become less empirical, and
our success more decided. As Dr. Lowenfeld remarks, it
ought to encourage us when we recall that little more than
ten years ago it was held as one of the best founded data in
physiology that the hemispheres of the brain were not ex¬
citable either by an electric or any other artificial stimulus.
And now how much of our knowledge of its functions is
dependent upon the opposite of this exploded proposition !
Assuming it as proved that we can pass the constant or
galvanic current through the brain or any other part of the
nervous system, it is scarcely needful to remark that so
powerful an agent should be used with great caution.

Dr. Lowenfeld observes that the electrician should be
especially careful with very nervous patients and with women
and children ; but the regulation of the current by a rheocord
is not needed. Flashes of light before the eyes, and swim¬
ming of the head are indications that the current cannot be
increased without danger. The giddiness is more easily in¬
duced by transmitting the stream from one side of the head
to another than in the longitudinal direction. The passage
of the continued current through the brain is sometimes at¬
tended by sounds in the ears and a metallic taste in the
mouth. Nystagmus has been also observed. Where sick¬
ness occurs it is supposed to be owing to the current having
reached the centre for the act of vomiting, which Schiff
places in the medulla oblongata. As regards the length of
the sitting, Dr. Lowenfeld quotes twelve physicians, the first
of whom would only allow one half minute for the duration
of a current passed through the brain, and the last thinks
there is no danger in letting the process go on for half an
hour! He himself thinks that if the current be prolonged
from three to six minutes, favourable effects are likely to be
changed into unfavourable ones, and that widening of the
vessels may succeed to the initial contraction. Butin many
cases it is not our object either to increase or diminish the
amount of blood in the brain. Dr. Tigges says that the
varying action of the two poles, which in a physiological
point of view is so marked, does not appear as a therapeutic
result. But to this general rule there are a few exceptions:

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sometimes one pole has a more favourable effect than
another. In a few cases of sounds in the ears and of
ptyalism, the anode, or positive pole had a soothing in¬
fluence, while the kathode had an exciting influence; in
most cases this difference was not observed. Neverthe¬
less, from some facts stated by Lowenfeld and others, it
seems likely that the question whether, and in what cases,
an ascending or descending current should be chosen is
one which demands further attention. Some of the authors
quoted think that the positive pole should be applied to the
head and the negative to the neck; others recommend the
reverse proceeding. Some consider it indifferent whether
the current be an ascending or a descending one ; but there
are grounds for believing that the effects'are modified by a
change in the application of the electrode, though the vary¬
ing results have not been studied with sufficient care to be
exactly formulated. Althaus mentions a case of hemiplegia
in which the patient, after the application of the descending
stream, the positive pole to the brow, the negative to the
neck, had a feeling of lightness as if he could fly, while
there was an unpleasant fulness and heaviness in the head
after the ascending stream. Onimus and Legros made an
opening in the skull of a dog, and found that by applying
the positive pole to the superior cervical ganglion of the
sympathetic the vessels contracted and the brain shrank,
while on the poles being reversed, there was observed injec¬
tion of the cerebral capillaries with bulging of the brain
through the opening.

Lowenfeld himself is inclined to believe that when the
tendency is toward hypersemia the descending current is in¬
dicated, and where it seems an object to increase the afflux
of blood to the brain that the ascending current should be
used.

Lowenfeld has made a large number of experiments upon
animals in order to ascertain the physiological effects of
electric currents upon the brain. The results were not always
constant, electricity keeping up its somewhat variable and
fitful character. Its effects on the brain are in many respects
obscure or unknown. During the passage of electrio cur¬
rents through the brain thought seems unaffected, and the
will retains its power. What chemical and nutritive changes
take place are still unknown. Lowenfeld thinks that Onimus
and Legros were rash in coming to the conclusion already

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mentioned from a single experiment; but the general course
of his own observations do not lead him to disagree with the
French physiologists. He observed the effect of electricity
on the brain of animals whose skull had been opened by the
trephine, and arrived at the conclusion that it is possible
through the conduction of the constant as well as of the
interrupted current, to influence the circulation within the
cranium. The influence of electric currents upon the circu¬
lation of the brain was not equally great in all the experi¬
ments. When there was a change of calibre in the arteries
during the circuit, the change lasted after the circuit was
opened. He found that the ascending current caused the
arteries of the brain to dilate, and that the descending cur¬
rent caused them to contract; but the results were not so
uniform as one might have expected. In other words, the
anode causes widening of the cerebral arteries of the side on
which it is applied, and the kathode causes contraction of the
arteries. In some cases he found that the interrupted current
caused injection of the pia mater where the constant current
failed to produce any visible alteration. A powerful inter¬
rupted current applied to the peripheral parts of the body
increases the injection of the membranes.

In his observations upon the human subject, Lowenfeld
remarked that vertigo following the passage of the continued
current through the brain is not so easily induced in patients
exhausted by sleeplessness or excitement. He found the
excitability of the peripheral nerves not increased by elec¬
tricity ; and he argues with Schiel that the normal strength
of the arm is not diminished during the passing of an elec¬
tric current through the head. He observed turning of the
head towards the anode in a child of six months sleeping in
his mother’s lap.

Some writers treat the direction of the electrical current
as indifferent; others can assign no clear reason for the
direction they give to the stream. Benedict places the anode
on the neck and the kathode on the brow on the right or left
side according to the site of the lesion.

Dr. Lowenfeld thinks it of importance, in circumscribed
lesions of the brain, to apply one pole to the site of disease
and the other to the neck, so that the current may pass
through the vaso-motor centres in the medulla oblongata.
Whether the current should be passed through the brain in
a longitudinal or transverse direction ought to be determined

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by the situation of the disease If the lesion be in the frontal
lobes, apply one pole to the temple; if in the posterior fossae,
apply an electrode to each mastoid process. Where it seems
an object to diminish the circulation of the right hemisphere,
the kathode may be applied to the right side of the head;
where it seems an object to increase the circulation, the anode
may be applied, and vice versa.

Various explanations have been given of the therapeutic
action expected or observed to follow the action of the electric
current upon the nervous centres. It is believed to influence
the calibre of tbe vessels through the sympathetic nerves
which follow them into the encephalon, to set in motion
trophical changes, and to cause the absorption of abnormal
exudations. Under the influence of such views different
methods of procedure are recommended.

Eighty years ago Aldini claimed to have effected a cure in
two cases of melancholia by passing the galvanic current
through the brain ; but our appreciation of the therapeutic
effects of this agent is still of an uncertain character. Its
effects are variable and capricious; sometimes the result is
very striking; sometimes disappointing. The immediate
therapeutic effects, according to Lowenfeld, are mitigation of
pain, relief from the sensation of tightness or weight in the
head, improvement of speech and general paralysis (Hitzig
and Schxile), improvement in aphonia (Emminghaus), in hys¬
teria and in paralysis of the limbs following haemorrhage of
the brain (Benedict). The secondary effects of galvanisation
of the head are stated to be better marked in the less grave
diseases and anomalies of nutrition, especially in neurasthe¬
nia, habitual headache, hemicrania, chorea, the slighter
forms of mental derangement, and melancholia. Favour¬
able results are said to have been obtained in haemorrhage of
the brain, embolisms of the cerebral arteries, general para¬
lysis, progressive paralysis from disease of the medulla,
syphilitic disease of the brain, and neuralgic and other
diseases of the cranial nerves. The improvement in cerebral
haemorrhage was not confined to the paralytic symptoms
alone. Though he has made use of electricity with a large
number of patients, Dr. Lowenfeld never met with decidedly
unfavourable effects following its application. Other reme¬
dies were generally used along with electricity, and this
makes him less certain as to its real therapeutic powers.

Dr. Lowenfeld, at the end of his pamphlet, remarks that

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the great majority of those who practice electro-therapeutics
hold that the induced current is not adapted for applications
to the head intended to reach the brain. It has been stated
that it was not possible to pass the faradic current through
the brain, and that it did not possess the power of influenc¬
ing the nutrition of deep-lying parts. This view was
strengthened by the observation that its employment was
rarely followed by flashes of light, giddiness, and other symp¬
toms of irritation which sometimes follow the application of
even a weak constant current. These arguments, he says,
are not now tenable, since Erb has shown that induced cur¬
rents traverse the brain as well as those of the constant
current.

Dr. Lowenfeld's own experiments prove that the circula¬
tion within the cranium can be influenced by the application
of the interrupted current. (c Like Erb and Benedict, 55 he
writes, “ I have been able to convince myself that the inter¬
rupted current, especially transmitted through the moistened
hand laid on the head, can produce great relief in intense
headaches. 55 He quotes the observation of other well-known
physicians on the favourable results of the interrupted cur¬
rent in neuralgia and sleeplessness.

Dr. Lowenfeld 5 s smaller pamphlet is devoted to the thera¬
peutic effects of the interrupted current in nervous diseases.
He has found great benefit in a few cases of spinal disease in
the application of the interrupted current to the back, espe¬
cially where the disorder seems to be merely functional. He
thinks that the remarkable effects following on general fara¬
disation as claimed by Beard, Rockwell, and others, are in
part owing to the current passing through the head. The
general procedure is to apply the one electrode to the feet or
gluteal, region, while the other pole is successively placed on
the head, trunk, or extremities. In the treatment of the
insane he recommends the use of peripheral faradisation
with strong currents passing through the trunk and extremi¬
ties, but would apply weaker currents through the head,
continued from ten to fifteen minutes through the wet hands
or with moistened electrodes. He himself has seen great
advantage from general faradisation in cases where there
was no deep-seated organic lesion, in hemicrania and sleep¬
lessness, neurasthenia, chlorosis, hysteria, hypochondria, and
other diseases of the same type not dependent upon an organic
lesion.

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In one of the cases given by Lowenfeld, there had been
for several months headache, ofteu with confusion in the
head, incapacity for mental exertion and a rapid sense of
weariness especially in calculating with figures. There was
weakness in the back and legs, so that the patient, a man of
thirty-eight, was tired by a short walk. There were pains
in the loins, descending to the legs; the appetite was bad;
the bowels constipated; and there was a feeling of tightness
and uneasiness in the abdomen, especially at meals, with
tenderness felt on pressure at the epigastrum; poet coitum
lassitudo gravis per dies nonnullos, propter hoc a muliere
abstinentice erectionibus et inquite nocturna recuta. These
symptoms were accompanied by great mental depression.
After three weeks’ treatment and general faradisation there
was an enduring improvement in all the symptoms. In the .
course of a few months, during which faradisation was
employed in a somewhat intermittent manner, the patient
completely recovered his health.

Engelhom treated in this way a case of hysterical insanity
and another of hysterical melancholia. In both patients
there was deep exhaustion of the nervous system and loss of
the power of digestion. They both improved after the first
use of general faradisation, and sleep and digestive power
returned. Against the Protean symptoms of neurasthenia,
Lowenfeld considers that general faradisation is the treat¬
ment par excellence. He has found the constant current
also useful, but somewhat slower in its action. He refers
to the work of Beard as to the proper way of managing the
electrical current. After discussing the modern medendi
suggested by the American physicians, he observes that not
only is the nervous system directly acted on, but that there
is a reaction from the stimulating effect of the current upon
cutaneous nerves, and the involuntary and voluntary muscles.
He considers the action upon the superficial nerves to be of
the greatest importance.

Dr. Tigges gives an analysis of the effects of electricity
upon several symptoms met with in the patients of a lunatic
asylum. He endeavoured to act upon the sympathetic
system by applying the pole of the galvanic battery to one
or other of the sympathetic ganglia of the neck, the other
pole being placed near the continuation of the sympathetic
nerves, or laid upon the transverse processes of the cervical
vertebrae, or on the arm, or one electrode was placed on the

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first ganglion of the sympathetic of the neck, and the other
electrode behind the occiput. By this treatment, intended,
we may suppose, to act upon the vaso-motor nerves, pains in
the head, neck, back, chest, and arms were relieved; the
apathy of the patient was lessened, and humming in the ears
made.to cease. Sometimes the passage of the current was
attended with sensations of heat or shuddering, or there was
tenderness over the region of the trunk or ganglia of the
sympathetic. The motor symptoms observed in various
cases were shuddering, and clonic and tonic spasms. On
passing the current with one electrode in front of the ear
the head was jerked from side to side; on * laying the
electrode on the mastoid process there followed in one case
chattering of the teeth and trembling of the left arm. In
one patient, after three weeks' treatment with the electric
current of moderate strength, there supervened epileptiform
fits without loss of consciousness, opisthotonus, emprostho-
tonus, and treading with the feet. An attack of this kind
was renewed on the application of the current, and on
ceasing the electricity the fits returned no more. In some
cases the face was observed to turn pale ; in others it became
suffused with perspiration. In cases of melancholy with
apathy or stupor, Dr. Tigges notes that after the constant
as well as the interrupted current he found the pulse fuller
and more frequent, the face pale, and the pupils generally
more dilated, rarely contracted. The passage of the con¬
stant current through the nervous centres evidently disposed
to sleep. The patients generally slept better after the
applications ; one of them could scarcely keep from falling
asleep during the sitting. The constant current had in one
case a better hypnotic effect than injections of morphia.
Giddiness was found to derive benefit from the electrical
method of treatment; sense of oppression in the head was
found to be relieved by currents passed through the organ or
applied to the sympathetic nerves, or to the neck and back.
Feelings of heat, lightness in the head or constriction in
the body or limbs, with flushings in the face, were found to
derive benefit from the constant and also from the inter¬
rupted current. Tender spots at different parts of the
body as well as on the head were successfully treated by the
applications of electrodes to the place. The uneasy sensa¬
tions of whatever character were apt to return ; but through
persevering treatment enduring improvement was obtained

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in many instances. The effect of electricity was tried on
ptyalism. The constant current passed so as to act upon the
sympathetic of the neck, or on the parotid gland, had a
favourable influence; but did not in any instance cause
permanent improvement. Once tried it in a case of excessive
salivation in an imbecile lad who had been epileptic. It
was found easy to stop the flow of the saliva by laying the
one electrode on the parotid, the other on the submaxillary
gland ; but when the current was withdrawn the flow of
saliva again began.

Especially interesting is Tigges* treatment of auditory
hallucinations by the constant current. He gives a short
account of thirteen cases in which there were sounds in the
ear, and in some instances hallucinations of hearing without
organic disease. The electrodes were applied in a variety of
ways. Sometimes the one pole was brought in contact with
the parts about the ear, either in front or behind, on the
mastoid process, the other electrode apparently being applied
to the neck ; or the anode was put on the forehead and the
kathode below the occiput; or the anode was put on the
neck and the kathode on the upper dorsal vertebrae.
Another arrangement was to lay the anode over the situation
of the third ganglion of the sympathetic, i.e., between the
trachea and the sternal attachment of the sterno-mastoid
muscle, the kathode being put under the angle of the inferior
maxilla; or the poles were reversed. What he calls the
local treatment, was to insert one electrode into the auditory
foramen, which was filled with water, or to make the pole
to rest upon the tragus while the other pole was applied to
the neck. In a few cases the anode was found to have a
soothing effect; the kathode, an excitiug one, increasing
the sounds in the ear. In one patient the subjective sounds
thus aggravated lasted an hour after the sitting ; but as a
general rule no difference was noticed in the effects of the
two poles.

We hope to return to these important researches in a
future number. It only remains for us now to express our
appreciation of the patience and ingenuity with which they
are being pursued, and our hope that they will prove of last¬
ing service in the treatment of the insane.

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425

PART III.—PSYCHOLOGICAL RETROSPECT.

1. German Retrospect .

By W. W. Ireland, M.D*

Relation of Diseases of Women to Insanity .

Dr. Ripping, in the “ Zeitschrift fur Psychiatrie (Band xxxix.,
Heft 1), considers the important clinical question of the relation of
the diseases of the sexual organs in women to mental alienation.
While he admits that changes in the uterus and its appendages,
whether physiological or pathological, have an effect upon the mental
susceptibilities of women, he is doubtful whether this effect is pro¬
found enough to become a potent cause of insanity. He is rather
disposed to place such affections in the second or third line of causes
as adjuvantia. The uterine diseases and the mental disturbance Are
sometimes the result of a common cause. “ I have never observed,”
writes Dr. Ripping, “ a single case in which the insanity was a pure
reflex neurosis of disease of the genital organs.” If in some patients
this seemed to be probable, it was found on more careful examination
that there were other circumstances which gave an‘easy and unforced
explanation of the mental derangement. It is only after uterine dis¬
orders which, from their severity, implicate the whole organism, or
lower the strength, as in continued bleedings, that insanity can be held
to supervene as a result.

Dr. Ripping finds that affections of the sexual organs, after the
puerperal condition is passed, do not hinder recovery from insanity.
He protests against the remark of Skene that the insane are less
affected than the sane by vaginal examinations. On the contrary, he
says that, in recent cases of insanity, such examinations sometimes
causeinjury to the course of the mental symptoms which are well-nigh
irreparable. He has a dislike to examinations under anaesthetics,
and observes that the effects of chloroform on the nervous system are
somewhat suspicious in patients afflicted with recent insanity.

There is a great variance of opinion about the frequency of diseases
of the genital organs in insane women. Verga places it as low as 6
per cent., L. Meyer 9 per cent., Landouzy makes it 50, and Hergt as
high as 66 per cent. Dr. Danillo, of St. Petersburg (Centralblatt
fur Nervenheilkunde, 1 Juni, 1882), has recently examined the ques¬
tion ; and of 200 insane patients he found diseases of the genital organs
in 80 per cent.; and out of 140 women who still menstruated, he
found 120 = 84 per cent, who had some affection of the uterus or its
appendages. In 60 who did not menstruate, he found only 18 = 28
per cent, so affected. Dr. Danillo therefore comes to conclusions
quite opposed to those of Dr. Ripping.

xxix. 29

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426 Psychological Retrospect* [Oct. f

Alterations in the Nervous Centres from Ergotism.

Dr. Franz Tuczek gives us (“ Archiv,” Band xiii., Heft 1) some
further information about the epidemic of ergotism which visited the
circle of Frankenberg, in Hesse Cassel, in the autumn of 1879, so well
described by Dr. Siemens in a previous number of the “ Archiv ” (see
“ Psychological Retrospect,” October, 1881, p. 429). Dr. Tuczek
tells us that since Dr. Siemens finished his paper more cases have
entered the hospital. The ergotism did not disappear till all the bad
rye was used up. In 1880 there was about from 1 to 2 per cent, of
ergot in the crops ; but the people, at last convinced of its hurtful
qualities, took the trouble to separate the spurred rye, and gave it to
their poultry, which caused great mortality amongst the fowls.

Since the autumn of 1880 there have been no new cases in Hesse, but
many relapses and sequelse of the disease; and in March, 1882, there
were still in the hospital four patients suffering from the effects of this
dreadful malady. Dr. Tuczek remarks that many children were
affgcted with ergotism, but never any infants at the breast. In the
epidemic under his observation the nervous symptoms were the most
prominent; he had met with no case of gangrene. All the patients
were affected with convulsions, and all, without exception, showed
symptoms of disease in the posterior column of the spinal cord. This
would perhaps have escaped attention had it not been found that the
patellar reaction was wanting.

The principal nervous symptoms were ataxia, diminution of sensi¬
bility, dulness of perception, giddiness, loss of memory, a feeling of
mental incapacity, and dislike to work. The feelings of mental dis¬
tress often took the form of overburdened consciousness of sin. Some¬
times there was melancholia passing to suicide; sometimes there were
maniacal symptoms. Death took place in a state of stupor passing
into coma.

Dr. Tuczek did not find hallucinations common, although many
children were affected by the ergotism who do not make any accurate
distinction between their dreams and the observations of their waking
moments. He gives the case of a little girl of seven years of age who
had eaten of the diseased rye. She had epileptic fits, became very
talkative and restless, spoke to everyone whom she saw, told absurd
stories, laughed and made faces, was passionate, danced about, wept,
and showed other signs of great excitement.

In all the cases epileptic attacks appeared at one time or another,
sometimes going before the mental derangement, sometimes accom¬
panying it, and often outlasting it, so that, after the mental alienation
had disappeared, typical epilepsy remained.

After the fits involuntary movements of an automatic character
were observed in one case; in another anaesthesia of the skin followed;
and in a third there was ataxia, which soon disappeared to return after
a new epileptic attack.

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Dr. Tuczek distinguishes between the primary intoxication caused
by ergot and the after effects, evidenced by emaciation, anaemia, low
temperature of the body, dislike to food, diarrhoea, and a tendency to
skin eruptions, especially furuncles and carbuncles.

Of twenty-eight cases received into the hospital, four died ; eight
recovered ; four are still under treatment, not giving much promise of
recovery. Of the remaining twelve, some appeared to be permanently
injured in intelligence ; and in all the failure of the patellar reaction
showed that there still existed some affection of the spinal cord. Dr.
Tuczek mentions that while his article was going to press a woman
suffering from mental derangement through ergot had lighted a heap
of flax near her house by which her child was burned to death.

Of the four patients who died, two are noted to have had the
mesenteric glands much enlarged and to have been the seat of tuber¬
cular degeneration. Similar deposits were found in the intestines ;
there were no traces of tubercular deposit in the brains of those
examined.

In the brain of a girl of nine years, who died in a state of stupor
after repeated epileptic fits, the dura mater was strongly adherent, and
there was some fatty degeneration in the middle-sized vessels and their
ramifications near the great ganglion cells of the cortex, principally in
the upper parietal gyri and about the cornu ammonis. In the other
three cases the alterations found in the brains were trifling; but the
scrutiny was not prosecuted so diligently as with the four spinal cords,
which were examined with great care. In all the knee jerk had been
wanting, and the posterior columns were found to be the seat of a de¬
generative process characterised by hyperplasia and fibrillar meta¬
morphosis of the neuroglia at the cost of the nerve elements. This
alteration was confined to the root-zone or columns of Burdach, those
of Goll being slightly invaded in one case only. In three of the
spinal cords Dr. Tuczek believes that he had lighted on traces of a
chronic myelitis, the process being of an interstitial character, though
principally affecting the neuroglia. He thinks that we have here an
affection of the root-zone, which only differs from the typical tabes
dorsalis by its rapid development and the want of contraction of the
atrophied tissues. One patient died a few days after the disappear¬
ance of the knee jerk ; but the alterations found in the root-zone were
of a character already chronic, showing that there may be recognisable
alterations in the cord before the failure of the patellar reaction. In
the cases which recovered, the reaction returned after a considerable
time. Dr. Tuczek thinks that as long as the axis cylinder of the
nerve fibre remains intact, repair and recovery are possible. In all
cases but one the ordinary reflex action of the skin remained, and the
excitability of the quadriceps extensor to mechanical irritation was
sustained or increased.

The disease which presents the most obvious similarity to ergotism
is no doubt pellagra. As the one is caused by degenerated rye,

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[Oct.,

the other is caused by degenerated or ill-ripened maize. In both
cases we have a slow poison mingled with the food, producing
a profound constitutional* cachexia, shown by weakness, anaemia,
emaciation, and diarrhoea. In pellagra, instead of furuncular
eruptions, there is a livid erythematous discoloration of the face and
hands ; in ergotism there is a marked tendency to epileptic attacks ;
in pellagra to cramps and spasms. In pellagrous insanity hallucina¬
tions seem more common ; but in both forms there is a pronounced
tendency to melancholia and great anxiety of mind, fears of damnation
and proclivity to suicide being noticed as prominent symptoms in
both. In pellagra symptoms of ataxia and choreiform movements are
common. If Dr. Tuczek will consult Dr. Adriani’s pamphlet on
“ Pellagra,”* he will find that amongst the lesions noticed after death,
in patients affected by this form of nervous disease, there are adipose
liver and fatty degeneration of the walls of the cerebral vessels, and
hyperaemic adhesions and opacity of the membranes of the encephalon
and spinal cord, serous or sanguinolent effusions under the arachnoid,
and degenerative changes in the brain itself. Dr. Adriani also
mentions traces of diffused granular myelitis, and says that a charac¬
teristic softening of the dorsal portion of the cord, especially of the
white substance, has been long ago noticed and described by numerous
observers. He also mentions fatty degeneration of the great sympa¬
thetic. Apparently in the cases of ergotism the sympathetic was
not examined.

Dr. Tuczek recalls several drugs, such as lead and arsenic, which
produce inflammation of the spinal cord with ataxia and disorders of
sensation. Among the active principles in ergot he mentions
sklerotine and trimethylamine. Dr. Tuczek’s experiments on animals
were not so successful as those of Italian physiologists with pellag-
rozeina. In some animals he induced bad health and emaciation, but
no epileptic fits or diseased condition of the cord.

Poliomyelitis Potatorum .

Dr. Fischer (“ Archiv,” Band xiii., Heft 1) describes a peculiar
disease of the spinal cord met with in drunkards. He gives at great
length the clinical history of two cases which bore so great a likeness
to one another that he thinks himself warranted in assuming that they
belonged to one type with a common physiological lesion. Both the
patients were stupid, lazy men, much addicted to drinking wine and
beer, and the inordinate use of tobacco, and leading a listless and lazy
life. Neither of them had syphilis or any hereditary neurosis. They
fell into a condition of nervous weakness especially characterised by
atrophy, and diminished power of the voluntary muscles, which were
found not to be excitable either by the continuous or by the inter-

* “ La Pellagra • nella Provincia dell’ Umbria ” del Dott Roberto Adriani.
Perugia, 1880.

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1883.] Psychological Retrospect . 429

rupted currents of electricity. The peculiar reaction had disappeared,
and the quadriceps was not affected by mechanical stimulus ; and the
usual reflex action from the stimulus to the skin was diminished ;
sensibility to heat was not affected. There was marked ataxia, slight
parsesthesia, diminution of the sense of touch, and retardation of the
conduction of general sensibility. Standing and walking when the
eyes were shut were uncertain. There was great hyperesthesia to
touch, a faint pressure causing pain.

There were slight febrile movements, want of appetite, and
symptoms of gastritis. The pulse was quick and feeble. There was
an absence of pain or feeling of tightness round the body, and no
special tenderness to pressure or rigidity of the spine. The pupils
were normal. The first patient, a man aged 36 years, completely re¬
covered ; the other, 44 years old, made considerable improvement. In
the first case the weakness or paresis of the muscles was more
marked, in the second the ataxia. Though both were 6tupid, inert
men, the first was of a much easier disposition, the second patient
being disposed to melancholy.

Dr. Fischer remarks upon the existence of extreme hyperaesthesia
of the skin with retardation in the time of conduction of general
sensibility.

An interesting peculiarity common to these two cases is the im¬
possibility of exciting some muscles by electricity which were still
under the control of the will. The extreme sensitiveness of the
patients was a bar to the careful investigation of this condition, but it
was well ascertained in the muscles of the fingers and thumb. The
same thing has been noticed in lead paralysis.

Dr. Fischer thinks that this group of symptoms is connected with
inflammation of the spinal cord. He assigns to it the name of
Poliomyelitis anterior subacuta.

On a Source of Fallacy in the Knee Phenomenon.

Dr. Westphal (“ Archiv,” Band xii., Heft 3) warns us against mis¬
taking the reflex action from the skin with that brought out by strik¬
ing the patellar tendon, and gives an instance where pressure on a
fold of skin was mistaken for the real phenomenon. In one instance
he could distinguish two reactions, that produced by striking the
tendon, and another contraction of the quadriceps following a little
after, owing to the reflex action from contact with the cutaneous sur¬
face. The Professor is not satisfied with the arguments of Eulenberg
that the knee jerk cannot be of a reflex character, because the time of
its following the knock is too short for conduction to the spinal cord
and back again. He says that other observers have come toother re¬
sults, and there are grounds of fallacy in these minute calculations of
fractions of instants. Observing that the knee phenomenon disappears
after the section of the posterior root of the crural nerve, he found

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430 Psychological Retrospect . [Oct.,

that its disappearance was not hindered by the injection of strychnia,
which is believed to increase the muscular tone.

Syphilitic Tabes Dorsalis ,

Dr. Benedikt (“ Centralblatt fiir Nervenheilkunde,” 15 August,

1881) observes that some people are born with a tendency to certain
diseases, or to diseases of certain tissues. Some men are born to be¬
come fat, others to have hypertrophy of the connective tissues. He
recognizes a syphilitic form of tabes which, however, is rare. This
form is characterised by a frequent oscillation of the symptoms, so
that complete or well-nigh complete recovery alternates with severe
relapses. Instead of the usual kind of pain beginning at the toes and
extending upwards, we have pains which may commence at the sciatic
nerves, or portions of the skin remain anaesthetic. These cases derive
benefit from iodide of potassium and mercury, while the other cases
receive ham from anti-syphilitic treatment. There are other cases
where syphilis has preceded the locomotor ataxia, which do not assume
the syphilitic type. In the ordinary course of tabes Dr. Benedikt
uses nitrate of silver, ergot, Chapman’s ice bags, Priessnitz’s baths
and galvanism. He treats the eccentric pains with points de feu.

Connection between Syphilis and Locomotor Ataxia .

Dr. Pusinelli (“ Archiv,” Band xii., Heft 3) finds that out of 51
cases no syphilis could be made out in 24 == 47 per cent. ; but con¬
stitutional syphilis was present in 16 cases = 31 per cent. In nine
there was chancre without secondary symptoms = 17*6 per cent., and
two cases of soft chancre = 4 per cent.

He has come to the conclusion that although tabes dorsalis is not
a form or manifestation of syphilitic disease and not improved by anti¬
syphilitic treatment, nevertheless the constitutional- degeneration fol¬
lowing upon this form of venereal disease is a powerful predisposing
cause.

Dr. E. Rchlen ( u Centralblatt fiir Nervenheilkunde,” 31 August,

1882) found syphilis in 22 per cent, of the cases of tabes dorsalis
which he studied, and a history of soft chancre in the same proportion.
His observations were made on 35 patients.

Loss of Weight after Epileptic Fits .

Our readers have already been made aware of the observations of
Dr. Kowalewsky, who, in a paper published in the u Archiv,” stated
that he had found that there was a noticeable diminution of weight
in epileptics after each attack. The subject has been examined by
Victor von Olderogge, (“ Archiv,” Band xii., 3 Heft,) who has found
that there is not nearly so great a loss in weight as Dr. Kowalewsky
has given out, that some epileptics never lose weight at all, and that

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Psychological Retrospect .

431

where the loss occurs it is no greater than what often takes place in
healthy men in the same space of time.

Four other observers, Dr. G. Kran^, Dr. Schuchard, Dr. Jolly, and
Dr. Lehmann have, after carefully examining the question, arrived at
the same conclusion. They all roundly deiiy any special loss of
weight after epileptic attacks.

Case of Word Deafness or Sensorial Aphasia (“ Centralblatt fur
Nervenheilkunde,” 1 Juni, 1882.)

“ The 46-year-old shoemaker S.” consulted Dr. Schwabach because
for some weeks he had not been able to hear well. Dr. S., finding that
it was not an affection of the ear, but of the brain, sent him to Dr. M.
Bernhardt, of Berlin, who gives a full description of the case. S. was
a strongly built man, who had about two months before fallen down
and lost consciousness. This was succeeded by slight paralysis, with
some difficulty of speaking, which soon disappeared. Eight days
later he sprang suddenly, was very restless, spoke a good deal of non¬
sense, and seemed to hear badly. It was found that he understood
what was written. This state of excitement lasted for two days, end¬
ing in a passionate outburst of tears. He now became quiet and
thoughtful. No other symptom of moment was noted, save that
there was a doubling of the second sound of the heart heard at the
apex.

The pulse was small. It was found that he could read and under¬
stand what he read. He read aloud out of a newspaper quite correctly
to his wife passages which interested him, but could not understand
what was said to him. When one asked him his name, in writing, he
immediately pronounced it, and wrote it at once. He hears sounds
and voices quite well with both ears, but does not understand what is
said to him. He himself remarked :—“ I hear every sound, but I
cannot understand the word, what it properly means.” The association
between the words spoken by another and the idea was lost ; but . the
association between the written words and the idea still remained. In
speaking he occasionally changes the word, putting in wrong letters,
lie knows the use of objects held before him, but does not always give
the proper name to it.

To the question what is this object ? he answers :—Messer—a knife
(messer) ; propfenzicher—corkscrew (propfen-zeiger); biirste—burst
(e left out) ; cigarren-spitze—cigar top (cigarren spatz); thermometer,
portmonater.

Generally, however, he names objects correctly. When asked to
write “ Haus,” he wrote “ aus ” ; when asked to write “ Schoneberg,”
he wrote “ Schoneberch, ,, but afterwards wrote it properly. When he
was made to look steadfastly at the speaker’s mouth he understood a
few words if pronounced slowly. When English was spoken to him
he said that it had a foreign sound. When Dr. Bernhardt sang to him
the first verses of the well known airs—“ Heil dir im Siegerkranz ”

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432 Psychological Retrospect. [Oct.,

and “ Die Wacht am Rhein,” he answered, “ It first goes high then
low, then again high,” without recognising the tunes.

Dr. Bernhardt observes that this is a good instance of the word-
deafness of Kussmaul or the sensorial aphasia of Wernicke. It is
quite uncomplicated, the intellect appearing to be intact. No paralysis
remained save a slight slowness of the right side of the face. The
man’s spelling was peculiar ; but it was doubtful whether this was not
owing to an imperfect education. Dr. Bernhardt is inclined to believe
that there is an embolic softening of the left hemisphere, probably of
the first and perhaps of the second temporal convolutions.

The Professor gives a shorter account of another case of a similar
kind.

Dr. N. Weiss (“ Centralblatt fur Nervenheilkunde,” 31 August,
1882) gives the lesions found in the brain of an old man who died after
having had for three months aphasia, word-deafness, and paralysis of
the right side. There was degeneration and softening of the parts
supplied by the artery of the Sylvian fissure on the left side. As in
all cases of word-deafness there was a lesion of the first temporal gyrus.

2. English Retrospect.

Asylum Reports.

(Concluded from p. 304J

Eastern Counties Asylum for Idiots , Essex Hall f Colchester .—
This institution, which is still under the assiduous care of
Mr. Millard, is being enlarged, the demand for admission being
much greater than the accommodation could supply. Provision
is, or is about to be, made for about 50 more cases; a new steam
laundry; a gymnastic and recreation hall combined; bath rooms,
lavatories and water-closets; the outlay being estimated at about
£12,000. At the last annual meeting a powerful appeal was made
for funds. Dr. Bateman stated that there are in the Eastern Counties
3,000 idiots, of whom at least 1,000 needed the benefit of such an
asylum, whereas there was accommodation for only 99, and he justly
describes the inmates of the cottages where an idiot dwells as doomed
to constant association with the most repulsive features of humanity,
and obliged to breathe an atmosphere of moral miasma. No doubt
the appeal of the committee will be responded to, but doubtless the
efforts required to obtain subscriptions and donations involve much
labour and anxiety.

Kent County Asylum , Baiming Heath , Maidstone .—Dr. Pritchard
Davies has, we are glad to observe, adopted the proposed tables of the
Association. Although unable to go back so far as the opening of
the asylum, he has given the figures from 1875. The result as re¬
gards recoveries is as follows :—Persons admitted during eight years,

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1883.] .

2,412 ; persons discharged recovered, 910, being 37*72 per cent, of
persons admitted. Of these 302, or one-third, relapsed, leaving 608
persons still sane. Further of the relapsed persons 249 were again
discharged well, leaving the net recoveries 35*53 of the number of per¬
sons admitted. The statistics of recovery are in this way brought out
in a most interesting maimer. Had the calculation been made in the
old-fashioned way on cases instead of persons the number correspond¬
ing to 37*72 would have been 40*5.

The crowding of the asylum with patients who might have been
just as well in workhouses is referred to. It appears that the Com¬
missioners in their last report commented upon the unreasonable use
of wards. Dr. Davies observes—I am convinced that, apart from
over-crowding, these patients exercise an injurious influence upon
those whose disorders are of an acute and consequently more curable
nature. I think, therefore, that in the long run it would be cheaper
for the Guardians to provide suitable accommodation for them in the
workhouses, and forego the present advantage of the grant in aid
when in an asylum. It is, however, almost impossible to get this
view adopted in the right quarters, so that the only hope left is that
the Government will, at no distant date, re-consider .this grant, and
dispose of it in a less objectionable way. If a change of some sort is
not made soon, the question of providing increased asylum accommo¬
dation will once more force itself upon your notice, as despite every
care upon my part we are unduly full.”

Two striking cases of “ homicidal impulse ” are chronicled, a male
attendant having in each instance been murderously assaulted. “ Each
patient had been previously regarded as harmless, and the attacks were
absolutely unprovoked, and must have been the result of that sudden
homicidal impulse we but too frequently meet with in asylums ; and
which, from the impossibility of predicting its advent, renders every
person of unsound mind a source of danger.”

We are very glad to observe that Dr. Davies is pushing the em¬
ployment of patients to the greatest extent compatible with the
strength and health of the patients. The latest addition to the work¬
shops is a carpenter’s shop. There is great force in the remarks made
in this connection. “ Worshops where the artizans are not attendants
may be necessary for some purposes, but an asylum cannot be regarded
as satisfactory if no provision is made for the suitable employment of
all classes of patients, under the constant supervision of responsible
attendants. Where such workshops do not exist it must of necessity
happen that some patients, who are skilled workmen, are unable to
follow their handicrafts on account of the undue risk that would be run
in sending them to shops where only ordinary mechanics can give
them but intermittent care. Already skilled painters, basket makers,
and carpenters, not formerly employed here at their trades, have been
set to congenial work in these new shops, and derived great benefit
from the change. Not only are shops of this kind valuable for the

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Psychological Retrospect .

[Oct.,

class of patients I have just named, but they serve another purpose,
viz., that of schools, where patients can be taught some interesting
work, and be roused out of the misery of an idle life. I hope to
develope this system more in the future, as I regard work, and more
particularly skilled work, as one of the most potent remedial agents
we possess.”

Great improvements have evidently been made in this asylum from
time to time, and there are several points in the treatment of the
patients which render the results of more than usual interest. We
referred in the last number of the Journal to the fact that the with¬
drawal of beer from the dietary had proved satisfactory, as in not a
few.other asylums, and the practice of the asylum as regards nar¬
cotics is already well known.

Wilts .—The sanitary condition of this asylum is evidently much
improved. Only three slight cases of typhoid occurred during the year,
and no erysipelas. It is believed that this beneficial change is due
to improved ventilation of the wards and ventilation of the sewers.

Worcester .—The drainage of this asylum calls for, and is about to
receive, immediate attention.

Dr. Cooke presented a very full report to his Committee on beer.
He recommends its almost total abolition, and the substitution of
milk. His report is thorough and sensible.

Yorkshire , East Biding .—It is very satisfactory to find that walk¬
ing parties beyond the asylum grounds have become a matter of
routine, and that all but six male and two female patients are able
to take part in them.

Yorkshire , North Riding. —Dr. Hingston reports favourably of the
dormitories constructed for the use of epileptic and suicidal patients,
lie has introduced an electric clock, by which an unerring record
of the visits paid by the night attendants is obtained. The manage¬
ment of the asylum is evidently carried out vigorously.

Yorkshire , West Riding .—Important alterations have been made
in the drainage, with markedly good results.

No fewer than 97. patients w'ere discharged “relieved,” being
handed over to the care of their friends or the Union authorities. In
spite of this the asylum remains full.

Dr. Major reports that he has sought to diminish, as far as prac¬
ticable, the number of patients confined to the airing courts for
exercise, and now the patients from the female refractory wards have,
equally with others, daily recreation in the walks skirting the estate,
to their decided advantage, and with the result of securing compara¬
tive tranquillity in the airing court.

Yorkshire , South .—This asylum continues to fill up rapidly. Addi¬
tional accommodation is to be provided for 150 patients, and the
Visitors report that a third asylum is necessary, and must be built
without delay. This is a dismal conclusion, and suggests unplea¬
sant reflections. Surely we are on the wrong track.

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1883.] Psychological Retrospect. 435

York Retreat .—Amongst the improvements effected during the year
not the least important was the warming by hot water of all the
rooms on the male side. There has been no lack of zeal or expendi¬
ture in the attempt to introduce every comfort and improv.ement into
the institution. Dr. Baker states that the Turkish bath has been in
daily use for nearly five years, u with very satisfactory results.”

York Lunatic Hospital (Bootham ).—A very decided difference of
opinion has for long existed between the Governors of this hospital
and the Commissioners relative to the presence of paupers in the
asylum. Whatever may be the legal aspects of the question, it is
quite certain that for the success of the institution as a middle-class
asylum the pauper should not be there. Witness the Murray Royal
Asylum, where the pauper patients were removed with marked benefit.
We know that the late Mr. Gill warmly approved of the protests of
the Commissioners. The asylum seems fated to get into hot water,
notwithstanding the pleasing contrast it presents in its old age to that
by which it was characterised in the days of its youth.

PART IV.—NOTES AND NEWS.

THE ANNUAL GENERAL MEETING OF THE MEDICO-
PSYCHOLOGICAL ASSOCIATION, 1883.

The annual meeting of the Medico-Psychological Association was held on
Friday, 27th July, at the Royal College of Physicians, London, Dr. Orange pre¬
siding. The following members and visitors were present: — Drs. C. Aldridge,
Alliott, D. Bower, W. Burman, R. Boyd, Blandford, Fletcher Beach, Bucknill,
J. Crichton Browne, E. Maziere Courtenay, D. Cassidy, P. E. Campbell, J. A.
Campbell, A. C. Clark, F. P. Davies, English, J. T. Hingston, W. W. Ireland*
O. Jepson, J. Murray Lindfcay, Thos. Lyle, H. J. Manning, Donald Mackintosh,

G. Mickley, W. J. Mickle, John Manley, M. D. Macleod, G. W. Mould, H. H.
Newington, A. Newington, D. M. M’Cullough, T. W. McDowall, W. Orange, G.

H. Pedler, H. T. Pringle, H. Rayner, A. H. Stocker, H. Sutherland, G. H.

Savage, Arthur Strange, Edward Swain, J. Beveridge Spence, George Thompson*,
E. Toller, D. Hack Tuke, C. Molesworth Tuke, John A. Wallis, W. E. R. Wood,*
A. Law Wade, Francis J. Wright, J. F. Wright, Lionel A. Weatherly, E. s!
Willett, H. Winslow, T. Outterson Wood, D. Yellowlees, &c. Also, Dr. Nugent* of
Dublin. *

Dr. Orange, in taking the chair, thanked the Association for the honour they
had done him in selecting him to be their President, and assured them that he
would discharge the duties of the office to the best of his ability. He was
sorry to be obliged to communicate to the Association as the first business tha^
the President for the year that had just expired, Dr. Gairdner, would be unable
to be present. In a letter he had received from Dr. Gairdner that gentleman
said “ You will remember that when it was agreed to hold the Annual Meeting
in July, I felt obliged to intimate to the Secretary, Dr. Rayner, that it would be
extremely difficult, if not impossible, for me to be present on account of the
arrangements connected with our graduation. After due consideration, it was
held that my duty in occupying the chair being merely formal, it would not in
any way interfere with the business of the meeting were I to bo absent. I have
therefore only to request that the Chairman, whoever he may be, who shall

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Notes and News .

[Oct.,

temporarily occupy my place, will have the kindness to give effect to this my
apology, and to assure the Association of the great and abiding sense 1 enter¬
tain of the entirely unlooked for honour they did me in electing me their Pre¬
sident. I can most truly say that the duties of the office have been rendered
light and full of enjoyment to me by the cordial co-operation of all concerned
in them,a nd that I shall cherish to the last hour of my life the recollection of
the many friendships made and received in connection with my year of office.”
He (Dr. Orange) could only express on his own part, and he was sure that in
doing so he was expressing the feeling of the meeting, great regret that Pro¬
fessor Gairdner was unable to be present.

Dr. Murray Lindsay proposed a vote of thanks to Dr. Gairdner for his ser¬
vices as President during the last year. All who had had the pleasure of being
present at the Glasgow meeting last year would well remember the hospitality
and kindness with which they were received, and those who were privileged to
listen to the address must have been impressed with the comprehensiveness of its
nature. He thought the Association was honoured by having secured the services
of so eminent a practitioner.

Dr. Jepson seconded the motion, saying that they all knew that it was a
great disappointment to Professor Gairdner hot to have been present with them.

The vote of thanks was carried with acclamation.

Dr. Ireland proposed a vote of thanks to the Editors of the Journal. Dr.
Hack Tuke and Dr. Savage were well known as men who were very well ac¬
quainted with the literary art. He did not think that two other gentlemen
could be found in the United Kingdom who were better qualified to fulfil the
office of Editor. He had himself worked under those gentlemen, and he had
always had every kindness, courtesy, and assistance—not only from those gentle¬
men but from the previous Editors, Drs. Maudsley and Clouston. He considered
that the editors should be supported by the members of the Association. Want
of information, perhaps, sometimes kept back a great deal of valuable matter
which might be very usefully recorded in the Journal. He hoped members
would remember this, and think what an assistance, often, their very valuable
notes of cases would be. He might say that be thought it would be a consider¬
able advantage if the papers and notes could be always printed in the report of
the proceedings. Without them it was difficult to understand the discussions,
and in fact the speeches and criticisms made might as well not be printed at all.
He had great pleasure in proposing the thanks of the meeting to the Editors.

Dr. Mickle confirmed all that Dr. Ireland had said. Those who had the
pleasure of contributing to the Journal were very well aware of the kindness
and consideration they had received from the Editors. The post of Editor was
one of great delicacy and difficulty, aud he was sure they were all agreed that
the present holders of the office had accomplished all their duties with the
greatest kindness and consideration j therefore, without further detaining the
meeting he would beg leave to second the vote of thanks.

The President said it was the unanimous expression of the Association
that they were under the very greatest obligations to the Editors. If all the
members would make it a sort of rule that they would make one communication
to the Journal in the course of the year it would be a good thing. It seemed
scarcely fair that the Editors should have to write articles for want of other
material.

Dr. Hack Tuke, on behalf of Dr. Savage and himself, thanked the Associa¬
tion for the kind way in which their services had been referred to. It was
often a very difficult matter to decide between various articles in regard to their
admission, and therefore the Editors had to look to the members for their for¬
bearance in many instances. He hoped they would always understand that it
was their strong desire to be kind and courteous to all who sent papers. With
regard to the observations of Dr. Ireland, he quite agreed with him that the
papers and the discussions should come together, but they must understand that
it had not been the fault of the Editors, but simply the fault—if it were a fault—

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Notes and News,

437

1883.]

of the writers of papers, the writers having elected to send their papers to other
journals. It was an understood rule that anyone reading a paper at one of the
meetings should send that paper to the Editors of the Journal. Perhaps the
Journal had in some.respects of late met with the approval of the iliembers of
the Association from the Editors having endeavoured to seize the most impor¬
tant points of interest during the quarter, and to comment upon them in the
Journal. The Editors would certainly be very glad to be supported more than
they were, especially in regard to communications having reference to topics
which they had suggested in the Journal for discussion—for example, moral
insanity, &c. In such cases, the number of communications had been extremely
small. Considering the vast number of opportunities for observation possessed
by medical superintendents of asylums, it would seem that many more of these
communications might be forthcoming, and yet, as anyone might see by refer¬
ence to the Journal, the communications had been very few indeed. Not only
had they had difficulty, as Dr. Savage put it last evening, in obtaining “even
facts,” but they had had difficulty in obtaining original articles.

The President said that he had the pleasure of proposing a vote of thanks
to the Treasurer. He felt sure that the members must feel very much indebted
to the Treasurer for the mode in which everything connected with his depart¬
ment was carried on; the courtesy with which all the members were informed
from time to time of the advent of a new financial year, the accuracy of his
accounts, the satisfactory nature of them throughout, the readiness with which
he acted not only as Treasurer, but, if he might say so, as one of the permanent
officials of the Association, were such as to deserve their warmest thanks.

Dr. Jepson seconded the motion, which was carried by acclamation.

Dr. Paul said that he felt most deeply gratified at this renewed expression of
their goodwill. It had been for many years a source of great pleasure to him
to promote the welfare of the Association, and also the pleasure and comfort of
the members. He thanked them most sincerely and cordially for the kind way
in which their sentiments had been expressed.

The General Secretary (Dr. Rayner) then submitted the minutes of the
last annual meeting, which were printed in No. CXXIII. of this Journal
(October, 1882).

The minutes, having been taken as read, were confirmed.

Dr. Murray Lindsay moved a vote of thanks to the Secretaries. He said
he did so with the greatest pleasure, and he felt that he was only expressing
the feeling of the Association in saying that they had three excellent secretaries
who did and had done very excellent work, and who were energetic, and had
the interests of the Association at heart. They had served the Association well,
and were deserving of a vote of thanks.

Dr. H. Winslow seconded the motion, which was carried.

Dr. Rayner (General Secretary) said that on behalf of his brother secretaries
and himself he most cordially thanked the Association for the vote of thanks.
He added that he could not help agreeing with Dr. Savage’s expression of
opinion on a previous occasion that there was considerable difficulty—more
than there should be—in getting papers for the meetings, but he differed from
him as to where the fault lay. He thought the senior members should be more
willing to come forward, and start the discussions which were so much needed.

The Treasurer, Dr. Paul, submitted the Balance Sheet of the Accounts for
the past year, which will be found on page 438, the same having been duly
examined and certified as correct by Dr. Willett and Dr. Hingston.

The President remarked upon the satisfactory circumstance that there had
been an increase in the amount received by the sale of the Journal.

The next business being the appointment of Officers and Council for the
ensuing year,

The President explained the mode of voting, and nominated, in accordance
with the rules, the three following gentlemen to act as scrutineers, via :—Drs.
Lindsay, Ireland, and Campbell.

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i—i

361

263

<tt

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A ... , . , , \E- SPARSHALL WILLETT.

Audited and found correct, J j TREGELLES HINGSTON.

. Royal College of Physicians. J. H. PAUL,

July 27th, 1883. Tbeasuheb.

Notes and News.

439

Dr. Thompson said he had long felt that the Council was not sufficiently re¬
presentative. There was one class of members who had never been represented,
viz., the Assistant Medical Officers of the Asylums. The private asylums were
represented, the county asylums and hospitals represented, but the assistant
medical officers were not represented. He would suggest, in fact he would pro¬
pose, that all the names be taken except one—say the last name—in the list of
members of the Council, and that the name of Dr. Bevan Lewis should be sub¬
stituted as representative of the assistant medical officers.

The President asked Dr. Thompson if he adhered to the last name as the
one to be struck out. That particular name was the only name representing the
northern division.

Dr. Thompson said there was a secretary for Scotland, and he thought there
were others on the list.

The President said that in substituting one name for another it would be
well to strike out an English name.

Dr. Campbell suggested whether, the subject having been ventilated, the
matter should not be allowed to rest till next year. The Council might in the
meantime give consideration to it.

Dr. Murray Lindsay said he would suggest that his own name should be
struck out in favour of Mr. Bevan Lewis, .who would be a very excellent repre¬
sentative.

Dr. Thompson said he was very pleased to find that his proposal had been re¬
ceived with such favour. If the Association would allow him, he would with¬
draw the motion for this year, but he hoped that next year that very important
class would not be excluded. There were many excellent men who had not yet
won their spurs who were doing good work at the asylums.

The lists having been collected the scrutineers retired to examine them, and
subsequently reported that the nominations of the Council had been unani¬
mously supported, whereupon the following gentlemen were declared by the
President to be duly elected as

OFFICERS AND OTHER MEMBERS OF THE COUNCIL FOR THE

YEAR 1883-4.

President-Elect
Treasurer ...

Editors op Journal...
Auditors .

Honorary Secretaries

John Manley, M!.D.

John H. Paul, M D.

D. Hack Tuke; M.D.

G. H. Savage, M.D.

E. S. Willett, M.D.

J. Murray Lindsay, M.D.

E. M. Courtenay, M.B. For Ireland.
J. Rutherford, M.D. For Scotland.

H. Rayner, M.D. General Secretary.

NEW MEMBERS OF COUNCIL.

Henry F. Winslow, M.D. I J. T. HingsIun, M.R.C.S.

H. R. Ley, M.R.C.S. | T. Aitken, M.D.

Dr. Manley said that no one was more surprised than himself when he
received the intimation that he was to be proposed as President. He did not
know that he had done anything to merit that honour, so he wrote to Dr. Rayner
asking him to induce the Council to appoint someone else, but Dr. RaynePs
views did not coincide with his own in that respect. He therefore thanked them
very much for the position in which they had placed him, and in accepting it
he relied much upon the assistance of Dr. Rayner, who knew so well the way
in which the business was conducted, and also on their indulgence and kind¬
ness in overlooking and pardoning any faults.

The election of ordinary members was then proceeded with. The balloting
box having been sent round, and there being no dissentient vote, the list was

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440 Notes and News . [Oct.,

taken en masse , and the following gentlemen were declared to have been duly
elected ordinary members, viz.:—

Henry A. Layton, L.R.C.P.Edin., Cornwall County Asylum, Bodmin.

S. Macken, M.B.Ed., Hertford British Hospital, Paris.

Rowland H. Wright, M.D. Ed., Melrose.

E. D. Rowland, M.B., C.M. Ed., Whittingham Asylum, near Preston.

W. Crump Beatley, M.B.Durham, Somerset County Asylum.

S. Ernest de Lisle, L.K.Q.C.P., Three Counties Asylums, Stotfold, Baldock.

F. H. Walmsiey, M.D., Leavesden Asylum.

Geo. E. Miles, M.R.C.S., Res. Med. Officer, Northumberland House. Finsburv
Park, N. J

A. Henry Boys, L.R.C.P.Edin., Lodway Villa, Pill, Bristol.

R. J. Legge, M.D., Ass. Med. Officer, County Asylum, near Derby.

F. A. Selby, M.B., C.M.Ed., Ass. Med. Officer, Wye House, Buxton.

J. B. Spence, M.A., M.B.Ed., Ass. Phys., Royal Asylum, Morningside, Edin¬
burgh.

J. A. Johnston, M.D., District Asylum, Monaghan, Ireland.

Dr. Hack Tuke said that it very frequently happened that members would
leave the locality in which they were living without communicating their change
of address. The Journal would go to the old address and would be returned
through the post-office. He hoped that the members would take pains to inform
the Editors of change of address. Neglect of this caused great difficulty, and
members omitting to do so could not complain if they did not receive the
Journal.

Dr. Campbell said he hoped he might be permitted to offer a suggestion to
the Secretary for Ireland. Might he be allowed to call his attention to the
success which had attended the Quarterly Meetings, both in England and Scot¬
land, and suggest that more meetings might be held in Ireland. He merely
threw this out as. a suggestion.

Dr. Courtenay said that they had made several attempts, and if Dr. Campbell
would go over and help, they would be very pleased to see him. The distances
were very great, and travelling was not so easy as in England, and up to this
time Quarterly Meetings in Ireland had been rather a failure.

On the subject of the appointment of the next Annual Meeting,

Dr. Campbell moved that the meeting should be held in London. He said
he would also suggest that it should take place before the end of July. Hitherto
they had frequently met at a time very inconvenient for them—in August. That
year he was glad to find they were meeting in July. Many of them were accus¬
tomed to go for their holidays in August, and so if it met the convenience of the
President and members of the Association he, for one, would be very glad if the
meeting could be arranged for the third or last week in July.

Dr. Manley said that he should be very pleased to adopt any wish of the
Association as to time.

Dr. Yellowlees pointed out that the British Medical Association very|often
met at this time, and many of the members tried to make the two fit.

Dr. Strange asked whether they could not hold their meetings at the same
place as the British Medical Association. The Psychological section there had be¬
come almost a more important matter than the Association here, and if they could
hold their meetings at the same time, they would probably have a larger attend¬
ance and take a better position. This year the British Medical Association was at
Liverpool. He thought all would agree with him that the meeting at Liverpool
would be a larger one than their present meeting, and it might be almost worth
their while if they made some arrangement to join their meetings, and if they could
get the management of the Medico-Psychological section of that Association it
would be a good thing. He # would not propose a motion, because he had not
given notice of it, but he thought it would be well if they could meet in the same
week as the British Medical Association.

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1883.]

Dr. Campbell said that that had been already discussed years ago, and he
thought the conclusion arrived at was that it would be inadvisable for them to
attach themselves to a much larger society.

Dr. Thompson said that he brought the matter up some time back. His
reason for suggesting July was this—that there was a great attraction in London
for countrymen then, viz., the Royal Academy. Dr. Rhys Williams fell in
with his suggestion, and he believed ever since the meeting had been held in
London in July. He thought it would be a great pity if they were attached to
the British Medical Association. They did not know where the next meeting
of that Association would be held. He thought they had better go on as they
had been doing.

The President said that in fixing the date for their Annual Meetings in
London they had to take into consideration the date when the premises in which,
by the kindness of the President and Fellows of the College of Physicians, they
were meeting, would be disengaged. With regard to what had been said as to
meeting in the same place as the British Medical Association, it would be hardly
possible to meet in the same place and preserve their individuality. To actually
merge themselves in the section of that Association might or might not be ultima¬
tely advantageous to this Society. He thought the same thing might be said in re¬
gard to the Obstetrical Society and other Societies meeting in London. Their
own Association held Quarterly Meetings, as well as an Annual Meeting, and it
would not be possible, except by the discontinuance of the plan of the Quarterly
Meetings, to absolutely cease to be a separate society, which he took it would
almost be a natural result if they simply went to the meeting of the British
Medical Association.

Dr. Hack Tukk seconded Dr. Campbell’s proposition that the meeting should
be hel J in London, and it was resolved—That the place of meeting next year be
London, and that the day of meeting be as near as possible to the last Friday in
July. He trusted they would never be so wanting in self-respect as to allow
themselves to be merged into the British Medical or any other Association.

The next business being the consideration of reports of committees, Dr.
Rayner, General Secretary, reported that the Parliamentary Committee had
met two or three times since the last Annual Meeting to consider the Bill which
had seemed to be likely to be brought before Parliament, and which had since
died a natural death, and that Committee had also adopted some resolutions
with reference to pensions, which resolutions were printed in the Journal and
forwarded to various members of the Government.

Dr. Campbell said that he felt sure the Association would join him in ex¬
pressing to Dr. Murray Lindsay their extreme thanks for the trouble he had
taken in rpgard to the question of pensions. Dr. Lindsay must have spent
money and time in working in their interests for years, in a most disinterested
way. He (Dr. Campbell) very much regretted that their meeting at Glasgow
was so hurried that the time did not permit of his thanking Dr. Lindsay then.

As regards the Statistical.Committee, the General Secretary read the
following report, which was adopted :—

The Statistical Committee, having considered whether it is desirable that any changes
should be made in the New Statistical Tables, propose that they should be continued in
their present form for another year, attention being again drawn to printers’ errors in the
said tables by a reprint in a future number of the Journal.

The Committee are glad to observe that a considerable number of Superintendents have
adopted these tables, and hope that in the course of another year they will have been
generally adopted. In the meantime, the Committee will be glad to receive any sugges¬
tions from Superintendents who have found the tables defective or incorrect.

Dr. Campbell said that he would suggest that, instead of one year, ten years
should be inserted in the motion for the adoption of the tables. He thought it
was a great pity for them to introduce tables for a year—a very great pity
indeed. If the members were satisfied with the new tables, he thought it should
be for a ten years’ period. Before moving this, however, it would afford him
great satisfaction if Dr. McDowall would inform them of his opinion of the
xxix. 30

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442 Notes and News. [Oct.,

tables. He would himself have gladly introduced them last year, were it not
that he was reporting on a decennial period of his asylum.

Dr. McDowall said that he thought honestly that the new tables were a
little troublesome to prepare, at all events for the first year, but that they were
decidedly better than the previous tables ; and he thought that the proposal
read by the Secretary, that they should be continued from year to year, was
better than the proposal that they, should be continued for ten years. The
matter was entirely optional, and as the tables were still under trial, it would be
well they should only be continued for a single year.

The President pointed out that in the proposition that the tables should be
adopted for this year, there was nothing to prevent their being continued for
ten years.

Dr. Campbell said, no there was not; but they might adopt them as the
tables of the Society. If they did not intend to adopt the tables, probably a
great many men would not adopt them.

Dr. Hack Tuke said there were certain points admitting of improvement;
and to adopt the tables without those improvements would give rise to dis¬
satisfaction. He hoped they would see their way to adopt them as the tables of
the Association, subject to revision by the Statistical Committee. At present
they had been adopting the new tables on trial for one year, and the question
was—should they be continued for another year or adopted permanently as the
tables of the Association ? He thought they might be adopted permanently, if
the Association would now leave them in the hands of the Statistical Com-
mittee.

Dr. Thompson said that the only improvement he should suggest as to the
new tables was that they should be erased altogether. He could not see a bit of
use in them. The old tables contained everything anybody would like to know,
and gave sufficient scope. The more tables they had the more manipulation of
figures there would be. The best way, he thought, would be to express no
opinion ; but if any opinion were expressed, it should be that they should place
reliance upon the old tables and none at all on the new ones.

Dr. Campbell said he would move the adoption of the report of the
Statistical Committee, and would propose that the tables should be adopted as
the tables of the Society, subject to revision as required ; also that they should
be forwarded to the English and Scotch and Irish Boards of Lunacy. He would
also suggest that the present Committee should be continued.

Dr. Thompson said it would be better to leave it alone. Let those who liked
to adopt the tables do so. Let the matter stand over, and be taken up again in,
say, four or five years’ time. He would propose an amendment to the effect that
no opinion whatever be expressed on the new tables as published in some o'f the
reports of the asylums, and that no action be taken.

Dr. Strange seconded Dr. Thompson’s proposal. As a matter of fact, he
preferred the old tables. He might be converted to the new ones in time, but he
was not at present prepared to adopt them.

Dr. Campbell said he thought it only right that they should remember the
thought and trouble which had been taken in connection with the new tables.

Dr. Manley thought the new tables ought to be adopted. If each superin¬
tendent presented his own tables, there would be no means of getting com¬
parisons.

The President pointed out that the Statistical Committee consisted of about
seventeen members, being therefore a largely representative Committee ; and
he thought they could hardly now throw over the work which had been done.

After some further discussion, in the course of which Dr. Yellowlees urged
that the amendment was irregular and unintelligible, and Dr. Burman sug¬
gested that it would be best to simply adopt the report of the Committee,

The President put the amendment proposed by Dr. Thompson, viz.:—
“ That no opinion be expressed as to the supplementary tables until time be
allowed for testing their usefulness.”

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1883.]

Notes and Nem.

443

The amendment was declared to be lost, only two votes being given in favour
of it.

The original motion was then put to the vote, and it was resolved as follows:
u That the tables be adopted, subject to revision- as required, and that the
Secretary forward copies of the tables to the different Boards, of Lunacy in the
kingdom.”

Dr. Campbell then moved that the Committees of the Association should
be heartily thanked for their work in the past,- and requested to accept re¬
appointment.

Dr. Thompson seconded this, and the Committees were re-appointed
accordingly.

The Secretary then read the following Report of the Adjudicators on the
Essays prepared by Assistant Medical Officers of Asylums, in accordance with
the resolution of the Annual Meeting of the Association in 1882, viz.

We beg to report tliat four Essays were sent in by the appointed time.

Of these. Nos. 3 and 4 approach most? nearly to the conditions of the prize in respect to‘
the most important particulars—clinical and pathological observations No. 4 was accom¬
panied by some microscopical preparations illustrative of the writer 7 * .essay; and we have,
in deciding between the merits of Nos. 3 and 4, been finally guided by the consideration
whether the pathological observations of the latter are of real interest. Assisted by Dr.
Savage and by Dr. Coats, of Glasgow, who have kindly examined the preparations, we have
concluded to recommend that the prize of £10 10s (without a medal) should be awarded
to the writer of No. 4 (“ Multum in Parvo 77 ). We would, at the same time, highly com¬
mend Essay No. 3 (“ Faire sans dire ,7 ). The other papers, while possessing merit, do not
appear to us to answer to the intention of the Association in offering the prize.

We regret that out . of the large number of Assistant Medical Officers attached to
Asylums, so few should have been willing to compete for the prize.

(Signed) W. G. GAIRDNER.

D. HACK TUKE.

W. ORANGE.

No. 1 Motto *" He shall be as a god to me who shall rightly divide and define. 77 — Plato.

No. 2 “ From a few elevated points we triangulate vast spaces enclosing infinite, un¬

known details. 77 —(O. W. Holmes.)

No. 3 “ Faire sans dire. 77

No. 4 :—** Multum in Parvo. 77

The President then declared the winner of the prize to be Dr. J. Wigles-
worth, of the Rainhill Asylum, Lancashire, adding that it was not the first time
that that gentleman had been heard of in connection with literary contributions.

Dr. Campbell asked whether he heard rightly that the money-prize was to
be given, and not the bronze medal ?

Dr. Hack Tuke replied, referring to the minutes of the last Annual Meeting,
and pointed out that the bestowal of a medal was discretionary.

Dr. Campbell said he was quite satisfied.

Dr. Weatherley said he should like to make a proposal that the time of the
Quarterly Meetings should be more defined. The notice given was too short.

The General Secretary replied that the difficulty lay in obtaining a room
and obtaining papers. If they could always calculate upon having a room,
much of the difficulty would be removed.

After further discussion,

Dr. Hack Tuke suggested that, as Dr. Savage was kind enough to make it
convenient for them to meet at Bethlem, it woiUd be well to have his views on
the matter.

Dr. Savage replied that the last Friday of any month would suit as regards
Bethlem j and after further discussion, it was agreed that, if possible, a card
should be issued to members fixing the date of the Quarterly Meetings for
the year.

The President stated that some microscopic preparations had been kindly
prepared by Drs. Savage, Bevan Lewis, and Fletcher Beach, principally with
the view of endeavouring to mark whether there had been any advance made
in being able to connect pathological changes with the disorder of mental
functions. Very few steps had been taken in that direction, and there was a
wide field before them for investigation.

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Notes and News,

[Oct.,

The Secretary then read the following letter from Dr. Clouston:—

Royal Asylum, Morningside, Edinburgh.

23rd July. 1883.

Dear Sir,— Will you allow roe to bring before you the suggestion of a respectful petition
to the Lord Chancellor by the Medico-Psychological Association, that his Lordship, in
making the higher Lunacy appointments of the kingdom, such as the Medical Commis-
sionerships in Lunacy and Lord Chancellor’s Visitor in Lunacy, should bestow them on
members of our profession who have devoted special attention to the subject of mental
diseases, and have a recognised reputation in that department of medicine.

Borne of the reasons that might be adduced to his Lordship for this step, on the part of
the Association, are the following, viz. :—

1. The Association contains by far the greater number of medical men who have specially
studied mental disease in the United Kingdom, and consists of over 400 members. It may
therefore be regarded as having by its position some justification to look after the interests
and fair claims of that department of medicine.

2. This department of medicine has enormously increased in importance and numbers of
late years, there being now over 500 medical men engaged in it, wholly or in part.

3. It is a difficult department, having to do with obscure questions most important to a
very helpless class of society; and the practice of it has many things specially disagreeable
and trying to those who follow it. It is most important for the insane, for the future pro¬
gress of medicine, and for society, that some of the very best minds in the profession
would be attracted towards its study.

4 . The prizes and rewards of successful work in the department are not many or very
high, and the appointments referred to have been always considered in that category. To
attain them has been the incentive to gooo work among many in the past. To see them
conferred on men who have done no work in the department acts as a discouragement to
those who have entered it, and will prevent good men entering it in the future. The
teachers of the subject in the medical schools have already much difficulty in inciting the
best men to take up the subject.

6. Those who have to be directed and advised by the holders of such appointments
would have far more confidence in, and pay more respect to, the opinions of men who had
devoted special attention to the subject of mental diseases, or who had practical acquaint¬
ance with the management of. the insane. Many of the insane in whose interest those
appointments are made, would also have far more confidence in such men.

I am. Dear Sir,

Yours faithfully,

T. fl. CLOUSTON.

Lecturer on Mental Diseases in the University of Edinburgh.

Professor W. T. Gairdner,

President of the Medico-Psychological Association.

The reading of this letter was followed by loud applause.

The President said that he was sure they all appreciated the very chivalrous
motives with which that letter had been sent to the Association, and he had
only to make a very short proposal, namely, that it should be received and
entered on the minutes.

This course was adopted in silence, and the morning meeting was brought to
a close.

AFTERNOON MEETING.

Dr. Orange, the President, read letters from the following noblemen and
gentlemen expressing regret at not being able to be present :—The Right Hon.
Sir W. Vernon Harcourt, the Earl of Shaftesbury, the Earl of Rosebery, Dr.
Mierzejewsky, Dr. Motet, Dr. Foville, Dr. Blanche, and Dr. Ritti.

The President then read his Address, which is printed at page 329 of this
Journal (Original Articles, No. 1).

Dr. Bucknill said that it was a most agreeable duty to him to propose a
vote of thanks to Dr. Orange for the admirable address to which they had just
listened. It was one of the most interesting addresses he had ever listened to,
and he thought he should carry, with him the general consensus of the opinion
of that meeting that it was one of the most able, if not the most able, of the
addresses which had been delivered before that Association. It was the result of
Dr. Orange's great wealth of material for observation, of his very great dili¬
gence in making use of that material, of his great common sense, and of the
peculiar subtlety of mind which had enabled him to grasp successfully and to
deal with the difficult questions bordering upon metaphysical study which were
inextricably involved in that most important question of Hie responsibility—or,

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1883.] Notes and News . 445

he would rather say—the irresponsibility of the insane. Dr. Orange occupied
a very useful, high, and important position. He did not know that any man
in the specialty occupied a more arduous and more useful one, not only in the
management of that great institution which was under his care—so successful
and humane as it was—but in the use he made of the materials which it afforded
for knowledge; not only in the way they then experienced, but also in the more
frequent and practical and responsible way in which he was called upon by the
Government to exercise it, when they were asked to review the action of courts
of law, and practically to decide upon the fate of the unhappy fellow-creatures
whose state of mind he had to report upon to the Home Secretary as to whether Her
Majesty should exercise the prerogative of mercy. Dr. Orange had exercised that
function with undeviating skill, diligence, and ability, and his services to the
community and the Government, had been such as it would be very difficult to
overrate. Dr. Orange had referred to the Lumleian Lectures in the year 1878, but
his modesty had prevented him from saying how much of the material for those
lectures had been sought for under his guidance at Broadmoor, nor had he
stated the very wise advice he had given to that lecturer on the most intricate
and difficult questions which arose, but he (Dr. Bucknill) knew well that obli¬
gations of the lecturer to Dr. Orange were extremely great in both those respects,
and if ever the Lectures should be published in a separate form the lecturer
owed it to Dr. Orange to acknowledge that great help. He would not further
detain them from the discussion he trusted would follow, but would move—
that the best thanks of the meeting be given to Dr. Orange for his admirable
address, and that the Association were also delighted to see him in his present
state of health after the perilous accident which had befallen him.

Dr. Nugent, in seconding the motion, said that he cordially coincided with
the opinions expressed by the President in regard to the question of Criminal
Lunatics. He had drawn a clear distinction as to the characteristics of criminals,
and ordinary insanity. There were difficulties, no doubt, and great difficulties,
connected with the distinction which should be recognized between criminality
and responsibility in persons who committed crimes. In his own department
in Ireland he judged of every case upon its individual merits, looking to the
antecedents.of the person, and other attendant circumstances. If a person at
Dundrum had committed an offence and was recovering, the length of his
detention would depend upon whether he had shown a malicious disposition
during the time of his treatment. Judgment was formed upon the conduct of
the person in the institution. The number of lunatics discharged during the
last fourteen years was 82, and he was happy to say that of all those cases there
had been no case brought back convicted of any offence since discharge.

Dr. Bayneb then put the motion to the meeting, and it was carried with
applause.

Dr. Obange could only say that he felt that the terms used by the proposer
of the vote of thanks were altogether in excess of the circumstances of the
case or of his merits. He had also to thank the Inspector and Commissioner
of Control of Asylums in Ireland for the kind manner in which he had seconded
tile vote, and to tell him how very much he had learned from the early
reports of Dundrum Asylum, which, as those present knew, was established
before Broadmoor. The object of his somewhat disjointed address was rather
to provoke discussion by the members of the Association, and he would there¬
fore not detain them with any further remarks of his own, but would simply
thank them all very heartily for the manner in which they had received the vote.

Dr. Hack Tuke said that he remembered that the late George Dawson, when
lecturing on Shakespeare, said that he had often differed from him, but he had
found in every instance that the great poet was right and he was wrong. In
the present instance he thought that any difference of opinion from Dr. Orange
was also almost certain to be wrong. In almost everything Dr. Orange had
said, he (Dr. Tuke) for one united, and he thought that the way in which he had
brought forward Sir James Stephen’s work would be of great use. He thought
they ought to congratulate themselves that an eminent jurist like Sir James

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Notes and Nevis.

[Oct.,

Stephen had discussed subjects of interest to medico-psychologists in the way he
had. The admirable tone of his remarks ought to be a model to themselves. He (Dr.
Tuke) was not quite so sanguine as the President as to the manner in which the
legal test would be interpreted by other lawyers. The way in which Sir James
Stephen interpreted it was so wide and liberal that it seemed to include almost
everything they wished ; but, seeing that the opinions of the Judges were
before the minds of great lawyers previously, such as Lord Chief Justice Cock-
burn and Mr. Justice Blackburn, who understood them to speak in a
much narrower sense than Mr. Justice Stephen read them, he could not but
fear that other lawyers would understand them in the same sense. If the
President could really convince the lawyers that by a “ knowledge of right and
wrong ” was not meant what everyone had thought it did mean up to the present
time—and was synonymous with absence of self-control—then the battle between
medical men and lawyers was practically at an end. The test of responsibility
really amounted to this as now explained :—That every one who had not the
power of self-control had not at the particular time a belief that the act which
he was committing was wrong for him to commit. Well, of course it may be
said that if a man knows he cannot help doing a particular thing, he would not
think himself culpable. That seems a truism. If that were the reading of the
law, then the two things were indeed synonymous. But he could hardly think
this was an interpretation which the Judges would sanction. There was a
reference made to Baron Bramwell in the case of Dove, who was tried at York
for poisoning his wife. Having himself been present at that trial, he (Dr.
Tuke) must say that the impression produced at the trial was that the clear¬
headed Baron believed the legal test to be simply that of the knowledge of
right and wrong. As he (Dr. Tuke) understood Mr. Justice Stephen, he wished
to interpret the existing text thus :—'It is the deprival of the power (in conse¬
quence of mental disease), of judging the moral character of the act committed.
Mr. Justice Stephen, however, found that this did not entirely embrace the whole
question, because, in one paragraph he says—“ No doubt, however, there are
cases in which madness interferes with the power of self-control, and so leaves
the sufferer at the mercy of any temptation to which he may be exposed ; and
if this can be shown to be the case, I think* the sufferer ought to be excused.”
Therefore that was supplementary to the new reading of the old test. They still
had the vexed question of self-control to consider. Therefore he was afraid
there was a great deal for medical men to do in regard to placing the matter
in a just light. He happened to meet yesterday with an admirable addresfc
delivered by the President some years ago, and Dr. Orange then put the matter
exactly in the way that he (Dr, Tuke) should have liked to put it. Dr. Orange
said, “Indeed, the mode in which this test has been explained by some
writers is such as to make the knowledge of right and wrong equivalent,
to all intents and purposes in effect, to the power of refraining from the act
in question ; that is to say to the power of controlling conduct.” (That was
almost anticipating Sir James Stephen’s chapter.) “ I do not, however, think
that the want of knowledge that an act is wrong in the ordinary sense, is by
any means the same thing as the want of power in consequence of mental
disease to refrain from doing it,” &c. Then, a little later on, he said, “ Such
an opinion appears to be based upon this manner of reasoning—I believe the
accused, from his history and from ray examination of him, to be insane ; I
know that insane persons constantly do commit acts as the result of their
insanity, which, at ordinary times, they know to be wrong; I assume that
they would not commit such acts if they knew, at the moment when thought
was passing into action, that the act was wrong; and I therefore arrive at
the conclusion that the accused did not know that the act committed by him is
wrong. That is to say” (Dr. Orange put it very forcibly) “instead of ascer,
taining as a fact, in the first place, whether the person knew right from wrong-
in order from that fact to deduce the presence or absence of legal insanity, this
method reverses the order of things, and ascertaining in the first place by
some independent method, that the person is insane, it argues that because he

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1883.]

is insane, therefore he cannot distinguish right from wrong as a sane man
would.” Then Dr. Orange said, “ Surely it is better to abandon this obsolete
test than to apply it thus.” Dr. Hack Tuke continued to say that his fear was
that, in attempting to retain the old test and apply it with the larger interpre¬
tation now proposed, there was still considerable danger of punishment being in¬
flicted in cases in which there was a loss of self-control from cerebral disease,
but a knowledge of right and wrong in the estimation of the judge charging the
jury. It seemed a pity when the late Lord Chief Justice had admitted the
force of our contention, that we should change our own minds.

The President, in inviting further discussion, said that he had to thank Dr.
Hack Tuke for the very tender manner in which he had dealt with him, as
indeed he was bound to do, inasmuch as he (Dr. Orange), like many otherp, was
among Dr. Tuke’s disciples, and had learned from Dr. Tuke’s writings much of
what he knew in regard to the question of derangement of mind. Dr. Tuke
had done him the honour to quote from an address which he had given in 1876,
but Dr. Tuke would perceive, if he examined the passage again, that the inter¬
pretation assumed to be put upon the words, “ knowledge of right and wrong in
•respect to the very act with which he is charged,” against which he was then
endeavouring to contend, was by no means the interpretation which Mr, Justice
Stephen had adopted. In the passage that Dr. Tuke had quoted, he was referr¬
ing to what he thought was the mode in which some writers had at that time
attempted to apply the words, and if time had permitted he would have given
chapter and verse. The point he had iu his mind when writing that passage
was the supposition that a person might know the difference between right and
wrong both just before and just after the commission of an act, but that just
at the instant of the passing from thought to action he lost the knowledge that
the act was wrong. This was quite a different thing from saying that a person
who laboured under a delusion and who committed an act as the result
of that delusion was as much unable to rightly estimate the moral quality of the
act as he was to estimate rightly the character of his delusion. Much error had
crept in from imagining that acts were sudden, when, in reality, they were pre¬
meditated. In the case mentioned by Lord Blackburn, to which he had referred,
his Lordship had, in recounting the case, spoken of the woman as having killed
her child “ suddenly,” but, as he liad explained, it proved upon inquiry that the
act was not done suddenly, but that it had been premeditated. It was, therefore,
not when thought passed over into action that the loss of control occurred.
The poor woman did control herself to a very large extent. She told her husband
that she had had agood night, and that she felt better, simply to induce him to go
to his work, and to leave her alone to carry out what she had been thinking over
all the night. Few of the acts of that description were sudden, but they were
usually the outcome of deranged thought. He had said that the interpretation
adopted by Mr. Justice Stephen was very different from what he (Dr. Orange)
had in his mind when he wrote the address quoted. But that was only a sign of
growth. He hoped none of them stood absolutely still, and never had reason to
modify opinions which they held ten years ago. He was glad, in this connec¬
tion to be able to quote Lord Chief Justice Coleridge who, in a recent trial, when
speaking of the application of the common law, in the way it was applied years
ago, said: “ It is to forget that law grows, and that though the principles of law
remain, yet (and it is one of the advantages of the common law) they are applied
to the changing circumstances of the times.’’ . That was certainly the case in
regard to the application of the principles of the common law to the question
of insanity. Many of the opinions of the Judges had been based upon medical
opinions and medical statements of supposed facts which had, perhaps, after¬
wards turned out to be incomplete facts; and therefore it was not to be
wondered at that the explanation of the common law had undergone some
modification, pari passu with the modification, and, it was to be hoped, im¬
provement, that had occurred in the medical treatment of persons of de¬
ranged mind during the last half century.

Dr. Yellowlees said he did not rise to differ, but only to ask a question.

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They were in great danger of getting metaphysical in this matter, and of
fighting over words. Was the suggestion made by Dr. Orange one which
could be of any practical importance? He himself had always felt that their
legal friends insisted upon having a man either absolutely mad or quite sane.
Now did they not note and see every day the graduation of disease? Was there
not a graduated degree of responsibility, and ought there not to be some
graduation of punishment ? Did they not often see cases where they could
say, “ No, that fellow does not deserve the utmost penalty of the law, but he
does deserve some. ,, Was there any reason why they should not be enabled,
through a recommendation of jury, to graduate the penalty according to the
graduation which undoubtedly the disease implied ?

The President said he had formed a very definite opinion upon that matter,
which was not in favour of the proposal that there should be graduated
punishments for persons of varying degrees of insanity. He had come to the
conclusion that one ought to make up one’s mind upon the point—Is this per¬
son or is he not in such a condition mentally as to be liable to be punished
according to law ? He did not think that a graduated punishment would be
advisable in any way. What they had to ascertain was just like ascertaining
any other condition by a medical examination; and it was necessary that the
examination and the diagnosis should have reference to the particular point in
question. A patient might be insane, but he was not received into an asylum
until he was certified. He was either a fit subject for an asylum or he was
not. The same with regard to an inquiry de lunatico. The person was
either to have the control of his property or not. It must be one thing or the
other. Then again a person may make a contract or he may not make a con¬
tract. The contract must be void or not void, and it should be thus with re¬
gard to the question of the legal responsibility for a criminal act. He could
mention a case in which just what Dr. Yellowlees suggested was done; the case
of a man in 1862, who shot a woman with whom he was cohabiting, and then
attempted to kill himself. The verdict was given in the following terms:—
“Guilty. Very strongly recommended to mercy by the jury in the belief that
although at the time responsible for his actions, he was labouring under great-
excitement, and also on account of his previous good character; the jury were
unanimously of opinion that he had a belief that there was something improper
between the deceased and someone in the house, and that though responsible
for his actions, yet he was under a delusion about the young woman.” Although
the man was insane, the jury trimmed, and the result of that was that the man
was not hanged, but was sentenced to penal servitude for life, which in practice
meant twenty years. He was received into Broadmoor at the expiration of
twenty years from the date of his sentence, and had then become a complete
lunatic. For fourteen years he was going down hill, and it was not till after
that period that he was sent to the insane ward of the prison. What could
have been the good of torturing him during those fourteen years that elapsed
between the date of his sentence and the date at which he became too utterly
demented to be fit for any further penal discipline ?

Dr. Yellowlees said that they would have to take some definite action
with reference to the two resolutions of the President. He thought good ought
to come out of it in this way. The medical officers of the prisons ought to be
persons who would recognise the presence of insanity. In the case quoted by
the President, the rider to the verdict had the effect of saving the man’s life.
He had the very strongest feeling as to the wisdom of the resolutions proposed
by the President, and he thought the meeting should now proceed to consider
them, and, if they thought fit, to adopt them.

Dr. Campbell asked who had the sanction of the[appointment of the medical
officers of the prisons.

The President replied the Secretary of State for the Home Department.

Dr. Campbell said he thought that it would more fully meet with the wish
of the Association if the prosposal were modified to say that skilled advice on
the subject should be called in. He did not think they need insist that the

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prison medical officers should be skilled exceptionally in that subject. They
might just as well say that because cases of midwifery occurred at the prisons
that therefore it should be required that the medical officers of the prisons should
have special knowledge of the obstetric art.

Mr. Wallis said that it was a case of almost daily occurrence that some
knowledge of the sort was necessary for prison surgeons, because those surgeons
were frequently seen to mistake cases of insanity both ways ; either recognizing
persons wrongly as insane or not insane. That showed that some special know¬
ledge would be very advantageous to the prison surgeons, and he thought the
resolution read would meet that want.

Dr. Bucknill said that he was inclined to agree with the observations made
by Dr. Campbell, because he thought that such a useful knowledge of psycho¬
logical science as would enable prison surgeons to make successful diagnoses of
the different cases, was not so easily obtained that they would be able to obtain
it. He remembered when he was the medical superintendent of a county
asylum being very frequently called upon to go to the county prison to give
his opinion as to the sanity or insanity of prisoners, and he thought some ar¬
rangement might be made by which the benefit of the advice of the medical
superintendents of the county asylums might be made available.

Dr. Hack Tuke said he entirely supported the motion in this way—that the
surgeon in charge of the gaol should have sufficient knowledge of the disease
to detect and diagnose the disease, which otherwise might entirely pass without
his noticing it. It was different with an obstetric case, because although a
prison surgeon might perhaps have to treat that, there would not be the same
difficulty in diagnosis.

Dr. Bucknill asked if the President would think it worth consideration that
the superintendent of the county asylum should be substituted for the neighbour¬
ing doctor in the council of three.

The President pointed out that the superintendent was already mentioned.
His proposal was:—“The medical officer of the prison, the medical officer
of the county asylum or hospital for the insane in the neighbourhood,
and a physician of standing in the town where the prison is situate.”
With regard to the other resolution, it was only a suggestion, putting forward
a motion for the consideration of the Association. The necessity for some
knowledge might be supported by the writings of a prison surgeon of con¬
siderable eminence in Scotland, who said :—“ From large experience among
criminals I have come to the conclusion .... that the principal
business of prison surgeons must always be with mental disease ; that the
number of physical diseases are less than the psychical; that the diseases caus¬
ing death amongst prisoners are chiefly of the nervous system; and, in fine,
that the treatment of crime is a branch of psychology.”

Dr. Dover said he should like to mention that there were two classes of prison
surgeons, those who gave their whole time to the service and those who only
gave part of their time. Those who gave the whole of their time were first em¬
ployed as assistant surgeons. Every candidate for that post had to go up to a
meclical board, and a satisfactory knowledge of mental disease was one of the
subjects of examination. That was only a comparatively recent arrangement.
He thought that that would ensure sufficient knowledge on the part of those
who gave their whole time to the service, aud who gave their time as as¬
sistant surgeons, afterwards being promoted. As to the other class who gave
only a part of their time, they were generally persons in practice in the neigh¬
bourhood of a prison which only required the services of a medical man during
a part of the day, and the prisons of that kind being small, there were not many
criminals there to pick and choose from. He thought it would require serious
consideration to frame the proposed resolution. He could not agree with the
statement which had been read that nervous diseases formed the greatest propor¬
tion of the diseases which the prison medical officers had to deal with.

The President said that he was not aware that what Dr. Dover referred to
had been commenced. It seemed to be an advance upon the hitherto existing

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state of things, and he thought that the plan would be found to answer, and that
the amount of knowledge would be gradually increased, and would, in time, be¬
come sufficient for the purpose. Originally he said nothing more than that it
was very desirable that the medical officers of prisons should possess a certain
knowledge of mental disease, and in that Dr. Gover really seemed to concur.

Dr. Bower said he should like to call the attention of members present to
the system in force in Norway where in each of the four large public asylums
there are what they call “ observation wards ” where prisoners suspected of being,
or professing to be, insane are placed for a term of three months or less, so that
the medical superintendent may be able by constant observation of the prisoner
to pronounce authoritatively on his sanity or insanity. This would obviate the
necessity of visiting surgeons of prisons having a special knowledge of mental
disease.

Dr. Yellowlees said that he would propose the first resolution in reference
to the prison medical officers. It simply said that it was very desirable that
they should have a knowledge of insanity. He thought it extremely desirable
that men having to do with prisons should know something about insanity.

The President said that now that Dr. Gover had told them that it did form
a subject of examination, the expression of feeling already elicited would be
sufficient.

Dr. Yellowlees then proposed the second resolution, as set forth in Dr.
Orange’s address.

Dr. Hack Tuke seconded the resolution, which he considered very important.
He would lay considerable emphasis upon the words “ as soon after the com¬
mission of the crime as possible.” As regards the provision for three consulting
together, he should be inclined to hesitate about that, because he thought the
two first-named would be amply sufficient to carry weight in a court of law, but
he knew it was felt by the President and some others that public opinion
would not favour such a conclusion. The public would say that the officer
of an asylum would be sure to make out that a man was mad, and there¬
fore the opinion would not carry weight. It was therefore suggested that
the third should be a physician of standing in the town, who would be sup¬
posed to have a less knowledge and no prejudice in favour of persons
supposed to be mad. He believed that the practical effect of the resolution
would be to prevent a large amount of provoking cross-examination which oc¬
curred under the present system. Practically, an opinion given by three com¬
petent medical men would carry so much weight that it would probably be
conclusive. He felt very strongly upon this subject, and had read a paper some
time ago upon “Experts and Criminal Responsibility” in which he urged
some steps similar to these being taken. He then referred to both the points,
and he was very glad to see them being put in the form of resolutions by the
President.

Dr. Gover asked Dr. Tuke in what cases would an examination be necessary ?

Dr. Hack Tuke said that might be left to the discretion of the magistrate at
the time. Mr. Flowers had told him that if there were some circumstances
on the face of the case which suggested insanity he asked the police surgeon to
examine the prisoner. He said he would be extremely glad if he could ask some
one who had a more complete knowledge than a police surgeon might have.
Then, there might arise circumstances afterwards which would necessitate
such an examination. He would like to kuow the opinion of the President as
to who would appoint these examiners.

The President replied that it would be either through the solicitors of the
Treasury or the Public Prosecutor. No doubt some suitable mode would be
discovered for doing it. Something similar was done and always had been
done in very important cases where public attention was directed to the
case, and it was only extending and systematizing a plan which had always been
acted upon in the more notorious cases.

After some further discussion the resolution was agreed to, and it was resolved
as follows.—

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That prisoners suspected of being mentally deranged should be examined by competent
medical men as soon after the commission of the crime with which they are charged as
possible, and that this examination should be provided for by the Treasury in a manner
similar to that in which counsel for the prosecution is provided. It is suggested that the
examiners should be the medical officer of the prison, the medical officer of the county
asylum or hospital for the insane in the neighbourhood, and a medical practitioner of
standing in the town where the prison is situated; that the three medical men shall,
after consulting together, draw up & joint report, to be given to the prosecuting counsel; the
cost being borne by the public purse, inasmuch as it is useless to tell an insane man that the
burden of proving himself insane lies upon himself.

The President stated that Dr. Cassidy had been good enough to exhibit
several instruments of restraint which had been used in former times at the
Lancaster Asylum.

A vote of thanks was unanimously accorded to the Royal College of Physicians
for the use of the room, and the proceedings then terminated.

The members of the Association afterwards dined together at “ The Ship * at
Greenwich.

ANNUAL MEETING OF THE BRITISH MEDICAL ASSOCIATION,
JULY 31st TO AUGUST 3rd, 1883, AT LIVERPOOL.

SECTION G. PSYCHOLOGY.

The meeting of the Psychological Section was held under the presidency of
Dr. T. L. Rogers, of Rainhil), and was for the most part well attended. Four
meetings of the Section took place, and at each, in addition to miscellaneous
papers, a special subject was introduced for discussion.

The “ abstracts ” sent in by the authors of papers, and of their speeches by
some of the speakers, not being available, the following is merely an incomplete
summary.

On Wednesday afternoon Dr. Rogers opened the proceedings by the de¬
livery of his very interesting Presidential Address.* Taking for his subject
“ General Hospitals and Hospitals for the Insane,” he compared the respective
rise and progress of the two classes of institutions, showing that up to recent
times, at all events, the comparison was anything but favourable to the latter.
He proceeded to point out the essential differences between asylums and general
hospitals, and to remarkon the limits within which the purely medical treat¬
ment of the insane might be beneficial, alluding also to the duties devolving on
the asylum physician in consequence of the involuntary character of most of
his patients. In conclusion, some good practical hints were given as to the
indications for sending insane patients to be treated in an asylum, and reference
was made to the social statistics of insanity.

A vote of thanks, proposed by Dr. Paul, and seconded by Dr. Sankey, was
unanimously accorded to Dr. Rogers.

Dr. Yellowlees then introduced a discussion on the “ Employment of the
Insane.” He advocated the discriminate occupation of lunatics in some well- -
selected form of industrial work as tending to promote recovery, or, in less
favourable cases, as counteracting the tendency to mischievous excitement.
He reprobated, however, indiscriminate so-called employment of patients merely
for the purpose of swelling the statistics of nominal workers, pointing out that
there could be no possible advantage in sending a patient to “ shiver under a
hedge ” if it were impracticable or inexpedient to induce him to take part in
field labour.

The discussion on this subject was sustained with considerable spirit, amongst
the speakers being Dr. Rees Philipps, Mr. Cassidy, Dr. W. H. 0. Sankey, Dr.
Paul, Dr. Murray Lindsay, Dr. Savage, Dr. Shuttleworth, Dr. Bower, Dr. F. A.
Jelly, Mr. Mould, Dr. Ireland, and Dr. Rogers, the general consensus of opinion
being in accord with the remarks of Dr. Yellowlees. Amongst the points sug¬
gested were the introduction of musical drill as a recreative employment for

* Reported in extenso. “ Brit. Med. Journ.,” August 4th, page 232.

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patients of the better class, and the advantage of making money payments to
patients as a compensation for, and encouragement to, meritorious exertion in
useful industry. Dr. Yellowlees replied.

Dr. F. A. Jelly subsequently read a paper on “ Lunacy in Spain,” giving
an interesting sketch of a private asylum which he had visited there ; and on
this remarks were made by Dr. Rogers, Dr. W. Jelly, Dr. Yellowlees, and Dr.
W. H. 0. Sankey.

On Thursday morning Dr. Joseph Wiglesworth (of Rainhill} read a
paper and introduced a discussion on the subject of “ Bone-Degeneration in the
Insane.” Dr. Wiglesworth illustrated his views by means of a number of
carefully prepared microscopical sections. Remarks were made by Dr. Rogers,
Dr. Sankey, Dr. W. J. Mickle, Dr. Yellowlees, Dr. Jelly, Mr. Mould, Mr. Rooke
Ley, and Mr. Cassidy.

Dr. Wiglesworth described osteo-porosis as occurring in several of the
insane under his notice ; and one speaker argued that not only did the bones
suffer in the general defect of nutrition so common in the insane, but that in
some cases there was a marked and special disorder of bone nutrition.

Dr. Wiglesworth also exhibited microscopical sections of the brain from cases
of general paralysis and of stupor.

Dr. Wiglesworth also read a paper on the ‘‘Pathology of Mania.” Re¬
marks thereupon were made by Dr. W. J. Mickle, Dr. Sankey, Mr. Bevan
Lewis, and Dr. Rogers.

Dr. Wiglesworth replied.

The paper held that mania is a disease of the highest co-ordinating centres ;
the maniacal manifestations flowing from activity of lower centres which
have escaped from the control of the higher ; and hypersemia of brain being
secondary. The highest centres were hypothetically localized.

Dr. W. Julius Mickle next read a paper on “Visceral and other Syphilitic
Lesions in Insane Patients without Cerebral Syphilitic Lesions.” Dr. Sankey,
Dr. Rogers, Dr. Yellowlees spoke thereupon, and Dr. Mickle replied

The paper described a group of cases in the insane, in which there was no
cerebral Syphilis, although there was extensive visceral or bone or skin
syphilis—or all these; and although in some cases the insanity had been
attributed, and apparently due, to syphilis. These facts had a relation, in some
respects complemental, to others mentioned in the paper.

On Thursday afternoon Mr. Bevan Lewis (West Riding Asylum) intro¬
duced the discussion on “ Cerebral Localization in Relation to Psychological
Medicine,” by reading a paper descriptive of many cases, and dealing with the
subject generally.

Dr. James Ross (of Manchester) followed, and referred to some cases in
which localized cerebral lesion had co-existed with mental disturbance, allud¬
ing also specially to a case of fracture of the skull, in which conjugate
deviation of the eyes was removed by trephining.

Dr. Ireland complimented Mr. Bevan Lewis on the pains he had bestowed
upon his paper, though he said he was somewhat disappointed that the author
had, like Moses, led them within view (apparently) of the promised land, but
had not taken them thereinto. He trusted, however, that Mr. Bevan Lewis
might have a long life to follow up this most important subject, and if he
succeeded in fixing a definite mental pathology upon the basis of cerebral
localization he would indeed attain immortality. For his own part he had not
seen in autopsies of idiots any cerebral deficiencies corresponding (on the
theory of localization) to sensorial defects; and before assenting to the
affirmative view he would very much like to hear disproved the negative
instances published by Goltz and other eminent German observers.

Dr. W. J. Mickle, criticized the conclusions of those physiologists who make
extremely circumscribed and rigid localization of functions in the cortex of the
brain, inscribing circles on brain-diagrams as enclosing parts devoted to this
or that function ; thought that while one cortical centre holds the leading
place in regard to a given function, yet others are supplementary or accessory,

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and, after destruction of the former, if retaining the necessary relations and
connexions, are more or less educable, and take up, to some extent, the work
of the part destroyed ; spoke of the convenient propinquity of the several
parts of the symbolic cortical area; and concluded by mentioning the different
clinical course and accompaniments of similar lesions of the two cerebral
hemispheres, and the non-symmetry of the exact disposition, and the unequal
extent, of parts subserving similar functions in their two respective cortices.

Dr. Fletcher Beach drew attention to the agreement of mental character¬
istics which often coincided with similar defects of formation in cases of idiocy,
and referred to the remarkably simple character of the cerebral nerve cells from
deficiency of processes in certain classes ; this simplicity perhaps accounting to
some extent for the mental incapacity.

Dr. Shuttleworth referred to a case of microcephalic imbecility in which
arrest of formation and development of the temporo-sphenoidal and occipital
lobes coincided with congenital dulness of hearing (the auditory centre being
placed by Ferrier in the superior temporo-sphenoidal convolution). In this case
there were considerable powers of observation and of imitative movement, as in
drill; and the frontal and parietal lobes were comparatively well developed.

Dr. Joseph Wiglesworth, Mr. Victor Horsley, and Dr. Sankey also took part in
the discussion, and Mr. Be van Lewis replied.

Dr. G. E. Shuttleworth (of Lancaster), next read a paper on the question
“ Is Legal Responsibility Acquired by Educated Imbeciles ?*’ giving an account
of the various views taken by legal authorities in the proceedings against an in¬
mate of the Royal Albert Asylum, who, startled from his sleep by another
patient, had knocked down the latter and unhappily fractured his skull (which
was abnormally thin); the proof of the fact depending upon the evidence of
other patients. The question of the admissibility of the evidence of educated
imbeciles was considered, and their civil capacity and legal responsibility were
discussed.

Dr. Ireland, Dr. Fletcher Beach, and Dr. Yellowlees made remarks upon this
paper, the tenor of opinion being that whilst the question might be answered in
the affirmative, there was need of caution in accepting the evidence of those
who had been recognised as imbeciles, as they were not unlikely to be
“ tutored ** to suit the views of unscrupulous persons. At the same time they
might give very trustworthy evidence upon simple matters of fact recently
occurring under their observation. As regards criminal responsibility the same
rules which applied to lunatics also applied to imbeciles.

Dr. Huggabd (of London) read a paper on “ Definitions of Insanity/ ” remarks
on which were made by Dr. Rogers and others. Dr. Huggard pointed out the
defects of some definitions, and made suggestions as to rightly defining.

On Friday morning (Dr. Yellowlees, Vice-President, taking the chair in the
absence of Dr. Rogers), a discussion on “ General Paralysis ” was opened by Dr.
W. J. Mickle; papers also being read by Dr. W. H. 0. Sankey (of
Shrewsbury) on the question “What Phenomena are Included in the Name
of General Paralysis of the Insane ? ” and by Dr. G. H. Savage (of Bethlem
Hospital) on “ Some Cases of General Paralysis with Lateral Sclerosis of the
Spinal Cord.” A long and interesting discussion ensued, Dr. Cassidy, Dr. Oscar
Wood, Mr. Rooke Ley, and Dr. Yellowlees being amongst those taking part, in
addition to the readers of the papers.

Dr. Mickle began his contribution by referring to the pathology of general
paralysis, and the question whether it is inflammatory or degenerative ; then took
up the several forms of disorder of speech and of gait observed in it, with refer¬
ence to their relation of dependence on lesions of encephalon, of medulla oblon¬
gata, or of spinal cord ; and, finally, touched briefly upon treatment with
potassium-iodide.

Dr. Sankey’s paper dealt with the question whether there are not several kinds
of cases, differing widely in symptomatology and morbid anatomy, included
under the name of general paralysis ; thus leading to much discrepancy as to
the seat and pathology of the disease ?

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Dr. Savage's paper described cases of general paralysis with lateral sclerosis
of the cord, as generally occurring in young single persons ; the mental symptoms
being early or late, and usually exalted ; as usually accompanied with marked
tremorsof tongue and in speech,exaggerated reflexes, a bedridden state, contracted
limbs, bedsores; grinding of teeth common, fits occurring or not. With it a
wasted brain ; excess of ventricular fluid ; adhesions present or not, if present,
comparatively slight; generally some wasting of special gyri. Question raised, Is
the Lateral Sclerosis Primary or Secondary ?

In the general discussion Dr. Yellowlees summed up the salient points of the
three communications.

Dr. Savage referred to the higher functions, as speech, being affected early in
general paralysis.

Dr. Oscab Woods spoke of the comparative immunity of Ireland from
general paralysis, and of syphilis as a cause.

Mr. Rooke Ley brought forward examples in which there was no propor¬
tional relationship between the incidence of syphilis and of general paralysis on
the population.

Dr. Mickle, in closing the debate, agreed with what had been stated in re¬
ference to the early and marked impairment of the highest functions in general
paralysis ; and as to the desirability of subdividing the affection into varieties,
and of excluding many of the cases which are often called general paralysis,
alluding more particularly to some senile cases. In Dr. Mickle's experience
general paralysis with lateral sclerosis of the cord had not occurred specially in
young, single (i.e., unmarried) subjects ; among other points there were often
some rigidity of frame and stiffness of limbs, spasmodic twitches and jerks of the
limbs, spontaneously or on passive motion, jerky grasp, shaky speech, with much
twitching of face and lips, as also on protrusion of the jerkily protruded tongue,
often, also, paralytic and apoplectiform attacks, but not very frequently epilepti¬
form seizures. Adhesion and decortication varied much in different cases, and
from a slight to an extreme extent. Atrophy affected the gyri of the anterior
more than those of the middle region of the brain-surface, and the central parts
of the brain were softened in some cases. He believed that here the sclerosis is
usually secondary.

The hour for closing the Section having now arrived, a paper by Dr. C. A.
Mercier on “ An Epidemic of Delirium ** was taken as read ; as was also a paper
by Mr. J. H. Baker and Dr. W. J. Mickle on tm Some Acts during Temporary
Epileptic Mental Disorder.” W T e hope to publish, in the next number of the
Journal, several ot the papers read at the Liverpool meeting.

On the invitation of Dr. Rogers some thirty members of the Association (for
the most part connected with the Psychological Section) visited the Asylum at
Rainhill on Friday afternoon. They were conducted through the wards by Drs.
Hickson and Wiglesworth, and afterwards had the opportunity of inspecting the
extensive annexe now in course of construction.

ASYLUM BENEFIT CLUB.

Mr. Millard, of the Eastern Counties Asylum for Idiots, informs us that a
Benefit Club is now in operation, upon a very liberal basis, in connection with
the Eastern Counties Asylum for Idiots, Colchester. It provides help in sick¬
ness and an annuity at the age of 65 years, or earlier if members are per¬
manently disabled. About fifteen years since, the Superintendent foresaw the
difficulty of providing pensions to superannuated attendants, nurses, and
servants out of the regular income of the charity. He therefore asked the Board
of Directors to establish this Club, to which they agreed, and voted part of the

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proceeds of a bazaar as the commencing capital, which was supplemented by a
donation of £100 from a generous member of the Board, who has ever since
been an annual subscriber of two guineas to the honorary fund. Very few
parties connected with the Asylum became members of the Club, partly because
the premiums were high in proportion to their wages, but principally because if
they left the Asylum they ceased to belong to the Club, and only three-fourths
of their money would be returned. The capital of the Club became so augmented
by accumulation, that last year the Board were enabled to re-arrange the rules
upon very advantageous terms, with the proviso that the Club must be limited
to 18 members until the capital is still further increased. Unless the annuity
payable at the age of 65 years has been commenced, all the money paid by any
member is returnable at any time, less benefits received, and if death should
occur the money is payable to the executor or nearest relative, so that the Club
acts as a savings’ bank without interest as well as an insurance society, pro¬
viding for sickness and old age. The pension is doubled out of the honorary
fund if the parties have been members for a period of ten years and have paid
the full premiums. Ten members may be admitted, and pay ohly three-fourths
of the premiums, thus rendering the payments easy; but the pension is not
doubled out of the honorary fund as when the full premiums are paid.

It is very desirable that some such club should be provided in all voluntary
institutions or private asylums, and the wages should be sufficiently high to
allow of the premiums being paid without difficulty. The certainty of having
provision during sickness and in old age would relieve anxiety and encourage
cheerful service. Pensions are granted in borough and county asylums after a
certain length of service, and similar provision is needed for other asylums.

“ AFTER-CARE ” ASSOCIATION.

The annual meeting for 1883 of the “ Association for the After Care of
Poor and Friendless Female Convalescents on leaving Asylums for the
Insane ” was held on 5th July at 20, Eaton Place, by kind permission of Lord
Cottesloe.

There were present the Earl of Shaftesbury (President), in the chair, Lord
Cottesloe, Dr. D. Hack Tuke, Dr. Claye Shaw, Dr. Edgar Sheppard, Dr. Seward,
Miss Fremantle, Miss A. Gladstone, Mrs. Ellis Cameron, and others.

The minutes of the last meeting having been read and confirmed, the Rev.
H. Hawkins, Hon. Sec., read the report of the past year, in which some cases
relieved were noted. Particular mention was made of the formation of an
“ After Care Ladies’ Working Society ,” for the assistance, by grants of clothing,
of indigent convalescents. The foundress of the Society is Mrs. Richardson,
Parkwood House, Whetstone.

Dr. T. C. Shaw, Hon. Treasurer, gave an account of the financial position
of the Association. Its funds were slender, but whatever good had been effected
had been accomplished almost without resort to the money in hand.

Mrs. Ellis-Cameron gave a short address, indicating ways in which the
work of the Association might be expanded, and expressed willingness to
continue temporarily to hold the office of Secretary of the Ladies’ Committee,
and to receive periodical meetings at her house.

The Earl of Shaftesbury spoke words of encouragement with respect to
the genuine need of such an Association, and to its ultimate acceptance, and
he also referred to his association for 53 years with lunacy work.

Dr. D. Hack Tuke, Dr. Edgar Sheppard, and Dr. Seward addressed
the meeting.

Thanks were proposed to the Earl of Shaftesbury and Lord Cottesloe, and the
meeting separated.

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THE “OPEN-DOOR” SYSTEM AND THE RISK OF PROSECUTION.

In May last a female patient escaped from the Lenzie Asylum, Glasgow,
through an unlocked door, and was killed—whether suicidally or not is un¬
known—on the railway near the Asylum.

The Public Prosecutor for the County has intimated to the Asylum
authorities that if such an accident occurs again it may be his duty to
institute an investigation as to whether there has not been culpable negligence
in the custody of the lunatic ; and the husband of the deceased woman has, we
observe, raised an action against the managers of the Asylum for damages for
the loss of his wife. The managers have compromised this “action by a payment
of £50 to the husband. A very serious question is thus raised, and one which
involves the increase of the already sufficiently heavy risks and anxieties of
asylum physicians. We believe that during the last year the number of suicides
in Scotch Asylums has been unusually large. Is this a mere coincidence, or is it
associated with the granting of a greater amount of liberty ?

CHANGES IN THE LUNACY BOARD.

Early in July Dr. Nairne, who had held the appointment of Commissioner in
Lunacy since 1857, resigned his seat at the Board. The vacancy was so quickly
filled up that the resignation of Dr. Nairne and the appointment of his suc¬
cessor, Dr. Reginald Southey, of London, were announced at the same time.

We are sure that the best wishes of Dr. Nairne’s numerous friends attend him
in his retirement from his very protracted term of service.

Obituary.

B. H. EVERTS, M.D.

Doctor B. H. Everts died at Arnhem, on the 2nd of July, 1883.

He was bom in 1810, ard after having passed through a grammar school took
his degree at the University of Leyden. His medical studies were interrupted in
1830 by the war with Belgium; he joined the corps of volunteers formed by the
Leyden students. After having taken his medical degree he settled at Deventer,
and there held the position of Superintendent of the Lunatic Asylum (1844).

The provincial government of North Holland having resolved to build an
asylum, Everts was appointed to be Medical Superintendent, and he devoted
the time between 1847, while Meerenberg was being built, and 1849, when it was
opened, to visiting several foreign asylums.

In England he was greatly interested in the non-restraint system, and it was
only natural that his humane nature warmly supported it. The result was that he
decided upon introducing it into the Meerenberg Asylum, and thanks to his care
this was the first asylum on the Continent of Europe where it was introduced.
We were much pleased with his asylum in visiting it in 1853.

It may be said that he loved his work and his patients, and to his attachment
to them, it must be ascribed that he refused a call to Amsterdam where a
chair of pathology was offered him.

Dr. Everts resigned his position as Superintendent in 1874, and spent the rest
of his days at Arnhem.

In him the profession loses a devoted member.

ROBERT BOYD, M.D. Edin.

On the 14th of August, 1883, at his Private Asylum, Southall Park,
Middlesex, in the fire by which the building was destroyed, Dr. Boyd, aged 75.
Dr. Boyd was the son of Captain William Boyd (South Devon Militia), and

. Digitized by LjOOQle

Notes and News ,

457

1883.]

was bora Nov. 24, 1808, at Tullamore, King’s Co., Ireland. He was M.D.
Edin. 1831, L.R.C.P. Lond. 1836, F.R.C.P. 1852. He was formerly Lecturer
on Medicine at the Charlotte Street School of Medicine, and Resident Physician
at the Marylebone Infirmary, which he left June, 1847, on his appointment to
the Somerset County Asylum. He resigned in 1868, leaving Wells in July.
He took Southall Park Asylum January, 1874. He survived his wife only a few
months .—{See Occasional Notes of the Quarter.)

Correspondence .

To the Editors of The Journal of Mental Science.

Gentlemen, —The proposal of Dr. Ingleby to lift the floor of the chancel of
the church of Stratford-on-Avon, where Shakespeare is known to lie, has
aroused some ill-considered objections from the daily newspapers, some of which
threaten “ a storm of indignation ” against all who wish the project carried out.
It is one which I have often talked about to my friends, and which I have even
thought of proposing in your Journal, so I hope that you will allow me to
bespeak the influence of scientific men in support of Dr. Ingleby and those who
are disposed to take his part.

In spite of such words as “ bad taste,” “ sacrilege,” and “ desecration,” I do
not believe that any person within the British Isles would shed a single tear, or
eat an ounce less of beef and potatoes, or drink a pint more beer, because a few
stones were lifted in the floor of the church and the light of day allowed to fall
on the honoured bones of the great dramatist. The argument most likely to
tell with the«public is that Shakespeare himself, in the doggerel rhyme inscribed
on his tomb, requested that his bones should not be moved. In a life of Shakes¬
peare in my copy of his works, published twenty-four years ago, the following
commentary is made :—“ It is uncertain whether this request and imprecation
were written by Shakespeare or by one of his friends. They probably allude to
the custom of removing skeletons after a certain time and depositing them in
charnel houses, and similar execrations are found in many Latin epitaphs.”
This simple observation disposes of all the arguments drawn from the inscrip¬
tion. To all appearance Shakespeare was quite unconscious of the immortality
he had gained. Assuredly he never considered the question whether he ought
to forbid that his cranial outline should be examined hundreds of years after in
order to repair the neglect of his contemporaries, who have left us in doubt as to
what he was like when he lived.

It seems to me that the two portraits of Shakespeare presented in engravings
are taken from two different men, one a very handsome and fine face, somewhat
like a Spaniard, the other a much more English looking countenance, resem¬
bling the bust on the wall of the church. Of this bust we are neither sure that
it was taken before Shakespeare was buried, nor that the sculptor could be
trusted to make a good likeness. There is no doubt that his bones might be
identified, when measurements and observations could be made that would be
useful in deciding which of the portraits most resembled the illustrious dead.
Iu the name of common-sense, what is there in Shakespeare dead that his re¬
mains should be for ever kept under an opaque slab of sandstone, never to be
seen by the living even for a few hours, when anyone dwelling in London at
the beginning of the seventeenth century might see him on the boards of the
Globe Theatre for a few pence ? A few years ago the grave of Dante was opened,
and anthropologists now know the capacity of the cranium and the probable
weight of the brain of the great Florentine.

The body of Richard II. was examined, and the story of his being brained by
a pole-axe proved to be untrue. The remains of Charles I. were also examined,
and the decapitated head was found to retain a striking likeness to the well-
known portraits of Vandyke. And what are Richard II. and Charles I. to us

xxix. 31

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458

Notes and News.

compared with Shakespeare ? Save a very few, the dead are dead ; their memo¬
ries buried amongst the dead who once Uved with them. Heine said, “ I live
and am stronger than all the dead/ 7 Shakespeare might say, “ I am dead, and
yet I am stronger than all the living.” There are more plays of Shakespeare
acted than of any living dramatist. It is for this reason that we are so anxious.
to snatch from the grave something more about Shakespeare, and this is called
saorilege. Is there one living who ever struggled for fame, or breathed a hope
that men will not forget him in his grave, who would not feel it as an honour
given to few amongst the sons of men to know that 267 years after he was laid
to rest, those who kept alive the lamps of learning and of science would desire
to lift his remains for a day in order to measure the capacity of his skull, and to
ascertain whether there was anything to be observed in the structure of the bony
case which contained a brain from which came manifestations of unapproach¬
able mental power ? And with what disgust and aversion would he look down
upon the dull and ignorant writers in the daily journals of the year 2150 who
would try to represent such an act of homage to his genius as a piece of
sacrilege ?

It seems to me likely enough that Dr. Ingleby’s proposal may be put off
till a more educated generation appears, unless the public are made clearly
to understand the advantages its adoption would give to the study of craniology.

I should therefore hope that the members of our Association will exert them¬
selves to prevent the public being misled.

I am, yours, &c.,

Preston Lodge, Prestonpans, William W. Ireland.

10th September, 1883.

Dr. Ireland's forcible appeal is in the name of science, not sensational
curiosity.— [Eds.]

Appointments.

Evans, D. T., M.R.C.S, appointed Assistant Medical Officer to the Three
Counties Asylum, Beds, vice E. C. Rogers, M.R.C.S., resigned.

Ewart, C. Theodore, M.B., M.Ch., appointed Assistant Medical Officer to
the Fisherton House Asylum, Salisbury, vice W. G. Coombs, M.D., resigned.

Legge, R. J., M.D., appointed Assistant Medical Officer to the Derby County
Asylum, vice W. W. Horton, M.B., resigned.

Benham, H. A., M.D., appointed Assistant Medical Officer to the County
Lunatic Asylum, Stapleton, near Bristol, vice R. Fullerton, M.B.

Gibbon, Wm., L.K.Q.C.P.I., appointed Junior Assistant Medical Officer to the
Joint Counties Asylum, Carmarthen. '

Macdonald, Peter William, M.B. and C.M. Univ. Aberdeen Gate Assis¬
tant Medical Officer to the Cheshire County Asylum, Macclesfield), has been
appointed Assistant Medical Officer to the Dorset County Asylum, vice W. H.
Gillespie, L.K.Q.C.P.I., &c., resigned.

Clapp, Robert, L.R.C.P.Lond., M.R.C.S., has been appointed Assistant
Medical Officer to the Devon County Lunatic Asylum.

Gibb, William, M.B., C.M., has been appointed Assistant Physician to
Woodileo Asylum, Lenzi e,vice John Keay, M.B., C.M., resigned.

Moore, E. E., M.B., has been appointed Resident Medical Assistant to Down
District Lunatic Asylum.

Brunton, Chas. Edw., M.B. Cantab., M.R.C.S.,has been appointed Assistant
Medical Officer to the County Lunatic Asylum, Colney Hatch, vice Brown,
resigned.

Wilson,. Gerald Barry, L.K.C.P.Ed., L.R,C.S.Ed., has been appointed
Second Assistant to the Resident Medical Superintendent of the District Lunacy
Asylum, Cork.

Barnes, J. J. F., F.R.C.8., appointed Assistant Medical Officer to the
Fisherton House Asylum.

Digitized by LjOOQle

THE

MED I CO-PSYCHO LOGICAL ASSOCIATION.

THE COUNCIL, 1883-84.

president.— W. ORANGE, M.D., F.R.C.P.
president-elect. —JOHN MANLEY, M.D.
ex-president.— PROFESSOR W. T. GAIRDNER, M.D.

treasurer.— JOHN H. PAUL, M.D.

T „ IT1JMAT /D. HACK TUKE, M.D.
EDITORS OF JOURNAL j GE0< h. SAVAGE, M.D.

AUDITORS

J E. S. WILLETT, M.D.

\ J. MURRAY LINDSAY, M.D.

HON. SECRETARY FOR IRELAND.— E. M. COURTENAY, M.B.
HON. SECRETARY FOR SCOTLAND.— J. RUTHERFORD, M.D.
GENERAL SECRETARY.— HY. RAYNER, M.D.

T. S. CLOUSTON, M.D.

J. A. LUSH, M.D.

W. J. MICKLE, M.D.
HERBERT MAJOR, M.D.
T. OSCAR WOODS, M.B.
W. W. IRELAND, M.D.

H. HAYES NEWINGTON, M.R.C.P.
F. NEEDHAM, M.D.

HENRY F. WINSLOW, M.D.

H. R. LEY, M.R.C.S.

J. T. HINGSTON, M.R.C.S.

T. AITKEN, M.D.

Members of the Association .

Adam, James, M.D. St. And., Private Asylum, West Mailing, Kent.

Adams, Josiah 0., M.D. Durh., F.R.C.S. Eng., late Assistant Medical Officer, City
of London Asylum, Dartford j Brooke House, Upper Clapton, London.

Adams, Richard, L.R.C.P. Edin., M.R.C.S. Eng., Medical Superintendent, County
Asylum, Bodmin, Cornwall.

Agar, S. H., L.K.Q.C.P., Burman House, Henley-in-Arden.

Aitken, Thomas, M.D. Edin., Medical Superintendent, District Asylum, Inverness.

Aldridge, Charles, M.D. Aberd., M.R.C.S., Plympton House, Plympton, Devon.

Alliott, A. J„ M.D., St. John’s, Sevenoaks.

Argo, G. C., M.By, Assist. Med. Officer, Durham County Asylum.

Ashe, Isaac, A.B,, M.D., Medical Superintendent, Central Criminal Asylum,
Dundrum, Ireland.

Atkins, Rin^rose, M.A., M.D. Queen’s Univ. Ire., Med. Superintendent, District
Lunatic Asylum, Waterford.

Atkinson, R., B.A. Cantab., F.R.C.S., Assist. Med. Officer, Powick, near Wor¬
cester.

Baillargar, M., M.D., Member of the Academy of Medicine, formerly Visiting Phy¬
sician to the Saln£tri£re j 7, Rue de PUniversite, Paris. {Hon. Mem.)

Baker, BeBj. Russell, M.R.C.S. Eng., L.S.A., Assist. Med. Off. Prestwich Asylum,
Manchester.

Baker, H. Morton, M.B. Edin., Assistant Medical Officer, Leicester Borough
Asylum, Leicester.

Digitized by LjOOQle

ii.

Members of the Association .

Baker, Robert, M.D. Edin., The Retreat, York.

Balfour, G. W., M.D. St. And., F.R.C.P. Edin., 17, Walker Street, Edinburgh.

Ball, Professor. Paris, Professor of Mental Diseases to the Faculty of Medicine,
179, Boulevard St. Germain, Paris. (Hon. Member.)

Banks, Professor J. T., A.B.. M.D. Trin. Coll., Dub., F.K. and Q.C.P. Ireland,
Visiting Physician, Richmond District Asylum, 11, Merrion Square East,
Dublin.

Banks, William, M.B., The Retreat, York.

Barton, Jas. Edwd., L.R.C.P. Edin., L.M., M.R.C.S., Medical Superintendent,
Surrey County Lunatic Asylum, Brookwood, Woking.

Barton, A. B., M.D. St. And., Ticehurst, Sussex.

Bayley, J., Lunatic Hospital, Northampton.

Beach, Fletcher, M.B., M.R.C.P. Lond., Medical Superintendent, Darenth Asylum,
Dart ford.

Beatley, W. Crump, M.B. Durham, Somerset County Asylum.

Beattie, J. A., M l)., Hospital for the Insane, Paramatta, Sidney, New South
Wales.

Benedikt, Prof. M., Franciskanes Platz 5, Vienna. (Hon. Mernb.)

Benham, H. A., M.B., C.M., Ass. Med. Officer, City and County Asylum, Staple-
ton, near Bristol.

Biffi, M., M.D., Editor of the Italian <c Journal of Mental Science,” 16, Borgodi
San Celso, Milan. (Honorary Member.)

Bigland, Ihomas, M.R.C.S. Eng., L.S.A. Lond., Big'and Hall, Lancashire, and.
Medical Superintendent, The Priory, Roehampton.

Bishop. Sidney O., M.R.C.S. Eng., Negriting, Upper Assam, E. Indies.

Blackall, John Joseph, M.D. Qu. Univ. and Killadysert, Co. Clare, Irel., late
Assist. Med. Officer, Richmond District Lunatic Asylum, Ireland.

Blair, Robert. .M.D., Woodilee Asylum, Lenize, near Glasgow.

Blake. John Aloysius, Esq., ex-M.P., 12, Ely Place, Dublin. (Hon. Member.)

Blanchard, E. S., M.D., Medical Superintendent, Hospital for Insane, Charlotte
Town, Prince Edward’s Island.

Blanche, M. le Docteur, 15, Rue des Fontis, Auteuil, Paris. (Hon. Member.)

Bland, W. C., M.R.C.S., Borough Asylum, Portsmouth.

Blandford, George Fielding, M.D., Oxon., F.R.C.P. Lond., 71, Grosvenor Street, W.
(President, 1877.)

Bodington, George Fowler. M.D. Giessen, M.R.C.P. Lond., F.R.C.S. exam., Eng.,
Ashwood House Asylum, Kingswinford, Dudley, Staffordshire.

Bower, David, M.B. Aberd ..Springfield House, Bedford.

Bowes, John Ireland, M.R.C.S. Eng., L.S.A., Medical Superintendent, Wilts
County Asylum.

Bowes, William, M.R.C.S. Eng., and L.S.A. Lond., Assist.Med. Officer, Gloucester
County Asylum.

Boys, A. H., L.R.C.P. Edin., Lodway Villa, Pill, Bristol.

Braddon, Charles Hitchman, Esq., M.D. St. And., M.R.C.S. Eng., Mansefield,
Cbeetham Hill, Manchester, Surgeon, County Gaol, Salford, Manchester.

Brodie, David, M.D. St. And., L.R.C.S. Edin., Ventnor House, Canterbury.

Brosius, Dr., Bendorf-Sayn, near Coblenz, Germany. (Hon. Mernb.)

Brown, John Ansell, M.R.C.S. Eng., L.S.A. Lond., late Medical Staff, Indian
Army, Med. Supt., Peckham House, Peckham,

Brown, M. L., M.D.. County Asylum, Colney Hatch.

Browne, William A. F., F.R.S.E., F.R.C.S.E., late Commissioner in Lunacy
for Scotland; Dumfries, N.B. (President, 1866.) (Honorary Member.)

Browne, J. Crichton, M.D. Edin., F.R.S.E., Lord Chancellor’s Visitor, New Law
Courts, Strand, W.C. (Honorary Member.) (President 1878.)

Browq-S6quard, C., M.D., Faculty de Medicine, Paris. (Hon. Mernb.)

Brushfield, Dr., Budleigh Salterton, Devon.

Bucknill, John Charles, M.D. Lond., F.R.C.P. Lond., F.R.S., J.P., late Lord Chan¬
cellor’s Visitor ; The Albany, Piccadilly, W. (Editor of Journal , 1852-62.)
(President, 1860.) (Honorary Member , 1862-76.)

Burman, Wilkie, J., M.D. Edin., Ramsbury, Hungerford, Berks.

Burrows, Sir George, Bart., 18, Cavendish Square, London, W. (Hon, Member.)

Butler, John, M.D., Hartford, Connecticut, U.S. (Hon. Member.)

Byas, Edward, M.R.C.S. Eng., Grove Hall, Bow.

Cadell, Francis, M.D. Edin., 20, Castle Street, Edinburgh.

Digitized by LjOOQle

Members of the Association.

iii.

Cailleax, Gerard de, M.D., formerly Inspector of Asylums in the Department of
the Seine, Bu?in-les-Aveni£res, Is£re, France. {Hon. Member.)

Callcott, J. T. ; M.B., Durham County Asylum.

Campbell, Cohn M., M.B., C.M., Medical Supt., Perth District Asylum, Murthly.

Campbell, John A., M.D. Glas., Medical Superintendent, Cumberland and West¬
moreland Asylum, Garlands, Carlisle.

Campbell, Donald C., M.D. Glas., M.R.C.P. Lond., F.R.C.P. Edin., Medical
Superintendent, County Asylum, Brentwood, Essex.

Campbell, P. E., M.B., C.M., Senr. Assist. Med. Officer, District Asylum, Caterham.

Calmeil, M., M.D., Member of the Academy of Medicine, Paris, late Physician to
the Asylum at Charenton, near Paris. {Honorary Member.)

Cameron, John, M.B., C.M. Edin., Medical Supt. Argyll and Bute Asylum,
Lochgilphead.

Case, H., M.R.C.S., Medical Superintendent, Leavesden, Herts.

Cassidy, D. M., L.R.C.P.Edin., F.R.C.S. Edin., Med. Superintendent County Asylum,
Lancaster.

Chapman, Thomas Algernon, M.D. Glas., M.R.C.S. Edin., Hereford Co. and City
Asylum, Hereford.

Charcot, J. M., M.D., Phys. to Salp&tri&re, 17* Quai Malaquais, Paris. {Hon.Memb.)

Christie, Thomas B., M.D. St. And., F.R.S.E., F.R.C.P. Lond., F.R.C.P. Edin.,
Medical Superintendent, Royal India Lunatic Asylum, Ealing, W. (Hon,
General Secretary } 1872.)

Christie, J. W. Stirling, M.D., County Asylum, Stafford.

Clapham, Wm. Crocbley S., L.R.C.P,, M.R.C.S., The Limes, Thornton Heath,
Surrey.

Clapp, Robert, Assist. Med. Officer, Barn wood House, Gloucester.

Clapton, Edward, M.D. Lond., F.R.C.P. Lond., Physician, St. Thomas’s Hospital,
Visitor of Lunatics for Surrey j 10a, St. Thomas Street, Borough.

Clark* Archibald C., M.B. Edin., Medical Superintendent, Glasgow District
Asylum, Both well.

Clarke, Henry, L.R.C.P. Lond., H.M. Prison, Wakefield.

Cleaton, John D., M.R.C.S. Eng., Commissioner in Lunacy, 19, Whitehall
Place. {Honorary Member.)

Clouston, T. S., M.D. Edin., F.R.C.P. Edin., F.R.S.E., Physician Superintendent,
Royal Asylum, Morningside, Edinburgh. (Editor of Journal, 1873-1881.^

Cobbold, C. S. W., M.D., Med. Supt., Earlswood Asylum, Redhill, Surrey.

Compton, T. J., M.B., C.M. Abera., Assist. Med. Officer, Thorpe, Norwich.

Cooke, Edwd. Marriott, M.B., M.R.C.S. Eng., Assist. Med. Officer, County
Asylum, Worcester.

Cooper, Ernest F., St. Andrew’s Hospital, Northampton.

Courtenay, E. Maziere, A.B., M.B., C.M.T.C.D., Resident Physician-Superinten¬
dent, District Hospital for the Insane, Limerick, Ireland. {Hon. Secretary
for Ireland.)

Craddock, Fredk. Hurst, B.A., M.R.C.S. Eng., L.S.A., Medical Superintendent,
County Asylum, Gloucester.

Crallan, G. E. J., County Asylum, Fulbourn, near Cambridge.

Crampton, John S., F.R.C.P. Edin., 77, Warwick Street, Belgrave Road,
London, S.W.

Cremonini, John, M.R.C.S. and L.S.A. Engl., Hoxton House, Hoxton, London, N. *

Daniel, W. C., M.D. Heidelb., M.R.C.S. Engl., Epsom, Surrey.

Davidson, John H., M.D. Edinburgh, Medical Superintendent, County Asylum,
Chester.

Davies, Francis P., M.B. Edin., M.R.C.S. Eng., Kent County Asylum, Bann¬
ing Heath, near Maidstone.

Daxon, William, M.D. Queen’s TJniv., Ireland, F.R.C.S. Ireland, Resident
Physician, Ennis District Asylum, Ireland.

Deas, Peter Maury, M.B. and M.S. Lond., Medical Superintendent, New Cheshire
Asylum, Macclesfield.

Delany, Barry, M.D. Queen’s Univ., Ire., Med. Superintendent, District Asylum,
Kilkenny.

Delasiauve, M., M.D., Member of the Academy of Medicine, Physician to the
Bic£tre, Paris, 85, Rue des Mathurins-Saint-Jacques, Paris. {Hon.
Member.) •

Denholm, James, M.D., Dunse, N.B.

Digitized by ^.ooQie

IV,

Members of the Association.

Denne, T. Vincent de, M.R.C.S. Eng., Audlej Heath, Brierley Hill, Staffordshire.

D^spine, Prosper, M.D., Bue du Loizir, Marseilles. (Honorary Member.)

Dickson^F. K., F.R.C.P. Edin., Wye House Lunatic Asylum, Buxton, Derbyshire.

DoddB, Wm. J., M.D., D.Sc. Edln., Assist. Medical Officer, Borough Asylum,
Birmingham.

Down, J. Langdon Haydon, M.D. Lond., F.R.C.P. Lond., late Resident Physician,
Earlswood Asylum; 81, Harley St., Cavendish Sq., W., and Normansfield,
Hampton Wick.

Duncan, James Foulis, M.D. Trin. Col., Dub., F.K. and Q.C.P. Ireland, Visiting
Physician, Farnham House, Finglas; 8, Upper Merrion Street, Dublin.
(President, 1876.)

Dunlop, James, M.B., C.M., 1, Somerset Place, Glasgow.

Dwyer, J., M.B., Mea. Supt., District Asylum, Mullingar, Ireland.

Eager, Reginald, M.D. Lond., M.R.C.S. Eng., Northwoods, near Bristol.

Eager, Wilson, L.R.C.P. Lond., M.R.C.S. Eng., Med. Superintendent, County
Asylum, Melton, Suffolk.

Eames, James A., M.D. St. And., F.R.C.S.I., Medical Superintendent, District
Asylum, Cork.

Earle, Pliny, M.D., Med. Superintendent, Northampton Hospital for the Insane,
Mass.. U.S., (Honorary Member.)

Eastwood, J. William, M.D. Edin., M.R.C.P. Lond., Dinsdale Park, Darlington.

Echeverria, M. G., M.D., New York. [Honorary Member.)

Elliot, G. Stanley, M.R.C.P. Ed., L.R.C.S. Ed., Medical Superintendent, Cater-
ham, Surrey.

Eustace, J., M.D. Trin. Col.,Dub., L.R.C.S.Ire.; Highfield, Drumcondra, Dublin.

Evans, E. W., M.D., Munster House, Fulham, London.

Falret, Jules, M.D., 114, Rue du Bac, Paris. (Honorary Member.)

Finch, W. Corbin, M.R.C.S. Eng., Fisherton House, Salisbury.

Finch, John E. M., M.B., Medical Superintendent, Borough Asylum, Leicester.

Finlayson, James, M.B , 351, Bath Crescent, Glasgow.

Finnegan, A. D. O’Connell, Northumberland County Asylum, Morpeth.

Fletcher, Robert V., Esq., L.R.C.S.I., L.R.C.P. and L.R.C.S. Ed., Medical Superin¬
tendent, District Asylum, Ballinasloe, Ireland.

Foville, Achille, M.D.,- 177, Boulevard St. Germain, Paris, France. (Honorary
Member.)

Forrest, J. G. S., L.R.C.P., Assist. Med. Officer, Camberwell House, Camberwell.

Fournie, Ed., M.D., 11, Rue Louis le Grand, Paris. (Hon. Memb.)

Fox, Edwin Churchill Pigott, M.B. and M.C. Edin., Brislington, Bristol.

Fox, Charles H., M.D. St. Amd., M.R.C.S. Eng., Brislington House, Bristol.

Fox, Bonville Bradley, B.A., M.B., Brislington House, near Bristol.

Fraser, Donald, M.D., 44, High Street, Paisley.

Fraser, John., M.B., C.M., Assistant Lunacy Commissioner for Scotland, 31,
Regent Terrace, Edinburgh.

Gairdner, W.T., M.D. Edin., Professor of Practice of Physic, 226, St. Vincent St„
Glasgow. (Ex-President.)

Gardiner, Gideon G., M.D. St. And., M.R.C.S. Eng., 47, Wimpole St., W.

Gamer, W. H., Esq., F.R.C.S.I., A.B.T.C.D., Medical Superintendent, Clonmel
District Asylum.

Gasquet, J. R., M.B. Lond., St. George’s Retreat, Burgess Hill, and 127, Eastern
Road, Brighton,

Gelston. R. P., Esq., L.K. and Q.C.P.I., L.R.C.S.I., Assistant Medical Officer,
Clonmel District Hospital for the Insane, Ireland.

Gibson, William R., M.B., C.M., District Asylum, Inverness, N.B.

Gilchrist, James, M.D. Edin., late Resident Physician, Crichton Royal Institution,
Lin wood, Dumfries.

Gill, Stanley A., M.R.C.P. Lon., M.R.C.S. Eng., Med. Superint., Royal Lunatic
Asylum, Liverpool.

Gilland, Robert B., M.D. Glas., L.F.P.S. Glas., M.R.C.S. Eng., L.S.A., Medical
Superintendent, Berks County Asylum, Moulsford, Wallingford.

Glendinning, James, M.D. Glas., L.R.C S. Edin., L.M., Assist. Med. Off, Joint

\ Counties Asylum, Abergavenny.

Gover, Robert Munday, M.R.C.P. Lond., Hereford Clambers, 12, Hereford Gardens,
London, W.

Digitized by ^.ooQie

Members of the Association .

Granville, J. M., M.D., 18, Welbeck Street, Cavendish Square.

Gray, John F., M.D., LL.D., Medical Superintendent, State Lunatic Asylum,
Utica, New York. (Honorary Member.)

Grieve, B., M.D., Medical Superintendent, Public Asylum, Berbice, British
Guiana.

Greene, Bichard, L.B.C.P. Edin., Med. Superint., Berry Wood, near North¬
ampton.

Grierson, S., M.B.C.S., Medical Superintendent, Border Counties Asylum,
Melrose, N.B.

Guy, W. A., M.B. Cantab, late Professor of Hygiene, King’s College, London,
12, Gordon Street, W.C. (Honorary Member),

Gwynn, S. J., M.D., St. Mary s House, Whitechurch, Salop.

Hall, Edward Thomas, M.B.C.S. Eng., Blacklands House Asylum, Chelsea.

Harbinson, Alexander, M.D. Ire., M.B.C.S. Eng., Assist. Med. Officer, County
Asylum, Lancaster.

Harrison, B. Charlton, 4, St. Mary’s Vale, Chatham, Kent.

Hatchell, George W., M.D. Glas., L.K. and Q.C.P. Ireland, Inspector and Commis¬
sioner of Control of Asylums, Ireland, 25, Upper Merrion Street, Dublin.
(Hon, Member.)

Haughton, Bev. Professor S., School of Physic, Trinity Coll., Dublin, M.D.,
T.C.D., D.C.L. Oxon, F.B.S. (Hon. Member.)

Hoarder, George J., M.D. St. And., L.B.C.S. Edin., Medical Superintendent,
Joint Counties Asylum, Carmarthen.

Hetherington, Charles, M.B., District Asylum, Derry, Ireland.

Hewson, John Dale, Esq., Ext. L.B.C.P. ling., Medical Superintendent, Coton Hill
Asylum, Stafford.

Hewson, B. W., L.B.C.P. Ed., Assist. Med. Officer, Boyal Asylum, Cheadle,
Manchester.

Hicks, Henry, M.D., Hendon House, Hendon.

Higgins, Wm. H., M.B., C.M., Assist. Med. Officer, County Asylum, Leicester.

Hill, Dr. H. Gardiner, Assist. Med. Officer, Coton Hill Asylum, Stafford.

Hills, William Charles, M.D. Aber., M.B.C.S. Eng., Medical Superintendent,
Norfolk County Asylum, Norwich.

Hingston, J. Tregelles, Esq., M.B.C.S., Eng., Medical Superintendent, North Biding
Asylum, Clifton, York.

Hitchcock, Charles, L.B.C.P. Edin., M.B.C.S. Eng., Fiddington House, Market
Lavington, Wilts.

Hitchcock, Charles Knight, M.D., Bootham Asylum, York.

Hitchman, J., M.D. St. And., F.B.C.P. Lond., F.B.C.S. Eng., late Medical
Superintendent, County Asylum, Derby j The Laurels, Fairford, (President,
1856.)

Hood, Donald, M.B., M.B.C.P. Lond., 43, Green Street, W.

Howden, James C., M.D. Edin., Medical Superintendent, Montrose Boyal Lunatic
Asylum, Sunnyside, Montrose.

Huggard, William B., M.A., M.D., C.M., M.B.C.P., Medical Superintendent,
Sussex House, Hammersmith.

Hughes, C. H., M.D., St. Louis, United States (Hon. Memb.)

Humphry, John, M.B.C.S. Eng., Medical Superintendent, County Asylum,
Aylesbury, Bucks.

Hutson, E., M.D. Ed., Medical Superintendent, Lunatic Asylum, Barbadoes,

Huxtable, Louis B., 99, Priory Boad, West Hampstead, N.W.

Hyslop, James, M.D., Petermaritzburg Asylum, Natal, S. Africa.

lies, Daniel, M.B.C.S. Eng., Besident Medical Officer, Fairford House Betreat,
Gloucestershire.

Ingels, Dr., Hospice Guislain, Ghent, Belgium. (Hon, Member .)

Inglis, Thomas, F.B.C.P. Edin., Cornhill, Lincoln.

Ireland, W. W., M,D. Edin, Preston Lodge, Prestonpans, East Lothian.

Isaac, J. B., M.D. Queen’s Univ., Irel., Assist. Med. Officer, Broadmoor, near
Wokingham.

Jackson, J.Hughlings,M.D. St. And., F.B.C.P. Lond., Physician to the Hospital
for Epilepsy and Paralysis, &c. j 3, Manchester Square, London, W.

Jackson, J. J., M.B.C.S. Eng., Medical Superintendent, Lunatic Asylum,

1 Jersey.

Digitized by LjOOQle

vi. Members of the Association .

Jamieson, Robert, M.D. Edin., L.R.C.S. Edin., Medical Superintendent, Royal
Asylum, Aberdeen.

Jarvis, Edward, M.D., Dorchester, Mass., U.S. ( Hcmorary Member .)

Jepson, Octavius, M.D. St. And., M.R.C.S. Eng., late Medical Superintendent, St.
Luke’s Hospital; Medical Superintendent, City of London Asylum,
Dartford.

Jeram, J. W., L.R.C.P., Brooke House, Upper Clapton.

Johnston, J. A., M.D., District Asylum, Monaghan, Ireland.

Johnstone, J. Carlyle, M.D., C.M., Assist. Physician, Royal Asylum, Morningside,
Edinburgh.

Jones, Evan, M.R.C.S. Eng., Ty-mawr, Aberdare, Glamorganshire.

Jones, D. Johnson, M.D. Edin., Senior Assistant Medical Officer, Kent County
Asylum.

Jones, David Rhys, Joint Counties Asylum, Carmarthen.

Jones. R., M.B. Lond., Colney Hatch, W.

Joseph, T. M., Gladesville Asylum, New South Wales.

Kay, Walter S., M.B., Assistant Medical Officer, South Yorkshire Asylum, Wadsley,
near Sheffield.

Kebbell, William, L.R.C.P. Lond., M.R.C.S. Eng., Senior Assist. Med. Officer,
County Asylum, Gloucestershire.

Kesteven, W. B., M.D., Little Park, Enfield.

Kirkbride, T. S., MJ)., Physician-in • Chief and Superintendent, Pennsylvania Hos¬
pital for the Insane, Philadelphia. ( Honorary Member.)

Kirkman, John, M.D., 13, St. George’s Place, Brighton. (President, 1862).

Kitching, Walter, M.R.C.S. Engl., 39, Old Town, Clapham.

Kornfela, Dr. Herman, Wohlaw, Silesia. ( Corresponding Member .)

Krafft-Ebing, R. v., M.D., Graz, Austria. {Hon. Memb.)

Laehr, H., M.D., Schweizer Hof, bei Berlin, Editor of the ,c Zeitschrift fur Psychia-
trie.” {Honorary Member.)

Lalor, Joseph, M.D. Glas.. L.R.C.S. Ireland, Resident Physician-Superintendent,
Richmond District Asylum, Dublin. (President, 1861.)

Lawrence, A., M.D., County Asylum, Chester.

Lawrence, James, Dr., County Asylum, Chester.

Layton, HenryA., L.R.C.P. Edin., Cornwall County Asylum, Bodmin.

Leeper, Wm. Waugh, M.D. Ed., Loughgall, Co. Armagh.

Legge, R. J., M.D., Assist. Med. Officer, County Asylum, near Derby.

Leidesdorf, M., M.D., Universitat, Vienna. {Honorary Member.)

Lennox-David, Royal Naval Hospital, Haslar.

Lewis, Henry, M.D. Brass., M.R.C.S. Eng., L.S.A., late Assistant Medical Officer,
County Asylum, Chester ; West Terrace, Folkestone, Kent.

Lewis, W. Bevan, L.R.C.P. Lond., Assist. Med. Officer, West Riding Asylum,
Wakefield.

Ley, H. Rooke, M.R.C.S. Eng., Medical Superintendent, County Asylum,
Prestwich, near Manchester.

Lindsay, James Murray, M.D. St. And., L.R.C.S. Edin., Medical Superintendent,
County Asylum, Mickleover, Derbyshire.

Lisle, S. Ernest de, L.K.Q.C.P., Three Counties Asylums, Stotfold, Baldock.

Lister, Edward, L.R.C.P. Edin., M.R.C.S. Eng., Swaithdale, Ulverston.

Lovell, W. Day, L.R.C.P. Edin., M.R.C.S. Eng., L.S.A., Bradford on-Avon, net r
Bath.

Lovett, Henry A., M.R.C.S., Plas Newydd, Swansea, Tasmania.

Lowry, Thomas Harvey, M.D. Edin., M.R.C.S. Eng., West Mailing Place, Maid¬
stone, Kent.

Lush, John Alfred, F.R.C.P. Lond., M.D. St. And., 13, Redcliffe Square, S.W.
(President, 1879.)

Lush, Wm. John Henry, F.R.C.P. Edin., L.M., M.R.C.S. Eng, F.L S., Fytield
House, Andover, Hants.

Lyle, Thos.jM.D. Glas., Penbery Hill Asylum, near Bromsgrove, Worcestershire.

MacBryan, Henry C., L.R.C.S.. County Asylum, Han well, W.

Macfarlane, W. H., New Norfolk Asylum, Tasmania.

Macken, S., M.B. Edin., Hertford British Hospital, Paris

Mackintosh, Donald, M.D., Durham and GJas., L.F.P.S. Glas., 10, Lancaster
Road, Belsize Park, N.W. >

Digitized by LjOOQle

Members of the Association .

vii.

Ma ckintosh, Alexander, M.D. St. AndyL.F.P.S. Glas., late Physician to Royal
Asylnm, Gartnavel, Glasgow, 26, Woodside Place, Glasgow.

Maclaren, James, L.R.C.S.E., Stirling District Asylum, Larbert, N.B.

Macleod, M.D., M.B., Med. Superintendent, East Riding Asylum, Beverley, Yorks.

Maclintock, John Robert, M.D. Aber., late Assistant Physician, Murray's Royal
Institution, Perth j Grove House, Church Stretton. Shropshire.

MacMunn, J. A., M.B. St. And., 110, Newtownards Road, Belfast.

Macphail, Dr. S. Rutherford, Assist. Med. Superintendent, Garlands, Carlisle.

Madden-Medlicott, Charles W. C., M.D. Edin., L.M. Edin., Medwyn House,
Carlisle Road, Eastbourne.

Major, Herbert, M.D., Med. Superint., West Riding Asylum, Wakefield.

Manley, John, M.D. Edin., M.R.C.S. Eng., Medical Superintendent, County
Asylum, Knowle, Fareham, Hants. (President-Elect.)

Manning, Frederick Norton, M.D. St. And., M.R.C.S. Eng., Inspector of Asylums
for New South Wales, Sydney.

Manning, Harry, B.A. London, M.R.C.S., Laverstock House, Salisbury.

Marsh, James Welford, M.R.C.S, Eng., L.S.A., Assistant Medical Officer, County
Asylum, Lincoln.

Marshall, William G., M.R.C.S., Medical Superintendent, County Asylum, Colney
Hatch, Middlesex.

Maudsley ? Henry, M.D. Lond., F.R.C.P.Lond., Professor of Medical Jurisprudence,
University College, formerly Medical Superintendent, Royal Lunatic Hospital,
Cheadlej 9, Hanover Square, London, W. (Editor of Journal , 1862-78.)
(President, 1871.)

McDonnell, Robert, M.D., T.C.D., F.R.C.S.I., M.R.I.A., Merrion Square, Dublin.

McDowall, T. W., M.D. Edin., L.R.C.S.E., Medical Superintendent, Northumber¬
land County Asylum, Morpeth.

McDowall, John Greig, M.B. Edin., Assist. Med. Officer, South Yorkshire Asylum,
Waasley, Sheffield.

McNaughten, John, M.D., Med. Supt., Criminal Lunatic Asylum, Perth.

M'Cullough, David M., M.D. Edin., Medical Superintendent of Asylum for Mon¬
mouth, Hereford, Brecon, and Radnor; Abergavenny.

M'Kinstry, Robert, M.D. Giess. ? L.K. and Q.C.P. Ireland, and L.R.C.S. Ireland,
Resident Physician, District Asylum, Armagh.

Mercier, C., M.B., F.R.C.S., Assist. Med. Officer, City of London Asylum, Stone,
near Dartford, Kent.

Merson, John, M.D. Aberd., Medical Superintendent, Borough Asylum, Hull.

Merrick, A. S., M.D. Qu. Uni. Irel., L.R.C.S. Edin., Medical Superintendent,
District Asylum, Belfast, Ireland.

Meyer, Ludwig, M.D. University of Gottingen. (Honorary Member.)

Mickle, A. F. J,, M.A., M.D., Kirklington, Ripon.

Mickle, Wm Julius, M.D., M.R.C.P., Med. Superintendent, Grove Hall Asylum,
Bow, London.

Mickley, George, M.A., M.B. Cantab., Medical Superintendent, St. Luke's
Hospital, Old Street, London, E.C.

Mierzejewski, Prof. J., Medico Chirurgical Academy, St. Petersburg. (Hon.Memb.)

Miles, Geo. E., M.R.C.S., Res. Med. Officer, Northumberland House, Finsbury
Park, N.

Millar, John, Esq., L.R.C.P. Edin., L.R.C.S. Edin., Late Medical Superintendent,
County Asylum, Bucks j Bethnal House,’Cambridge Heath, London, E.

Minchin, Humphry, A.B. and M.B., T.C.D., F.R.C.S.I., Surgeon to the City of
Dublin Prisons, 66, Lower Dominick Street, Dublin.

Mitchell, Arthur, M.D. Aberd., LL.D., Commissioner in Lunacy for Scotland j 34,
Drummond Place, Edinburgh. (Honorary Member.)

Mitchell, R. B., M.D., Assist. Med. Officer, Royal Asylum, Morningside, Edin¬
burgh.

Mitchell, S., M.D. Edin., Medical Superintendent, South Yorkshire Asylum,
Wadsley, near Sheffield.

Moody. Jumes M., M.R.C.S. Eng., Senior Assist. Med. Officer, County Asylum, Cane
Hill, Surrey.

Moore, W. D., M.D., Assist. Med. Officer, Wilts County Asylum, Devises.

Monro, Henry,M.D. Oxon,F.R.C.P. Lond., Censor, 1861, late Visiting Physician, St.
Luke's Hospital; 14, Upper Wimpole Street, London, W. (President, 1864.)

Digitized by LjOOQle

viii,

Members of the Association,

Moreau, M.(de Tours), M.D., Member of the Academy of Medicine, Senior Physician
to the Saltp£triere, Paris. (Honorary Member.)

Motet, M., 161, Hue de Charonne, Paris. (Hnn. Member.)

Mould, George W., M.R.C.S. Eng., Medical Superintendent, Royal Lunatic
Hospital, Cheadle, Manchester. (President, 1880.)

Muirhead. Claud. M.D., F.K.C.P. Edin., 30, Charlotte Square, Edinburgh.

Mundy, Baron Jaromir, M.D. Wurzburg, Professor of Military Hygiene, Uni-
versitUt, Vienna. (Honorary Member.)

Munro, A. C., M.B., B.Sc. EdiD., Medical Officer of Health, South Shields.

Murdoch, W., M.B. C.M. Edin., Assist, Med. Officer, Kent County Asylum,
Banning Heath.

Murray, Henry G., L.K.Q.C.P. IreL, L.M., L.R.C.S.I., Assist. Med. Off., Presl-
wich Asylum, Manchester.

Nairne, Robert. M.D. Cantab., F.R.C.P. Lond., late Commissioner in Lunacy;
19, Whitehall Place, London. (Honorary Member.)

Needham, Frederick, M.D. St. And., M.R.C.P. Edin., M.R.C.S.Eng., late Medical
Superintendent, Hospital for the Insane, Bootnam, York; Bam wood House,
Gloucester.

Neil, James, M.D., Borough Asylnm, Portsmouth.

Newington, Alexander, M.B. Camb., M.R.C.S. Eng., Woodlands, Ticehurst.

Newington, H. Hayes, M.R.C.P. Edin., M.R.C.S., Ticehurst, Sussex.

Newth, A, H., M.D., Haywards Heath, Sussex.

Nicholson, William Norris, Esq., Lord Chancellor’s Visitor of Lunatics, New Law
Courts, Stiand, W.C. {Honorary Member.)

Nicholson, W. R., M.R.C.S., Assistant Medical Officer, North Riding Asylum,
Clifton, York.

Nicolson,David, M.B. and C.M. Aber., late Med. Off., H.M. Convict Prison, Ports¬
mouth. Deputy Supt., State Asylum, Broadmoor, Wokingham, Berks.

Niven, William, M.D. St. And., Medical Staff H.M. Indian Army, late Superinten¬
dent of the Government Lunatic Asylum, Bombay, St. Margaret’s, South
Norwood Hill, S.E.

North, S. W., Esq^ M.R.C.S. E., F.G.S., 84, Micklegate, York, Visiting Medical
Officer, The Retreat, York.

Norman, Conolly, M.D., Med. Supt., District Asylum, Castlebar, Ireland.

Nugent, John, M.B. Trin. Col., Dub., L.R.C.S. Ireland, Senior Inspector and
Commissioner of Control of Asylums, Ireland j 14, Rutland Square, Dublin.
(.Honorary Member.)

O’Meara, T. P., M.D., District Asylum, Carlow, Ireland.

Orange, William, M.D. Heidelberg, F.R.C.P. Lond., Medical Superintendent, State
Asylum, Broadmoor, Wokingham, Berks. (President.)

Owen, R. F., Tue Brook Villa, Liverpool.

Paley, Edward, M.D., M.R.C.S. Eng., late Res. Medical Officer, Camberwell
House ? Camberwell j Med. Superintendent, Yarra Bend Asy., Melbourne,
Victoria.

Palmer, Edward, M.D. St. And., M.R.C.P. Lond., M.R.C.S., Medical Superin¬
tendent, County Asylum, Lincoln.

Parkinson, John R., M.R.C.S., Medical Officer, Whittingham. Lancashire.

Parsey, William Henry, M.D. Lond., B.A. Lond., F.R.C.P. Lond., Medical
Superintendent, County Asylum, Hatton, Warwickshire. (President,
1876 .)

Pater, W. Thompson, M.R.C.S. Eng., L.S.A., Medical Superintendent, County
Lunatic Asylum, Stafford.

Patton, W. J., B.A., M.B., Ass. Med. Off., Three Counties Asylum, Herts.

Patton, Alex., M.B., Resident Medical Superintendent, Farnham House, Finglas,
Co. Dublin.

Paul, John Hay ball, M.D. St. And., M.R.C.P. Lond., F.R.C.P. Edin.; Camber¬
well House, Camberwell. (Treasurer.)

Peeters, M., M.D., Gheel, Belgium. (Hon. Memb.)

Peddie, Alexander, M.D. Edin., F.R.C.P. Edin., F.R.S. Edin., 15, Rutland Street,
Edinburgh.

Pedler, George H., L.R.C.P. Lond., M.R.C.S. Eng., 6, Trevor Terrace, Knights-
bridge, S.W.

Petit, Joseph, L.R.C.S. Ire., District Lunatic Asylum, Sligo.

Digitized by LjOOQle

Members of the Association ,

IX,

Philip, Jas. A., M.A., M.B.and C.M. Aberd., Marisbank, Lasswade, near Edin¬
burgh.

Philipps, Sutherland Rees, M.D., Qu. Univ., Irel., O.M., F.R.G.S., Wonford House,

. Exeter.

Philipson, George Hare, M.D, and M.A. Cantab., F.R.C.P. Lond., 7, Eldon Square,
N e wcastle • on-Ty ne.

Pim, F., Esq., M.R.C.S. Eng., L.K. and Q.C.P. Ireland, Palmerston, Chaplezod,
Go. Dublin, Ireland.

Pitman, Sir Henry A., M.D. Cantab., F.R.C.P. Lond., 28, Gordon Square, W.C.,
Registrar of Royal College of Physicians. ( Honorary Member.)

Platt, Dr., Upton Villa, Kilburn.

Plaxton, Joseph Wm., M.R.C.S., L.S.A. Eng., Medical Superintendent, Lunatic
Asylum, Ceylon.

Powell, Ev&n, M.R.C.S. Eng., L.S.A., Medical Superintendent, Borough Lunatic
Asylum, Nottingham.

Pringle, H. T., M.D. Glasg., Medical Superintendent, County Asylum, Bridgend,
Glamorgan.

Pyle, Thos. ’Ihompson, M.D. Durh., L.M., M.R.C.S. Eng., L.S.A.., J.P., 5,
Lower Seymour Street, Portman Square, W.

Rayner, Henry, M.D, Aber., M.R.C.S. Eng., L.S.A., Medical Superintendent,
County Asylum, Hanwell, Middlesex. {Honorary Oen. Secretary.)

Rice, Hon. W. Spring, late Secretary to the Commissioners in Lunacy. ( Honorary
Member.)

Richardson, B. W., M.D. St. And., F.R.S., 25, Manchester Square, W. {Honorary
Member.)

Robertson, Alexander, M.D. Edin., Medical Superintendent, Town’s Hospital and
City Parochial Asylum, Glasgow.

Robertson, Charles A. Lockhart, M.D. Cantab., F.R.C.P. Lond., F.R.C.P. Edin.,
Lord Chancellor’s Visitor, New Law Courts, Strand, W.C. {General Secre¬
tary , 1855-62.) {Editor of Journal, 1862-70.) (President, 1867.) (Honor¬
ary Member.)

Robertson, John Charles G., Esq., L.R.C.P. Edin., M.R.C.S. Eng., L.S.A. Lond.,
Medical Supt., County Cavan District Asylum, Monaghan, Ireland.

Rogers, Edward Coulton, M.R.C S. Eng., L.S.A., Senior Assistant Medical Officer
Three Counties Asylum, Stotfold Baldock, Herts.

Rogers, Thomas Lawes, M.D. St. And., M.R.C.P. Lond., M.R.C.S. Eng., Medical
Superintendent, County Asylum, Rainhill, Lancashire. (President,
1874.)

Ronaldson, J. B., L.R.C.P. Edin., Medical Officer, District Asylum, Haddington.

Roots, William S., M.R.C.S., Canbury House, Kingston-on-Thames.

Rorie, James, M.D. Edin., L.R.C.S. Edin., Medical Superintendent, Royal Asylum,
Dundee. {Late Honorary Secretary for Scotland.)

Rowland, E.D., M.D., C.M. Edin., Whittingham Asylum, near Preston.

Russell, A. P., M.B.Edin., Lunatic Hospital, Lincoln.

Russell, F. J. R., L.K.Q.C.P. Irel., 48, Lupus Street, London, W.

Rutherford, James, M.D. Edin., F.R.C.P. Edin., F.F.P.S. Glasgow, Physician
Superintendent, CricLton Royal Institution, Dumfries. {Hon. Secretary for
Scotland.)

Sankey, H.R., M.B., County Asylum, Hatton, Warwick.

Sankey, R. Heurtley H., M.R.C.S. Eng., Medical Superintendent, Oxford
County Asylum, Littlemore, Oxford.

Sankey, W. H. Octavius, M.D., F.R.C.P. Lond., Boreatton Park, near Shrewsbury,
and Almond’s Hotel, Clifton Street, Bond Street. (President, 1868 .)

Saulle, M. Legraud du, M.D. Paris, 9, Boulevard de Sebastopol, Paris. {Honorary
Member.)

Saunders, George James S., M.B. Lond., M.R.C.S. Eng., Medical Superintendent,
County Asylum, Exminster, Devon.

Savage, G. H.. M.D. Lond., Resident Physician, Bethlem Royal Hospital, London.
{Editor of Journal.)

Schlager, L., M.D., Professor of Psychiatrie, 2, Universitats Plata, Vienna.
{Honorary Member.)

Schofield, Frank, M.D. St. And., M.R.C.S., Camberwell House, Camberwell.

Scholes, H. B., Callan Park Asylum, /New South Wales.

Digitized by v^ooQle

Members of the Association.

. i

Seaton, Joseph, M.D. St. And., F.R.C.P. Edin., Halliford House, Snnbnry.

Seccbmbe, Geo., L.R.C.P.L., The Colonial Lunatic Asylum, Port of Spain, Trini¬
dad, West Indies.

Seed, Wm., M.B., C.M. Edin., Assistant Medical Officer, Wbittingham, Lanca¬
shire. j

Selby, F. A., M.B., C.M. Edin., Assist. Med. Officer, Wye House, Buxton.

Semal, M., M.D., Mons, Belgium. ( Hon.Memb)

Seward, W. J., M.D., Med. Superintendent, Colney Hatch, Middlesex.

Seymour, F., M.R.C.S. Eng., L.S.A., Odiham, Hants.

Shapley, Dr. F., Assist. Med. Officer, County Asylum, Bridgend, Glamorgan.

Shaw, Thomas C., M.D. Lond., F.R.C.P. Lond., Medical Superintendent, Middle¬
sex County Asylum, Banstead, Surrey.

Shaw, James, M.D., Haydock Lodge, Newton-le-Willows, Lancashire.

Sheldon, T. S., Assist. Med. Officer, Somerset and Bath Asylum, Wells.

Sheppard, Edgar, M.D. St. And., M.R.C.P. Lond., F.R.C.S. Eng.,42, Gloucester
Square, Hyde Park, W.

Shuttleworth, G. E., M.D., Heidelberg, M.R.C.S. and L.S A. Engl., B.A. Lond.,

Medical Superintendent, Royal Albert Asylum, Lancaster.

Sibbald, John, M.D. Edin., F.R.C.P. Ed., M.R.C.S. Eng., Commissioner in Lunacy
for Scotland, 3, St. Margaret’s Road, Edinburgh. ( Ed/Lior of Journal,

1871-72.) \Honorary Member.)

Simpson, Alexander, M.D., Professor of Midwifery, University, Edinburgh, 52,

Queen Street, Edinburgh.

Skae, C. H., M.D. St. And., Medical Superintendent, Ayrshire District Asylum,

Ayrshire, Glengall, Ayr.

Smart, Andrew, M.D. Edin., F.R.C.P. Edin., 24, Melville Street, Edinburgh.

Smith, Patrick, M.A. Aberdeen, M.D., Sydney, New South Wales, Resident
Medical Officer, Woogan Lunatic Asylum, Brisbane, Queensland, Australia.

Smith, Robert, M.D. Aber., L.R.C.S. Edin., Medical Superintendent, County
Asylum, Sedgefield, Durham.

Snell, Geo., M.R.C.S., Ass. Med. Off., Berbice, British Guiana.

Spence, James B., M.D. Ire., Med. Supt., Burntwood Asylum, Lichfield.

Spence, J. B., M.A., M.B. Edin., Assist. Phys., Royal Asylum, Morningside,

Edinburgh.

Spencer, Robert, M.R.C.S. Eng., Med. Superintendent, Kent County Asylum,

Chartham, near Canterbury.

Squire, R. H., B.A. Cantab., Assist. Medical Officer, Whittingham, Lancashire.

Stewart, James, B.A. Queen’s Univ., L.R.C.P. Edin., L.R.C.S. Ireland, late J

Assistant Medical Officer, Kent County Asylum, Maidstone; Dunmurry,

Sneyd Park, Bristol.

Stilwell, Henry, M.D. Edin., M.R.C.S. Eng., Moorcroffc House, Hillingdon, :

Middlesex. /

Stocker, Alonzo Henry, M.D. St. And., M.R.C.P. Lond., M.R.C.S. Eng., Medical f

Superintendent, Peckham House Asylum, Peckham.

Strahan, S. A. K., M.D., Assist. Med. Officer, County Asylum, Berrywood, near
Northampton. •

Strange, Arthur, M.D. Edin., Medical Superintendent, Salop and Montgomery

Asylum, Bicton, near Shrewsbury. 4]

Sutherland, Henry, M.D. Oxon, M.R.C.P. London, 6, Richmond Terrace, Whitehall,

S.W.; Blacklands House, Chelsea; and Otto House, Hammersmith.

Sutton, H. G., M.D. Lond., F.R.C.P., Physician to the London Hospital, 9,

Finsbury Square, E.C.

Swain, Edward, M.R.C.S., Medical Superintendent, Three Counties* Asylum,

Stotfold, Baldock, Herts.

Swanson, George J., M.D. Edin., Lawrence House, York.

Tamburini, A., M.D., Reggio-Emilia, Italy. (Hon. Memb.)

Tate, William Barney, M.D. Aber., M.R.C.P. Lond., M.R.C.S. Eng., Medical
Superintendent of the Lunatic Hospital, The Coppice, Nottingham.

Terry, John, M.R.C.S. Eng., Bailbrook House, Bath.

Thomson, D. G., M.B., C.M , Assist. Med. Officer, Camberwell House, S.

Thompson, George, L.R.C.P., M.R.C.S., Medical Superintendent, City and County
Lunatic Asylum, Stapleton, near Bristol.

Thumam, Francis Wyatt, M.B. Edin., C.M., Yardley Hastings, Northampton.

Digitized by

Google

XI.

Members of the Association .

Toller, Ebenezer, M.R.C.S. Eng., 11, Porchester Terrace, Hyde Park, W.
Townsend, Charles Percy, M.R.C.S. Eng., Tring, Berts.

Tuke, John Batty, M.D. Edin., 20, Charlotte Square, Edinburgh. {Honoram
Secretary for Scotland ,1869-72.)

Tuke, Daniel Hack, M.D. Heidel., F.R.C.P. Lond., M.R.C.S. Eng., late Visiting
Physician, The Retreat, York ; Lyndon Lodge, Hanwell, W.,and 4, Charlotte
Street, Bedford Square, W.C. ( Editor of Journal .) (President, 1881.)
Tuke, Thomas Harrington, M.D. St. And., F.R.C.P. Lond. and Edin.,
M.R.C.S. Eng., Visiting Physician, Northumberland House, Stoke New¬
ington j 37, Albemarle Street, and The Manor House, Chiswick. (General
Secretary, 1862-72.) (President, 1873.) 1

Tuke, Chas. Moulsworth, M.R.C.S., The Manor House, Chiswick.

Turnbull, Adam Robert, M.B., C.M., Edin., Medical Superintendent, Fife and
Kinross District Asylum, Cupar.

Tweedie, Alexander, M.D. Edin., F.R.C.P. London, F.R.S., late Examiner
in Medicine, University of London, Visiting Physician, Northumberland
House, Stoke Newington, 119, Pall Mall, and Bute Lodge, Twickenham.
{Honorary Member.)

Urquhart, Alexr. Reid, M.B., C.M., Med. Supt., Murray Royal Institution, Perth.
Virchow, Prof. R., University, Berlin. {Hon. Memb.)

Voisin, A., M.D., 16, Rue Seguin, Paris. {Hon. Memb.)

Wade, Arthur Law, B.A., M.D. Dub., Med. Supt., County Asylum, Wells, Somerset.
Wallace, James, M.D., Medical Superintendent, Greenock New Lunatic Asylum*

Smithstone. *

Wallis, John A., M.B. Aberd., L.R.C.P. Edin., Medical Superintendent, County
Asylum, Whittingbam, Lancashire. J

Walmsley, F. H., M.D., Leavesden Asylum.

Walsh, D., M.B., C M., Assistant Medical Officer, Kent County Asylum, Barming
Heath. 6

Ward, Frederic H., M.R.C.S. Eng., L.S.A., Assistant Medical Officer, County

Asylum, Tooting, Surrey.

Ward, J. Bywater, B.A., M.D. Cant., M.R.C.S. Eng., Medical Superintendent,
Wameford Asylum, Oxford.

Warren, C. E. H., 16, Dagnall Park Villas, Selhurst, S.E.

Warwick, John, F.R.C.S. Eng., 25, Woburn Square, W.C.

Weatherly, Lionel A-, M.D., Portishead, Somerset.

West, Geo. Francis, M.D., District Asylum, Omagh, Ireland.

Westphal, C. Professor, Kronprinzenufer, Berlin. {Honorary Member.)

Whitcombe ? Edmund Banks, Esq., M.R.C.S., Med. Supt., Winson Green Asylum
Birmingham. *

Wickham, R. H.B., • F.R.C.S. Edin., Medical Superintendent, Borough Lunatic
Asylum, Newcastle-on-Tyne.

Wiglesworth, J., M.D., Rainhill Asylum, Lancashire.

Wilks, Samuel, M.D. Lond., F.R.C.P. Lond., Physician to Guy’s Hospital • 72
Grosvenor Street, Grosvenor Square. r ’ *

Wilkes, James, F.R.C.S. Eng., late Commissioner in Lunacy: 18. OueanV
Gardens*, Hyde Park. {Honorary Member.) ^

Willett, Edmund Sparshall, M.D. St. And., M.R.C.P. Lond., M.R.C.S. Eng
Wyke House, Sion Hill, Isleworth, Middlesex ; and 4, Suffolk Place. PallMall *
Williams, S. W. Duckworth, M.D. St. And., L.R.C.P. Lond., Medical Superin¬
tendent, Sussex County Asylum, Haywards Heath, Sussex.

Williams, W. Rhys, M.D. St. And., M.R.C.P. Ed., F.K. and Q.C.P Ire
Commissioner in Lunacy. 19, Whitehall Place. {Hon. Member). ’ * ’’

Wilson, Jno. H. Parker, Surg. H.M. Convict, Prison, Brixton.

Winslow, Henry Forbes, M.D. Lond., M.R.C.P. Lond., 43, Queen Ann-Street
London, and Hayes Park, Hayes, near Uxbridge, Middlesex. ’

Winslow, Lyttleton S. Forbes, M.B. Camb., M.R.C.P. Lond., D.C L. Oxon 23
Cavendish Square, London, W. 9 *

Wood, William, M.D. St. And., F.R.C.P. Lond., F.R.C.S. Eng., Visiting Physician
St. Lukes Hospital, late Medical Officer, Bethlehem Hospital: 99 Harlev
Street, and The Priory, Roehampton. (President, 1865.) * J

Wood, Wm. E. R., M.A., M.B., F.R.C.S. Edin., Assist. Medical Officer, BethLni
Royal Hospital, London.

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xii. Members of the Association .

Wood, Thomas Outterson, F.R.G.P. Edin., F.R.C.S. Edin., M.R.C.S. Engl.
Medical Superintendent, General Lunatic Asylum, Isle of Man.

Wood, B. T^ Esq., M.P., Chairman of the North Riding Asylum, Conyngham,
Hall, Kn ares boro. (Honorary Member.)

Woods, Oscar T., B.A., M.B. Dub., Medical Superintendent, Asylum, Killarney.

Woollett, S. Winslow, M.R.C.S. Eng., Assist. Med. Officer, County Asylum,
Banstead Downs, near Sutton, Surrey.

Worthington, Thos. Blair, M.A., M.B., and M.C. Trin. Coll.. Dublin, Senior
Assistant Medical Officer, County Asylum, Haywards Heath*

Wright, Francis J., M.B. Aberd., M.R.C.S., Eng., Northumberland House, Stoke
. Newington, N.

Wright, John Fred., M.R.C.S. Eng., L.S.A., Asst. Medical Officer, County Asylum,
Han well, Middlesex.

Wright, Rowland H., M.D. Edin., Melrose.

Wyatt, Sir William H., J.P., Chairman of Committee, County Asylum, Colney
Hatch, 88, Regent’s Park Road. (Honorary Member.)

Yellowlees, David, M.D. Edin., F.F.P.S. Glas., Physician Superintendent, Royal
Asylum, Gartnavel, Glasgow.

Young, W. M., M.D., Assist. Med. Officer, County Asylum, Melton, Suffolk.

Younger, E. G., M.D. Bruss., L.R.C.P. Lond., M.R.C.S. Eng., Asst. Medical
Officer, County Asylum, Hanwell, Middlesex.

Members are earnestly requested to send changes of address , <fc., to Hr* Ray tier, the
Honorary Secretary , County Asylum, Hanwell , Middlesex , and in duplicate
to the Printer of the Journal, H. W. Wolff, Lewes , Sussex.

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No. 128. (New Series, No. 92.)

THE JOURNAL OP MENTAL SCIENCE, JANUARY, 1884.

[Published by authority of the Medico-Psychological Association.]

CONTENTS.

PART I.—ORIGINAL ARTICLES.

PAOB.

A. Campbell Clark, M.B.—The Special Training of Asylum Attendants. • 469

G. E. Shuttleworth, M.D.—Is Legal Responsibility acquired by Educated

Imbeciles? .... .... 467

William R. Haggard, M.D.—Definitions-of Insanity. .... 475

Joseph Wlglesworth, M.D.—On the Pathology of Mania. . . . 485

Wm. Julius Miokle, M.D.—Visceral and other Syphilitic Lesions in Insane

Patients without Cerebral Syphilitic Lesions. .... 492

Charles Meroler, M B.—The Basis of Consciousness: An Answer to Professor

Cleland. ......... 498

Clinioal Notes and Cases.—A Case of Melancholy, with Stupor and Catalepsy j
by James Adam, M.D.—Three Cases: one with the usual Symptoms of
General Paralysis, one with Doubtful Symptoms, and the third with
Marked Symptoms; Pachymeningitis in all (with Illustration); by Gko.

H. Savage, M.D.—Case Resembling General Paralysis; Meningitis
followed by Effusion of Lymph and Pus into the Arachnoid Sac; by
John Manley, M.D.—Case of Exophthalmic Goitre with Mania; by J.
Carlyle Johnstone, M.B.—A Case of General Paralysis in a Woman;
by P. M. Cowan, M.D. ...... 508—534

Occasional Notes of the Quarter.—The Case of GouldstCne.—The Case of Cole,
and the Legal Procedure in Ascertaining the Mental Condition of
Prisoners. ........ 634—643

PART II.—REVIEWS.

Thirty-seventh Report of the Commissioners in Lunacy, March 31,1883. . 544

Twenty-fifth Annual Report of the General Board of Commissioners in

Lunacy for Scotland, 1883. ...... 562

Thirty-second Report of Inspectors of Irish Asylums, 1883. . . . 558

Enquiries into Human Faculty and its Development. By Francis Galton,

F.R.S.564

Die Alcoholischen Geisteskrankheiten in Basler Irrenhause. Vora damaligen

Assistenzarzte, Wilhelm von Speyr, 1882. .... 576

A Treatise on Insanity in its Medical Relations. By William A. Hammond, M.D. 679
A Treatise on Diseases of the Nervous System. 2nd Edit. By James Ross, M.D. 685

PART III.—PSYCHOLOGICAL RETROSPECT.

1. Italian Psychological Literature. By J. R. Gasquet, M.B. . . 586

2. French Retrospect. By T. W. McDowall, M.D. . . . 591

PART IV.-NOTES AND NEWS.

The Quarterly Meeting of the Medico-Psychological Association held at
Bethlem Hospital, London.—British Medical Association; Metropolitan
Counties Branch.—The Trial of Gouldstone, and Correspondence.—

The Trial of Cole.—Contemplated Lunacy Legislation in France.—
Dalrymple Home for Inebriates.—Appointments, &c. . . 599—616

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The Journal of Mental Science ,

Original Papers, Correspondence, &c., to be sent by Book-post direct to Dr.
Hack Tuke, Lyndon Lodge, Hanwell, W., or 4, Charlotte Street, Bedford
Square, W.C.

English books for review, pamphlets, exchange journals, &c., to be sent
by book*post to the care of the publishers of the Journal, Messrs. J. and A.
Churchill, New Burlington Street. French, German, and American publica¬
tions should be forwarded to Messrs. Churchill, by foreign book-post, or by
booksellers* parcel to Messrs. Williams and Norgate, Henrietta Street, Covent
Garden, to the care of their German, French, and American agents:—Mr.
Hartmann, Leipzig ; M. Borrari, 9, Rue des St. Peres, Paris ; Messrs. Wester-
mann and Co., Broadway, New York.

Authors of Original Papers (including “ Cases”) receive 25 reprints of their
articles. Should they wish for additional Reprints they can have them on
application to the Printer of the Journal, H. W. Wolff, Lewes, at a fixed
charge.

The copies of The Journal of Mental Science are regularly sent by Booh post
(prepaid ) to the Ordinary and Honorary Members of the Association, and the
Editors will be glad to be informed of any irregularity in their receipt or
overcharge in the Postage.

The following are the EXCHANGE JOURNALS :—

Zeitschrift fur Psycliiatrie; Archiv fiir Psychiatric und Nervenkranh-
heiten; Centralllatt fiir Nervenheilkunde , Psychiatrie, und gerichtliche
Psyehopathologie ; Per Irrenfreund; Jahrbiicher fiir Psychiatrie, neue Folge
des psychiatrischen Centra Iblattes ; Neurologisches Centralblatt; Revue des
Sciences Medicates en France et a V Etranger ; Annales Medico-Psychologiques ;
Archives de Neurologic ; Le Progres Medical; Annales de Dermatologie et de
Syphilographie ; Revue Philosophique de la France et de VEtranger, dirigte
par Th. Ribot; Revue Scientiftque de la France et de VEtranger; L'Encephale ;
Annales et Bulletin de la Societe de Medecine de Oand ; Bulletin de la Sociiti
de M&decine Mentale de Belgique; Archives Medicates Beiges; Archivio
Italianoper leMalattie Nervose eper le Alienazioni Mentali; Archiviodipsichia -
tria , scienze penali ed antropologia criminate : Direttori , Lombroso et Garofalo ;
Rivista Clinica di Bologna , diretta dal Projessure Luigi Concato e redatta dal
Bottore Ercole Galvani; Rivista Sperimentale di FreniatHa e di Medicina
Legale , diretta dal Dr. A. Tamburini; Archives Ital . de Biologie;
The American Journal of Insanity; Ihe Journal of Nervous and
Mental Disease; Archives of Medicine; The Quarterly Journal of
InebHety , Hartford , Conn. ; Index Medicvs. N. Y.; The Alienist and
Neurologist , St. Louis , Misso.; The American Journal of Neurology and
Psychiatry ; The Dublin Quarterly Journal; The Edinburgh Medical Journal;
The Lancet; The Practitioner ; The Journal of Physiology , edited by Dr.
Michael Foster; The Asylum Journal (British Guiana); Brain; Mind;
Canada Medical and Surgical Journal.

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THE JOURNAL OF MENTAL SCIENCE.

[Published by Authority of the Medico-Psychological Association]

No. 128. nbw n ® e S! E8 ’ JANUARY, 1884. Vol. XXIX.

PART 1.—ORIGINAL ARTICLES.

The Special Training of Asylum Attendants . By A. Camp¬
bell Clark, M.B. Edin., Medical Superintendent of the
Glasgow District Asylum, Bothwell.

Read at the Quarterly Meeting of the Medico-Psychological Association ,
held at Edinburgh November 16, 1883.

Seven years ago Dr. Clouston read a paper to this Asso¬
ciation “ On the Question of Getting, Training, and Retaining
the Services of Good Asylum Attendants.” Such a paper
could scarcely fail to attract considerable notice and elicit a
very hearty discussion, for the subject is one of far-reaching
importance to us as asylum physicians, and of very great
moment in the interest of the insane. To get the best raw
material possible, and to manufacture out of it the best asylum
attendant possible, were two great aims suggested by Dr.
Clouston, and the subsequent discussion of his paper showed
that the Association was fully alive to these, and the serious
obstacles which lay in the way of their accomplishment. If
the aims here indicated should be more fully realised in the
future than in the past, we will probably find that the third
desideratum , viz., the keeping of our attendants for a reason¬
able length of time, will be realised in like proportion as the
others. We all willingly admit that the first serious difficulty
is how and where to get them. What will attract the best
raw fnaterial into the asylum market ? or, putting the question
in a negative way, what is it that does not attract the best raw
material into asylums ? These questions will admit of a
variety of answers, many having their root in the idea of non¬
respectability. Undoubtedly the status of an attendant is at
present an inferior one in the industrial scale. Some common
popular notions are that the rougher and stronger the material
the better is the attendant ; that it is not a trade for men, and
xxix. 82

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460 The Special Training of Asylum Attendants , [Jan.,

is suited only for the coarser types of women; that it leads to
nothing reliable or desirable as a permanent occupation; and
that as a life-work it is not sufficiently respectable to satisfy
an average ambition. These and other considerations materially
afEect the supply of good attendants. Seeing, therefore, that
in attendants themselves we find the best advertisement, and
through them may command the highest success, it is worth
considering, whether or not it is possible for us to advertise
asylums, in such a way as to attract to them the better raw
material which we crave so much after, and which we need so
much. If the public mind must be educated to better purpose
we must go upon a new tack . We shall require to bring
more elevating influences to bear upon our attendants. In
raising their social and industrial status we shall raise them in
the estimation of the public and themselves, and may reason¬
ably expect a more marketable article by-and-bye. It is
surely fair, in the interest of all concerned, that attend¬
ants should receive from us the best possible training of
which they are capable. There is reason enough for it in
this, that as medical helps they will then develope more fully,
and their work will become a life-work worthy of the name.

For me the subject possesses a more than usual interest, and
the interest seems to grow with the progress of time. My
experience of asylum life has been a peculiarly varied one,
and circumstances have favoured my viewing this question
from many standpoints. Having been officially connected with
five different asylums, and having occupied several lay as well
as medical positions, you will, perhaps, allow me to-day to
take up the subject where Dr. Clouston left off, and on behalf
of attendants to plead for an organised scheme of special
training. In a very few words T shall tell you how I became
impressed with the necessity for such a scheme; in the second
place, how, at the Glasgow District Asylum, a limited scheme
developed itself and the results of it; and in the third place I
shall plead for a more extended application of the system.

My first thought on the subject arose from observations
made in the company of attendants themselves. There was
abundant evidence that however mechanical they may be in the
performance of their duties, in their hours of leisure they do
not evince any apathy in the exercise of their brain
functions. Personal feeling does at times interfere with a just
appreciation of their patients, but they often exhibit an un¬
skilled cleverness in diagnosis, and give proof of an interest
which might well be fostered for medical purposes. To hear

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461

1884,] by A. Campbell Clark, M.B.

these men and women discuss their surroundings, criticise
their superiors, and venture crude theories regarding indivi¬
dual patients was to realise more forcibly than I can tell you
the abundance of raw material ready to hand that might be
rendered more productive if only some trouble were taken
with it. Three things were patent to my observation— -first,
that too great a barrier existed between officers and attendants;
second , that the mental and moral qualities of attendants were
not utilised so fully as they might be; third , that attendants
require to be individualised as well as patients. My opinions
were, however, wanting in shape, and my position did not
permit of their being ventilated. It was, therefore, with very
great pleasure that I learned of Dr. Clouston’s more matured
ideas in the same direction, and perused his paper on the
subject. The Association expressed. their approval of Dr.
Clouston's endeavours in a practical form by appointing a Com¬
mittee. of three members to report to the next annual meeting
“ on the advisability of forming an association or registry of
attendants in connection with this Association, and the best
manner of carrying it into effect/ 5 I have not yet learned,
however, that the labours of the Committee are ended, and
therefore presume that their report is not yet submitted. I have
reason, however, to know that Dr. Clouston's ideas and aspira¬
tions have expanded during the last seven years, and to his
encouragement and help I am mainly indebted for the
success, such as it is, which has attended my own endeavours
to bring the problem nearer solution.

Two and a half years ago, when the new asylum at Bothwell
was opened, we admitted in rapid succession a number of female
patients suffering from serious bodily disease. Gladly availing
myself of the abundant indications for treatment afforded by
them, I at once enlisted the services of the matron (who had
been specially trained to hospital work) and of an attendant
who had been trained in a London hospital. Without much
difficulty we individualised several interesting cases in a way
that stirred up a wholesale envy among the other attendants.
The latter felt keenly their ignorance and inaptitude for
scientific nursing, but they evinced a desire to learn, and we
were not slow to teach them. In going round the wards every
hint or scrap of information was welcomed by them. They
began to share with me an interest in individual cases, and
they soon took pleasure in storing up medical news- for me at
next visit. This new-born zeal rather staggered me at first.
It either proved that I had got an exceptionally good staff of

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462 The Special Training of Asylum Attendants , [Jan.,

female attendants or that attendants as a class had been too
much ignored. Several of them had seen service in other
asylums, and therefore I conclude that they could not be
much above the average. It rather appeared that they had
been too much left out in the cold. I did not, however, jump
to the conclusion that the success of the scheme was assured.
My feeling was still one of hesitation, and the subject of a
course of lectures was broached with some doubt as to the result.
When the edge of novelty wears off will the scheme collapse ?
Will the failure be due to the attendants or to myself? These
were the questions which now puzzled my brain. To give a
lecture, even to attendants, was to me a serious contemplation.
“ Well begun is half done ” became my motto, and the lec¬
tures were started. It may be of interest, and possibly of use,
to mention briefly how the course was conducted. It was
found convenient to write on the black-board an abstract of
each lecture before its delivery. The attendants were allowed
half an hour to copy this abstract, and thereafter about
half an hour was taken up in discussing the several heads
of it seriatim. In this way the class was able to devote
its whole attention to the lecture without the distressing inter¬
ruption of having to take notes. This plan succeeded fairly
well, though I am free to admit that the preliminary note¬
taking involved a severe strain on some attendants. A printed
abstract would obviate this, and make the lectures much more
enjoyable. Diagrams were freely had recourse to, and proved
exceedingly useful. Two written examinations were held. At
these the questions were stated in as homely language as
possible, and a few blank lines were allowed after each to give
room for the answers. The following are examples of ques¬
tions :—(1) What is the meaning of the word function? Show
by an example that you understand it. (2) What should be
done with an epileptic when he is seized with a fit ? State
your reasons. (3) What risks does an epileptic run ? Other
questions were suggested by lectures bn general paralysis,
puerperal insanity, the treatment of epilepsy and epileptic
insanity, the treatment of bed-sores, &c. The result of these
examinations was an agreeable surprise, and it was also a dis¬
appointment to me. The more practical questions were
answered rightly or wrongly by every one. The anatomical
and physiological ones were answered by only about one-half
of those pre'sent, and the answers were fairly good. The
number of lectures was 18 (14 being for mixed classes), and
the average attendance was 20 out of a staff of 26, the de-

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1884.]

463

by A. Campbell Clabk, M.B.

faulters being non-residents and tradesmen. It was not made
compulsory. The attendance at examinations, was—first
examination, 15; second examination, 17. Attendance at 14
lectures, and 65 per cent, or over entitled to a first-class certifi¬
cate. Attendance at 12 lectures, and 35 per cent, or over
entitled to a second-class certificate. The results were as
follows:—Seven received over 65 per cent.; four received
under 65 and over 35 per cent.; and eight received under 35
per cent. The failures were chiefly among the males, and this
in spite of the energetic support of the male officers. They
were often due to sadly deficient education, rarely to want of
natural ability, though sometimes to want of ambition. Lastly,
they were due to exigencies which contrasted the male depart¬
ment unfavourably with the female department. At the same
time I was forced to the conclusion that many of the lectures
had been aimed too high,but nevertheless a careful analysis of the
results encouraged me to persevere when the next winter came,
and to try a more generally practical style. Meanwhile the
training did not stop here. Lectures alone would, compara¬
tively speaking, be barren and unfruitful, and it became my
aim, so far as the time at disposal permitted, to follow them up
with ward teaching. This, for reasons obvious, probably, in
many asylums, was more easily started in the female wards;
indeed, for cases of special interest the male wards, except the
sick ward, have been somewhat neglected in this respect. The
attendants have been trained and encouraged to write brief
notes of individual cases under the direction of the officers
and myself, and interesting symptoms are pointed out from
day to day during the visit, and indications for special vigi¬
lance or new treatment demonstrated. The male attendants
are often glad to be helped in the same way, and facilities were
especially afforded in the case of the sick ward attendant and
the night attendant. The study of general paralysis and
epilepsy, for example, furnished frequently a topic of discus¬
sion and- original remark among the men, and they have
occasionally directed my attention to symptoms which I had
not previously observed, and are encouraged to ask questions
regarding their cases.

The second course of lectures was attended with unabated
punctuality and interest. The interest, indeed, was greater—
perhaps because the lectures were plainer, more easily grasped,
more easily applied to individual patients, and, in a word, more
utilitarian in their scope. The first compared the attendant
of the past with the attendant of the present and the possible

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464 The Special Training of Asylum Attendants , [Jan.,

attendant of the future, and mentioned the various qualities
which wouy fetch a price in the asylum market of to-day.
It endeavoured to show them the value of a special train¬
ing, and to stimulate them to make their work something
more than mere mechanical drudgery. Lectures followed on
the bodily diseases common in asylums, those that could be
guarded against, and the means that lay ready to hand for this.
One lecture was devoted to delusions, hallucinations, suicides,
and homicides, another to asylum accidents treated in detail,
to bed-sores, bathing and its dangers, &c. One more illustra¬
tion will suffice—it was a lecture on Waste and Repair and Sleep,
with special reference to asylum practice. The delivery of the
second course gave me greater satisfaction, and I felt that I
had hit the right nail on the head this. time. Prizes were
offered for the three best essays on hallucinations, each essayist
to select three patients as a basis. Three men and five women
responded, and Dr. Clouston kindly decided their respective
merits. The examinations were well attended, and the result
was most gratifying. Five females and four men got first-class
certificates, one female and three men got second-class certifi¬
cates.

While observing the educational and strictly medical advan¬
tages of the scheme, we must not fail to realise that it is an
agency capable of working good social results as well. Informal
club meetings were held among the attendants themselves.
The lectures and their application to particular patients were
there fully discussed, and thus a kind of mutual improvement
society was established on both sides of the house. This must
be admitted, therefore, to have an elevating social influence.
A keen rivalry existed between the two sexes, not always free
from jealousy and bad feeling, but these were less conspicuous
last session, and further experience will probably find them less
conspicuous still.

Unfortunately we see a good deal of such in our student
days, and can scarcely be hard on our officials when they
exhibit a kindred spirit.

Thus far we have been pioneers in this new venture, but
isolation must ere long sap our vitality, for only in union
is there life and strength. Therefore I come here to-day to
plead the cause of our attendants, to ask the Association to
promulgate what has been done, and to encourage renewed
effort in the same direction. In putting forth this plea I am
fortified by the knowledge, that several asylum physicians have
been led by observation and experience to anticipate its

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1884.] by A. Campbell Clark, M.B.

necessity; by the growth in my own mind, through several
years, of the conviction that a scheme of special training will
materially advance asylum practice; and by the experience
which I have just detailed of how far we can calculate on the
co-operation and intelligence of attendants themselves.

I hope the Association will speak in this matter with no un¬
certain sound; that it will put its hand to the plough with
the determination not to look back; and that it will foster to
the utmost of its power a scheme that, if well-advised and
wisely guided, must surely give a powerful impetus to the
practice of psychological medicine. To prove this new depar¬
ture, and to determine for certain whether it is a good, solid,
sensible thing or a mere bubble, it is necessary for tis to enter
into combination. Considering that so much has already been
done, it seems only fair to give it an honest trial, and thereby
let it stand or fall. This means that in the first place we must
move our asylum superintendents. I admit that this is a
serious consideration, and my expectation for some little time
to come is not over sanguine; but I am not to be disappointed
by further obstacles, and in the meantime pin my faith to some
asylum superintendents and to many assistant medical super¬
intendents. To the latter there is one word worth saying, and
it is this : that to them very especially the scheme offers per¬
sonal advantages, and they can aid very effectually in con¬
solidating it. They will find that not only are their case¬
books very much the better for it, but that they themselves
have acquired methodical habits in the study of cases; that
their knowledge of insanity is wider, better formulated, and
more concrete ; and that they have learned to lecture with ease
and fluency.

I have one more argument with which to enforce my plea,
and it is this: that we are becoming more and more fully
impressed with the idea that the asylum of the future will
partake largely of the hospital type. Our knowledge of insanity
and its appropriate treatment is growing apace. Consciously
or unconsciously we are individualising more. Instead of
trusting to the precarious chance of asylum routine effecting a
cure, we are more fully alive than ever to the merits of a
special study and a special course of treatment for our new
cases ; and the asylum physician is often gratified by results
which he can claim for Ins own hand alone. It is a triumph of
science, a triumph of skill; and if he reflects on the stages
which led up to it, he is struck with the fact that the institu¬
tion appliances on which he depended were more those of an

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466 The Special Training of Asylum Attendants . [Jan.,

hospital than an asylum. And here is the main-spring of a
new idea. He determines that the new wing on the male side
must be an hospital in the best sense of the term. The hos¬
pital is constructed; it realises every hopeful expectation, and
then the principle is extended to the female side with a like
happy result. But still this ambitious man is not satisfied;
there is just one screw loose. The attendants are not suffi¬
ciently trained and elevated to fit into the new order of things.
The moral of this is obvious. If our asylums are to be more
like hospitals, our attendants, like hospital nurses, must be
specially trained.

And now, in conclusion, perhaps you will allow me to offer
a few suggestions for the future of such a scheme—suggestions
which may help to lift it on to another and surer basis, and
which I hope you will endorse to-day :—

First .—I would suggest that by authority of the Medico-
Psychological Association a simple and merely tentative ar¬
rangement should be come to whereby those superintendents
who are willing to give the experiment a fair trial shall enter
into a combination for two years at least.

Second .—That this combination shall merely experiment to
the extent of supplying a special training, not compulsory, con¬
sisting of lectures in winter and ward teaching so far as the
exigencies of their respective asylums will allow, and also to
the extent of furnishing a special certificate, first, second, or
third class, according to efficiency and duration of service.

Third .—That a register of attendants who have received
certificates be printed and circulated at the end of two or three
years, by authority and at the expense of the Association.

Fourth .—That the gentlemen forming the combination con¬
stitute a Committee, empowered to make arrangements and
rules for the carrying out of such an experimental scheme.

My ideas go much further than this, but it is wiser to take
one step at a time, and thus safely float the venture. I may
here state that Dr. Clouston requests to have his name put
down as one of those desirous of entering into combination in
a manner such as has been indicated, and it is perhaps need¬
less to say that I follow suit. If the body psychological will
now take the matter under its wing I shall be glad to give
what help I can.

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1884.]

467

Is Legal Responsibility Acquired by Educated Imbeciles ? *
By G. E. Shuttleworth,. B.A., M.D., &c., Medical
Superintendent, Royal Albert Asylum, Lancaster.

Bead at the Section of Psychology of the British Medical Association, Annual
Meeting at Liverpool, Avgust, 1883.

The question of the legal responsibility of the insane has
been frequently under discussion both by legal and medical
writers; and its conditions and limits must, I fear, still be re¬
garded as far from settled; divergent views being held, perhaps
naturally, according to the standpoint respectively taken up by
the lawyer and the physician. “ A lawyer, when speaking of
insanity/ 5 says Sir J. F. Stephen, “ means conduct of a certain
character ; a physician means a certain disease, one of the
effects of which is to produce such conduct/ 5 It is somewhat
remarkable that the legal responsibility of the idiot, and of his
milder congener, the imbecile, has hitherto hardly been deemed
worthy of discussion ; but a recent law case, in which several
patients under my care were concerned, has led me to think
that a few remarks on the subject may not be altogether un¬
interesting or unprofitable.

It would seem that the earliest legal definitions of madness
correspond rather with the mental states now known as amentia
and dementia than with the acute forms of insanity. Thus
Bracton in the thirteenth century speaks of a madman
( furio8us ) as “ one who does not understand what he is
doing ( non intelligit quod agit ), and, wanting mind and reason,
differs little from brutes/ 5 Littelton “ explaineth a man of no
sound memorie to be non compos mentis” Sir Edward
Coke, commenting on the above, is the first to recog¬
nise different classes of mental unsoundness, describing
four kinds of men who may be looked on as non compos
mentis, f “ 1* Ideota, which from his nativitie by a
perpetuall infirmitie is non combos mentis. 2. Hee that by
sickness, griefe, or other accident, wholly loseth his memorie
and understanding. 3. A lunatique that hath sometimes his
understanding and sometimes not, aliquando gaudet lucidis
intervallis , &c.; and lastly, Hee that by his own vitious act
for a time depriveth himself of his memorie and understand-

* Throughout this paper the term imbecile is used to denote a person suffer-
ing from mental deficiency, either congenital or supervening in infancy, the
degree of such deficiency being less than that denoted by the term idiocy.

t “ Coke upon Littelton/’ 247A.

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468 Legal Responsibility of 'Educated Imbeciles , [Jan.,

ing, as hee that is drunken.” The first two classes are indeed
in old writers both described under the name of idiot ; No. 1
being idiota a nativitate, and No. 2, idiota a causd et in -
firmitate. I note in Paris and Fonblanque's “ Medical Juris¬
prudence ”* cases cited in which it had been stated “ that an
inquisition finding that a person had not had any lucid inter¬
vals per spatium octo annorum, was a good finding of idiocy,”
lunacy being evidently regarded as possessing different charac¬
teristics from idiocy . It was reserved for a later age legally
to confound and confuse under the common designation of
hmatic “ any person found by inquisition idiot, lunatic, or of
unsound mind, and incapable of managing himself and his
affairs” (16 and 17 Viet., c. 70, and 25 and 26 Viet., c. 86).
Henceforward the essential difference between the imperfect
and ill-ordered mental action of idiocy and the deranged and
disordered mental action of insanity seems to have been
somewhat lost sight of in the course of legislation ; in some
sense, indeed, idiocy may be likened to the Cinderella of the
unhappy family under the jurisdiction of the Lunacy Com¬
missioners.

Notwithstanding this confusion it would seem that there still
lingers in legal authorities some notion of the idiot's in¬
dividuality. Thus in a recent case of homicide, the proof of
which, so far as eye-witness was concerned, depended upon the
testimony of imbeciles,t “ Archbold’s Criminal Pleading ” was
quoted to the effect that “ an idiot shall not be allowed to give
evidence, but a hmatic during a lucid interval may.” The
case referred to was that of an imbecile lad, an inmate of the
Royal Albert Asylum, who, having been startled and provoked
by a younger patient suddenly denuding him of his bedclothes,
jumped out of bed, knocked down his assailant, and bumped his
head against the floor with such effect as to cause death from
fracture of the skull, which was abnormally thin. The attendant
was temporarily absent from the dormitory on a necessary duty,
but the affray was witnessed by several imbecile boys who were
awake at the time, and, of these, three, who seemed best able
to give an account of what they had seen, were tendered as
witnesses at the coroner's inquest. The Coroner (Lawrence
Holden, Esq.), in opening the enquiry, said : “ Some of the
evidence would be peculiar in this respect—that they would
have to rely on the evidence of boys who were imbecile
if not idiotic. If the doctor, who would be called before them,

* “ Medical Jurisprudence,” Paris and Fonblanque (London, 1823), Yol. i., p. 290.
t “ Archbold, C. P.,” p. 288.

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469

1884.] by Gr. E. Shttttleworth, M.D.

said that the boys who witnessed the transaction were able to
give evidence, he (the Coroner) should receive that evidence.
It Was for the Coroner to admit such evidence as he thought
proper, and it was for the jury to decide afterwards upon the
amount of credibility they would attach to that evidence/ 5
Accordingly as each imbecile witness was tendered for examina¬
tion I was called on to state that in my opinion he was €i cap¬
able of judging between truth and falsehood, and able to give
credible testimony. 55 Three imbecile lads were consequently
allowed to give evidence, and in one case in which speech
(owing to partial paralysis) was indistinct, T was permitted to
act to a certain extent as interpreter, the Coroner being also
good enough to accept some of my suggestions as to the form
in which his questions would be most intelligible to the wit¬
nesses. Under these circumstances the evidence of the lads,
who were sworn in the usual way without special interroga¬
tion as to their views of an oath, was sufficiently clear and con¬
sistent to obtain credibility from the jury, who accordingly
returned a verdict of manslaughter against the accused.

At the magisterial inquiry which followed at the' County
Petty Sessions, the competency of the imbecile lads to give
evidence was objected to by the solicitor for the defence, who
quoted from Archbold the dictum that “ an idiot shall not be
allowed to give evidence, 55 (this being founded upon “ Coke upon
Littelton, 55 6 B), and maintained that in the absence of any pre¬
cedent to the contrary “ a boy coming from an asylum for
idiots could not give reliable evidence. 55 Fortunately the
Bench was particularly strong in legal acumen, amongst the
sitting magistrates being W. H. Higgin, Esq., Q.C., and E. B.
Dawson, Esq., LL.B., both members of the Bar. The former,
while admitting a primd Jade objection to the competency of
a boy coming from an idiot asylum, said that, nevertheless, if
he should be found on examination “ to believe in the existence
of a God, and to believe in a future state either of reward or
punishment; if he knew what telling an untruth was, and if in
kissing the Testament he knew what that kissing meant,
although that boy did come from an idiot asylum still he might
be a perfectly competent witness. 55 Mr. Dawson remarked
“ that the authorities quoted by the solicitor for the defence were
old ones, though they might be very good for the time in which
they were written, when it was considered that a person suffer¬
ing from amentia could not be a credible witness nor his
position improved; but they knew that by the care which had
been bestowed in recent years upon such persons, a degree of

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470 Legal Responsibility of Educated Imbeciles , [Jan.,

information had been imparted to them that they might be
accepted as competent witnesses. The question was whether
they should go back to the days of Coke and Littelton, and be
ruled by their judgments which were given according to the
lights they then had.” Ultimately it was decided to follow the
procedure in the case of Reg. v. Hill, and I was examined as to
the first witness’s information as to religion and the nature of
an oath, and also as to the degree of his mental deficiency. I
was able to say that he knew it was wrong to tell a lie, as he
had stated to me that persons who told lies after kissing the
Testament were (to use his own-words) first “ shut up in the
Castle, and then if they died went to the old fellow with the
fork ! ” Interrogated as to whether the boy was admitted into
the asylum as an idiot , I explained that he was an imbecile of
a comparatively high degree of understanding, and not an
idiot in the sense of being entirely destitute of intelligence.
He could now read and write imperfectly, and was a capital
workman in the joiner’s shop, though only fifteen years of age.
Thereupon the lad was called into the box, and a number of
questions were put to him by the Bench and through the honorary
solicitor of the Asylum with a view of ascertaining how far he
understood the nature of an oath. These questions being
addressed to him by persons with whose converse he was un¬
familiar, were evidently not fully comprehended by him. To
the question, “ What do you mean by an oath ? ” no intelligible
answer was given; but when by way of explanation he was
asked, “ Can you tell us anything about swearing ? ” the reply,
“ It’s what bad lads do,” argued, I think, some acquaint¬
ance with the third commandment! In the result the magi¬
strates ruled that in consequence of the unsatisfactory replies
of this lad to their interrogatory, his evidence was not
admissible, and the same ruling was held to apply to the other
imbeciles who were to be tendered as witnesses. The accused
was consequently discharged by the magistrates, but having been
committed on the Coroner’s inquisition, he was brought up
(from bail) for trial at the Lancaster Summer Assizes.

At the Assizes the Judge (Sir James Fitzjames Stephen)
ordered an indictment to be drawn and submitted to the Grand
Jury, who consequently examined the witnesses upon their
depositions, and apparently took no exception to the imbecile
evidence, as they found a true bill against the accused. The
accused was accordingly put forward in Court to be arraigned,
but the Judge, interposing, directed that the jury should be
sworn to decide “ whether the poor boy was in a condition to

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471

1884.] by G. E. Shuttleworth, M.D.

plead in answer to the charge against him—not whether he was
guilty of manslaughter.” I was thereupon called to depose to
his state of mind, and deposed that in my opinion he was not
able “ thoroughly ” to understand the nature of a criminal
trial; that his mental condition was that of imbecility; and
that he was unable to plead. On his Lordship's direction the
jury found that “ the prisoner was not able to plead,” adding
also “ that he was not answerable for his acts.” The accused
was consequently discharged to the care of his father, who was
bound over in his own recognisances to produce the lad for
trial when called upon, the Judge having previously satisfied
himself of the safety of that course.

This case involves the two-fold question of the civil
capacity and the criminal responsibility of educated imbeciles;
for I presume that, had it been established that the imbecile
witnesses were competent to give evidence on oath, the penalty
for perjury would certainly have attached to them in the event
of false statements. The further question of the degree of
responsibility for crime which may fairly rest upon an imbecile
according to the degree of his mental development was, owing
to the prisoner being declared unable to plead, not entered
upon in court, though it comes within the scope of our present
discussion.

In considering the question of civil capacity we will first
look at that aspect in which it has already come before us,
viz., the competency or otherwise of an imbecile to give
evidence in a court of justice. The ancient objection already
quoted, that “an idiot shall not be allowed to give evidence,”
may, I think, soon be disposed of by inquiring what meaning
formerly attached to the term idiot. If we turn to “ Black-
stone's Commentaries,” Book I., p. 302,’ we shall find this
definition: “ An idiot, or natural fool, is one that hath no
understanding from his nativity, and therefore is by law pre¬
sumed never likely to attain any.” For such an idiot no one
could possibly claim competency to give evidence. But on
p. 304 we read : “ A man is not an idiot if he hath any glim¬
mering of reason, so that he can tell his parents, his age, or the
like common matters.” We may, I think, therefore fairly
cite Blackstone as not shutting out from personal rights such
imbeciles as are found in the higher classes of our Training
Institutions. Having regard to the very various gradations
of mental power which we find even in the same school-class
of imbecile pupils, it seems to me it would be impracticable to
formulate any test of competency of universal application;

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472 Legal Responsibility of Educated, Imbeciles , [Jan.,

but some analogy may perhaps not unreasonably be traced
between the lucid or illuminated portions of the imbecile's intel¬
lect and the lucid intervals of the insane, and competency be
measured by lucidity. Thus an imbecile may be able to give a
correct account of the successive incidents of a transaction which
he has recently seen, because his general powers of observation
have been cultivated; at the same time, he may go utterly wrong
if asked (for instance) how many times a blow was struck, from his
incapacity to count or comprehend the meaning of figures. It
would be as unjust to reject the whole evidence of such an one
on account of his failure with regard to numbers, as it would
be to reject that of a colour-blind man with regard to the
incidents of a street fight because he might mis-describe the hues
of the costumes of the combatants. Then, again, with respect
to the understanding by an imbecile of the nature and moral
obligation of an oath, it may (I think) be fairly argued that
if he understand that he is punishable * both here and here¬
after for falsehood after having solemnly promised (by kissing
the Testament) to speak the truth, he understands all that is
essential, though he may not be able to explain his theological
views in open court. On the important subject of the
testimonial capacity of imbeciles, I may quote the remarks
of Mr. Balfour Browne.* “ In many cases,” says he,
" imbeciles are competent to give very useful evidence, and to
-further the ends of justice, which but for their evidence could
not be efficiently promoted. The question of the credibility
of a person of weak mind, which is left to the jury, is very
much the same as that which falls to be considered by them
with respect to witnesses who have scarcely reached the years
of discretion. In the case of R. v . Perkins, Alderson, B.,
said: i€ It is certainly not the law that a child under seven
cannot be examined as a witness. If he shows sufficient
capacity on examination a judge would allow him to be sworn.”
In many respects idiots are to be regarded as children, and
their evidence, where it is unsatisfactory, will have failed in.
virtue of the same, or similar, qualities which take from the
excellence of the testimony of very young children.” The
mental plasticity of imbeciles is another point in which they
resemble children, and the possibility of their being tutored to
relate as matters of observation what is really but an “ oft-
told tale ” must not. be lost sight of. Some caution also is
jjecessary with regard to their evidence on matters which are

* “Medical Jurisprudence of Insanity,” p. 305.

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473

1884.] by G. E. Shuttleworth, M.D.

not recent* as many educated imbeciles have but indifferent
memories for events at all remote.

I do not propose to do more than make a passing reference
to the capacity .of educated imbeciles to enter into contracts
and otherwise manage their own affairs. Personally I have
known very few who might prudently be allowed to do so,
for figures and accounts are almost invariably ill understood
by imbeciles, though, if my memory serves me, I have read
of a former patient of an idiot asylum who was acting as
agent of a loan society! With the majority, however, the
safest course is certainly a life-long tutelage, and now that the
Crown no longer claims the profits of the estate of one found
idiota a nativitate , there seems but little hardship in a per¬
petual infancy under the guardianship of Chancery. The con¬
tract of marriage is certainly one into which no imbecile, how¬
ever well educated, should be permitted to enter.

Passing now to the question of the criminal responsibility of
idiots and imbeciles, I think I cannot do better than quote
from fihe admirable chapter on the Eelation of Madness to
Crime in Sir J. F. Stephen's “ History of the Criminal Law
of England."* The learned author, after referring to the
hypothesis “ that certain forms of insanity cause men to live as
it were in waking dreams," goes on to say that “ knowledge has
its degrees like everything else, and implies something more
real and more closely connected with conduct than the half¬
knowledge retained in dreams. This last observation is
specially important in connection with the behaviour of idiots,
and persons more or less tainted with idiocy. Such persons
will often know right from wrong in a certain sense, that is to
say, they will know that particular kinds of conduct are usually
blamed, but at the same time they may be quite unable to appre¬
ciate their importance, their consequences, and the reasons why
they are condemned, viz., the suffering which they inflict and
the alarm which they cause. An idiot once cut off the head of
a man whom he found asleep, remarking that it would be great
fun to see him look for it when he woke. Nothing is more
probable than that the idiot would know that the people in
authority would not approve of this, that it was wrong in the
sense in which it was wrong for a child not to learn its lesson,
and he obviously knew that it was a mischievous trick, for he
had no business to give the man the trouble of looking for his
head; but I do not think he could know it was wrong in the

* Stephen's “ Hist, of Crim. Law,*' Vol. ii., p. 166.

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474 Legal Responsibility of Educated Imbeciles . [Jan.,

sense in which those words are used in the answer of the judges
to the House of Lords ”— (i.e.> in McNaghten’s case). The view
thus lucidly set forth by a distinguished judge will, I think, com¬
mend itself to all who have had practical acqaintance with imbe¬
ciles. Truly “ knowledge has its degrees/ 5 and the degree of
knowledge in the case of the educated imbecile will, of course,
vary with his original capacity and the degree of mental
development which has resulted from education. It will
require but little capacity or education to know that a blow
hurts, or even to learn that it is wrong to hurt a companion.
To know that a blow on the head may cause death by frac¬
turing the skull is a higher degree of knowledge, only to be
imparted to the imbecile by special instruction; for without
this he may very possibly imagine that such a proceeding
may produce no more grievous bodily harm than it apparently
does in the case of Punch and Judy. It is obvious that the
same measure of criminal responsibility cannot justly be held
to attach to the imbecile with the higher and to the imbecile
with the lower degree of knowledge, though in both cases
there may be said to be some knowledge of right and wrong.
While I should be the last to advocate the plenary punishment
by law of any congenital imbecile, however much improved by
education, I think it a dangerous doctrine that such persons
should escape all punishment simply because they have been
imbecile. The punishment should (it seems to me) bear some
relation to the degree of knowledge of right and wrong
possessed by the individual, allowance being moreover made
for the defective judgment which may, in a particular case,
interfere with the application of such knowledge. At best, the
knowledge and judgment even of an educated imbecile must
be reckoned as imperfect by the side of those of his “ normal 55
fellow-man; and though committing things “worthy of
stripes 55 his stripes should in comparison be few. Yet I think
we may fairly claim that, along with the knowledge imparted
by education, the imbecile does acquire responsibility in
measure and degree, so that to him also society may apply,
always with a wise discretion, the Scriptural maxim, c • To whom
men have committed much, of him they will ask the more. 5 ’ *

* It may perhaps be well to add that the unfortunate subject of the judicial
investigations above referred to was but little improved by education, so that
his case hardly falls within the scope of the concluding remarks.

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1884.]

475

Definitions of Insanity. By William R. Httggabd, M.A.,
M.D., M.R.C.P.Loncl.

Read at the Section of Psychology of the British Medical Association t
held at Liverpool August 2nd > 1883.

An old teacher of mine, in days gone by, used frequently to
remark in his lectures on Logic that the test of accurate know¬
ledge is the ability to give an exact and comprehensive
definition. Now, if this criterion were applied to us, alienists,
in regard to the subject we are supposed to know most about,
the result would, I fear, be somewhat disastrous, and not at all
likely to shed lustre on our speciality.

To start with, let us have a clear idea of what we want to
do when we wish to define a word. What is a definition ? A
definition expresses the meaning of a word, and that only; it
fixes by language the connotation of a general name. It
states the essential points in which all objects agree to which
the term can be applied—those points of community the
absence of one of which warrants the refusal of the name. It
follows from this, of course, that a definition is a verbal or
identical proposition. It does not convey any new fact; it
does not state anything capable of proof or disproof. It only
expresses in full what is meant when the word is employed. If
it increases our knowledge, it is only because a clear idea is
substituted for a hazy one.

We are now in a position to look into the opinions of those
who say that insanity cannot be defined. One view holds that
insanity is a simple or ultimate fact, incapable of analysis or
resolution; that, as c whiteness 3 can be explained only by
showing white objects, so insanity can be explained only by
exhibiting insane persons. The test of this opinion lies in the
possibility of analysis, and that test shall presently be put in
action.

Another view states that the manifestations of insanity are
so various and contradictory that no one definition can include
them all. This, it appears to me, is the essence of the diffi¬
culty ; though the language employed clouds the real aspect of
the facts. The true import of the facts, the accurate expres¬
sion of the difficulty, is this : The term insanity is arbitrarily
restricted by custom to certain cases, some of which do not
differ in essence from cases to which the name is not applied.
The delirium of fevers and that due to drugs are not ordinarily
termed insanity. Yet if a crime were committed in the delirium
xxix. 33

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476 Definitions of Insanity , [Jan.,

of fever there can be little doubt that a plea of temporary in¬
sanity would be allowed. In delirium from drugs the test of
legal responsibility, according to Dr. Chevers, is the question
whether the unsoundness of mind was wilfully caused by the
person himself. Under some circumstances, therefore, and for
some purposes, it will be acknowledged that the delirium of
fever and the delirium of intoxication would be classified as
insanity. The circumstances, nevertheless, that determine
such an opinion are purely accidental or extrinsic, and have
no reference to the essential phenomena observed in the
patient. The delirium of fever would be called insanity if it
led to crime. If bhang, taken by compulsion, brought on a
state of frenzy, this, too, would be called temporary insanity.
The mental derangement in intoxication differs from some
cases of universally recognised insanity only in the different
duration of the symptoms. And yet chronicity is properly re¬
garded by all as not being an essential factor of insanity. In
essential points it follows, therefore, that these cases are iden¬
tical.

We see, then, that custom makes arbitrary restrictions,
restrictions not founded on essential points. It is not to be
wondered at, thpn, if it is found difficult to define insanity
when an attempt is made to reconcile science and custom as it
stands at present.

Glance at the current definitions. One of the features most
commonly regarded as an essential is that the mental symp¬
toms must be caused by disease. This view appears to me to
be open to two objections. It is unsound in point of logic and
too narrow in point of fact.

As to the logic, supposing it to be true in fact. There
are two reasons here why the causation should not be included
- in the definition. The statement of the cause is a real, not
a verbal or identical proposition. It is not involved in the
meaning of the term. If in a case of insanity it could be
discovered that there were no disease, we should not on
that account refuse the name. The second reason why it is
bad logic to define insanity by disease is less technical. It
is this. The definition moves in a circle. Insanity proves that
disease is present, whilst in its turn the disease proves the
symptoms to be insanity. It would, indeed, not be illogical to
say that insanity is a disease, meaning thereby that the term
disease might be applied to the group of phenomena charac¬
terising every case of insanity. Such a use of the word
“ disease” would not, however, be in accordance with the

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1884.] by William R. Huggard, M.D. . 477

meaning given to that word in the other applications of it, as I
think will presently be seen.

Another view taken of insanity is to say that it is a condi¬
tion of mind in which the free-will has been destroyed*by
disease. This point, and the question whether disease is
always present in insanity, will be dealt with in the exposition
of the view now to be laid before you.

In the first place, and chiefly, then, insanity, as I understand
it, must be regarded as a relative term—as a social or legal ex¬
pression rather than as a medical one. It is, indeed, frequently
said that insanity is a relative term—that what is a mark of
insanity in one case is not a mark of insanity in another. It
is not, however, in this comparatively trivial sense—the rela¬
tive value of the marks of insanity in different cases—it is not
in this sense that I use the expression r relativity/ I use it
in reference to the notion of insanity itself; that insanity is
relative to what may be termed the standard of sanity ; and
further, that this standard of sanity is not a fixed and definite
thing; that, on the contrary, it varies from time to time and
from place to place, and that it has a constant tendency to rise
with the progress of civilization.

The notion of insanity understood as a relative term involves
still two elements. One is mental defect, congenital or acquired;
the other concerns the nature and amount thereof.

In short, then, insanity may be said to be any mental
defect that renders a person unable to conform to the require¬
ments of society .

This definition comprises three notions—mental defect,
inability, and the requirements of society. Two of these, in¬
ability and the requirements of society, must themselves have
their meaning fixed.

To understand the meaning of ability or inability as used
in the definition, it is needful to glance at the relationship
between body and mind. As this point is fundamental, and
as a clear grasp of it is essential to the right consideration
of insanity, I trust I may be pardoned for recalling a few facts
well known to all.

I am not going to take up your time with a discussion of
the free-will controversy. I may say further that ontological
questions touching the nature of mind and of matter are alto¬
gether irrelevant. Matter may be only a mode of mind, or
mind may be only a function of matter. It does not concern
us. Even allowing that mind and matter are both separate
and independent entities, we have nothing to do with the

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*478

Definitions of Insanity , [Jan.,

nature of the connection between them, or with the way in
which one acts on the other. We may think with Descartes
that there is a system of Occasional Causes; that when the
mind makes a resolution, God prompts the body to the neces¬
sary movements for the performance of it. Or we may think
with Leibnitz that there is a Pre-established Harmony—that
the mind and body were originally so tempered and welded to¬
gether, that the mental effort and the physical movement are
simultaneous ; that, in fact, body and mind, like two clocks,
are wound up to go together.

It was needful to say so much to prevent misapprehension.
Our sole object is to express the fact of the concomitance of
mental and nervous action, and to state the laws that bind
together the two series of phenomena—mind and matter.

The general laws connecting body and mind may, I think,
in so far as they concern us, be formulated somewhat in this.
manner :—

I. —The brain is the organ of mind, and all mental action is
preceded or accompanied by molecular changes in some
part of the higher nervous centres.

The evidence of this law is found in various facts. (1)
Prolonged mental exercise induces a sense of fatigue in the
head, just as prolonged gymnastic exercise produces a sense of
fatigue in the muscles. (2) Injuries and diseases of the brain
are attended with mental symptoms. The facts put before us
by experimental researches on the functions of the brain are of
especial value in this connexion.

A second law of wide reach, which may be called the Law
of Quality or of Kind, may be expressed as follows :—

II. —As is the constitution or structure of the brain, so
will be the mind and character; and likewise, if it be pre¬
ferred, as is the mind and character so will be the
constitution and intimate structure of the brain.

The proof of this law lies in three sets of facts: (1) the
correlations of the anatomy and psychology of man, (2) the com¬
parative anatomy and psychology of man and the lower
animals, and (3) heredity. There is a gradation in brains
corresponding to the gradations in mind. Idiots are defi¬
cient not merely in mind ; they lack also the brain develop¬
ment. Moreover, heredity displays itself in mental not less
than in physical characteristics. In such cases it is clear that
the finer shades of character are determined by organization.

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1884.] by William ft. Huggard, M.D.

A third law, which might be called the Law of Plasticity,
may be formulated thus :—

III.—Mental action tends to modify the constitution of the
nervous tissues.

It is necessary here to guard against misconception frotn
the phraseology employed. Any of these laws could be ex¬
pressed either in terms of mind to suit the Idealist, or in
terms of matter to suit the Materialist. In the case of the
present law, for example, it might be said that the molecular
changes that accompany mental changes tend to become them¬
selves ingrained in the constitution or structure of the nerve-
cells. Nevertheless, such language, however correct it might
be, would fail for the purpose in hand. It would obscure or
altogether hide the part of the law that is significant for us;
that the mental phenomena—thoughts, emotions, and volitions
—re-act on the body so as to mould its configuration. This is
the ultimate meaning of education; and it is recognized in the
popular expression, “ formation of character.” In accord¬
ance with this law, too, habits are formed. The emotions,
moreover, stamp their impress upon the face; and the expres¬
sion in repose denotes the predominant cast of mind. All the
facts illustrating the effects of mind upon body are in point.
Ideas become actualities. Sydenham could always bring on
an attack of gout by thinking of his great toe for half-an-hour.
This law, observe, is expressed rather as a tendency than as
a fact. The limits within which it is operative are fixed by
the Law of Quality or Kind.

These are the chief laws that regulate the interaction of body
and mind. Whatever may be the ultimate nature of mind,
there can be no doubt that it conforms to the material laws im¬
posed upon it by its bodily organ. If mind be not a function
of brain, it is at least held in absolute thraldom by it. Not¬
withstanding this, our attention must be directed, not to the
physical phenomena,* but to the mental; and for a very
obvious reason. The presence and the nature of the mental
phenomena are indicated with tolerable certainty by various
marks; but the nature of the molecular changes that underlie
a brilliant thought, or an insane idea, are alike beyond the
reach of human eye. The important thing to remember is
that the brilliancy and the insanity are equally impossible
without the molecular changes; and that the nature of these
changes, the circumstances that determine whether the thought
shall be a spark of wit or an insane delusion, depend altogether

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480 Definitions of Insanity , [Jan.,

on antecedent physical causes, such as organization, congenital
and acquired, as well as the molecular changes immediately
preceding. Even supposing the mind to be a separate and
independent entity, it must have an organization of its own,
and obey laws as unbending and of the same nature as those
that govern the instrument it uses.

From these facts it is evident that they err who say that the
freedom of the will may be lost by disease. Leaving out of
the discussion the expression “ free will/ 5 we find that not
less in health than in disease does the material organ
determine the thoughts, desires and actions. But, perhaps,
there may be a grain of truth underlying what they
say; or, perhaps, they mean something which is true
though by the form of expressing it they make it false. In
health the thoughts and actions — the “ choice ”—are in
harmony with the previously known mental organization; in
diseases of the brain, accompanied by insanity, the mental
phenomena are out of harmony with the only previously
known factor, the mental organization, though they are still of
necessity conformable to the physical organization. Thus in
health, mind obtruding itself we are apt to forget that it is for
us indissolubly linked to body, and consequently obedient to
the laws of the matter that serves it. In disease it preserves
the individuality thus fallaciously obtained; but here its total
subjection to matter can no longer be concealed. It is, how¬
ever, glossed over and disguised by recognizing merely the
subjection of the will.

Those who have followed me so far will have no difficulty in
understanding what is meant by ability in the definition. It
means not so much, “Is he able?” as “Can he be made
able ? ” Do the nervous structures, or if it be preferred, does
the mental organization possess such plasticity that it can be
educated up to the required standard ? To put the matter in
a less general form, in what does the lunatic who breaks the
law differ from a criminal ? The lunatic is not able to conform
to the requirements of society, and cannot be made able. The
criminal, on the contrary, though he may not have been able
to withstand his temptation, will, if he is punished, be able to
withstand it next time. In other words, if a man breaks the
law he is either a criminal or a lunatic. If, owing to mental
defect, punishment will not cure him, he must be regarded as
insane; in other cases, as a criminal. •

We come now to the last term in the definition, the require¬
ments of society. It is in considering this point that we see
the broad sense in which insanity is .a relative term*

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1884.] by William R. Huggard, M.D. 481

It is generally recognized that sanity and insanity shade into
each other by insensible gradations; that they are not sepa¬
rated by any sharp line of demarcation ; that though the
extremes are clearly contrasted, the margin of transition is
broad and ill-defined. This is true so far as it goes, but it
falls short of the whole truth. Thus the opinion seems to
prevail that the line of separation, though not clearly marked,
is one altogether of Nature’s making. We have good reason
for thinking, however, that this is not so; and that the line is
to a large extent conventional. Nature makes a broad margin
of gradations, but the circumstances that determine in what
place the line should be drawn are the result chiefly of con¬
vention and of accident.

Thus it can be readily understood, on the one hand, that a
man able to conform to the laws of a primitive society, may be
absolutely incapable of complying with the exacting require¬
ments of a more advanced community; and on the other hand,
that a man able to take care of himself in a pastoral or nomad
stage of civilization may require to be taken care of in the
more sharp-witted and dishonest civilization of to-day, when
people rob not so much by violence as by fraud. In the
lower types of society less self-control is required on the one
hand, and less brains on the other.

For example, amongst a barbarous and ferocious people, the
fury of the epileptic, the paroxysmal violence of the general
paralytic, and the boisterous excitement of acute mania if
evanescent, might in some cases differ so little in outward
appearance from the normal manifestations of undisciplined
passion that they would be passed over as transient outbreaks
of temper. Again, there is a variety of mania to be found
in every asylum, the manifestations of which are almost
identical with slight intoxication. The mind is always in a
state of excitement of one kind or another. The ideas flow
with great rapidity, but are bound together not so much by a
natural or logical association as by the varying emotion of the
moment, or by some accidental connection, such as verbal
similarity. Speech, though not actually incoherent, is incon¬
secutive. These lunatics are mischievous and cunning. Though
they lack self-control, yielding to every passing impulse, they
can, like drunken people, pull themselves together, so to speak,
under the spur of a strong emotion or of impressive circum¬
stances. Thus at times they can hide their delusions, if they
happen to have any, and can talk connectedly and with as
much shrewdness and common sense as any sane man.

Who can doubt that, in a stage of civilization somewhat

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482

Definitions of Insanity, [Jan.,

lower than ours, such persons would be regarded as of sound
mind ? To this it may be answered that the reason would
simply be that their insanity was not recognized; that they
were not the less on that account really insane.

This answer will not, however, stand examination. It pro¬
ceeds on that narrow and erroneous view of insanity that
regards it as something fixed and absolute, and not merely as
a relative term.

It may be laid down in general terms that the question of
insanity cannot arise except in regard to matters that are below
the general standard of the particular society. There can be
no insanity in matters that are indifferent. It would be un¬
meaning to talk of homicidal mania as a form of insanity
where murder is a recognized social habit. If one of the assas¬
sins of the Middle Ages, or one of the Thugs of India felt a
homicidal impulse, he had no difficulty in satisfying his desire at
once. Amongst the Kamtschadales murder, suicide, adultery,
and rape were looked on as in themselves quite indifferent
matters ; while to rescue a man from drowning was regarded
as a mortal sin. In this last case there might be some sus¬
picion of a man’s intellect if he saved a friend's life, but none
n he destroyed.it. Hence the derangements in question if
recognized would only be regarded as diseases of the nervous
system, not accompanied by insanity.

What is meant by the requirements of society or the mental
standard may be further illustrated by one or two examples
from our own times and from our own country. Take the case
of sexual excesses. A sexual tendency that overbalances pru-^
dence and conquers self-control would in a young lady of high
station be regarded as nymphomania, and would be held to
warrant any restraint that might be necessary. In a young
man of the same circumstances, the case would be looked on
simply as one of “wild oats.” Disease is not necessarily
present any more in the one case than in the other. Should
public opinion ever come to condemn sexual excesses as severely
in men as in women, an attempt to sow “ wild oats ” will be
regarded as a definite form of insanity. Habitual drunkenness
is another example. It may be said to be in a stage of transition.
Not until recently has it been held to be a form of insanity.
One author of eminence still holds it to be a vice, and nothing
else. A hundred years ago drunkenness was thought nothing
of. A hundred years to come the insanity of the habitual
drunkard will be unquestioned.

An instructive case of “ Emotional Insanity with Homicidal
Violence ” is recorded in the “ Journal of Mental Science ” for

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483

1884.] by William E. Huggard, M.D.

Jan. 1882. A young lady of mixed blood (father an English¬
man, mother a Persian) had a most ungovernable temper. On
one occasion she made a fierce attack with a pair of scissors on
another lady. Upon this she was put in an asylum, and the
Commissioners in Lunacy approved of the step. The writer
of the article, however, though he regarded her confinement
as perfectly justifiable, nevertheless did not consider her
insane, and he accounts for her temper by her racial charac¬
ters and by her mixed descent. As I understand the word
insanity, that woman was genuinely insane in reference to an
English standard of sanity. She was unable to conform to the
requirements of English society. Her disposition was so
ingrained in her that mere punishment could not cure it.

This case, too, shows why I think it wrong to speak of
insanity as being a disease, much more to its being considered
as of necessity caused by disease. The word disease is too
narrow : insanity may be due not only to disease but to con¬
genital defect. In fact, most cases of moral insanity are of
this last description. The defect may be of the nature of an
original absence of balance of the various faculties or appe¬
tites, or an imperfect quality of the organism characterised by
little plasticity. In the case just mentioned the ordinary
characteristic of one race becomes a defect in a race more
highly organized. A large proportion of what are known as
incorrigible criminals would also be found to come under this
head. And should that day ever come when it is considered
more important to prevent crime than to discover the criminal,
an effective machinery of supervision will put it out of the
power of persons labouring under congenital or acquired
mental defect to damage irretrievably other members of the
community. It is not, as some have declared, a sufficient test
to say that a man differs from his former self; that whereas he
was once amiable and affectionate, he is now irritable and
morose. That this test omits cases of congenital defect where
there has not been a change in the character is decisive against
it. And again, in many cases, though the character is changed
and the change is due to disease, it is not of such a kind or is
not so great in amount as to constitute insanity.

It may perhaps be said that the definition here put forward
does not serve as a test of insanity. It is not meant to do so»
That is not the business of a definition. We may know what
constitutes insanity, and yet be unable to lay down a satisfac¬
tory test, or set of tests, that will indicate unfailingly the
presence or absence of the essential elements. The definition
only shows what we must try to find out.

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484

Definitions of Insanity . [Jan.,

It may further be said, that delusions are not included. But
they are included in so far as they concern us. If a delusion
is of such a kind or of such degree that it does not interfere
with conduct or with the ordinary affairs of life, it cannot,
according to the meaning here given to insanity, be considered
an insane delusion.

One point further requires explanation. A standard implies
that there must be some persons to make the assay; some
persons to judge each case by reference to proper tests. The
standard, in the last resort, is public opinion; and it is
represented indirectly in the professions of medicine and of
law, and directly in a Board of Commissioners.

May I be permitted to say a word here about a definition of
insanity given by Dr. Charles Mercier in a somewhat elaborate
paper on the “ Nature of Insanity ? ” Dr. Mercier defines it
as “ a failure of the organism to adjust itself to its environ¬
ment.” Without criticising the way in which the definition
was reached, I may say that it appears to me to have three
faults. First, it defines an obscure term by others still more
obscure. In this respect it reminds one of Dr. Johnson's defi¬
nition of network. 'That eminent scholar said that network
was “ anything reticulated or decussated, having interstices
between the points of intersection ! v Secondly, it is vague.
What amount of mal-adjustment constitutes failure ? It may
be so understood that it includes, or that it excludes, all persons
whatever. Everyone fails to adjust himself-to his environ¬
ment in some ways. In a broad sense, on the contrary, the
inexorable laws of nature do not permit such a thing as mal¬
adjustment at all; everything fits in perfectly. The third
fault is, that it is too narrow. It does not take account of the
insanity so long as it remains in thought, though it may be
quite evident that it will soon express itself in action. The
failure must first occur. And again, an acute maniac, who,
when put into a padded room, knocks his head against the
wall, adjusts himself to his environment, and so, by virtue of
the definition becomes sane.

In conclusion, I may remark that it is a principle of nomen¬
clature that every term should have a definite meaning, and
that every important idea should have a term to represent it.
I submit that the term insanity has hitherto been without this
definite meaning, and that the meaning I have ascribed to it
is an important and definite idea requiring a term of its own,
and that moreover it is the meaning that underlies every appli¬
cation of the term insanity.

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1884.]

485

On the Pathology of Mania. By Joseph Wiglesworth,
M .D.Lond., Assistant Medical Officer, Rainhill Asylum.

Bead at the Section of Psychology of the British Medical Association ,
Annual Meeting , held at Liverpool, August , 1883.

In investigating the complicated phenomena of mental
action, normal and abnormal, it is not sufficient that we con¬
fine our attention to the nervous system in its latest stage of
development, but we must direct our thoughts to the manner
in which it has been built up; in other words, if we wish to
understand how the nervous system acts, we must see how it
has been developed.

Briefly, then, we consider that there is no essential differ¬
ence between the simplest reflex action and the highest mani¬
festations of intelligence. The nervous arc consisting of
afferent and efferent fibres and intervening corpuscle, shows us
the unit out of which the nervous system is built up ; and it is
by the combination of two or more such reflex arcs, fibres from
which meet in a common centre, that the simplest form of
nervous system is produced, and by the combination* and re¬
combination of an infinite number of such simplest nervous
systems, the highest nervous systems are elaborated. The
union of a number of nerve fibres from a number of nerve cells
in one centre permits of the action of such nerve cells being*
controlled and co-ordinated by that centre ; and by the union
of a number of such centres of co-ordination in one higher
centre it is possible for the numerous plexuses of cells and
fibres individually combined in such lower centres of co¬
ordination to be all co-ordinated together in such higher centre;
and the process of evolution implies a perpetual superposition
of higher upon lower centres of co-ordination, so that what were
at one stage of development, the highest centres, become at a
more advanced stage subject to the control of still higher
centres, and are therefore themselves relegated to an inferior
position, so that when we reach the last term of evolution, at
present expressed, we have an infinity of lower centres of co¬
ordination, controlled and co-ordinated by one or a few higher
centres. These highest co-ordinating centres are of course the
latest developed; but the more recently a nerve centre has
been evolved the less stable is it, and the more likely is it to
give way in an adverse environment.

We arrive, then, at .the important conclusion that the highest

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486 On the Pathology of Mania , [Jan.,

centres in the human brain are the latest evolved , and therefore
the most liable to decay .

I wish to lay particular stress on this proposition, because in
my opinion a full appreciation of it will assist us largely in
our endeavours to comprehend the intricacies of mental
pathology.

In every investigation into the phenomena of Mind it is
necessary to keep clearly in view the distinction between Feel¬
ing and Intellect; for, as Herbert Spencer insists, the former is
the material out of which the latter is formed. Feelings con¬
stitute the inferior tracts of consciousness, out of which in the
superior tracts of consciousness Intellect is evolved by struc¬
tural combination.* Intellect comprehends only the relational
element of Mind. The highest centres in the human brain,
therefore, will consist of the latest evolved relational ele¬
ments.

The proposition here advocated is that Mania is a disease in¬
volving disorder of the relational elements of Mind, and of a
greater or less number of these according to the intensity of
the disease; in other words, what we clinically know as Mania,
has for its material substratum, an affection, functional, or
organic, of the higher co-ordinating plexuses of the brain.

Let us take an ordinary case of Mania, in which an individual
after a period more or less short of mental under-action —so-
called “ Stage of Melancholia ”—passes into a condition of
mental* over-action, the most prominent characteristics of which
are excitement and incoherence. These manifestations are
readily explicable on the theory here advocated. As we saw the
lesion is confined to the higher co-ordinating plexuses of the
brain, and we will suppose it to be of an irritative character.
In the first place, then, these centres will be over-active, and
will inhibit the lower centres in connection with them; but an
individual who has the greater number of his nerve cells in¬
hibited will be to that extent inactive—he will present more or
less of mental torpor, and will probably be described as Melan¬
cholic ; but an irritative action proceeding in the delicate pro¬
toplasmic substance of which a nerve cell is composed will
probably quickly render it functionless; so heie the over¬
activity of the higher centres quickly passes into under-activity,
and the lower centres before inhibited now escape altogether
from the control of the higher, and being neither controlled nor
co-ordinated act over-vehemently and incoherently, and such

* “ The Principles of Psychology,” by Herbert Spencer, Vol. i., p. 192.

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487

1884.] by Joseph Wiglesworth, M.D.

over-action and incoherence will coDtinue until such time as
the higher centres recover their controlling and co-ordinating
power.

Dr. Hughlings Jackson, in a paper to which I have pleasure
in expressing my acknowledgments, has well laid this down
with respect to Epileptic Mania.* “ On removal,” says he,
“ of the influence of some of the highest nervous arrangements
the next lower nervous arrangements, no longer controlled,
spring into activity, and it is from their activity that the
maniacal movements result. On the physical side there is loss
of function of some of the highest nervous arrangements, and
increased activity of the next lower. Correspondingly on the
psychical side there is loss of consciousness and mania.”

This explanation given of post-epileptic. Mania by exhaustion
appears to me to be fully applicable to the cases of what may
be styled Idiopathic Mania, so frequent in asylums.

It is clear on the theory here advocated that the nervous
plexuses, which by their activity produce the manifestations
which we style maniacal, are really the healthy parts of the
brain; and equally clear is it that they make up the major part
of that organ, the actual lesion being confined to a compara¬
tively small portion.

In styling these lower centres as healthy, it is true that they
must be looked upon as hyperaemic; for to say that a nervous
plexus is acting with abnormal vigour, and to say that it re¬
ceives an abnormally large supply of blood, are different sides
of the same question. But what I wish to insist upon is that
this hyperaemia is a purely secondary thing—that it is the re¬
sult of a demand on the part of the nervous plexuses for an
increased supply. And this leads me to consider the current
theory of Mania, viz., that it is due to hyperaemia of the brain;
for whether the hypothesis of higher and lower centres be in¬
voked or no, the theory in possession seems to be that a vaso¬
motor paralysis has led to a general hyperaemic condition of
the cerebral cortex, and it is from this hyperaemia that the
mania is supposed to result. The hypothesis of a vaso-motor
paralysis, due to a primary lesion of the sympathetic, is so con¬
venient a way of disposing of complicated questions in
pathology that one can hardly wonder at the tendency to avail
one's self freely of it; nevertheless, I think it necessary to pro-
• test against the disposition to put everything down to lesion of

* “ On Temporary Paralysis after Epileptiform and Epileptic Brain Seizures ;
a Contribution to the Study of Dissolution of the Nervous System,” Vol. iii.,
p. 443.

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488

[Jan.,

On the Pathology of Mania ,

the sympathetic. This system, doubtless, has its diseases, as
every part of the b<?dy has; but when the contention is between
a primary lesion of the sympathetic and a primary lesion of the
cerebrum, it is desirable to call to mind the relative stability of
the two nervous systems, for the sympathetic system is not
only uniform for the race, but has maintained a more or less
constant character through a long series of inferior organisms;
whereas the cerebrum in its higher developments is of quite
recent origin, and is therefore infinitely more unstable than the
former.

Let me emphasise the position here taken up, viz., that Mania
is a primary disease of the highest co-ordinating plexuses of
the cerebral cortex, and that from the temporary or per¬
manent abolition of the function of these centres the lower
centres—comprising the greater portion of the cerebral cortex
—are thrown into activity, and that the tendency to over¬
action in these lower centres causes, by a reflex stimulus through
the vaso-motor system, an extra supply of blood to be sent to
the parts in question, just as we see when a gland is called into
activity, which increased supply of blood will last just as long •
as the demand for it continues.

A pathological theory to be acceptable should explain not
only the ordinary type of a disease, but also the lightest and
most severe forms under which it occurs ; and the theory here
advocated seems peculiarly applicable to all varieties of mania ;
for in the most trivial forms we should suppose that the very
highest co-ordinating plexuses were alone involved, whilst in
the severest cases we have only to consider that the lesion has
spread in depth so as to involve a much larger number of co¬
ordinating plexuses, to obtain a ready explanation of the
phenomena manifested; indeed, in the very mild forms, the
impression distinctly conveyed to the mind of the clinical
observer is that the individual is to a great extent conscious of
his slight vagaries, but has lost to some extent control over
himself; but this is only another way of saying that his highest
nervous plexuses do not properly inhibit his lower. Again, in
the severest forms, great incoherence goes along with great
excitement; but the greater the number of the higher plexuses
in abeyance the worse co-ordinated will be those that remain,
that is to say the more incoherent will be their action, and they
will act with all the greater activity.

The hypothesis here advocated of the pathology of mania
may be further elucidated by a consideration of the parallel
states of Dreaming and Delirium. If a dream instead of being
buried in the depths of subjective consciousness were acted

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1884.] by Joseph Wiglesworth, M.D.

upon the world's stage it would be called an attack of Mania.
I do not mean that it would be like Mania in every particular,
but it would at least resemble it sufficiently to be nominated
as a species of the genus. Now we have in sleep an anaemic
condition of the brain, which, though possibly not the cause of
sleep, is nevertheless its constant accompaniment; we may
suppose the anaemia to be pretty uniform throughout the cere¬
bral cortex, but this being so, clearly the highest and most
delicate nervous plexuses, will be most plunged in torpor, and
will thus lose their control over the lower, which, themselves
subject to the general paresis, will exhibit activity in a
modified form. It is clear, indeed, that the rest of a nerve cell
is altogether relative, for whilst the function of the highest
plexuses is probably for a time altogether in abeyance during
sleep, the nerve cells which preside over the respiratory move¬
ments for instance are ever vigilant. It is probable, indeed,
that the lower centres in the cerebral cortex are always acting
more or less in ordinary sleep; but it is only when the higher
centres are sufficiently active to take some kind of cognizance
of the activity of these lower centres that we become aware of
a dream.

Take again the case of Delirium, which presents many re¬
semblances to Mania. What is the cause of Delirium ? We
say that it is due to the circulation of impure blood through
the cerebral cortex, which produces degradation of the proto¬
plasmic substance of the nerve cells, and it is doubtless true
that such a state of things would produce abnormal mental
action; but why does this take the form of delirium ? We
have a ready explanation on the principles here advocated, for
the circulation of impure blood being uniform throughout the
cortex, the highest and most delicate nervous plexuses would
suffer first and most—would be involved in a disproportionate
degree to the lower, which for a time at least would be per¬
mitted a period of over-activity and incoherence.

In both these cases we have an agent acting on the whole
cerebrum at once, and it is owing to the disproportionate
extent to which the unstable higher centres are affected, as
compared with the relatively stable lower ones, that the phe¬
nomena in question are considered to be produced ; whereas in
Mania the argument is, that the higher centres are affected
idiopathically, so to speak, and the activity of the lower centres
is manifested without modification.

The question may be further illustrated by a consideration
of the effects of anaesthetics.

How are we to account for the stage of excitement through

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[Jan.,

On the Pathology of Mania ,

which an individual passes, during the administration of chlo¬
roform for instance ? That is, how can the same agent produce
at one moment over-activity and at another under-activity of
nervous action ? We may readily account for it on the prin¬
ciples here advocated; it might be said, indeed, that an indi¬
vidual in the course of Chloroform Narcosis passes through a
very transitory attack of mania; for the action of the anaes¬
thetic must be exercised first and mainly on the unstable higher
co-ordinating centres, through the depression of which the
lower centres are thrown into exalted action, and are permitted
a brief period of activity before they too are overtaken by the
paralysing influence of the drug, and pass into temporary qui¬
escence. The difference in action between different anaesthetics
may be explained by the different degrees of rapidity with
which they make their action felt.

It is not out of place to refer for a moment to the action of
nervine sedatives in the treatment of maniacal excitement. I
think it will be the opinion of all present, that these drugs are
not of much service in an attack of ordinary mania. I do not
mean that they are never of use, but that their employment
has not been attended with the results that might on a priori
grounds have been anticipated. But on the view here advo¬
cated of the state of a maniacal patient’s brain—that it is in a
negative and positive condition—negative as regards the higher
centres, positive as regards the lower—we find an explanation
of the difficulty, for a sedative drug will doubtless exert its
action pretty uniformly over the cerebrum, and whilst it will
depress the positive lower centres, it will doubly depress the
negative higher ones, and thus tend to perpetuate the vicious
cycle.

The terms “ highest centres ” and “ highest co-ordinating
centres" have been frequently made use of in the course of
the foregoing remarks, but though these must necessarily be
situated in the cerebral cortex, no attempt has yet been made
to localise them more definitely; the centres themselves being
in some sense hypothetical, their exact situation must neces¬
sarily be more so, nevertheless data are not wanting to indicate
the path * on which we should travel. The nervous system
sensori-motor in its first beginnings, is sensori-motor in its
latest endings, and the gradual superposition of Intellect upon
Feeling is rendered possible by the gradual co-ordination of
the sensori-motor elements. Herbert Spencer has pointed out
that Feelings correspond to the molecular changes going on in
nerve corpuscles, and Relations between feelings ( i.e ., the In-

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1884.]

by Joseph Wiglesworth, M.D.

491

tellectual Element of Mind) to molecular changes in the fibres
which connect these nerve corpuscles.* But in the course of
evolution, the relational elements are co-ordinated in a series
of centres, and centres of co-ordination imply nerve-vesicles;
therefore there should be in the cerebral cortex a series of co¬
ordinating centres corresponding to the connecting system of
the brain. Does such a system exist ? If so, it should not be
met with in other nervous tissues, but should be peculiar to the
cerebral cortex, this being the sole seat of the Intellect, as dis¬
tinguished from a more or less confused sentiency. In the
grey matter of the spinal cord we have the sensori-motor
mechanism in a comparatively simple form, for it is now clearly
established that the nerve cells of the posterior cornua subserve
sensory, and those of the anterior cornua, motor functions.
Have we any analagous elements in the cerebral cortex ? I
think it may be said that we have. Putting aside the first
layer of the cortex as non-ganglionic, modern anatomical and
physiological research renders it highly probable that the second
and third layers of the cortex have a sensory, and the fourth
layer a motor function, so that the nerve-cells of these three
layers would constitute the sensori-motor mechanism of the
cerebral cortex. But we have here an additional layer—the fifth
layer—that of spindle cells, in which the characters sought for
appear to be realised; for in addition to being unrepresented
elsewhere, and therefore peculiar to the cerebral cortex, it
belongs, as Meynert long ago pointed out on purely anatomical
grounds, to the connecting system of the brain. The pre¬
sumption therefore here hazarded is, that the spindle-celled #
layer subserves the relational, that is, the intellectual element
of mind; and since Mania was concluded to be an affection of
the latest evolved relational elements, we are now brought to the
further conclusion that it is an affection of the latest-developed
nerve-plexuses of the spindle-celled layer.

Since in all probability in the frontal lobes the whole brain
is re-represented, it is legitimate to consider that it is in the
frontal region that the latest developed plexuses are to be
sought, though they would not necessarily be confined to this
district.

I wish to point out, however, that the conclusions formerly
reached as to the nature of the lesion in Mania, have no neces¬
sary connection with the hypothesis here suggested as to its
seat , which latter may or may not be illusory, without afEect-
ing the validity, of the former.

* “ The Principles of Psychology.” Vol. i., p. 190.
xxix. 84

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492

[Jan.,

On the Pathology of Mania .

Towards the commencement of this paper, I defined Mania
as an affection functional or organic of the highest co-ordi¬
nating plexuses of the brain, and this leads me to the final
consideration as to whether or no there is a material lesion
underlying the phenomena which we know as Mania—a lesion
of nerve-cells that is capable of demonstration by the micro¬
scope. Some varieties of Mania indeed are of such a transi¬
tory character as to forbid us to suppose that there can be
more than a functional derangement at work; many cases,
however, appear to run such a definite clinical course, are more¬
over of such lasting duration, and end in such utter mental
wreck, as to compel one to think that there is a definite mate¬
rial affection of nerve-cells at the bottom of the disease; but
though unable at present to demonstrate its presence, if there
be such a lesion, sooner or later it will surely come to light;
for dark as is the pathology of Insanity at the present, we
may confidently anticipate the time when the daystar of human
knowledge will arise, even over this benighted region, and the
shadows flee away.

Visceral and other Syphilitic Lesions in Insane Patients with¬
out Cerebral Syphilitic Lesions . By Wm. Julius
Mickle, M.D., Grove Hall Asylum, London. -

Read in the Section of Psychology at the Annual Meeting of the British
Medical Association held at Liverpool , August , 1883.

It has been stated by some that it is syphilis originally
mild and benign in its manifestations, that is most apt to
cause cerebral syphilis; one saying that the subjects most
liable to cerebral syphilis are those in whom the secondary
symptoms have been slight or transitory; another asserting
that often one can find no history of preceding cutaneous or
other affection of either the secondary or tertiary order;
another, that any syphilis may be followed by specific cerebral
affections, the original mildness of a syphilis being no
guarantee against future cerebral affections of syphilitic
origin, and that the great majority of the cerebral affections
are furnished in examples of syphilis which is of medium
severity, or (less often) is benign. This last observer, in 47
cases of cerebral syphilis, found three after severe or grave
syphilis; 30 after syphilis of medium severity, and 14 after
syphilis benign in its manifestations. As stated by myself

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1884.] Syphilitic Lesions in Insane Patients .

in a paper* published more than seven years ago: “It is
particularly in instances where syphilis affects the nervous
system that its evolution is sometimes insidious; that its
later lesions are not preceded by its usual characteristic
development on the exterior of the body, or by only a partial,
or slight, or transitory development; and that the diagnosis
is surrounded by obscurity. This is the opinion of several
writers on the.subject, and more than once the fact has forced
itself upon my attention.”

But I am not about to speak of cases of this kind, or to
look at the subject from this point of view. On the contrary,
I wish to bring forward a typical case or two of an entirely
different group, the special feature of which, to some extent,
holds a complemental relation to some of the facts to which
reference has just been made. This group, of which I would
now speak, consists of insane and syphilitic persons in whom,
whether the syphilis ha$ or has not originally given rise to
the insanity, the encephalon escapes recognizable syphilitic
lesion, although syphilis runs riot, so to speak, elsewhere in
the organism, and although all the circulating fluids of the
body must have been richly infected with syphilitic elements.

And, of course, it is in cases where syphilis is the active
factor in the production of the insanity that this escape of
the brain from syphilitic lesion is matter of greater surprise.

But even where the insanity is itself due to some other
causation, the disordered state of the brain renders the latter
a part of less resistance and more obnoxious to the morbific
influence of the syphilitic virus ; more liable to the ravages
of syphilitic lesions. Like intellectual overwork, like pro¬
tracted or frequently recurring emotional and moral perturba- •
tion, and like alcoholic and sexual excesses, insanity itself
should, we suppose, make the brain a more easy prey to the
specific lues.

But, I repeat it, whether the cases follow this course, or
whether, on the other hand, the mental disorder is attri¬
butable to syphilis—in the sense that had the patient not
been syphilitic he had not been insane—in either event is* an
example afforded us of the group now under notice. Briefly,
the group in which brain-syphilis is absent in insane persons
who are the subjects of abundant syphilitic lesions of the
viscera, and sometimes of other parts, such as the bones and
skin.

* “ British and Foreign Medico-Chirurgical Review,” July, 1876; p. 161.

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494 Syphilitic Lesions in Insane Patients , [Jan.,

Nevertheless, it may be suggested that the slightly
opalescent and milky state of parts of the pia-arachnoid in
these cases might have been the trace of a former syphilitic
meningitis. I think this is unlikely. The condition had
none of those other appearances and changes which are
usually found associated with a similar meningeal condition
in examples undoubtedly syphilitic; and, again, it was in all
respects quite the same as one sees in an immense number of
the chronically insane who have never incurred syphilis.

With reference to the mental symptoms, the first patient
had the intellectual feebleness and incoherence which form
features of so many cases of syphilitic origin. Latterly he was
a chronic dement, having at an early period exhibited some
depression, and, occasionally, more or less excitement. There
was, however, nothing distinctive in the association, succes¬
sion, or course of the mental symptQms; nor were there, in
any marked degree, those conditions more usual to syphilitic
mental disease in its ultimate stage. But here the modifying
influence of protracted special anti-syphilitic treatment must
be taken into account. On the whole, I take it, that the
case was one in which the syphilitic poison produced mental
disorder either by way of toxaemia, or by way of the combined
influence of syphilitic cachexia and anaemia, together with
the. exhausting and disturbing influence of the pain of local
syphilitic affections of the bones and other parts.

I have already placed on record* many examples of cerebral
syphilis, and of syphilitic insanity. Here I will briefly
describe a case in which with chronic mental derangement,
apparently due to syphilis, there were wide-spread visceral
syphilitic lesions, but still no distinctly specific organic
lesions of the cerebrum or its meninges. A few words will
be added as to another case. The history of the second case
is defective as to the time-relations of the associated condi¬
tions—syphilis and mental disease.

J. M., private 45th Regiment, was admitted January, 1868, and
died January, 1876, at the age of 34. The attack of mental disease
for which he was admitted was stated to be the first, and of about
eight months’ duration. This insanity had been insidious in origin, but
preceded by frequent manifestations of constitutional syphilis, and
syphilis was the cause assigned for its appearance.

When at Fort Pitt, Chatham, previously to admission, he had been

* “British and Foreign Medico-Chirnrgical Beview,” Jnly, 1876; Oot., 1876;
and April, 1877. “ Journal of Mental Science,” Oct., 1879, and Jan., 1880.

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495

1884.] by Wm. Julius Mickle, M.D. •

quite irrational, muttering and talking to himself, hoarding rubbish
(believing it to be jewels, so it was said), and obstinately morose and
unsociable, wandering about with depressed mien and bowed head, but
easily roused to violence. There was a papular eruption on the
body ; and on the right parietal bone the scar of a node.

The case-book states that on , and after, admission he was restless,
excited, disposed to violence, irrational in conduct, confused and in¬
coherent in conversation, muttering to himself, and indisposed to occu¬
pation or amusement.

When I first knew him in 1872, and afterwards, he was still restless,
excitable, confused, incoherent, but not disposed to violence. He
worked well, laughed much without apparent cause, and chattered away
cheerily to himself. Hallucinations were not clearly made out. Some
tertiary syphilitic lesions made their appearance from time to time ; as,
for example, a node on the right tibia, followed by ulceration, and finally
by permanent osteal and periosteal changes, and by a brownish de¬
pressed cicatrix. The same thing occurred with the right ulna. The
scars of somewhat similar disease were seen over the right parietal bone,
and the left ramus of the lower jaw. Iodide of potassium was given
freely, perchloride of mercury and opium sparingly. Subsequently,
indications of pleuritic thickening and apparent phthisis were noted ;
then the pulmonary tissue began to break down, and with thoracic pain
the condition became sub-febrile, the pulse frequent and feeble ; and
refusal of food, vomiting, constipation, mitral bruit, and epigastric pain
preceded death.

Abstract of Necropsy . —The calvaria was thin, not indurated; the
dura-mater ordinary. The meningeal changes were of a chronic
ordinary kind, the pia-arachnoid being slightly thickened, and the pia-
mater slightly cedematous, and gyri slightly wasted, over the superior
and lateral fronto-parietal surfaces of the cerebrum, also somewhat
over the lateral temporal surface and internal frontal surface. The
grey cortical substance was of a mottled lilac hue ; many blood-vessel
contents were visible to naked eye ; the middle strata were of a yellowish
tinge ; there were many puncta cruenta in the medullary substance.
The brain was otherwise of ordinary characters. The heart weighed
8^ ozs. ; it was fairly healthy ; there was an adherent pale clot in the
right chambers. In the left lung there was an excavation at the apex
surrounded by induration and fibrosis, partly of iron-grey hue ; other
fibroid bands in upper lobe and upper part of lower lobe ; the lung-
surface was puckered and cicatrized at the apex and at posterior surface
of lower lobe, and beneath the cicatrices the bands of fibrous tissue ran
to caseous-like nodules, rather easily shelling out from vascular-walled
cavities. Elsewhere, and in the right lung, were firm greyish-white
nodules, and pneumonic patches. There was bronchitis on the left
side. Thick, close, old, leathery, pleuritic, adhesive pseudo-membranes
were found ; much more marked over the left lung. The mesenteric
glands were swollen, of granular appearance on section, and exuding a

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496

Syphilitic Lesion* in Insane Patients, [Jan.,

creamy fluid Some solitary and Peyerian glands were swollen, a few
highly vascular, one or two slightly ulcerated.

Liver. There were perihepatitic adhesions. Huge gummata, partly
consisting of yellow caseous material, lying near their outer surface, and
also here and there in masses of irregular shape scattered throughout
the rest of a gumma ; the intervening substance, and that invading the
circumjacent hepatic tissue, being greyish, semi-translucent, fibrous,
firm and elastic. Most of the left lobe was gummatous. Nine or ten
puckered cicatrices on right lobe, mostly on upper surface ; from these,
fibrous branchings traversed the gland-substance. Around one or two
firm whitish fibrous masses the gland-tissue was pale and homoge¬
neous in appearance. Left lobe adherent to spleen and to diaphragm ;
dense adhesion-bands covering its upper surface especially. Weight
of liver 66 ozs.

Spleen, a large cartilaginoid plate of capsular thickening on the ex¬
ternal surface. Spleen thick, shapeless, boggy ; weight 12£ ozs.

Kidneys. Gumma of left kidney partly embedded in the gland,
partly projecting from its surface; an old adhesion-band connected
this with surrounding structures. Atrophy, cortical pallor, slight
capsular adhesions, weight 2£ ozs. ; non-waxy. Right kidney, 4 J ozs.,
yet in general state much the same as the left .

Adrenals firm, mis-shapen by compression.

Bones. The pit on the ulna was filled with tough fibrous tissue,
which bound down the skin over the brownish irregular scar. Right os
parietale of ordinary appearance ; the node here had permanently
affected the superficial structures only.

Microscopical .—The nodules from beneath the lung-cicatrices were
of caseous microscopical appearances. As for the hepatic gummata,
their yellowish portions showed granules, molecular material, granule
masses, granular cells, oil globules, square crystalline plates. Their
greyish, tough, elastic portions showed cellular growth, connective
tissue-like elements, and points of commencing caseation. The
mesenteric-gland-fluid exhibited pus-like globules, and a rich cellular
growth.

Remarks .—Here there were extensive visceral, syphilitic
lesions, as well as other traces of syphilis, as in the bones
and skin, in an insane person whose insanity was attributed
to syphilis; and yet no coarse intracranial syphilitic lesions.

The lung-changes raised the question of syphilitic phthisis.
The cicatrices on both lobes of the left lung, and the asso¬
ciated changes, led one to think of tuberculosis supervening
on old pulmonary syphilitic changes.

A much less marked case was that of H. G., a soldier of
the 3rd Battalion, Rifle Brigade, who died, aged 37 years. It
was for his second attack of mental disease he was admitted.

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497

by Wm. Julius Mickle, M.D.

At first maniacal, incoherent, and the subject of exalted
delusions as to his being of royal parentage, he subsequently
became silent, and, except during his last illness, had not
spoken for some two years before death, being under the
delusions that his speech had been stopped by the power of
a former medical attendant, that his speech was visible, and
that his words flew into the others in his vicinity, and
affected them most injuriously. Transient delusions of ill-
treatment and neglect arose during the last days of his life.

After death, the liver was extensively puckered on the sur¬
face by cicatrices, which also extended deeply into the organ,
and were associated with gummatous remains. These were
found mainly on the upper surface of the right lobe, and the
under surface of the left. Some lardaceous and fatty changes
of liver were present also. Pylorus thickened; stomach
dilated. Kidneys granular, somewhat atrophied, with
ordinary cysts. Ulceration of end of colon, and more parti¬
cularly of rectum, where slight perforation had produced a
sanguineo-purulent collection in the recto-vesical pouch.

Cerebral pia-arachnoid rather thickened; cedematous,
passively congested. Cerebral grey cortex somewhat thin
and anaemic; in some gyri its deeper layers were fawn-
coloured. The oedema of pia, widening of sulci, and slight
wasting of gyri, were mainly fronto-parietal.

Left lung, universal, old, close, thick, leathery, and even
semi- cartilaginoid, pleuritic adhesion-layers. Cirrhosis,
bronchiectasis, vomicae, and caseous nodules of lung. Slight
similar affection of right lung. Some enlarged lymphatic
glands at the summit of the thorax, pressing upon the left
subclavian artery (possibly assisted by an extension of the
compressing influence of pleural induration and thickening),
gave an explanation of the smaller left radial pulse observed
during life; and by pressing on the neighbouring veins they
accounted, also, for the distension of the veins • of the left
chest, arm, and neck which was observed for some time, but
had disappeared for months before death. Praecordial inter¬
costal pulsation, extending over several interspaces, and wide
area of cardiac percussion-dulness had also been noted, and
were explained by the heart being uncovered by lung, while
its right chambers were dilated, and the thoracic frame was
emaciated. Then, too, the aortic-arch was almost uncovered
by lung, the pulmonary artery was surrounded by consoli¬
dated lung tissue, the pulsation being at the second, third,
fourth and fifth left intercostal spaces.

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[Jan.

The Basis of Consciousness : an Answer to Prof Cleland.

By Charles Mercier, M.B.

The motives that impel me to take up the cudgels against
Prof. Cleland are written in the thirty-second chapter of the
Book of Job. Far better would it have been had the challenge»
been accepted by someone whose authority and standing
were comparable with those of Prof. Cleland, but in default
of such a champion my feelings are those so vividly described
in the seventeenth and three following verses of the said
chapter, by Elihu the son of Barachel the Buzite, of the
kindred of Bam.

As pugilists shake hands and fencers salute each other
before they set to, so let me first acknowledge Prof. Cleland’s
transparent fairness, and indicate the points of agreement
between us. He asserts, and the assertion is of the greatest
value as coming from a professor of anatomy, that “the
questions raised are not to be solved in the main by experi¬
ment, though the biologist of the present day is too liable
to take for granted that his science can be forwarded by ob¬
servation and experiment alone, and that there is no art
required to draw just conclusions from these.” How far
Prof. Cleland's rather vague charge against biologists in
general could be substantiated is perhaps doubtful, and is
not very material; but with his belief in the insufficiency of
observation and experiment alone to deal with problems of
this nature, I most heartily agree. The paper which I am
now endeavouring to answer, and which appeared in the
number of the “Journal ” for last July, is a purely destructive
criticism. “ I cannot too much insist,” says the writer, “ that
to prove one theory false it is not necessary to be prepared with
another which is true to replace it.” “ While I can add no
light myself, I maintain my liberty to point out that the
light declared to be seen by other people is no light at all.”
Such a liberty must be freely admitted, and the function of
the pure critic must be allowed to be not only legitimate, but
useful in a high degree. Here, however, our lines of coin¬
cidence end; the salute is over.

Since his sole object is to expose the falsity of the preva¬
lent theory of the relations of the nervous system to con¬
sciousness, it behoves Prof. Cleland to be very sure that he
rightly apprehends that theory and has correctly stated it.
If his attack is directed against a position which the current

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1884 .] The Basis of Consciousness .

theory of consciousness does not include, and which the
holders of that theory do not maintain, it is obvious that,
however successful his attack may be, the soundness of the
theory is not in the least affected. The obnoxious position
may be pounded into flinders by Dr. Cleland's bombardment,
but the tenants of the current theory may look on with com¬
plete unconcern. Let us first see, then, whether the position
that he attacks is within or without our lines. “The preva¬
lent theory of the seat of consciousness,” says Prof. Cleland,
“ assumes that consciousness is entirely localised within a
definite and unvarying part of the encephalon.” I deny it.
I deny in ioio that such a doctrine is held by such a number
or such a proportion of recognised authorities that it can
by any permissible latitude of expression be called prevalent.
It is a crude and rudimentary concept, which represents \ no
doubt, a stage that most thinkers pass through at an early
period of their meditations on the matter, but which does
certainly not rank as a standard doctrine at the present day.
Prof. Cleland does not, and I will venture to say he can¬
not, bring forward a single expression by a single writer in
direct support of his statement. He almost formally admits
that he cannot. “ No one,” he says, “ may have expressed
it so, but rather the assumption has been made, simply
because it has not occurred to anyone that it could be other¬
wise.” If none of his opponents have expressed this opinion,
it is surely somewhat hazardous of Prof. Cleland to attribute
it to them, and the statement that it has never occurred to
anyone that it could be otherwise is erroneous. So far from
this being the case, a physiologist and psychologist of the
very foremost rank in this generation, has written a work
which is largely devoted to the exposition of a doctrine the
very reverse of this, and which carries the main principle for
which Prof. Cleland contends—the non-localisation of the
basis of consciousness—much further than it is carried by
Prof. Cleland himself. I refer to the “Physical Basis of
Mind,” by the late G. H. Lewes. Prof. Cleland admits the
whole cerebro-spinal axis as the seat of consciousness, and
goes so far as to say that it may even “ extend along the
nerves.” Mr. Lewes extended it not only to the spinal cord
and the nerves, but to the* whole of the organism. Prof.
Cleland has no doubt that in lesions of the cerebro-spinal
axis, consciousness continues in connection with the larger
mass of nervous substance, and that “ after division of a
nerve the distal part can no longer affect or be affected by

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500 The Basis of Consciousness , [Jan.,

consciousness, and thus neither spinal cord nor nerves give
evidence of an independent affection of consciousness.” Mr.
Lewes went much farther than this. He taught that after
division of the spinal cord, not only was there consciousness
in connection with the larger mass of nerve-substance, but
that the part of the body below the section had another and
distinct consciousness of its own. It is true that the views
of Mr. Lewes are not generally accepted, but this is not to
the point. The point is that it has never occurred to any¬
one to confute the opposite view. Now, the doctrines of Mr.
Lewes are well known among psychologists, and if they err
by rejecting them they do not err blindly. So far, therefore,
as Prof. Cleland’s statement that the prevalent theory rests
upon the absence of a contrary doctrine, it is baseless, and
falls to the ground.

What other evidence has he that the prevalent theory of
consciousness is what he states it to be? It is implied, he
says, in certain statements, some of which he quotes. The.
gist of all these quotations is that complex “ purposive ”
actions performed in response to an irritation by an animal
whose hemispheres have been removed, are not necessarily a
proof of consciousness;—that adapted actions, such as in¬
telligence would dictate, are capable of being called into play
through the spinal cord, and without any accompanying con¬
sciousness. (The italics are mine). Presumably, if Prof.
Cleland could have found passages more unconditionally ex¬
pressed, he would have quoted them; and if these are all he
has to depend on, he is leaning on a staff that is rotten in¬
deed. All that these cautiously-worded passages express is
that a “purposive” or “adapted” action, such as is com¬
monly preceded and attended by motive and intelligence, may
under certain circumstances, occur without any change in
consciousness—that is, without any conscious accompani¬
ment. From this position to the position that they do so
occur is a good long step; and from the doctrine that pur¬
posive actions in a decapitated animal are not attended by
consciousness, to the doctrine that “ the seat of conscious¬
ness is entirely localised within a definite and unvarying part
of the encephalon,” is a leap compared with which any
“ gymnastic feat ” that Dr. Cleland attributes to Prof. Ferrier
is insignificant.

It seems to me that Prof. Cleland misapprehends the
position of his adversaries. He is battering away at an old
earthwork that has already been evacuated. He says that

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1884.] by Charles Mercier, M.B.

his arguments remain unanswered, not because they are
unknown, but because they are incapable of refutation. I
think it is mainly because the position that he attacks is
already abandoned. The very expression “ seat of conscious¬
ness,” appears to indicate a misapprehension of the current
state of opinion; and other expressions in his paper cor¬
roborate this view. Such expressions are “.that conscious¬
ness is not a function confined to the hemisphere-vesicle,”
&c.; “ the same functions, including those of consciousness,”
which occurs twice; “ I have not the slightest idea how it is
that the will acts on hosts of muscles.” Not only does
modern psychology not postulate such a “ localisation of the
seat of consciousness within a definite and unvarying part
of the encephalon,” as Prof. Oleland credits it with, but it
does not even acknowledge the existence of a “ seat of con¬
sciousness ” in the sense in which he appears to use the term.
It does not admit that consciousness is . a function of the
hemisphere-vesicles or of any other part of the nervous
system. It does not consider consciousness to be a function
at all, and not being a function it cannot have a seat or
location. Prof. Cleland says that he has not the slightest
idea how it is that the will acts upon hosts of muscles. The
prevalent theory of consciousness does not attempt to solve
this problem. More than this, it denies that the will can
act on the muscles at all. More still, it denies that it is
possible even to think of the will acting upon the muscles
or upon the nerves, or upon the nerve centres, or upon any
material thing. It denies that any such problem can exist
as that which Prof. Cleland finds insoluble. Such a problem,
it says, is not insoluble, it is unthinkable . If, therefore, Prof.
Cleland is endeavouring to refute a solution of this problem,
as it appears from his context that he is, then his refutation,
let it be as complete and successful as it is possible to be,
does not affect the current theory of consciousness in the
least. He may shoot as many crows as he pleases, but that
won’t hurt the pigeon that he is aiming at.

Let us see what is the next doctrine that Prof. Cleland
credits his adversaries with. “ Proceeding on that implicit
assumption [of the definite localisation of consciousness],
the next point has been,” he says, “to determine what is
the exact extent of brain in which consciousness is localised.”
I must meet this statement also with a denial. It appears
to me that here, as elsewhere, Prof. Cleland treats as identical
two things between which the prevalent school of psycholo-

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The Basis of Consciousness , [Jan.,

gists draw a profound distinction ; and that he not only does
not himself recognise the distinction, but that he proceeds
as if we, too, failed to distinguish between the two things,
and, like himself, treated them as identical. These two
things are the active physical process or change in the ner¬
vous system which we term its function, and the change in
consciousness which is concomitant with this function. Else¬
where—in his Lecture on the Relations of Brain and Mind—
he appears to recognise the existence of such a distinction in
other men's minds, although he does not himself subscribe to
it, and it is the more puzzling, therefore, that he should pro¬
ceed in the paper which has called forth this answer, as if
the distinction had not been made. What Prof. Ferrier's
experiments go to prove, and are accepted as proving, is cer¬
tainly not “ the exact extent of brain in which consciousness
is localised,” but the regions of brain in which certain func¬
tions are localised, which is, or is held to be, a very different
matter. He excites certain areas of grey matter, and traces
the current of force that he sets free to its destination in
certain muscles, and he notes the position, and number, and
combinations of these muscles, and the movements that result
from their contraction. Here there is no question of con¬
sciousness. The only elements involved are organs, spaces,
forces, and movements. Whether this physical nervo-muscu-
lar process is or is not accompanied by consciousness, does not
enter into the calculation. It may be or it may not. In
either case it does not affect the function. It is outside the
question that is considered. We don’t know whether it is
present or not, and so far as physiology is concerned we don't
care. We have localised a function—a physical process. We
have not localised consciousness, and we have not attempted
to do so. We have discovered that a certain area of grey
matter represents a certain movement—that activity of this
area produces this movement; and that is all. Now we may
go on to suppose that when this area of grey matter becomes
active, there arises concomitantly in the mind an idea of the
movement that the area represents ; and this is what the pre¬
valent school of psychologists actually do suppose. But is this
supposition equivalent to assuming that we have determined
the exact extent of brain in which consciousness is localised ?
I say it is nothing of the kind. It is determining approxi¬
mately the region of brain whose activity is accompanied by
the occurrence of a minute portion of consciousness. As to
the whole remainder of consciousness it says nothing.

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1884.] by Chables Mebcieb, M.B.

Now take experiments of the obverse character. Prof. Fer-
rier makes an impression on the retina or the tympanum, or
on a localised portion of the skin, and he traces experimen¬
tally the nerve current that is thus originated to a region in
the brain. He determines the locality in the brain to which
a disturbance from this or that region of the surface of the
body finds its way. Here again is a physical process—a
molecular agitation in the nerve-tissue, and nothing more.
There is no question of consciousness. The only things
treated of are forces and localities. - Now, however, comes a
difficulty, and this is where confusion constantly steps in. It
so happens that we have no special word to express the pro¬
cess that occurs in a nerve-centre on the arrival of a current
from a sense-organ ; and a vicious custom has arisen of using
the word Sensation for this process, and often indeed for the
incoming current also which starts the process. Hence it
has come about that, while the outgoing current from the
grey matter to the muscles is correctly named and represented
in thought as from beginning to end a physical process—a
wave of molecular agitation, the incoming current from the
sense organs to the grey matter h as been named a sensory
impression, and often a sensation; and hence has arisen a
misty notion that at some part of its course it becomes
actually transformed from a molecular movement into a sen¬
sation—into a state of consciousness—a change which as has
already been said, is, in reality, unthinkable. To imagine a
wave of sound becoming red, or the rotation of a wheel be¬
coming sour, or the flight of an arrow becoming cold, would
be precisely analogous tasks, and from these instances it will,
perhaps, more plainly appear that the change is not itself
regarded as possible or impossible. It is regarded as a change
about which no argument is possible. I do not charge Prof.
Cleland with holding the view that an incoming current
passing along the nerves can be transformed into a sensa¬
tion, but I think he has been misled by the phraseology
arising out of the unfortunate custom of which I have spoken,
to attribute to his adversaries doctrines that they do not hold.
The impression made upon a sense organ—say that of light
upon the retina—sets up a nerve current, which finds its
way to some region of the brain, and there initiates a state
of activity—of molecular agitation. This region of the
brain has been approximately determined, and has been
called, in the case mentioned, the “ visual centre.” But this
expression does not mean that the sensation of vision—the

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The Basts of Consciousness , [Jan.,

consciousness of colour or of light—is localised in that
region. Such a supposition would be not less absurd from
our point of view than that of the child who thinks that the
colour of an orange is in the orange. The colour is, accord¬
ing to the prevalent doctrine, neither in the object, nor in
the retina, nor in the optic nerve, nor in the corpora quadri-
gemina, nor in the white matter of the hemisphere, nor in
the cortex. It is in the mind. But it is not always present
to consciousness. The feeling of colour comes into being
only when the u visual centre ” is functionally active. This
is the conclusion that we found upon the experimental evi¬
dence. Is this “ determining the exact extent of the brain
in which consciousness is localised ? ” I say it is not. It is
determining approximately the region of the brain that is
active during one mode of consciousness. The mode of con¬
sciousness is but a fraction of the totality of consciousness ;
and even this mode is not localised. All that is localised is
the accompanying nervous process. It is quite true that
such unfortunate expressions are in use as “ the localisation
of sensations of sight and hearing,” &c., but these expres¬
sions are merely convenient abbreviations which are almost
forced upon us. by the meagreness of our terminology. If we
were always to put the expressions in full, and say “ the
localisation of the nervous process which has the conscious¬
ness of colour or sound for its subjective accompaniment,”
it would require the lifetime of an Enoch to write a book,
and the long-suffering of Job to read it. The abbreviation
contains, it is true, a meaning as portentous and as pro¬
foundly concealed as did the shake of Lord Burleigh’s head;
but when this meaning is known and agreed upon, it is as
easy to read it in the one case as in the other.

“ As regards the connection of mental operations with the
hemispheres,” says Prof. Cleland, “ three theories may be
distinguished. According to one of these, different portions
of the hemisphere are the organs of different mental quali¬
ties ; and that is distinctly the theory of Grail. According
to another hypothesis, individual memories and other notions
are represented as stored up in individual nerve-cells, as if
they were so many quantities of matter or of some conditions
of matter; and that idea undoubtedly crops up over and
over again in the language used by many biological writers
of the present day, though I am not aware that anyone
has attempted to demonstrate its truth. According to
the third view, there is no foundation for believing that
either the qualities or the acts of mind are lodged in

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505

1884.] by Charles Mercier, M.B.

so many separate receptacles, and that is the position
which was taken np against Gall’s phrenology long before
the second hypothesis crept in.” Without denying that
each of these theories may have some adherents at the
present day, they cannot, any of them, I think, be called
prevalent, except, in a very much modified form, the first;
and the theory that is most widely held, and that is indeed
generally accepted, is not mentioned by Prof. Cleland. I
refer, of course, to the theory that a mental state is the
subjective side of a nervous process; that when a nervous
process has once occurred—when a discharge has proceeded
along certain lines—those lines remain thenceforward more
permeable to nerve currents than they were before ; and that
this constitutes the statics of the basis of memory. Further,
that whenever a fresh discharge follows the same route as a
previous one, then the change in consciousness (if any) that
accompanied the first discharge is repeated; and that this
constitutes the dynamics of the physical basis of memory.
According to this theory, different portions of the hemi¬
spheres are the organs not of different mental qualities but
of different mental operations. Individual memories are
represented, not as stored up in individual nerve cells, as if
they were so many quantities of matter or conditions of
matter, but as permanent modifications of structure, allow¬
ing of the repetition of special modes of activity ; each such
repetition of activity being accompanied by a repetition of
the mental process—by a remembrance.

When I say that this doctrine reckons among its supporters
such representative names as those of Mr. Herbert Spencer,
Prof. Bain, the late Mr. Lewes, the late Prof. Clifford, M.
Taine, and M. Ribot, I think it will be seen that the onus of
showing that it is not the prevalent doctrine lies with Prof.
Cleland.

So far I have endeavoured to show that Prof. Cleland’s
statements of the prevalent theory of consciousness are un¬
warranted, and that the onus rests upon him of showing that
they are correct. I will now take his objections, and ask
how far they are destructive either of the views that he.
thinks we hold or of those that we actually do hold. “ The
received theory,” says Prof. Cleland, “ demands that each
distinctly recognisable spot of the body must be joined by a
separate tract with its own cerebral terminus, a thing that
is anatomically quite impossible, and so obviously so, that no
competent anatomist will ask the question to be argued.”
Against almost every expression in the above statement I

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[Jan.,

The Basis of Consciousness ,

put in a demurrer, and, in addition, I deny the conclusion.
I do not, of course, venture to dispute with Prof. Cleland on
a point of anatomy, but I maintain that the question is not
a wholly anatomical one, if by this we mean a question of
visible structure.

What does Prof. Cleland mean by a recognisable spot of
the body P What does he mean by a separate tract P What
does he mean by a cerebral terminus ? If by a recognisable
spot he means an area on the physiological surface of the or¬
ganism such that impressions made upon it can be discrimi¬
nated in space from impressions made upon surrounding areas;
if by a separate tract he means a continuous nerve fibre; if by
a cerebral terminus he means a cell or a group of cells; then,
of eourse, I agree with Prof. Cleland that the thing is im¬
possible ; but I deny that such an arrangement is demanded
by the current theory or by any other theory with which I
am acquainted. But if by a separate tract he means a per¬
meable channel of communication, and if by a cerebral ter¬
minus he means a region of grey matter, then I say that,
whether it is demanded by the theory or no, the thing is not
impossible. The current theory does not demand a separate
nerve fibre for each separate channel of communication. On
the contrary, according to that theory, it is not until a sepa¬
rate channel has long been formed, and multitudinous cur¬
rents have been transmitted through it, that the molecules
of the quasi-homogeneous grey matter slowly fall into the
permanent arrangement implied by a nerve fibre. To imagine
that no communication can pass from a definite area on the
surface to a definite area of the cerebral cortex without the
existence of a continuous nerve-fibre between them, is much
like denying the possibility of getting from a point on the
sea-coast to an inland village because there is no line of rail¬
way between them. Again, I demur to the expression “cere¬
bral terminus.” We do not acknowledge the existence in
the cerebral cortex of any turning-point at which the in¬
coming currents are abruptly reversed and become outgoing
currents. The arrangement that we picture to ourselves as
existing there is more like the arrangement of the cavities
of a sponge—a network of intercommunicating channels.

Having accused us of maintaining an impossibility. Prof.
Cleland next charges us with an incompleteness. He says,
“ that the received theory informs us of no mode by which
the child learns to associate the changes taking place at the
cerebral termini with the changes taking place at different
parts of the surface—that is to say, to translate them as

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1884.]

507

by Charles Mercier, M.B.

things happening at the surface—is possibly so psychological
as to be incomprehensible to some excellent persons.” With¬
out laying any claim to excellence, I must admit that this
objection is wholly incomprehensible to me. Prof. Cleland
surely does not mean that a child, or an adult either, has any
direct knowledge of changes taking place at its “ cerebral
termini?” And if not, there is nothing to translate.

On tbe whole, I cannot see that Prof. Cleland has damaged
the current theory of the Basis of Consciousness in the least,
and I believe that while there are no doubt differences between
his view and that which is generally accepted, the two are by
no means so widely divergent as he would have us believe.

In conclusion, let me say that I feel that Prof. Cleland will
look for no excuse for the uncompromising opposition with
which I have met him. He has shown himself so fair and so
able a disputant that I have perfect confidence in his dis¬
position and his ability to credit all my opposition not to
himself but to his opinions. These latter are so formidable,
both intrinsically and from the reputation of their author,
as, in my belief, to justify every effort that I could make to
oust them. In dealing with an antagonist of Prof. Cleland’s
calibre, one cannot afford to indulge in child’s play ; but the
buttons are still upon the foils, and so, as the Editors are
calling time, with another cordial salute I take my leave of
him. It is difficult to suppress an uneasy feeling that he will
reply with Hamlet, “ You cannot, sir, take from me anything
that I more willingly will part withal.”

[Prof. Cleland, to whom we have given an opportunity of
seeing Dr. Mercier’s article, in case he should wish to reply,
writes that he thinks no advantage would accrue to science
from a rejoinder to his criticisms. He trusts that those who
read the latter’s communication will also have the goodness
to refer back to the paper in the July number of the Journal
and the previous memoir which it supplements. He suspects
that’those who pursue this course will have a great advantage
over Dr. Mercier. He desires to say that if the doctrine in
question which he claims had been similar either to that of
Mr. Gr. H. Lewes or the old notion of a semorium commune , he
would have referred to both. Professor Cleland still believes it
impossible for anyone who has read his paper of 1870 to
see in his views any resemblance to those of Lewes, whose
memory he holds in the greatest respect, not only as a physi¬
ologist, but as an able metaphysician.— Eds.]

xxix. 35

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508

[Jan.,

CLINICAL NOTES AND CASES.

A Case of Melancholy , with Stupor and Catalepsy . By
James Adam, M.D., Mailing Place, Kent.

The following case, which has been under my own obser¬
vation from the period* of the invasion of its more acute
symptoms, appears to me so typical, and as so well illus¬
trating the peculiar features of this disease, that I am
induced to send a short outline of its more prominent symp¬
toms, especially as I have been able also to obtain a very
accurate history of the earlier symptoms from those well
capable of intelligently observing and noting them.

On the 14th July last I was asked by the friends of a
young lady, aged 21 years, to receive her under care and
treatment. She was reported by them to have always
enjoyed good health, and to have no hereditary tendency to
mental disease. When about 11 years old, however, and
when at a garden party on a very hot summer day, she com¬
plained of headache and sickness, for which she was put to
bed at the time ; she talked “ strangely,” and was supposed
to have had a slight sunstroke. No after-effects being
apparent, nothing more was thought of this. She has always
led a sedentary life, been much at home, has studied very
hard, and has gone very little into society. Last Christmas
it was first observed that noises seemed to excite her; she
complained of violent headache, but still went on studying.
At last it became evident to everyone, herself included, that
she must go for a change. This she did, and returned after
a month saying she was quite well, and resumed her studious
habits; but after a fortnight pain returned severely in the
frontal and occipital regions, and she said she must give up
study, as she personally attributed her own sensations to
this cause. In the month of March the period of incubation
appears to have come to an end, and decided symptoms of
mental disease declared themselves, for she is reported to
have now taken “ odd fancies ” into her head, and thought
that people were looking at her. She drew down the
blinds when walking through the rooms, and then she
fancied she was mesmerised by persons having malevolent
designs upon her to spirit her away. One night she got up
from bed and rang the dinner bell violently, declaring some-

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1884.]

Clinical Notes and Cases .

509

one was in the house. These symptoms being attributed to
nervousness, recourse was again had to change of scene, and
she went to reside with a relative. During all this time
there was great mental depression. She frequently wished
she were dead, and she became gradually more and more
morose, sensitive, and silent. She was still, however, at this
period, able to write letters quite coherently. On the 21st
of May a still further stage in the progress of her disease
was reached, and it was observed that there was “ something
peculiar” about her—described as a strange, down look, and
a constant habit of examining and fidgeting with her hands;
but she talked rationally, and worked in the garden a little.
She again became possessed with the idea of being spirited
away, and with being very wicked. On the 31st of May she
first began to refuse food, because she said that the same
malevolent persons had endeavoured to obtain an influence
over her, and that their spells must be resisted by fasting
and watching. Some days later she refused to go to bed,
sat up the greater part of the night, and absolutely and
resolutely refused all food. She now became intensely de¬
pressed, lay down on the floor, or knelt confessing, as she
said, all the wrong things she had done, but which she had
felt impelled to do. Exacerbation of these symptoms oc¬
curred at the monthly period, the appearance being very
slight. All at once, at the end of a week, she suddenly
began to eat, with the exclamation, “ I can eat now.” She
remained comparatively free from depression for a time
after this, although she appeared stupid, and was taciturn.
On the approach of the next monthly period she began to be
more uncertain in her habits, going to bed before supper and
not dressing before breakfast, and now a still further stage
was reached. One evening she appeared to be asleep, and it
was found she could not be roused even by shaking her; but
by persevering efforts she was at last induced to open her
eyes, and then she said she had been in a trance. This
trance-like condition returned frequently after this, but did
not last more than a few minutes at a time. Gradually more
acute symptoms supervened upon this. She began to talk
excitedly; she started up in the middle of the night ex¬
claiming, u Get thee hence, Satan.” She became deter¬
minedly suicidal, tried to throw herself out of the window,
and when prevented doing this to strangle or smother her¬
self, or to seize a knife. By no persuasion could she now be
induced to take food, and although she had been most care-

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510

Clinical Notes and Cases.

[Jan.,

fully and delicately brought up, began to use dreadful
language. The medical man in attendance had recourse to
feeding by means of the stomach pump. The acute symp¬
toms became continuous, and uninfluenced by the cessation
of menstruation or its onset. Sleeplessness was persistent.
At this stage I first saw her. The blanched, sallow, anaemic
shin, the facial expression, the downcast look, the hysterical
quivering of the upper eyelids, at once revealed the true
nature of the case. On opening the mouth an intensely
foetid odour and discharge followed, and it was found that
the fauces were in a state of great tumefaction and ulcera¬
tion, and that the adjacent glands were swollen, tense, and
inflamed. Blistering had been tried from the nape of the
neck to the 11th dorsal vertebra without perceptible effect.
She was exceedingly weak; the pulse, which could hardly be
felt, was extremely rapid. The gaze was fixed straight in
front, and the pupils dilated to nearly the full size of the
iris ; there was a tendency to a cataleptic condition. She
had a delusion that she was a destroying angel, and under a
Divine command to perform absurd and wicked actions. She
gave no reply to questions, fell on her knees, and remained
in that position till raised. She did not attend to the calls
of nature. The use of the stomach pump was precluded by
the state of the throat, and nourishment was administered in
sufficient quantity by spoon and nasal feeding.

July 13. Has been constantly watched and nursed by night
and day since her admission, and gradually gains a little
strength, nourishment being still given by spoon and nasal
feeding. She sometimes talks in an impulsive and deluded
manner, saying she is a Royal person. She throws herself
at length on the floor.

July 22. Has again become more strenuous in her resist¬
ance to taking food, and the throat and fauces having now
undergone great improvement, recourse is had to stomach
pump feeding with the soft tube three times daily.

July 23. About 9 p.m. was found to be very cold, slightly
cedematous in the lower extremities, and a somewhat alarm¬
ing faintness came on. The right leg was very cold, the
left perhaps more than naturally warm; the heart sounds,
although very weak, were clear. Liquid food, with stimulant,
failed for a time to produce any effect, but in course of time
the external application of warmth, and a stimulant applied
to the lips, rallied her. She became restless at first, and
finally fell into a sound sleep. On inquiry of her relatives

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511

1884.] Clinical Notes and Cases .

it was found that she had been subject to similar attacks
previously.

Aug. 4. Stomach pump feeding three times a day has
been steadily persevered with until last evening, when she
partook of food naturally. To-day she sat at table. She
does what she is asked to do, and attends to the calls of
nature. She is moved without resistance. The cataleptic
condition, which has been very marked, still continues so.
She remains fixedly in whatever position she is placed, and
the arms or legs, especially the upper extremities, retain for
an indefinite period the position they are placed in. The
pupils are now normal in size; she retains the same fixed,
trance-like stare.

Aug. 12. Takes all her meals well, and in full quantity;
is absolutely silent, cataleptic, and statuesque. Hysterical
quivering of upper eyelids continues; there is now observ¬
able a general filling up of the loose tissues under the skin
all over the body. A general cedematous condition. Her
actions are mechanical. There appears to be no exercise of
her own will; tickling the soles of the feet produces no effect
whatever. The gaze is straight forward, the eyes fixed and
staring; but she evidently understands what is said to her,
as she does what she is asked.

Sept. 5. Cataleptic condition less marked ; expression
more intelligent; pupils normal. Still insensible to tickling
the soles of the feet. (Edema has nearly disappeared. She
has made flesh, and has the appearance of being well
nourished. The functions are naturally performed. Men¬
struation is almost normal. She attends to the calls of
nature.

Sept. 19. Has been frequently out walking, although she
still has a cataleptic tendency, and when left alone she is apt
to lapse into the same fixed stare. She has not yet spoken,
and cannot be induced to do so. This afternoon, when
out walking, she was surprised into replying “ yes ” to a
question.

Sept. 20. Has to-day talked, played, and sang in quite a
natural manner.

# Nov. 7. Prom the date of last report, with some occa¬
sional temporary relapses, she has made fairly steady
progress in her convalescence, but she is not yet free from
the idea that she has been very wicked, and at times it ap¬
pears as if the cataleptic and stupid condition might very
readily be re-induced.

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Clinical Notes and Cases.

[Jan.,

Three Cases: One with the Usual Symptoms of General Paralysis ,
One with Doubtful Symptoms , and the Third with Marked
Symptoms; Pachymeningitis in all. [With illustration.']
By Geo. H. Savage, M.D.

The three Cases following are not so very rare, but are still
of interest from several points of view. In Bethlem we have
yearly ten or twelve post-mortems on more or less acute cases
of general paralysis, and in general hospitals cases similar in
the main, with but little mental perversion, but with weak¬
ness of mind are common, yet it is rare for the general patho¬
logist to come across cases of pachymeningitis. This con¬
dition, if not solely found in general paralysis, is by far more
common in this than in any other disease of the brain. In
Bethlem, out of over 100 cases of examination after death,
these are the only three well-marked examples of this con¬
dition of the membranes we have met with. In one other there
were slight effusions occurring with fits, but these after
death were found only as very thin discoloured layers, three
in number, together not being above one-eighth of an inch
in thickness. In the first case, the membrane was complete,
and resembled a dark, sodden dura-mater, and was very com¬
plete over the whole sides and vertex of the brain. It was
absent from the base, though here there was a staining at
the edge of the membrane.

In this case the patient had had a slight attack of insanity
shortly before admission into Bethlem, and had been taken
to the Stone Asylum. After admission he was found to have
a very large scar on his head; this was due to an injury
some years before, which he said—and the statement was
confirmed by friends—did not cause him any serious injury
beyond the skin wound; at any rate he followed his pro¬
fession satisfactorily till his attack of insanity.

The blow may have had something to do with the causa¬
tion of the paralysis, but this is not clear.

He had led a distinctly irregular life.

On admission he had all the symptoms of general paralysis,
and he rapidly lost mental power, and six months after was
so much weaker that I suspected that he had had a fit.

He had an attack of bronchitis and swelling of legs, but
there was very little albumen in his urine. He took to bed,
and then developed a very peculiar condition of breathing.
Whenever he was roused and made to speak or swallow, his
breathing became so difficult that one at first thought he

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Clinical Notes and Cases .

513

1884.]

would die, but as soon as he was quiet again his breathing
was normal. I have since seen one other case, one of loco¬
motor ataxy, with similar breathing, but this patient re¬
covered, at least for the time. Adhesions were present
between cortex and membranes.

In the second case the symptoms rapidly developed. On
admission there was considerable doubt as to the nature of
the disease; the only symptom markedly like general para¬
lysis was the tremulousness of tongue with loss of expres¬
sion. He looked like a case of melancholia with stupor.

One other symptom became noticeable, which was a certain
amount of exophthalmos, and the skin was greasy. He had
two distinct fits, and these were of interest from the fact
that there were two effusions on the brain surface, one partly
organised, the other fresh.

The head and eyes were turned to the side of the effusion.
In this case the loss of power was not as well marked as one
would have expected, the patient being only hemiplegic. In
this case, as in the last, the reflexes were slightly ex¬
aggerated. The former case was one of general pachymenin¬
gitis, and this latter was only partial. Yoisin has men¬
tioned the fact that the effusion may be local, but I have not
seen it myself so well defined. I believe it is very rare to see
similar effusions in the cord. I can only recall one in a young
general paralytic who had a fit; his temperature rose rapidly,
and he died, when we found a large effusion into the dura-
mater of the cervical region of the cord.

Case I.—Ralph B. G., aet. 59. Admitted Oct. 5th, 1882. Single.
Solicitor. First attack. Duration of attack six weeks.

Confined in Stone Asylum in August, 1882, for six weeks. Cause
of insanity not known. Not suicidal. Dangerous to others. Of
moderately sober habits. Good education. Good bodily health. Pa¬
ternal first cousin once removed similarly affected.

Copies of Certificates .—1st Med. Certificate.

1. Facts indicating insanity observed by myself .—He is excited in
manner, incoherent in conversation, and has delusions of an exalted
character, e.g ., that he is possessed of immense wealth, that he has
power from the Queen to confer honours and bestow lucrative employ¬
ment ; promises gifts of carriages and horses.

2. Other facts indicating insanity communicated to me by others.—
I am informed by G. P., attendant in charge of No. 2 ward, that
Ralph B. G. makes unprovoked attacks upon both attendants and
patients, and is uncleanly in his habits.

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Clinical Notes and Cases .

[Jan.,

2nd Med. Certificate.

1. He requested me to meet Lord Salisbury and members of the
late Government at breakfast, ordered the attendant to preside, and
offered me a post under the late Government. He had the same idea
as to his situation on every topic.

2. G. P. says that patient is hard to control, and is very quarrel¬
some with the other patients, so much so that he is always closely
watched.

Information given by a friend about the patient.

Family history. Insanity.
Neuroses in patient.

Phthisis.

Acute rheumatism or chorea.
Fits. Epileptic.

Fevers.

Other diseases.
Temperament.

Injuries or shocks.

Time of earliest symptoms.
Nature of ditto.

Progress of case.

Cousin of patient’s father.

No.

No. (?)

No.

Quarrelsome. Excitable.
Serious scalp wound 7 years ago.

Bone injury. (?)

4 months ago.

Fit.

Progressive excitability and ex¬
aggeration.

Suicidal. No.

Dangerous. Yes.

Tendency to leave home. No.

Condition on Admission .—Patient is a short, very thickset man.
He looks his age, and appears in good bodily health. Skin not greasy.
Pupils equal. He speaks very slowly and deliberately, and occasion¬
ally stumbles over a long word. His tongue is steady, lips slightly
tremulous. Knee-jerk quite up to average. His disposition is very
changeable, at times friendly, but easily put out, when he has little
control over his temper. Memory is fairly good, but, in describing
past events, he repeats himself, and often does not get to the point. His
delusions of exaltation are very prominent ; he is King of England,
Emperor of France, &c., &c. Very rich. On the whole he is con¬
tented, and talks a great deal about grand dinners.

Oct. 12th.—Bodily health continues good. He eats and sleeps well.
Loquacious.

Oct. 22nd.—Feebler both mentally and bodily.

Dec. 1st.— Not so well. Quieter. Less expression about his face.
„ 19th.—Will not speak or take notice of anything. Consider¬
able oedema of right eyelid. Probably had a fit this morning.

1883, Jan. 4th.—In much the same condition.

March 23rd.—No sugar in urine.

June 30th.—Has some cough. Bronchitic in character. Re-

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Clinical Notes and Cases .

515

1884.]

spiration hurried and shallow. (Edema of both ankles. Refuses to
allow any examination to be made.

July 3rd.—In bed. Breathing more laboured. Feet and legs more
swollen and oedematous. Eyelids puffy.

July 4th.— Urine . Lithates. Small quantity of albumen.

„ 7 th.—(Edema decreased.

„ 10th.—Whenever anyone goes into his room his breathing
becomes rapid and shallow. He becomes rather livid while breathing
thus. It does not last more than 3—4 minutes.

July 14th.—Breathing distinctly Cheyne-Stokes in character. Face
livid, and he seems much distressed. Died at 3.58 p.m.

P.M. 41 hours after death.

Head and Spine .—Brain weight, 31bs. 9ozs. Considerable amount
of fluid. Arteries much changed. Thick membrane implicating
arachnoid. (Pachymeningitis.) Adhesions on the whole surface of
the frontal lobes, but this part of brain is sodden. Unusual amount
of adhesion between the median surfaces of the frontal lobes. No
marked wasting.

Grey matter about normal depth, in appearance to naked eye. A
brain-sand tumour, about size and shape of a bean, in each choroid
plexus. In the anterior fossae of the base of the skull, on the dura-
mater lining the bones, especially on the horizontal plate of the
frontal bone, is a deposit of pigment. Also a similar deposit on the
upper surface of the tentorium cerebelli.

Cord .—Very decomposed.

Heart, —Weight, 26 ozs., very much dilated. Valves fairly healthy.
Atheroma of aorta, which was dilated and pouched.

Lungs, —R., 22 ozs.} r> ,, , .

* t in t Both oedematous.

L., 19 ozs.y

Liver, —31bs. 15 ozs. Much decomposed.

Spleen, — 9 ozs. Much congested.

Kidneys, —R., 7 ozs. Congested. Capsule slightly adherent.

„ L., 7 ozs. ditto. ditto.

Case II.—Edgar G.,aet. 33. Admitted Feb. 10th, 1883. Married.
No children. Draper.

One previous attack. Age on first attack, 14 days. Supposed
cause of insanity, anxiety on money matters. Not suicidal. Not
dangerous to others. He has been of sober habits. Grandfather had
melancholia.

Copies of Certificates, —1st Certificate.

1. General wandering and aimless restlessness; talking incoherently,
muttering to himself; stating that people get armsful of goods out
of his shop, and that the shop is being emptied, and that the assist¬
ants are not fed, and is getting excited about this.

2. By S. G. Unreasoning fear of fire ; fancied gas explosions j

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516 Clinical Notes and Cases . [Jan.,

believing that his assistants were being starved, and that persons
come into the shop taking away goods without payment.

2nd Medical Certificate.

1. His reasoning faculty is confused ; his ideas are erroneous ; he
is excited, and has fits of despondency. I have seen him slightly
violent.

2. Information given about the patient by his wife. —His grandfather
died of melancholia. Time of earliest symptoms, 14 days ago.
Nature of ditto—Incoherence in speech and hesitation. Progress
of case—Sleepless. Violent and refused food. All other facts are
negative.

Condition on Admission .—Tongue not markedly tremulous. Appe¬
tite fair. Pupils normal. Skin not greasy. Sensibility good. Has
delusions. Depression. Sleepless. Walk normal. Patellar reflexes
rather exaggerated.

Progress of Case . March 23rd.—No sugar in urine.

April 7th.—Distinct hesitation of speech.

May 2nd.—Fell down in fit and cut his forehead.

„ 25th.—Rather weaker.

June 13th.—Reported to have had a fit in the night. Now in a
semi-dazed condition. Complains of frontal headache. Pupils equal.
No vomiting. No loss of power, but movements uncertain and jerky.
Reflexes exaggerated, but equal on the two sides. Speech hesitating
and tremulous.

June 30th.—Found unconscious between 6 and 7 a.m. At 10 a.na.
quite insensible. General loss of power. Head turned to right.
Conjugate deviation of eyes to right. Pupils equal, act slightly to
light. Patellar reflexes exaggerated. Ankle clonus easily obtained.
Skin reflexes well marked. Has passed his urine under him. P. 170.
R. 55. T. 105°. Never regained consciousness, and died at 12.53 p.m.

Post-mortem 21 hours after death.

No marks of violence save slight extravasation in skin over right
eyelid.

On removing calvarium blood ran out, chiefly fluid, partly clotted,
about 4 ozs. in all; the dura-mater having been perforated in sawing
through skull.

The right hemisphere was much flattened and compressed, shelving
off in a very noticeable way at distances varying from an inch to a
quarter of an inch from the edge of the median fissure. The con¬
volutions on this side were seemingly atrophied, but this was due
mainly to the compression ; over this compressed portion was a large
sac, the walls of which were formed of a yellowish, translucent, homo¬
geneous membrane, to the naked eye not vascular. This was reflected
from the pia-mater of the right hemisphere on to the arachnoid surface
of the dura-mater. A considerable amount -of soft, dark, clotted blood
was lying in the sac, the remainder, as before mentioned, had run out.

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Clinical Notes and Cases .

517

1884.]

In left temporal fossa a small amonnt of sanguineous effusion.

The pia-mater peeled off the convolutions well. No adhesions any¬
where. There were several points of lymph beneath the pia-mater on
the right side. Grey matter normal but pale.

Fourth ventricle slightly granular on floor.

Lateral ventricles—no fluid, not enlarged.

Weight. —L. hemisphere, 19£ ozo.

K. „ 184 »

Cerebellum pons
and medulla

434 ozs.

Cord .—Weight, 2 ozs. Considerable amount of fluid in canal.
Lower Jrd very soft. Marked excess of connective tissue generally,
most in lateral columns. Degeneration of cells of anterior horns.

Heart .— Weight, 10 ozs. Valves healthy. Slight amount of fluid
in pericardium. No atheroma of aorta.

Lungs.- R, 37 ozs.j Both much congested .

Pleuritic adhesions both sides.

Liver .—57 ozs., healthy.

Spleen. —9ozs., healthy.

^„^.-R.,4Jozs.J Healthy

Case III.—Case of Mrs. Annie B., admitted into Bethlem Hospital
July 31, 1883.

One sister suffered from puerperal mania, one from delirium tre¬
mens. r Supposed cause, money losses about three years ago. Active
symptoms. 6 months was sleepless and then excited with exalted ideas.
She talked incessantly in a restless excited way. Muttered to her¬
self. Broke windows.

About three years ago a serious pecuniary loss was a great shock to
Mrs. B., and evidently preyed upon her mind, as in the course of time
she fell into a state of profound melancholy, and it was with difficulty
she went about her ordinary household duties. This feeling so far
increased as at times to render her perfectly speechless, and she would
sit apparently listless, and indifferent to any conversation that was tak¬
ing place. Change of scene was tried, but without beneficial effect, and
she returned home. After awhile she seemed to recover, and was
able to attend to her duties, shopping, &c., and to take short railway
journeys alone. But before long a relapse occurred, and on one of
these occasions she was brought home in a cab late at night, utterly
unable to give any account of herself or her movements during her
journey. From this period the disorder became obviously more pro¬
nounced. She was agitated, and had strange delusions about her
relationship to the Royal Family, and had exaggerated ideas of money.

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518

Clinical Notes and Cases .

[Jan.,

She also became helpless and incapable of doing anything for herself,
and neglecting her natural habits of cleanliness. Taken by her friends
as a last resource to a favourite sister, she broke out in a few days
into a violent paroxysm, imagining all sorts of strange things, as that
a favourite nephew was outside the house, and that nobody would let
him in or give him food. At intervals she had complained of violent
pains in the head, and of hearing strange noises as of cannons going
off, the sound of choirs singing, &c., which were very distressing to
her. She then became seriously worse, and so uncontrollable that her
friends placed her in Bethlem Hospital.

On Admission .—Had exalted ideas as to wealth and Royal Family.
Tongue tremulous. Right pupil slightly larger. Speech thick.
Patellar reflexes rather in excess. Walk staggering. She fell about,
and became steadily weaker in mind. Refused her food at times and
had to be fed. In September she was in much the same state, save
that pupils were equal and reflexes normal. She was incoherent, and
had exalted ideas. Memory almost gone.

In October the reflexes were fully marked or exaggerated.

On October 24.—Had a series of fits. Temperature normal.

„ 30.—Rallied a little.

Nov. 3rd.—Died. .

Post-mortem, Nov. otli, 1883.—(Head and spine only examined.)
The calvarium was normal, and on removal nothing unusual was seen
on surface of dura-mater. This easily separated on the right side,
but on the left it was adherent to the arachnoid, the cavity of which
was filled with a soft false membrane. This was very easily raised, save
at vertex, where it was adherent with the pia-mater and in places to
the cortex. After raising the dura-mater of right hemisphere one
was struck with the presence of lakelets of clear subarachnoid fluid,
which were seen at the vertex replacing wasted convolutions; these
were most marked over the base of the first frontal on right side, and
over the top of the ascending frontal convolution. The wasting, and
the fluid raising the arachnoid were present on the left side in corres¬
ponding sites, but not to such an extent. The wasting was most
marked in the areas mentioned. There were numerous adhesions of
membranes to the cortex, chiefly over frontal regions of both sides.
In spinal cord there was adhesion between the dura-mater and arach¬
noid and pachymeningitis most marked over the posterior and right
side. This was stripped off with fair ease, but was seen to be a
gelatinous matter. To the naked eye there was little abnormal visible
in the cord on section, but the right posterior horn was full and red.

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1884.]

Clinical Notes and Cases.

519

Case Resembling General Paralysis—Meningitis Followed by
Effusion of Lymph and Pus into the Arachnoid Sac. By
John Manley, M.D., Medical Superintendent of the
Hants County Asylum.

Henry Smith, aged 86 years, unmarried, was admitted
16th May, 1883, into the Hants County Asylum.

Very little was known respecting Ins history, but it was
reported that his mother was an old woman of 82 years of
age, still enjoying good health, and that there had been 16
in the family, of whom four brothers had been killed in the
Crimea, and that he was supposed to be her only remaining
child. No family history of either insanity or consumption
could be traced. His illness was variously stated to have
been from one week to five months’ duration, but no distinct
account could be obtained, yet it seemed probable he had
been becoming gradually ill for some months, though the
acute symptoms had not long shown themselves.

The illness was attributed to the fact that his sweetheart
had jilted him and married some one else. It had mani¬
fested itself at first by his having failed to recognize that
property in his neighbourhood did not belong to him, and
exercising the right of ownership over it, such as getting up
in the night and cutting the hedges, and by silly purposeless
actions as planting potato sets, and digging them up and
cutting them to pieces within a day or two of placing them
in the ground. He had lately been very restless and
excitable, requiring the attendance of two men to look after
him. He was reported as having always been a steady, well-
conducted man.

On admission he was, as regards his mental condition, very
incoherent and wandering in his ideas ; would not dress
himself, passed his evacuations in bed, and had threatened
violence to his mother, which was the immediate cause of
his removal from home.

With respect to his physical condition. His head was
hot, his tongue white, but there is no record whether it was
protruded with a succession of efforts, so that it was pro¬
bably done naturally. His speech very slow and thick,
sometimes he did not care to answer questions, and seemed
not to comprehend what was said to him. His expression
was excited, he was very shaky on his legs. He weighed
list. 5£lbs.

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520

Clinical Notes and Cases .

[Jan.,

The rest of the history is soon told. His excitement
passed off, he gradually became weaker and weaker, and
his speech entirely failed him. In a fortnight he was so
feeble that it was necessary to place him in bed where,
though water cushions were used from the first, he became
sore, and then large black sloughs appeared wherever the
parts rested, hanging eventually down from the surrounding
tissues. He suffered no pain, and took what was put into his
mouth. Finally on July 8th epileptiform convulsions came on
and continued until five o’clock in the afternoon, when death
occurred.

Post-mortem examination . Eighteen hours after death.
Body much emaciated, with many large sloughs on the pro¬
minences of the bones.

Head. The calvarium on section was readily removed
from the dura-mater below. The bones of the skull, par¬
ticularly the right temporal and parietal, were blanched and
anaemic. The frontal bone was honeycombed with a creamy
looking pus. The membranes of the brain were very pale.
The arachnoid had evidently been in a state of acute in¬
flammation, and was covered with a mixture of soft lymph,
and purulent matter which had a tendency to make its way
towards the cribriform plate of the ethmoid bone, and had
burrowed into the frontal bone. This covering over the
convolutions resembled both in colour and consistency a thin
layer of a plain omelette. When the dura-mater was divided
about 3ozs. of fluid mixed with pus escaped. The cerebrum
weighed 37ozs., the cerebellum and medulla more. The
consistence of the brain substance was almost normal, but
pale, and there was an absence of blood spots. The cerebrum
appeared to be healthy. The lining membrane of the fourth
ventricle was quite smooth.

This is the only instance in which I have seen such patho¬
logical appearances in any case simulating or actually being
one of general paralysis, although Bayle and Esquirol ex¬
pressed the opinion that this form of mental disease is in¬
dicative of inflammation of the meninges. I therefore think
it deserving of record.

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1884.]

Clinical Notes and Cases .

521

Case of Exophthalmic Qoitre with Mania . By J. Carlyle
Johnstone, M.B., Senior Assistant Physician, Royal
Edinburgh Asylum.

Mrs. G., aged 32, a native of Dumfriesshire, was admitted into the
Royal Edinburgh Asylum, 25th November, 1881.

The family history was good, with the trifling exception that a
brother had been intemperate. The patient herself had had no pre¬
vious ailments of any consequence, was naturally of a cheerful, frank
disposition, and had led a sober, industrious life as the wife of a re¬
spectable working man. She was the mother of three children, the
youngest being two years and nine months of age.

The history of the present attack was as follows. For the last three
years she had been gradually losing flesh and strength. Lactation
stopped four months after the birth of her child. Two months later
she had a severe attack of vomiting, and her neck became swollen.
It was next remarked that her eyes had become prominent, and this
was ascribed to the vomiting. At the same time her legs became
affected with prurigo. Nervous palpitations next made their appear¬
ance, and, owing to her emotional excitability, patient became unable
to attend to her household duties. On the 24th September, 1881,
she was sent to the Royal Infirmary, Edinburgh. For the following
notes of her case taken during her residence there, I am indebted to
Dr. E. H. Lawrence Oliphant, Resident Physician.

• On admission she complained of prominence of the eyes, swelling of
the neck, palpitation, itchiness of the legs, and nervousness. She was
fairly nourished. She complained of headache, giddiness, and dimness
of vision. She was restless, and fidgeted about in speaking, with her
hands frequently clasped behind her neck, and she moaned in her
sleep. The left eye was especially prominent. There was a certain
amount of nystagmus. When asleep the eyes were not completely
covered by the lids. Yon Grafe’s phenomenon (the disassociation of
the movements of the upper eyelids from those of the eyes) was best
marked in the left eye. This was very clearly demonstrated by watch¬
ing the patient reading, the eyelid remaining up. Ophthalmic discs
were hyperaemic. Considerable pressure was needed to push the eyes
back into the orbits.

The least excitement caused violent palpitation. There was a
general pulsation of the praecordia. The cardiac dulness was not much
enlarged. On auscultation a loud systolic murmur was audible all
over ; it was heard most distinctly in the pulmonary area.

In the neck the enlarged thyroid was seen as two pulsating tumours
united in the middle line. The right lobe was the larger. The pulsa¬
tion was most marked at the posterior borders. Over the tumour a
continuous bruit was audible, intensified by the cardiac systole.

There were occasional slight gastric disturbances.

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522

Clinical Notes and Cases .

[Jan.,

There was prurigo on the legs, which were slightly eczematous.
Vaginal examination showed that there was perimetritis with some
subinvolution. The vaginal walls were somewhat prolapsed. There
was leucorrhcea at the menstrual epochs.

Under the administration of digitalis and the application of the
constant current to the neck, patient progressed favourably for some
time, becoming less nervous and having less palpitation.

Five days before being sent to Momingside she suddenly and un¬
expectedly expressed the delusion that she had all the symptoms of
cancer of the stomach, as described in a newspaper she was reading.
This she dwelt upon, and soon after became violently excited to such
an extent as to require the use of mechanical restraint. From that
time she was sleepless, took little or no food, was obstinately con¬
stipated, and vomited persistently.

When admitted into the Royal Edinburgh Asylum, Mrs. G was in
a state of acute excitement. She presented a dishevelled and defiant
appearance, with strange, wild, prominent eyes, talked incessantly and
incoherently, and could not rest for a moment. She flung herself about,
writhed, and gesticulated ; clutched hold of any objects within her
reach ; violently resisted and struggled with all who endeavoured to re¬
strain her; laughed, shouted, screamed, and sang ; called upon various
friends by name ; and made use of profane and occasionally obscene ex¬
pressions. She displayed numerous vague and fleeting delusions ;
stated that the reporter was her son ; and affirmed that she had cancer
of the stomach. She was a thin, pale-faced, clear-skinned woman,
with brown hair and grey eyes. The pupils were dilated, equal, and
mobile. Tongue slightly furred in centre. Bowels constipated. Ap¬
petite poor. Pulse 100; irregular and feeble. Temperature 99°1.
The characteristic signs of Graves’s disease were present as already de¬
scribed. The right lobe of the thyroid was somewhat more enlarged
than the left, and the left eyeball was more prominent than the right.
The ordinary motor and sensory functions appeared to be unimpaired,
and the special senses were good.

For several weeks after patient’s admission her mental condition was
one of alternate tranquility and violent excitement. After sleeping well
for one or two nights, and spending a few days in a tolerably subdued
manner, she would become sleepless, restless, and acutely excited. She
broke panes of glass, threw the furniture about, rushed wildly about the
ward, tore her clothes off, chattered incoherently, mimicked what
was said in her hearing, and made strange grimaces ; said that she was
an angel, accused her husband of incarcerating her in an asylum
through jealousy, assailed everyone whom she met with foul and
abusive language, and shouted till she was hoarse. Her appetite was
very capricious, and great difficulty was experienced in persuading her
to take sufficient food. For some days she suffered from obstinate
vomiting. Temperature varied from 98° 2 to 100°*4. The pulse was
much accelerated, varying from 134 to 160.

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1884 .] Clinical Notes and Cases . 523

The further progress of the case is summed up under the following
dates. *

January 25th, 1882—(Two months after admission). The intervals
of quietude are now much more frequent and more prolonged, but
patient is still in an extremely irritable and excitable condition. When
secluded from the other patients she behaves in a subdued and rational
manner, but on the slightest provocation she has an outburst of
hysterical excitement. She is very weak and emaciated, and there is
little improvement in her general health. She, however, has a better
appetite, and suffers less from sickness. The temperature is now
normal, but the pulse continues rapid (148). There is no change
to note in regard to the palpitation of the heart, the enlargement of the
thyroid, or the protrusion of the eyes.

February 28th.—Since last note she has had a mild attack of ton¬
sillitis, and has suffered from severe headache. Every effort is being
made to improve her general health and nutrition, but, although she
takes her meals heartily, she has lost 14 pounds in weight since her
admission. She has made considerable progress, however, in regard to
her mental state. She is often very subdued and sensible, and at such
times discusses her present condition in an intelligent, though sad,
manner, expresses grief at being separated from her husband and
family, and asks plaintively when she will see them again, and if she
will ever be better. If, however, her thoughts are allowed to dwell on
such subjects, she becomes excited, begins to talk loudly and quickly,
and soon incoherently and wildly, cries out, laughs, sheds tears, and
displays violent agitation of a hysterical character.

March 11th.—Yesterday morning, patient, without any warning,
suddenly fell down in an unconscious condition. She came to in a few
minutes, but for some time she displayed great mental confusion, mis¬
taking the officials for old acquaintances. The pulse, taken im¬
mediately after the seizure, was 32 in the minute, with occasional rapid
double beats. This morning she had a similar attack of fainting, but
with less loss of consciousness. There were no motor phenomena, but
she complained of a numb feeling in her left arm, and spoke of her
attack of yesterday as a paralytic stroke.

April 26th.—She was to-day removed to the hospital of the insti¬
tution, in order that she may be more disposed to employ herself in a
domestic manner, and that she may benefit by the nursing and greater
quiet. Her mental condition is very much improved. Her periods of
excitement are much less frequent and much milder, and she displays
greater self-control. There is still, however, great instability of the
emotions, and a proneness to hysterical manifestations. She is visited
regularly by her husband, and, although often much affected by their
meeting, she behaves and converses in a sensible way, and is extremely
anxious to return to her home and its duties. She has gained a few
pounds in weight, but she is still wretchedly thin, and otherwise it can¬
not be said that there is much improvement in her physical condition.

xxix. 36

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524

Clinical Notes and Cases .

[Jan.,

The thyroid swelling appears to be painless, and not to interfere with
deglutition or respiration. The voice, however, is weak, high-pitched,
and somewhat husky and squeaky. The action of the heart is rapid
and irregular, with a bounding impulse. There is a soft systolic
murmur audible over the whole praecordial region and along the
carotids, and there is a loud continuous bruit in the neck at the borders
of the tumour. The exophthalmos is very distinct; the left eyeball is
more prominent than the right. She suffers at times from headache,
ringing in the ears, giddiness, and a sense of fulness in the head, and
she is subject to general flushings and excessive perspirations. She
was to-day ordered to have the bromide of iron.

May 26th.—In the beginning of this month she menstruated for the
first time since the birth of her child. Her general health is consider¬
ably improved, and she has gained seven pounds in weight within the
last fortnight. She works diligently in the hospital, and, except for
frequent periods of depression and subdued emotionalism, she behaves
very rationally. She converses in an intelligent and cheerful manner,
and is very grateful for the attention she receives, and very willing to
be of use.

June 23rd.—Has gained eight pounds’ weight since last note. Still
displays at times great irritability and emotionalism, but on the whole
appears to be making steady progress both mentally and physically.
She is, however, still troubled with the feeling of fulness in the head,
and with flushing and perspiration. The flushing is general, and so
intense that patient says “it is like having a hot iron run all over her
body.” The perspiration, also, is excessive, and generally comes on
immediately after her drinking however small a quantity of fluid.

July 23rd.—Last night she had two seizures, in which she lost the
power of the left arm and leg, and had a feeling of numbness in those
limbs, and all over the left side. This feeling had passed off in the
morning, but she feels very faint, and has a severe frontal headache.

September 8th.—Since last note she has had several returns of the
feeling of impaired power and numbness in the left limbs, and each
attack appears to be more severe than its predecessor. She has been
confined to bed for the last few days, suffering from sensations of
faintness, sickness, and giddiness. This morning her face was noticed
by the attendant to be quite livid, and the surface of left arm was very
pale and mottled with small purple patches. The numb feeling is very
pronounced to-day. Patient states that it is “ like needles and pins,”
and that it occupies the left arm and leg and exactly the left half of the
head and trunk, being limited by the mesial line. Over the affected
area tactile sensation is much impaired, while the sense of pain is in¬
creased. On the right side sensation appears to be normal. Owing to
the fault of touch and the sudden losses of power in the left arm,
patient often lets fall in an unexpected way anything that she happens
to be carrying in her left hand. The special senses are not, apparently,
affected to any great extent. (It may be remarked that patient has a

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Clinical Notes and Cases •

525

respectable horror of being “ experimented *’ upon, and generally de¬
clines to answer questions prompted by scientific curiosity.) The occur¬
rence of the above-described nervous phenomena is much to be regretted,
since, in other respects, patient’s condition is very satisfactory. She
now presents a well-nourished, healthy appearance, displays much
greater self-control, and is a general favourite in the hospital, where
she works very diligently when she is able. The leading features of
the exophthalmic goitre seem to cause her less annoyance, and the pro¬
minence of the eye-balls is, if anything, less marked.

November 1st.—The improvement in her mental condition and her
state of nutrition continues, but the motor and sensory phenomena on
the left side have become more pronounced, and the cardinal symptoms
of her disease show no signs of amelioration. The exophthalmos is very
marked, the left eye protruding in a painfully striking manner, and the
lids do not completely cover the eyes in sleep. The heart’s impulse is
very powerful, and a soft systolic murmur is audible as already de¬
scribed. Pulse at wrist 116; full and bounding. Urine: Highly
acid ; no albumen or sugar ; deposit of amorphous urates. Appetite
good ; tongue tremulous ; bowels regular. There appears to be no
alteration in the size of the enlarged thyroid. There has been no re¬
turn of the menstrual discharge. Patient has been having the bromide
of iron for the last six months, but, as it now makes her sick, she has
been ordered instead tinct. digitalis 11| 10 four times daily, and efforts are
being made to promote menstruation.

November 17th.—Has been feeling very ill for some days, and for
the last two days has been vomiting persistently, apparently with little
nausea. She has been given small doses of calomel frequently
repeated, and she feels considerably better to-day. The left side and
limbs are numb, and the arm and leg quite powerless. She frequently
tumbles out of bed owing to her want of balance. There is slight
inflammation of the left conjunctiva, and the face is at times intensely
flushed.

November 19th.—She appeared to be rather better yesterday, but
was very weak, and was unable to swallow. At 2 p.m. she suddenly
became unconscious. She never rallied, and at 12.10 this morning
she died.

Autopsy 36 hours after death .—Body well nourished. Cadaveric
rigidity present in limbs. Eyeballs imperfectly covered by lids, and
abnormally prominent, the left protruding more than the right; their
tension is below normal. Pupils equal, dilated. Left conjunctiva
presents an injected appearance.

Head .—Skull-cap symmetrical ; bones normal in consistence ;
hyperasmia of inner table, especially in bones of base. Dura-mater not
abnormally adherent, but thick, and in some places easily divisible into
two layers ; at base much injected. On removing the dura-mater the
convolutions of the right hemisphere present a flattened and glazed
appearance, while those of the left have a healthy look. The pia-

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526

Clinical Notes and Cases .

[Jan.,

mater on both sides is considerably injected, and there is some opacity
of the arachnoid along the lines of the sulci, the membranes being
especially affected over the right hemisphere. The vertebral, basilar,
and internal carotid arteries and their branches, as far as they can be
traced, and the optic tracts and cranial nerves show no signs of disease.
About one inch from the great longitudinal fissure on the right side
and covering the ascending frontal and ascending parietal convolutions,
to the extent of a half-crown piece, the pia-mater is thick, cedematous,.
and much injected, and the underlying convolutions feel soft and
pulpy. The membrane on being removed from this area drags off with
it a layer of the cortex, leaving a rough, pulpy surface studded with
minute haemorrhages. There are numerous adhesions of the pia-
mater over the whole of the superior and lateral aspects of this hemisphere,
and along the marginal convolutions of the longitudinal fissure, but
over the tip of the frontal lobe and the under and inner surfaces of the
hemisphere adhesions are absent. In some places the whole depth of
the cortex comes away with the membrane. Over the left hemisphere
the pia-mater has no adhesions. On slicing the right hemisphere the
whole of the white matter presents a pinkish, mottled, and injected
appearance, the puncta vasculosa being very large and numerous ; while
the cortical matter is universally soft, red and swollen, different convo¬
lutions being affected in various degrees. In the situation already
referred to and in a few scattered convolutions in the posterior third
of the hemisphere, the cortex is broken down into soft pulp full of
small red spots and extravasations. In the left hemisphere the grey
matter of the cortex is much injected, but otherwise does not present
any striking abnormality. There is hyperaemia and mottling of the
white matter, but this is less marked than on the right side ; the
frontal and parietal lobes are most affected, the temporo-sphenoidal less
so, and the occipital least. The optic thalami and corpora striata show
slight hyperaemia, but no gross lesion, and the same condition is
present in the pons, medulla oblongata, and cerebellum. The floor of
the fourth ventricle, however, is distinctly injected. On removing the
orbital plates the orbits are found to be tightly packed with adipose
tissue, the contents of the left feeling tenser than those of the right,
but the vessels, nerves, muscles, &c., present no abnormality.

The encephalon weighs 49 ounces. The cerebellum, pons, and
medulla oblongata weigh, together, ounces.

Thorax and Neck .

Heart, $c .—No fluid in pericardium. A few white patches on
surface of ventricles. Slight dilatation of cavities, with slight
hypertrophy of walls. Weight 10£ ounces. Valves normal. Aorta
somewhat dilated; slightly atheromatous. The left vertebral artery
arises from the arch of the aorta between the left carotid and left
subclavian arteries.

Lungs .— Some hypostatic congestion. Otherwise normal.

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Clinical Notes and Cases .

527

1884 .]

Thyroid and Thymus Glands .—The thyroid gland is much and uni¬
formly enlarged, and firm to the touch. The right lateral lobe
measures 3^ inches in length, 1^ inch in breadth and nearly 1^
inch in thickness at its thickest part. The left lateral lobe is 3j
inches long, nearly inch broad, and nearly inch thick. The lateral
lobes are connected anteriorly'a little above their lower ends by a
middle lobe, which, separated from the right lobe by a deep groove,
proceeds upwards and to the left, reaching as far as the central notch
of the thyroid cartilage, and lying to the left of the central ridge. This
lobe is conical in shape, and measures 2£ inches in length and £ inch
in breadth ; the upper extremity is separated from the rest of the lobe
by a deep furrow. The apex of the right lobe extends for half an
inch, and the apex of the left nearly a quarter of an inch, posteriorly,
above the superior border of the thyroid cartilage ; while the inferior
extremity of the left lobe reaches to a slightly lower level than that of the
right. The lobes embrace, but appear not to compress, the larynx, the
lower part of the pharynx, and the upper parts of the trachea and
oesophagus, leaving between their posterior borders a space of half an
inch. On cutting into the gland a few cysts are found in the right
lobe, each about the size of a pea, and containing white waxy-looking
" colloid ” matter. No abnormality is noticed in the vascular supply,
except that the arteries, and more particularly the venous plexuses,
are more voluminous than usual.

Extending from the lower border of the thyroid gland down in front
of the great vessels into the anterior mediastinal space lies the
remarkably large thymus gland. It is of an irregularly triangular
shape, with the base directed downwards, and consists of two flat
triangular lateral lobes which are firmly connected along the middle
line by fibrous tissue, and are themselves irregularly lobulated. The
apex of each of these lobes is attached to the inferior extremity of the
corresponding lobe of the thyroid gland by fibrous tissue and blood¬
vessels. The gland measures 3£ inches from base to apex, 3^ inches
from side to side, and ^ inch in thickness. It has a firm, fleshy feel.
Its vascular supply is normal.

The sympathetic cord in the neck, on being dissected out for future
examination, shows no appearance of disease.

Abdomen.—Liver normal; weight, 33£ ounces. Spleen 7 ounces in
weight. Kidneys hyperaemic ; capsule of left adherent in places, right
5£ ounces ; left 6 ounces. Uterus and appendages normal. Intestines
healthy.

Microscopical Examination —The following parts were examined.
The cerebral convolutions, portions being taken from the right and left
frontal, parietal, occipital, and temporo-sphenoidal lobes; the opto-
striate bodies, pons varolii, medulla oblongata, and cerebellum; the
superior cervical ganglia of the sympathetic (the middle and inferior
ganglia were unfortunately not examined) ; and the thyroid and
thymus glands.

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528

Clinical Notes and Cases . ,

[Jan.,

Cerebral Convolutions. —(The sections, were accidentally kept too
long in spirit; but the following appearances could be made out). In
the left hemisphere there is some slight thickening of the pia-mater,
with injection of its vessels ; the vessels of the cortical and medullary
matter are strikingly engorged with blood ; the nerve elements seem to
be little affected. In the right hemisphere there is considerable
irregular thickening of the pia-mater, with proliferation of its nuclei,
and engorgement and thickening of the vessels ; the brain-tissue
presents a broken-down appearance, and in the neighbourhood of the
soft foci numerous granular and dwindled cells and free nuclei are seen ;
there is marked hyperaemia, and the vessel-walls are thick and show
proliferation of the nuclei ; the tips of the frontal and occipital lobes are
much less diseased than the other convolutions.

Opto-striate Bodies , Pons, Medulla, Cerebellum , and Optic Nerves .
The sections display no abnormality, except that a very few granular,
fuscous cells are to be found in the medulla oblongata.

Superior Cervical Ganglia .—While many fairly healthy cells are to
be seen, the greater number are more or less pigmented, and many
are slightly atrophied. The pigmented patches are very distinct in
many cases, and in a few instances the whole cell is replaced by a
brownish or orange-coloured mass. There is some increase in quantity
of the connective tissue, but in other respects the ganglia appear to be
normal, and the sections from the right ganglion cannot be distinguished
from those of the left.

Thyroid Gland. —There is considerable thickening of the fibrous
capsule and the connective tissue framework, and the vessels are large.
The vesicles are of various shapes and sizes, and many have coalesced,
forming large irregular spaces. They contain colloid matter and some
corpuscles, and in most cases the epithelial lining can be made out.
Irregular masses of colloid are also to be found outside the vesicles. Along
the periphery of the gland, immediately inside the investing membrane,
is a richly corpusculated belt, in which follicles can be seen, apparently,
in different stages of development. Nearest to the surface, in the
midst of the granular-looking mass, one can detect small groups of
cells arranged in a more or less concentric manner, and proceeding
inwards towards the open, alveolar part of the gland, one finds small
round and oval follicles stuffed with cells, and finally normal vesicles,
with cell contents. The same appearances are observed in small islets
thinly scattered over the rest of the section. Each section thus
presents evidence of true hypertrophy of the gland in one part and
wasting in another.

Thymus Gland. —In the capsule, septa, and interfollicular trabeculae
there are scattered streaks of adipose tissue, and in some places fat and
connective tissue have encroached to a considerable extent on the
proper substance of the follicles, but otherwise the sections are those of
the normal thymus gland.

Commentary .—This case presents several interesting features,

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529

1884 .] Clinical Notes and Cases.

of which the following appear to deserve some considera¬
tion :—

1. The fact that the patient was a native of a goitrous
district.*

2. The order of invasion of the phenomena of the exoph¬
thalmic goitre; the occurrence of violent vomiting, followed
first by the enlargement of the thyroid gland, next by exoph¬
thalmos, and finally by nervous palpitations. According to
most authors, palpitation is the first phenomenon observed, but
numerous cases have been recorded where either the exoph¬
thalmos or the goitre was the first symptom. The same order
of development as in Mrs. G.’s case occurred in cases reported by
Dr. Sutro and Dr. Sutton.f In Dr. Sutton’s case it is interest¬
ing to note that “ acute paraplegia, seemingly due to acute
softening of the cord, supervened on the Graves’s disease, not only
was there complete loss of motor power and sensibility, but
extremely troublesome bedsores also formed, and yet she
recovered.”

3. The mental disorder .—Psychical disturbances have always
been noted in cases of exophthalmic goitre, and instances of
actual insanity have been recorded. J The irritability, capri¬
ciousness, emotional excitability, the hysterical manifestations,
the alternations of excitement and depression, characteristic of
the disease, were all present in Mrs. G.’s case, and exaggerated
to the extent of acute mania.

4. The further development of the symptoms. —The progress
from a state of acute maniacal excitement, accompanied by
extreme emaciation and bodily exhaustion and all the distress¬
ing symptoms of Graves’s disease, to a condition in which the
mania had subsided, the body had become strong and well
nourished, and the exophthalmic goitre had almost ceased to
annoy, was both interesting and gratifying. For some time
the patient’s prospects of ultimate recovery seemed excellent,
but soon after the appearance of the motor and sensory
phenomena on the left side, long fore-shadowed by the promi¬
nent left eye, it became evident that cerebral changes of a
grave character existed.

* See Mitchell, On the Nithsdale Neck or Goitre in Scotland, a Brit, and For.
Med. Chir. Review, 1 * April, 1862.

f Sutro, “ Medical Times and Gazette/* Dec. 26, 1868. Sutton, “ Brit. Med.
Journal/* Aug. 3, 1878.

X See papers on the subject by Dr. Alexander Robertson, “ Journal Mental
Science/* January, 1875, and Dr. Savage, “ Guy*s Hospital Reports/* Vol.
xxvi. Also Williams, “ Lancet/* Nov. 17, 1877, and Cane, “ Lancet/* Dec. 1,
1877.

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Clinical Notes and Cases .

[Jan.,

5. Among the secondary symptoms the most remarkable
were the sudden profuse perspirations, the intense flushing and
burning heat of the skin, with the tendency to skin diseases,
and the digestive disturbances.* * * §

6. The most striking of the post mortem features were the red
softening of the convolutions of the right hemisphere, the con¬
dition of the sympathetic and thyroid, and the presence of the
large thymus gland. In a case of exophthalmic goitre
recorded by Dr. Markham,f “ The thymus was remarkably
enlarged, weighing two ounces and a half; it passed down
along the anterior mediastinum, ending in two lappets, one of
which, larger and broader than the other, lay across the
pulmonary artery, and apparently pressed upon it. The
structure of the gland was perfectly normal.” In this case
also the thyroid enlargement appears to have been the first
symptom of the disease. Dr. GoodhartJ describes a case of
Graves's disease in which “ a part of the thyroid ran down to a
mass in the mediastinum, which consisted of a great over¬
growth of the connective tissue. The lymphatic glands were
enlarged, and the thymus gland was large, encapsuled, and not
adherent to the tissues around.” In another case§ of the same
disease the thymus was found enlarged.

A Case of General Paralysis in a Woman. By F. M ,
Cowan, M.D., Physician to the Meerenburg Asylum,
Holland.

In the Asylum Report of last year I published the case of a
woman suffering from general paralysis. The post-mortem
was somewhat different from that generally met with in
this disease. After reading the article of Dr. E. Mendel ||
I venture to publish this case, as I arrived at nearly the
same conclusions as this able alienist physician.

Some 25 years ago this case would have been considered a
curiosity only on account of the subject being a female.

* See Dr. Burney Yeo’s interesting cases and remarks, “ Brit. Med. Journal,”
March 17, 1877; and Cheadle, “ Lancet,” June 19, 1869.

t Markham, “ London Path. Society’s Transactions,” 1858.

J Goodhart, ** Brit. Med. Journal,” Dec. 6, 1873.

§ Howse, “ Brit. Med. Journal,” April 21, 1877.

|| Ueber Hirnbefunde bei der progressiven Paralyse der Irren. “ Berliner
Klinische Wochenschrift,” No. 17. 1883.

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Clinical Notes and Cases .

531

1884 .]

Since the days when Bayle and Baillarger studied this
disease, a large number of similar cases have occurred, and
almost every asylum physician has met with them.

I shall now give an account of the case, and add my re¬
marks afterwards :—

P. B., set. 36, was admitted into the Meerenberg Asylum
on the 5th of July, 1882, and displayed all the symptoms
of a general paralytic in the demented stage.

We learn from her previous history that immorality was
hereditary in her family. Her mother had led a very immoral
life, and the patient herself had been the inmate of a low
house at Amsterdam. She afterwards married and had two
children, both of them alive and healthy. As far as I could
learn, she never had a miscarriage. Her father died while
she was still a child; her mother lives, and is well. This
was all the information we could obtain about probable
heredity.

On her admission it was clear that she was not aware in
what place she was. She used to sit in the same place for
a long while, taking no notice of persons or things surround¬
ing her, and was heedless of the calls of nature, passing
stools and urine without being aware of it. Only when
spoken to she used to weep piteously, and the amount of
tears she shed was very great ; they did not trickle
down her face, but ran down in two continuous streams.
The weeping fits lasted about an hour, after which the
woman would settle down into her usual apathy.

There was a continual twitching of the facial muscles,
, especially of the zygomatici. The pyramidalis nasi and the
depressor anguli oris were often contracted, thus giving
the face a sad expression ; this was heightened by an arching
of the eyebrows and by her weeping when spoken to. The
left naso-labial groove was more furrowed than the right.
When no notice was taken of her she sat listlessly, with an
apathetic expression. The pupils were unequally dilated,
the left being largest. When required to do so, she pro¬
truded and drew back the tongue with a jerk. The tongue
was slightly furred, was indented on its edge, and displayed
the same muscular twitchings as the face.

A proper answer was not to be obtained ; a low moaning
was the only response to any questions. However, it was
clear she understood what was asked, as she opened her
mouth, put out her hand, &c., when requested to do so,

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532 Clinical Notes and Cases . [Jan.,

although we had to repeat the order some three or four
times.

I obtained a few sphygmograms, and they all gave us a
very irregular curve; the line of ascent slanting and present¬
ing a number of wavelets (two or three), the summit slightly-
rounded, the aortic notch in the line of descent very ill-
defined.

The frequency of the pulse varied from 98 to 76 beats.

The temperature amounted to 36*8° of the centigrade
thermometer, and in the evening rose to 38*1°

The gait was very bad; the patient used to stumble over
very slight obstacles.

Appetite voracious; she used to bolt her food without
chewing it, and it was necessary to cut it up, and she had
to be fed at last, the more so because she used to miss her
mouth and strike her fork against her cheek or chin.

The patellar reflex was exaggerated; at times very much so.

The lungs were normal, percussion giving negative results ;
auscultation, it seemed, frightened the poor woman. On
applying the stethoscope, the breathing took the character of
cogged-wheel breathing, while if watched during her sleep,
the respirations were deep and regular. On auscultation of
the heart, we sometimes heard a systolic blowing over the
mitral valve.

The physician who had attended her previously communi¬
cated to us that she had been ill upwards of two years, and
had passed through a maniacal period of great violence,
and with the ordinary delusions of greatness.

A strict examination was made to discover any signs of
previous syphilis; however, the result was altogether
negative. No scars or swollen glands were to be met with.
The only somatical (sit venia verbo) affections met with was
an ulcer on the right shin, just over the crista tibiae, of
about the size of a penny-piece. Habits foul and destructive.

Very soon after her admission saliva began to dribble out
of the corners of the mouth. On the 15th of October walk¬
ing was entirely out of the question, and even sitting in a
chair was impossible, as the poor woman kept dropping on
the ground ; she was consequently confined to bed. On the
1st of November a bad sore formed just over the sacrum,
spreading symmetrically on both sides. Notwithstanding
the greatest cleanliness and care it extended with almost
lightning-speed; sloughing ensued, and the patient died
on the 18th of November.

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Clinical Notes and Cases .

533

1884.]

Let me add that during the whole disease she never had
either apoplectic or epileptiform attacks.

Post-mortem 60 hours after deathThe skull was rather
thickened, and hard to saw. Its inner surface was smooth
and polished, nowhere displaying osteophytes or tumours of
any kind.

The dura-mater (thickened) lies in folds over the frontal
lobes. The arachnoid, where it bridges over the sulci, is dull,
and looks like ground glass. The pia-mater peels off easily,
save on the ascending frontal and parietal gyri and on the
paracentral lobules.

The gyri of the frontal lobes are distinctly atrophied,
leaving enlarged sulci between them in which lie dilated
venous vessels.

On the summit of the right paracentral lobule is a de¬
pression large enough to contain a rifle bullet. On cutting
through it, it appears that the grey matter is no more
atrophied there than it is elsewhere, but follows the slope of
the depression.

Weight of brain 1,170 grammes. The substance was
cedematous. The grey matter was reduced to a mere lamella
in the frontal lobes. The ependyma of the ventricles was
covered with granulations, like so many dewdrops ; this
was particularly the case in the fourth ventricle.

The ventricles were dilated, and filled with a slightly
turbid fluid. In the other organs nothing remarkable was
found, with the exception of congestion of the lungs and a
slight amount of fatty degeneration of the heart.

The results of the microscopical examination were most
remarkable. As a rule, the neuroglia, the connective tissue
of the brain, is the affected part. In our case the neuroglia
was normal. There was only a slight amount of proliferation
of nuclei in six slides out of forty.

Indeed the only changes met with were found in the nerve
cells and the vessels.

The smaller arterial vessels were affected by endarteritis,
which had greatly reduced their capacity. At very regular
intervals the intima was bulged into the interior of the
vessel, so as to narrow it to about one-third of its diameter,
without, however, entirely obstructing it. This diminished
arterial circulation caused a serious stasis and transudation
into the pericellular spaces, resulting in atrophy and dis¬
integration of the cells.

Dr. Mendel, in his paper, points out that the symptoma-

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534

Clinical Notes and Cases.

[Jan.,

tology of this form must still be studied. In his case the
patient was subject to repeated and severe apoplectic or
apoplectiform attacks while the course of the disease ex¬
tended over six years.

In the case above mentioned the symptoms were somewhat
different. No attacks, and a duration of between two and
three years.

May not the endarteritis have been of syphilitic origin P

Mendel denies syphilis most decidedly in his case. I
believe the absence of any other lesion pointing to this
disease renders it probable that it was not the cause in ours,
although the previous history of the woman rendered such a
cause very probable.

OCCASIONAL NOTES OF THE QUARTER.

The Case of Gouldstone.

First and foremost among the Occasional Notes of the
Quarter the case of Gouldstone calls for comment. The
observations to be made upon it will be ranged under the
following heads: First, the history of the man and his
crime; second, the examination in Court of skilled wit¬
nesses, with remarks on the futility of such examinations
from a scientific point of view; and thirdly, the question of
the legal dicta on responsibility.

First, then, the history of the patient.

His mother was insane at the time of his birth, and bis
mother’s sister was, and is still, insane. In both these
women there was well-marked melancholia, with the idea
that ruin was coming upon them.

On the father’s side, the father’s sister was insane, and
two cousins, one of whom died in an asylum, probably of
general paralysis.

Thus Gouldstone came of doubly nervous parents. It
may be said, Why have none of his brothers or sisters
suffered from neurosis ? I can only say I cannot tell, but
that it may simply be but the want of the spark to cause
the explosion. In Gouldstone the spark fell.

Gouldstone managed to make a fair living; he had no
serious illnesses, and was a quiet, sober man. He seemed
inclined to a solitary rather than a social life, and even

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535

1884.] Occasional Notes of the Quarter .

before his marriage he preferred to be alone rather than with
others.

He had no special tastes and no special ability. His em¬
ployment was that of a fitter of grates which had been sent
up from the foundry. This required only steady, quiet, un¬
original work.

He was not emotionally religious, but went to church when
he had a decent coat on his back.

He married a young woman of his own age and station,
and in no way changed his ways.

He was punctual at his work, careful in its performance,
and regular in his return home when it was done. He con¬
tinued to go to church as long as his wife could go with
him, and as long as his clothes were, to his idea, good
enough.

When he had children at home he spent his spare time in
playing with them, and was more fond than most artizans of
his family, and cared for no other society.

His fellow-workmen looked upon him as odd and unsocial.
He never made chums.

He would, like Joseph of old, tell strange dreams he had
had, and he gave his fellow-workmen the idea that he half-
believed what he told them. His dreams displayed heaven
opened, and he heard God speaking to him.

At times he had dreadful dreams, and he had very severe
pains in his head.

Besides these symptoms he had increasing trouble from a
double hernia, and at times he said he wished he were dead.
With his fellows he would talk about the easiest way to die,
and whether it would be painless to be crushed by the lift.
It can be seen from his fellow-workmen’s letter that they
thought him strange.

During the last year or two he managed to live and keep
his family, but he rarely had animal food, and then in very
small quantities, so that this nervously weak man was fight¬
ing a hard battle with feeble support.

His wife’s last confinement approached, and he was in no
way changed. When he heard there were twins he was not
unnaturally disturbed, and went to his work on the next
day, but on the annual holiday of the firm he did not go
with his fellow-workmen to the bean-feast, but was at home,
and appeared moody, and at times was in tears. It came
out afterwards that at this time he—like his mother—
contemplated suicide. He did not make any noisy, blus-

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536 Occasional Notes of the Quarter. [Jan.,

tering threats, but quietly rested while the morbid mental
growth developed.

On the day of the killing he went to work as usual, and,
as far as is known, he did his work well. But he was
disturbed and restless in himself, and thought of his misery,
and decided insanely to alter, but not to end it.

He even considered whether he should use a revolver or
not. He is said to have taken more drink than usual to
nerve him for the effort.

And now we come to the killing of bis children. There
was the calm action of a most determined criminal, an en¬
thusiast, or a lunatic.

No passion, no haste, only steady, purposeful, but unrea¬
sonable slaughter.

He had worked out the problem in his weak mind that it
were better for the children to go straight to heaven, and he
did what he considered the best for them. If he had killed
himself after the act, no one would have had a doubt
about the insanity of the act, but he lived without seeming
to care. That he knew he killed his children none can
deny—he owned it more than once—and equally he knew
that hanging was the penalty of murder.

He spoke and acted as if he had done a kind act to his
wife, and bade her an affectionate farewell.

After the killing of his children, and his conveyance to the
House of Detention, he seemed to be suffering from melan¬
cholia ; so said the doctor, though for some reason his evi¬
dence was never given in Court.

He was not, like the passionate criminal, overpowered by
the sense of his deed. He slept fairly, and took his food.

In the interview I had with him he talked in a calm,
uninterested way, quite unlike the callousness of a villain
or the justification of the pretended lunatic. He did not
try in one way or another to excuse himself, or make
light of his deed. He talked as if he were narrating some¬
thing which had occurred to someone else.

In this his manner contrasted markedly with that of a
murderer I once before examined, who was only too anxious
to make the most of his nervous relations, his own injuries
to his head, and of forgetfulness of his act. The man is a
physically weak man, with a small htxd, and with features
of a dull, but not brutal type. I wb^ld say, too, of his
lprothers who appeared in Court, that they ^ll had the appear-

1884.] Occasional Notes of the Quarter . 537

ance of dull men, and their examination showed them to be
intellectually weak and slow of perception.

I would, then, sum up the case in this way. A man with
strong direct inheritance of insanity is reduced by bad
feeding, pain, and worry, to a condition of misery that was
diseased. It was melancholia out of relation to its causes
and its end. The whole thing was as is general in mental
disorder—a morbid development, not a devilish afflatus.

As to my examination in Court, I can only say that the
skill of the prosecuting counsel and the ruling of the Judge
made my opinion appear to be that the prisoner was respon¬
sible. I could only say “yes ” when asked if the man knew
he had killed—I objected to the term “murdered”—his chil¬
dren, and again I could only say “yes” when asked if he
knew the punishment he had incurred. It would have
been folly, as well as false, for me to have said otherwise.

But I distinctly added that I believed him to be insane
at the time the act was committed. One most important
point was made out of the fact that I said that I could not
certify from facts observed by myself in my interview of from
20 minutes to half-an-hour.

I have been blamed for this, but I would defend myself by
saying that counsel strictly bound me down to answer simply
and solely as to facts observed by myself. Some say that,
as a physician, I was bound to take the history and the ante¬
cedent facts as part of the facts observed. This I must
demur to, as in the signing of a certificate the facts observed
by myself must be quite independent of information gained
from others. I own this is often a foolish necessity of the
law, but at present it exists. I did add that with the history
and from the facts I believed him to be insane, but I was
told by the Judge that this was not for me, but for the jury
to decide. And the Judge’s ruling quite outweighed my
opinion.

Surely the jury have a right to be instructed by experts
as well as by lawyers. Insanity and its various forms are
not less difficult to understand than forms of law.

It would have been better that there should have been a
contest of medical opinion, so that the jury should have
heard the points for and against the insanity, rather than
they should be wholly uninformed. It may seem strange
that medical opinions should differ as they are seen to do in
contested trials; but I for one do not see in this difference of

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538

Occasional Notes of the Quarter.

[Jan.,

opinion untruth or dishonour. Medical knowledge is not
as yet finite, and there are at least two sides to a shield.

I would suggest that, in any criminal case in which the
medical officer of the House of Detention states any doubt
about the sanity of a prisoner, the trial should not take
place till several months* observation have transpired; thus
a great deal of heart-burning would be saved, and some
lunatics would not be tried as criminals.

Lastly, as to the test of sanity.

I fear the want of any exact knowledge of the causes of
insanity must for very long leave us without any definition
of the condition.

The lawyer will say, “ Let common sense decide who are
responsible, and what is to be meant by responsibility

I know the most important safeguards are needed by society,
so that the weak should be kept from becoming wicked, but
at the same time I must protest against persons being
punished for what they cannot help.

First, I would do away with all definitions of responsi¬
bility, and let each case be tried on its own merits. For
just as a man is sane or insane in relation to his past history
and to his surroundings, and not according to any standard
that can be set up, so a man is responsible or not for his
acts, according as they are the natural outcome of his un¬
curbed passions or are due to diseased conditions.

I grant that harm has been done in several ways by the
medical expert, in too often and too indiscriminately drag¬
ging in such rare explanations as insane impulses alone.

Again, insanity is generally looked upon as like other
acute diseases, which can be as readily diagnosed as fevers
or heart disease.

It will not be understood in its criminal relationship till
it is looked upon merely as the morbid life-growth from the
diseased germ. The whole life has tended to irregularity,
and in many, direct insane inheritance must be admitted to
play a chief part in its production.

The subject is unsatisfactory, as may at once be seen from
the different ways it is viewed by the public.

The suicide is always considered to be insane.

The testator, again, is practically considered sane, but it
may be shown that he was insane without incurring odium.

But if a criminal is defended as insane, his defender
runs a great chance of being looked at as criminal also.

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Occasional Notes of the Quarter .

539

Finally, are we to be bound by any definitions in giving
our opinion? I should say “No.” We have got rid of
“ delusions ” as a necessary part of insanity. It is now,
moreover, admitted that a “ knowledge of right and wrong ”
is not necessary, and the question of loss of self-control and
impulses is so delicate a one as to make it dangerous for an
expert to attach much weight to it in giving evidence.

I am free to admit the fault lies in great part in our defec¬
tive knowledge, but is also partly due to the habits of the
law in exacting definitions from medical witnesses.

We can no more define insanity than we can by definition
give an impression of a rainbow or a landscape.

Geo. H. Savage.

The Case of Cole , and the Legal Procedure in ascertaining the
Mental Condition of Prisoners .

It would be difficult indeed to conceive any circumstances
more calculated to bring English Criminal Law into con¬
tempt than the results of the trials of Gouldstone and Cole
for wilful murder. Our only consolation is that such pitiful
exhibitions of the working of our present judicial machinery,
in cases in which the plea of insanity is set up, may lead to
some practical reform therein. Had any commentary been
desired on the necessity of carrying out the Resolution*
passed at the recent Annual Meeting of our Association,
under the presidency of Dr. Orange, and again at the October
meeting of the Metropolitan Branch of the British Medical
Association, such commentary, written in letters of blood, has
indeed been supplied by the occurrence of these two trials
in rapid succession.

The great object of this Resolution is to secure a full and

* “ That prisoners suspected of being mentally deranged should be examined
by competent medical men as soon after the commission of the crime with
svhich they are charged as possible, and that the examination should be pro¬
vided for by the Treasury, in a manner similar to that in which counsel for the
prosecution is provided. It is suggested that the examiners should be the
nedical officer of the prison, the medical officer of the County Asylum or
Tospital for the Insane in the neighbourhood, and a medical practitioner of
tan ding in the town where the prison is situated; that the three medical men
bally after consulting together , draw up a, joint report, to be given to the pre¬
senting counsel, the cost being borne by the public purse, inasmuch as it is
seless to tell an insane man that the burden of proving himself insane lies
pon himself.” (See Journal, Oct., 1883, p. 451).

xxix. 37

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540 Occasional Notes of the Quarter. [Jan.,

deliberate examination of the accused before instead of after
his trial, by competent medical men. In the cases of Gould-
stone and Cole, the result to them, it is true, would have been
the same, but with how much greater propriety, dignity, and
economy! We should have been spared the spectacle of
judges solemnly condemning to death, and clearly indicating
it to be their opinion that it was a just death, men who were
lunatics. We might also, perhaps, have been spared-the
spectacle of the oracle in Printing House Square gloating
over what is regarded as the courageous action of juries in
supporting the law against the wild and dangerous theories
of “mad doctors.” Had the deliberate examination we
urge been made in the case of Gouldstone, instead of one of
some twenty minutes at the eleventh hour (the deed was
committed at least five months before), the man’s mental
condition could have been carefully tested without haste;
and in the case of Cole the same course would have exposed
his insane condition for years previously, and all the facts
bearing upon it would have been procured at leisure. Im¬
portant in such a case, also, is the circumstance that his wife
could not give evidence in court, while her intimate know¬
ledge of his history would have been of the highest value to
a medical commission. Again, the law requires a man in
such instances to prove himself a lunatic ; but is not this a
mockery of justice ? How can a poor prisoner afford to pay ?
Counsel may, indeed, be assigned to defend the prisoner too
poor to pay, but this is at the last moment, and what possible
chance has he of doing justice to his client ? None ; for it
is then too late to make a skilled inquiry into and study of
the facts of most value in the determination of the prisoner’s
insanity. The, effect of this Resolution would be to prevent
a repetition of circumstances that make the interference of
the Home Secretary imperative; for, we repeat, it cannot be
other than prejudicial to the respect that we should always
wish to see entertained for courts of law, to go on continually
convicting and sentencing lunatics to the gallows, and then
reprieving them—a game which may be all very well for cats
and mice, but is scarcely worthy of being engaged in by those
who uphold and those who break the law.

Nor are these trials less remarkable as commentaries upon
the proper mode of understanding and interpreting the legal
test of insanity to which, truth to say, we are almost weary
of referring. As those who have read Mr. Justice Stephen’s
work on Criminal Law, reviewed in this Journal in July

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Occasional Notes of the Quarter.

541

1884.]

last, are well aware, he reads between the lines of the dicta
of the Judges of 1843, and charms his psychological readers
with the conclusion that the knowledge of right and wrong
does not merely refer to the law of the land, but involves
the question whether the accused was able to judge of the
moral character of the act at the time he committed it, not
merely in an abstract sense, but for himself, under the special
circumstances of his own delusion or loss of control.

So liberal a construction of the test seemed to open the
way to a sort of compromise between medical and legal
opinions. Now, what from this point of view is so note¬
worthy, is that neither of the judges who presided over these
trials (Mr. Justice Day and Mr. Justice Denman) appear
to have had the faintest idea of such an interpretation of
the terms. On the contrary, they obviously understood them
in the baldest, most literal manner possible, but not other¬
wise, we are bound to say, that we supposed that they would
understand them. Thus, Mr. Justice Denman, in addressing
Cole, told him he could not doubt that he knew he was doing
wrong. “You knew,” he added, by way of explanation,
“ that you acted contrary to the law of this country.” What¬
ever loss of control there might be was due to “passion.”
His Lordship did not, with Sir James Stephen, say that any
one would fall within the description of not knowing he was
doing wrong “who was deprived by disease affecting the
mind of the power of passing a rational judgment on the
moral character of the act which he meant to do ” (“ Criminal
Law,” Yol. ii., p. 163). Nor did he tell the jury that the
law when properly construed allows that “ a man who , by
reason of mental disease , is prevented from controlling his own
conduct , is not responsible for what he does ” (p. 167) ; nor yet
that if a man’s succession of insane thoughts is so rapid
as to confuse him and render him unequal to the effort of
calm sustained thought, “ he cannot be said to know y or have
a capacity of knowing , that the act which he proposes to do is
wrong ” (Op. cit.) . That such is, after all, the proper way of
understanding the dicta of the judges was equally foreign to
the mind of Mr. Justice Day. The judges succeeded also in
conveying to the juries the impression that they must take
the meaning of the terms in question in the sense in which
they have been hitherto understood. All we have to say on
this aspect of the matter is, that either official sanction must
be given to the interpretation of Mr. Justice Stephen, or the
words themselves must be so altered as to make their mean-

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542 Occasional Notes of the Quarter. [Jan.,

ing plain to jurymen, and not only to them but to the judges
themselves. The difficulty, however, presents itself that, not
only do most judges lay down the law in the old-fashioned
sense, but they do not conceal their sympathy with this in¬
terpretation, and they would regard it as a subterfuge were
a medical witness to reply —“ Yes,” in the sense attached to
the words by Sir James Stephen to the question —“ Did the
prisoner know that he was doing wrong ? ” In Gouldstone’s
case, for instance, Dr. Savage felt that to do so would be an
evasion of the real meaning attached by the Court to the
expression, and unworthy of a scientific witness.

Another point to which one of these cases forcibly calls
attention, is the neglect of the obvious symptoms of insanity
in a man from whom homicidal acts might have at any time
been expected. From what has transpired during and since
his trial, we find that Cole was in good work up to 1877, and
attentive to his wife and children; that then he fell out of
work, left home to seek it, and was found by the police, who
took him to the Croydon workhouse infirmary as a wandering
lunatic. When his wife went to see him he looked ill and
strange, and did not know her; he thought she was dead,
and that he was there for killing her. Unfortunately, in¬
stead of being placed under proper medical treatment in an
asylum, he was allowed to go home in a week’s time, and
frightened his wife by his mad actions, nailing down the
windows, &c., and placing a large knife under his pillow.
The insane suspicions which marked his case then have never
left him, and the wife had to earn a living by caning chairs,
which he would sometimes smash to pieces, the reason
assigned being that she was electrifying him. At night he
was sleepless, and would walk the room, hearing imaginary
noises, and declaring that strange men were concealed in the
house. A medical man saw him in 1879, and said he was
dangerous, that everything must be kept out of his way, and
that he couldn’t understand why he had been allowed to go
home from the workhouse instead of being sent to an asylum.
So he went on, fancying when in the house that his wife was
trying to poison him, and when out of it that people were
watching him in the street, and even assaulting them on this
ground. His wife expected that he would commit some
violent act, and that she would probably be the victim, but
she does not appear to have thought he would injure their
child, of whom he was very fond. The poor woman applied
to the magistrates, but they comforted her by telling her that

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1884.] Occasional Notes of the Quarter . 543

they could do nothing till he had committed some act. They
referred her, however, to the relieving officer, and in con¬
sequence the parish doctor examined Cole, and gave her a
certificate on which he was removed to the infirmary. Here
was a second opportunity for doing something, taking care
of the lunatic, and averting a dreadful catastrophe. But in
vain. He was sent out in two days as mad as ever, and his
wife, in mortal fear, called in the doctor, and he attended him
at home. Soon after the man killed his child. All the day
he had been walking about the house with a hammer and
chisel, following his wife, who eventually managed to take
them from him and conceal them. The wife at last went for
a policeman, and when at the gate heard a noise in the
house which induced her to return, when she found he had
done the deed for which he was tried, and which we maintain
might and ought to have been prevented by placing him in
an asylum long before. This is the moral of the story. We
have no desire to ignore the fact that Cole was an intemperate
man. But we are satisfied that he was a sober man up to
the time that he became insane in 1877, and that his giving
way to drink was one of the symptoms of his madness,
although doubtless a further aggravation of it. But while
it may be impossible to gauge with precision his moral
responsibility in relation to the intensity and continuance of
his mental disorder, proof is not wanting that he had been
sober for at least a week before the fatal act was committed.
In a word, this was not the result of drink, but the outcome
of a long, lasting state of delusional insanity. Had he
joined the Blue Ribbon Army for months before, his delusions
and their logical development in violence would have been
the same. Add to this, that in consequence of his inability
to earn a livelihood through his mental infirmity, he was
wretchedly poor, and his brain was consequently ill-nourished,
and rendered more and more a prey to suspicion.

The conclusion, then, to which we earnestly draw attention,
in the interests alike of the law, of life, and of the lunatic,
is the necessity of reforming the mode of Legal Procedure
in ascertaining the Mental Condition of Prisoners.

D. H. T.

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544

[Jan.,

PART II.—REVIEWS.

Thirty-seventh Report of the Commissioners in Lunacy ,
March 31, 1883.

No department of the public service has more important
functions to discharge than that which is administered by
the Commissioners in Lunacy, and to no class of public
officials is the country under greater obligation for the
painstaking and enlightened discharge of the duties which
devolve upon them, to a record of which for the year 1882
we have now to direct attention.

The returns made to the Lunacy Office, unfortunately,
show that the progressive increase in the total number of
registered insane persons still continues, and has advanced
since the 1st January, 1882, by 1,923, thus bringing the
total up to 76,765, or, including 356 lunatics so found by in¬
quisition residing in private houses, and 75 insane male
convicts, to 77,196, or one in every 346 of the estimated
population, the proportions of private patients and paupers
being 8,729 of the former to 76,840 of the latter.

As a bald statement of facts this would seem to convey a
sad imputation upon our 19th century civilization, and afford
but a gloomy prospect for future years.

The Commissioners, however, in the following words, show
that, when explained, the facts do not support so gloomy a
view. They say: “ The average annual increase of the last
three years on the whole of the pauper class has been 1,757,
or 248 above the annual yearly increase of the whole decen¬
nial period ending 1st January, 1882. This increase is,
however, more than accounted for by the diminished death-
rate in County and Borough Asylums during the last three
years as compared with the preceding ten years, the mortality
during 1880, 1881, and 1882 having fallen 1 per cent., thus
giving a death-rate upon the average daily numbers resident
of about 9*5 per cent., instead of 10*5 per cent, per annum.

“ Taking the average daily number resident in County and
Borough Asylums for the three years at 42,000, the dimi¬
nished death-rate of 1 per cent, would account for an
increase in the insane population of these establishments of
420 a year, or of 1,260 at the end of three years.

“ Among the private patients the ratio to population has
of late years been practically stationary, but the proportion
of the pauper class, deemed to require care and control, con¬
tinues steadily to rise.

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Reviews.

545

1884.]

“ During the last seven years, however, the increase in the
annual occurrence of fresh cases of insanity, pauper and
private, as indicated by the yearly admissions of new cases
(transfers being excluded) into establishments for the special
care and treatment of the insane has not been in excess of
the annual increase in the general population.

“ It would thus appear that, if we take the total popula¬
tion, the proportion of persons attacked with insanity is not
at present on the increase, and that the addition made
annually to the total number of certificated insane persons
maintained under care and control is due almost entirely to
the accumulation of chronic cases.”

With the burden of lunacy pressing as heavily as it does
upon the sane part of the community, this statement, sup¬
ported as it is by reference to facts,.is eminently satisfactory.

During the past year the private patients have increased
in County and Borough Asylums by 70, in registered'Hos¬
pitals by 101, and in Naval and Military Hospitals by 21;
but they have decreased in licensed houses by 11, in the
Broadmoor Asylum by K), and as single patients in private
charge by 1.

The pauper patients have increased in County and
Borough Asylums by 1,304, in registered Hospitals by 6, in
Broadmoor Asylum by 21, in the Metropolitan District
Asylums by 363, and the outdoor pauper lunatics by 142, but
they have decreased in licensed houses by 74, and in ordinary
workhouses by 9.

The average annual increase of pauper lunatics of the
preceding 11 years has been largely exceeded in 1882 in
Surrey, Kent, Gloucestershire, Worcestershire, Derbyshire,
Nottinghamshire, Cheshire, Devonshire, Cambridgeshire, and
the West Riding of Yorkshire. On the other hand, in Mid¬
dlesex, and in several of the agricultural counties, the contrary
has been the case.

It is interesting to notice that the ratio of admissions into
establishments for the insane in the year under review,
omitting transfers and the admissions of idiots, has been
lower, with one exception, than in any year since 1874.

While the total ratio of paupers to population has again
shown the usual decrease, that of pauper lunatics to paupers
goes on steadily augmenting year by year.

The distribution of pauper lunatics is extremely suggestive,
for whereas the proportion in establishments shows a gradual
annual increase, that in workhouses and in private houses
progressively diminishes. The four-shilling grant, and the

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546

Reviews.

[Jan.,

increasing confidence of the public in asylum care, are
working out their necessary results. In 1878 there were
59*81 per cent, of pauper patients in asylums, hospitals, and
licensed houses, 26*92 in workhouses, and 13*27 with rela¬
tives and others. In January, 1883, these proportions had
changed to 65*74, 25*17, and 9*09 respectively.

The patients admitted into the several classes of asylums,
and as single patients, during the year 1882, numbered
15,665—7,683 males and 7,982 females, of whom 1,836 were
transfers. Those discharged recovered were 2,361 males and
3,011 females, total 5,372; and the deaths numbered 4,785, of
which 2,703 were men and 2,082 women.

Excluding transfers and admissions into idiot-establish¬
ments, the percentage of recoveries upon the admissions was,
for males, 35*39, and for females 43*27, or for both sexes
39*41, which agrees as nearly as possible with the average
results of treatment for the last ten years.

The proportion of deaths to the daily average number
resident was, for males 11*11, for females 7*37, and for both
sexes 9*11, showing a reduction of nearly 1 per cent, upon
the average of the last 10 years.

Of the non-oongenital patients admitted in 1882, 63*3 per
cent, were suffering from their first attack of insanity, while
of the total number of patients admitted 9*2 per cent, were
epileptics and 8*5 per cent, general paralytics; 4 per cent,
only of private patients, as against 10*2 of paupers, being
epileptics, and 6*3 per cent, of private patients, as against
8*9 per cent, of paupers, being general paralytics.

Men were epileptic one-third more frequently than, and
general paralytic more than four times as frequently as
women.

The suicidal propensity was stated to have been present in
28*6 per cent, of the total admissions, and the deaths by
suicide were in all 17, 14 of them being in County and
Borough Asylums (two while out on trial), one in a regis¬
tered hospital (the injury having been inflicted previously to
admission), one in a provincial licensed house, and one in
single care.

The proportion of deaths in which post-mortem examina¬
tions were made has been as nearly as possible identical with
that of last year, and has amounted to upwards of 58 per cent.

We here repeat our table showing the assigned causes of
insanity in three classes of patients, in which there is but
little departure from the percentages of the previous year:—

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1884.]

547

Proportion per cent, to the Total Number of
Patients in each Class Admitted in 1882.

Causes of Insanity.

Private.

Pauper. C

leneral Paralytics.

Moral—

M. |

Domestic trouble (inclu')

4*0

10-1

7*1

3*8

9-6

4*9

ding loss of relatives and ^
friends) . )

5-0

11-4

8*1

Adverse circumstances (in-"]

eluding business anxie- [
ties and pecuniary diffi- f

10*8

3-7

7*3

8-9

4*1

6*4

13*6

6*5

12*2

culties) . )

Mental anxiety and"J

“ worry ” (not included (
under the above two C
heads) and overwork. J

13-4

8*7

11*1

4*4

4*8

4*6

7*0

1*3

5*9

1*6

4-9

3-2

3*1

Love affairs (including seO

1*1

3*9

2*5

•6

2*2

1*4

duction). S

Fright and nervous shock ...

•6

2*8

1-6

•9

1*6

1*2

•3

—

Physical—

Intemperance, in drink .

17*4

6’7

12*2

20-0

6*8

132

253

131

22*9

2’4

•2

1*3

1*0

•8

3*0

1*3

•1

•7

•4

•2

•3

1*0

1*7

1*1

2*5

•3

1*5

1*6

•8

•3

•9

•3

•7

•6

•5

1*5

1*2

Sunstroke ...

•1

1-3

2*3

•1

1*2

3*5

2*6

Accident or injury.

3*5

1*2

2*4

5-8

•9

3*3

7*7

1*3

6*4

Pregnancy ..

•8

•4

1*7

*£

Parturition and the puer- - )

6*1

2*9

6*6

3*4

5*7

i*]

peral state...)

Lactation ....

; i*o

•5

2*5

1*3

1*7

•j

Uterine and ovarian dis-1

4*5

2*2

1*4

orders....J

Puberty ....

•2

•7

•2

•8

Chan go of Life ....

5-3

2*6

3*7

1.9

2*6

Fevers tt ., T . r .. .

1*5

•9

1*2

•4

Privation and Starvation.

•1

1-6

3*0

2*3

1*9

3*0

Old age .

. 2*7

3-2

2-9

3*9

4*5

4*2

2*2

Other bodily diseases.

,. 8*9

9-7

11-7

11*2

11*4

12*4

15*3

13*i

Previous attacks.

,. 12*8

17-9

15-3

13*2

18*4

159

6*8

7*8

7*i

Hereditary influence ascer- J
tained.j

18-9

21*8

20*3

18*5

21*7

20*2

17*4

18*4

17*

Congenital defect ascertains

d 6*8

4*9

5-9

5*2

3*0

4*0

•1

Other ascertained causes.

.. 8*5

2*0

5*4

1-9

1*1

1*5

1*0

•9

TTnknown ..

,. 14*9

14*5

14*8

22*5

22*0

222

26*2

32*9

27*

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The following table shows the percentages of recoveries
and deaths in the several classes of institutions and in
private care, transfers and admissions into idiot-establish¬
ments having been excluded :—

Proportion per cent,
of Recoveries to
Admissions.

Proportion per cent,
of Deaths to the
Average Numbers
Resident.

County and Borough Asylums ...

36*18

44*53

40*41

11-75

7*64

9*50

Registered Hospitals.

41*34

46-85

44*66

7*37

3*85

5*42

Metropolitan Licensed Houses.

25*11

37*17

31*21

13*74

6*99

10*16

Provincial Licensed Houses.

27*94

36-56

33*37

11*24

8*55

9*70

Private Single Patients ..

19*44

15-71

16*98

2*87

5-90

4*72

We have compiled the following table from the Lunacy
Reports of the last five years as showing the percentages of
admissions into the various classes of asylums, in which
epilepsy and general paralysis were stated to be present, in
private and pauper patients respectively.

Proportions per cent, of epileptics and general paralytics admitted into
the various classes of asylums to the total number of patients admitted :—

Year.

Epileptics.

General Paralytics.

Private.

Pauper.

Private.

Pauper.

M. P.

1878.

7‘7

2*8

5-6

12-3 86

104

111

•8

6-5

14-4

3'7

9-0

1879.

5-9

12*1 8 0

10*0

8*8

136

3*6

8*4

1980.

6*0

4-7

11*1 8-0

7*9

5-1

12-5

3-5

7-7

1881.

3*6

4 5

11*9 8*3

101

9-4

2-0

124

3-3

7*7

1882.

6'2

2*8

4*0

12*5 1 81

102

10*9 j

1*4

6*3

144

3-6

8-9

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1884.]

The Commissioners devote considerable space in their
report to a series of interesting and valuable observations
upon the night watching of the epileptic and suicidal.

The views of the Board upon this subject are well known,
and their recommendations have met with general approval
and acquiescence. They still complain, however, of the in¬
adequacy of the provisions for securing the safety of these
classes of patients in some asylums, and, in urging their
general adoption, are able to point to the satisfactory results
which have followed their use wherever they have been car¬
ried out in an adequate manner.

After a reference to the “ observatory dormitory,” a plan
of which, drawn to scale, was published in the appendix to
their 28th report, they say, “ However well arranged the
dormitories may be, their purpose will be completely missed
unless provision be made for the constant presence of a
proper number of efficient night attendants, and for insur¬
ing, as far as possible, their vigilance.

“ Night attendants ought to have no regular day duty.

“ In many asylums the number of night attendants, espe¬
cially for the proper care of the suicidal and epileptic class,
is still insufficient. In our opinion, the number of such
patients in charge of one attendant should not exceed 25, or
at most 30.

“ A few of the medical superintendents of asylums, dis¬
trusting the action of mechanical contrivances for checking
the vigilance and regularity of the visits of night attendants,
rely on a system of visitation by inspectors ; but, in general,
mechanical or electric apparatus of some kind is in use, and
in this direction there has been much improvement of late.
The old * pegged ’ clock is now rarely met with, and has been
superseded by ‘ Dent’s tell-tale,’ with paper dials marked at
different stations.

“ Latterly various systems of electric recording apparatus
have been successfully introduced, and are likely to come
into general use. Pratt’s clock, manufactured by Bailey, of
Salford, has been used in many asylums, and the system in¬
vented by Messrs. Spagnoletti and Partridge is used at
Hanwell, at the Barming Heath Asylum, and at Banstead.

“ At the Winson Green Asylum, Birmingham, Gent and
Co.’s electric clock is employed, and at the North Riding
Asylum one manufactured by Harrison, Cox, Walker, and
Co., of Darlington, is stated to work very satisfactorily.

“ Whatever may be the nature of the recording apparatus

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employed, it should be supplemented by electric bells,
insuring, in case of need, an instantaneous communication
both with the day attendants, the head attendant, and the
medical officers, the pushes acting on the bells placed in
the day attendants’ room being more than one, and fixed at
short intervals on the special dormitory walls.

“In connection with this subject, we may notice that
from a recent report on the Norwich Borough Asylum, we
learn that in all the male dormitories there are bells fitted,
by means of which the patients themselves can, on an emer¬
gency, summon a night attendant.

“ The arrangement is said to be highly valued by the
patients, and never to have been abused. Should it continue
to work well, it may be worth adoption elsewhere. The
frequency with which the night attendants are required to
record their presence in the special wards varies consider¬
ably, being in some asylums every ten minutes, in others
every half-hour, or even every hour. The latter is certainly
too long an interval, and every half-hour would probably be
sufficient, unless in special cases, and would not unduly in¬
terfere with the other duties of the attendants.

“ It is of great importance that the recording stations
should be placed in positions which insure the presence of
the attendants in all parts of the dormitory successively, and
especially at the single rooms, if these do not open directly
into the main dormitory.

“Printed regulations, carefully drawn up, should be placed
in the hands of the special night attendants, containing in¬
structions for their guidance in case of fits and serious
emergencies. Among other precautions, attendants should
be taught not to allow epileptic patients to cover their heads
with the bedclothes, or in any way to prevent the mouth
from being always visible.

X All night attendants should wear noiseless slippers, and
should be trained to move quietly about the wards.”

These are very pertinent and sensible observations, and
will be generally accepted as expressing the results of expe¬
rience both of the Commissioners and a majority of asylum
superintendents.

With reference to the steady increase in the asylum popu¬
lation, and the insufficiency of asylum accommodation which
is constantly resulting from it, it is satisfactory to find that
the Commissioners endorse the view which is now so widely
entertained, that much of it is due to the inducement to

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1884.]

send patients unnecessarily to asylums which is held out by
the 4s. Government grant, and that they have brought the
matter prominently under the notice of the Local Govern¬
ment Board.

The cost of maintenance in County and Borough Asylums
appears again to have undergone a diminution to the extent
of 2£d. in the former and 2fd. in the latter. These figures
vary somewhat from those given in the report, in which
there would seem to have been a slight error of calculation.
The average weekly cost per head in 1882 was—

s. d.

In County Asylums . 9 1£

In Borough Asylums. 10 5§

distributed over the following details :—

County

Asylums.

Borough

Asylums.

Provisions (including malt liquor in ordinary diet) ...

s. d.

4 44

s. d.

4 7

Clothing .

0 8}

0 9

Salaries and wages .

2 2

2 6*

Necessaries, food, light, washing, &c. ..

0 10

Surgery and dispensary.

0 0|

o o|

Wines, spirits, porter .

0 0

o of

Charged to Maintenance Account

Furniture and bedding.

0 6

Garden and farm .

0 64

0 6

Miscellaneous.

0 8|

0 7J

Less monies received for sales .

9 4i

0 3

Total average weekly cost per head .

9 li

10 5 §

Such, briefly, are the principal contents of this interesting
report, which, in addition to a series of elaborate and valu¬
able tables, contains the usual entries of visits to the various
classes of asylums, from which it is obvious that, with very
few exceptions, they are doing good work in the best way,
in the care and treatment of the insane, and are fully main¬
taining a position which entitles them to favourable com¬
parison with any similar classes of institutions throughout
the world.

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552 Review 8. [Jan.,

Twenty-fifth Annual Report of the General Board of Com -
missioners in Lunacy for Scotland , for 1883.

There were in Scotland, on 1st Jan., 1883, 10,510 insane
persons, of whom 1,654 were private patients, 8,793 were
pauper, and 63 criminal lunatics, chargeable to the State, in
Perth Prison. The increase over the numbers of the previous
year was only 149, 135 being paupers, and of those only 10
were added to the numbers in asylums in that time. So far
as those establishments are concerned, therefore, the year
1882, has seen for the first time on record a decrease in their
inhabitants in proportion to the population of Scotland as
compared with the previous year. Happy country if it lasts !
No new accommodation, at £175 a bed, for pauper lunatics
needed. No pressing problems as to how to provide
humanely for the owners of worn-out, non-productive
brains, at the public expense. No new lunacy legislation to
solve such questions and spend ratepayers’ money—the
harmless, weak-minded people suitable for such treatment,
being taken out of asylums and scattered over the country in
cottages of decent working people, and kept thus cheaply
and comfortably under the inspection of the local doctors
and the Deputy-Commissi oners in Lunacy. Even for a year,
how thankful would the authorities in England be to have
such a state of matters. The factors that have produced
such a result seem to have been full asylums, the Govern¬
ment grant given to all lunatics in or out of asylums alike,
instead of to the former only, proper legal provisions for
removing patients from asylums, and placing them elsewhere,
asylum doctors who believe that chronic, incurable lunatics
can be taken care of by other people than themselves, in¬
telligent inspectors of poor anxious to carry out the pro¬
visions of the Lunacy Laws in their spirit, enthusiastic
Deputy-Commissioners in Lunacy who believe that a
a boarded out” dement is better off than an asylum
patient, and infinitely better off than a British working man,
and lastly, a small country where lunacy administration is
compact, and has not yet degenerated into routine. Without
a happy combination of all these circumstances, Scotland
would have had to build asylum wards for its surplus 135
pauper lunatics to the tune of about £25,000.

But if Scotland has, as is now generally admitted, gone
further in solving the great modern lunacy problem than
most other countries, it seems natural that other countries

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1884.]

should learn something from her. France has lately sent a
Committee from her Senate to study, among others, the Scotch
system. We do not think that England has paid too much
attention to what is going on beyond the border. And yet
it seems as if she might learn something thus. With her
asylums mostly full. With great additions being made to
them almost everywhere as the only remedy for their con¬
gestion. With the curable cases in them in great danger of
being swamped by the masses of incurables. With the
medical element and idea in danger of extinction through the
necessary labour of ordinary administration. With no increase
of the scientific work done in asylums as the materials for it
increase. With no proper provision for the limited discharge
from asylums of the manifestly harmless cases that can no
longer be benefited by hospital treatment, and no proper
means of supervision of such cases in the workhouses. With
no system of finding out guardians to take care of boarded-
out cases, and no proper supervision of them after they are
boarded-out. With the duties of central and local authorities
overlapping and undefined to a large extent. With an under¬
manned and overworked Lunacy Commission. With Boards
of Guardians and local ratepayers claiming to be admitted to
the control of the insane, and a Liberal Government in office.
With county government in that state of feebleness which is
produced by the knowledge of imminent change. With the
medical profession in a state of vague discontent at the
present state of matters. Surely, with these and many
more difficulties in this lunacy problem to surmount, it be¬
hoves the Government of this day to enquire into the best
means of overcoming them, first by legislation and after¬
wards by administration. We wonder whether the full
extent of these difficulties is realized by those in authority ?
With the experience of Scotland to guide them, they could,
it is possible, overcome some of the difficulties of the
situation. The fact is that the recent lunacy statutes of
England were dictated by philanthropic motives chiefly, and
founded on the false theory that English lunacy was a fixed
quantity with defined limits, that could be easily dealt with
and much diminished simply by building so many asylums.
Science and experience have since those Acts were passed im¬
mensely expanded the boundaries of what requires to be re¬
garded as technical insanity. The English lunacy statutes
were made for the typical mania, melancholia, and dementia.
Under cover of these, have crept in the mild congenital

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[Jan.,

imbecile, the epileptic in all his morbid mental phases, the
senile and paralytic dotard, the persons whose wits have been
soaked away.by alcohol, the half-cured persons who can’t fight
their way in the world by reason of previous acute attacks of
insanity, and the vast crowd has filled the lunatic hospitals
with their annexes and additions, and are fast changing
them from curative establishments into mental almshouses.
We hope that in any new lunacy bill brought in by the
Government, in addition to provisionsfor dealing with all those
clamant evils, there will be one for the establishment in the
large towns, either as adjuncts to the general hospitals, to
the county asylums, or as special institutions, small, strictly
curative asylums for probationary treatment of some of the
acute cases of mental disease of short duration, through
which the general profession of medicine will regain its
rapidly failing connection with the speciality of alienism.

The reports on the asylums by the Visiting Commissioners
are mostly laudatory. In most of them the Scotch Asylum
char acteristics of no airing courts, much farm-work and
out-door exercise, some unlocked wards, frequent discharges
of patients “on probation,” and many sent to be boarded-
out, prevail. The amount of excitement among the patients
seems to be small. The recovery rate is higher, the death
rate less than in England, and the accumulation of uncured
cases not so great. There is mention made of systematic
attempts to train attendants in hospital wards, where they
may imbibe ab initio, the sick-nurse idea and practice.
There is mention made of purchases of hundreds of acres of
land in addition to ordinary asylum farms, and of the erec¬
tion of large farm steadings with accommodation for many
patients, who will thus literally “ live on the farm.” Every¬
where there seems to be activity, zeal, a desire to try new
ideas, a backing-up of the medical officers by the Commis¬
sioners, and an honest attempt of the former to work out the
ideas of the latter—all which is pleasant to observe. The
efforts of Deputy-Commissioners Fraser and Lawson to ex¬
tend and improve the boarding-out system are mentioned
with approval in the report. Dr. Lawson, as usual, is strik-
jjig in what he says, and is almost paradoxical, for he tries
to show that “like cures like” in insanity, and that
the nursing of an excited, melancholic mother acted as
a prophylactic against an attack of insanity in a daughter
lately out of an asylum. He says:—“The presence of
the mother supplied the daughter with an occupation, in

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1884.]

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555

the performance of which a highly commendable sense of
duty was being acted on. The removal of the mother to an
asylum would have caused worry, and left her a prey to the
distressing self-accusation of having abandoned a duty which
she had felt specially called on to perform. Which of the
two causes does the study of the etiology of insanity lead us
to think would be the most powerful—the engrossing, mental
occupation in an arduous task faithfully performed, or the
distraction of vague dread and self-accusation ? ” We con¬
fess we think Dr. Lawson’s philosophy of the matter is correct
in certain cases. We have seen a mother become insane
from the self-accusation of having sent her daughter to an
asylum, but then we have seen many daughters becoming
insane, or nearly so, from nursing insane mothers. The
average cost of the boarded-out cases in Scotland is about
seven shillings per week. Dr. Lawson thinks the actual cost
to the guardians of the patients is 3s. 7d. per week. But
the sums paid by the parishes vary enormously according
to the district, and the nature of the case. This variety of
payment the Commissioners highly approve as being just
and expedient. They enter fully into their reasons for this.
They notice with approval that a yearly increasing number
of quiet and industrious patients are drafted from asylums
into private dwellings.

In addition to the ordinary topics of a lunacy report, there
are two special subjects gone into in an exhaustive way. One
is an elaborate enquiry, extending to 30 pages, founded on
Scotch statistics, into the question of The Relation of Pauper
Lunacy to Density of Population , and the other is a memo¬
randum of 40 pages by Dr. Mitchell, on the history of the
Royal Edinburgh Asylum at Morningside, and its complicated
relationships and responsibilities to its original contribu¬
tories, to the public of Scotland, to certain parishes with
which it has entered into contract, and to the District
Lunacy Board of the City of Edinburgh. The first will well
repay perusal by all physicians. The following are the con¬
clusions arrived at in the report :—

A larger number of persons annually become pauper lunatics in
urban than in rural localities.

Pauper lunatics in urban localities remain pauper lunatics for
shorter periods than in rural localities.

There are on the Register at any given date a larger number of
pauper lunatics in rural than in urban localities.

The larger number on the Register in rural localities is accounted
xxix. 38

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[Jan.,

for by the larger number of pauper lunatics in private dwellings, the
number of pauper lunatics in asylums being nearly the same for the
two classes of locality.

Although the number of pauper lunatics in asylums is nearly the
same for each class of locality, the number annually admitted is much
greater in urban localities.

The reason why the larger number of admissions in urban localities
does not lead to a larger number resident in asylums, is the shorter
average period of their residence there.

The excess in the number of admissions to asylums in urban locali¬
ties over those in rural localities consists mainly of persons who
would not be sent to asylums in rural localities. Such persons are
divisible into two classes—

1. Persons labouring under curable forms of insanity not of long
duration; and,

2. Persons placed in asylums during short periods on account of the
exigencies of urban life making removal from home necessary, so long
as their insanity manifests itself in an acute form.

The differences of the death-rates in asylums correspond for the
different classes of locality with the differences in the general death-
rates in the different classes of locality.

The number of pauper lunatics resident in asylums has been increas¬
ing at a much more rapid rate in rural localities than in urban
localities.

The nunjber of pauper lunatics annually sent to asylums has also
been increasing at a more rapid rate in rural than in urban localities ;
but the preponderance of the rate of increase in the annual number in
rural localities has not been nearly so great as the preponderance of
the rate of increase in the number of resident.

A larger number of persons annually become recipients of parochial
relief in urban than in rural localities.

Persons remain recipients of parochial relief for shorter periods in
urban than in rural localities.

There are on the Register at any given date a larger number of
paupers in rural than in urban localities.

This larger number of paupers on the Register in rural localities, in
spite of the smaller annual number who obtain relief, is due to the
shorter period during which they obtain relief.

All these particulars in regard to paupers are in accordance with
what occurs in regard to pauper lunatics.

The number of pauper lunatics in both classes of locality bears
nearly the same proportion to the number of paupers, notwithstanding
that the amounts of pauperism and pauper lunacy in different classes
of locality present material differences.

There is reason to believe that the statistics of pauper lunacy are
the results of causes similar to those which affect the statistics of
pauperism.

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1884.]

The statistics of pauper lunacy cannot be taken as an indication of
the amount of insanity in the country.

Dr. Mitchell’s memorandum on the Royal Edinburgh
Asylum possesses general interest, as showing the history of
a philanthropic movement affecting the insane in a then poor
but self-reliant community, with all its mistakes and failures
as well as its successes. To carry out their great end of
benefiting the insane, the managers of that institution have
from first to last entered into many engagements with
many bodies, whose interests have now become conflicting;
and the object of Dr. Mitchell’s elaborate researches into the
history of the institution is to extend its benefits, by ct un¬
ravelling the complications” that have arisen in the 77
years of its existence. One great effect of the memorandum
is to show that the Royal Edinburgh Asylum, and all such
chartered asylums, got up originally as philanthropic institu¬
tions, should limit the number of their pauper patients to
that point that will enable them to take in all the private
patients of their districts, poor and rich, but especially u to
be helpful ” to private lunatics who are in narrow circum¬
stances. Another effect will be to show that these asylums
should charge rates of board for pauper patients sufficient to
cover outlay, and not let the ratepayers of the district benefit
by the profits from private patients. In fact, the Royal
Asylums of Scotland should look on their provision for
private patients as their prime duty, and look on their
provision for pauper patients as secondary, because these
have, by the Lunacy Act of 1857, been provided for in
another way. No duty could be more humane or more
needful than providing good and suitable asylum treatment
for the middle and poorer classes without making technical
paupers of them. An institution which does this helps to
heighten the self-respect and self-reliance of one of the more
important classes of a nation.

The report concludes with the following statement:—

After making allowance for the increased population of the country,
the number of private lunatics in asylums has increased 9 per cent,
since 1858, and the number of pauper lunatics in asylums and
similar establishments has increased 89 per cent. And it is worthy of
note that the proportion of pauper lunatics in asylums to the popula¬
tion had decreased last year to 185 per 100,000 from 188, which was
the proportion in the previous year. This is the first time since the
establishment of the Board that we have been able to report a
decrease.

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[Jan.,

Thirty-second Report of Inspectors of Irish Asylums , 1883.

The Thirty-second Report of the Inspectors of Irish Asy¬
lums, shows a great advance in the improved series of sta¬
tistics, which have appeared for the first time, and which
are, in many cases, similar to those recommended by the
Medico-Psychological Association, and in general use in
public asylums. Prom year to year it has been pointed out
how much it would tend to elucidate the present condition
of the insane, and to throw additional light on the study of
psychology if a uniform system of statistics were adopted in
the three divisions of the United Kingdom, and everyone
interested in the treatment of insanity will receive with
pleasure the attempt made by the Irish Inspectors to adopt
the tables in general use, so far as it was possible whilst
fulfilling the requirements of a blue-book.

Comparing the distribution of the insane in Ireland in
1882 and 1883, it will be found that the numbers stand as
follows:—

1882.

1883.

In District Asylums .

. 8,978 .

. 9,271

In Central Criminal Asylums

173 .

. 173

In Stewart Institution .

18 .

. 16

In Private Asylums.

635 .

. 650

In Workhouses .

3,640 .

. 3,711

13,444

13,821

giving an increase of 377 on the year 1882. The Inspectors
are not of opinion that this increase shows any advance in
the number in the country, as the admissions were generally
of a chronic type. The decrease of the population by emi¬
gration, leaving the infirm, physically and mentally, to remain,
causes the ratio of the insane to the sane to be higher in the
present generation than it otherwise would, but the pre¬
sumption is that it will decline in the next to the legitimate
proportion.

The admissions into district asylums during the year
amounted to 2,645, being an increase of 113 more than in
the preceding. Of these 508, or 19 per cent., were relapses.

The Inspectors, as they have done from year to year, draw
attention to the forms of orders for admission to the public
asylums of Ireland. “We have,” they say, “frequently
adverted to the prevalent mode of admitting lunatics into
district asylums, and which, quite different from what obtains
in England and Scotland, though consonant with law, is by

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Iteviews.

559

1884.]

no means satisfactory in its practical results. Boards of
Governors in this country exercise little or no control in re¬
gard to the selection of cases.”

No control, however, exists, so far as we are aware, in the
committees of public asylums either in Scotland or Eng¬
land to select the cases for admission, and we would refer the
Irish Inspectors to the order for the reception of a pauper
lunatic in use in all parts of England under Act 16 & 17
Viet., c. 97.

They add that in Scotland last year eight lunatics only
were sent to asylums as dangerous, against 190 times as
many in Ireland. But no comparison can be made between
the orders for the admission of dangerous lunatics in the two
countries, as in Scotland no difficulty exists in obtaining
immediate admission for an insane pauper. Whatever irregu¬
larities may exist in Ireland from the indiscriminate use of
the Dangerous Lunatic Act, nothing could be more detrimental
to the treatment of insanity than to close the public asylums
to the admission of the insane poor till it was the will of
Committees of Visitors to admit. Better that a few mis¬
takes and irregularities should happen than that a single
case requiring speedy treatment should be sent away. The
utility of asylums has been clearly proved largely to depend
on the early admission of those requiring treatment, and the
Irish Inspectors fail to point out any possible way of obtain¬
ing this if the power of granting admission orders was rele¬
gated to Boards of Governors alone.

The Irish Inspectors seem to take a gloomy view of the
utility of the advances in psychological science in the treat¬
ment of insanity. “ As to the direct or specific operations
in asylums in effecting recoveries, it constitutes, in our
opinion, to a certain extent, a moot question. On the aggre¬
gate, judicious treatment is essential, and should be rigidly
carried out, hoping against hope; still we do not find that
success has been very largely advanced by modem science. At
all events cures seem to have borne, in general or delusional
lunacy, a rather close approximation to each other at long
intervals, and we are induced so to think on looking over
records extending backwards for many decennial periods.”

Their conclusion cannot be considered cheering to the
aspirant students of psychological medicine in Ireland, nor
such as would be likely to urge the executive to further
lavish expenditure to support the present system of the
treatment of insanity. Science without works is dead.

The percentage of recoveries on the average number under

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treatment last year was almost identical with that in the
preceding quinquennial, or eleven and a quarter per cent.

The mortality in public asylums in Ireland has always been
below the average. Last year it was 6 per cent, on the
number under treatment as against 6| in 1881. The extra¬
ordinary fact is reported that not one death resulted from
accident, violence, or suicide.

With respect to interior organisation, the Inspectors state
that the asylums under their care are, on the whole, favour¬
ably circumstanced as regards cleanliness, order, and venti¬
lation, comfortably furnished, the dietary ample, and the
clothing suitably chosen. Whilst it is allowed there is not
the same air of comfort observable as in English institu¬
tions, taking into consideration the antecedent habits of the
humbler classes in both countries, the advantages are much
greater in the Irish asylums. Amusements are fairly afforded ;
but it is stated that the means of occupation, particularly
employment in the open air, should be more a matter of
requirement than it is at present. It is evident that though
not sanguine as to the progress and results of the treatment
of insanity in Irish asylums, the Inspectors are nevertheless
determined to bestow every praise on the management of
these institutions. In like manner, from a comparison with
the return of the English and Scotch Commissioners, as to
the discharges and resignations of attendants, it is concluded
that the changes in Ireland are not nearly so many, being
only 128 in an average subordinate staff of 960. The question
would, however, arise whether the discipline carried out in
these institutions in the three divisions of the kingdom is
equally strict.

As regards education, about one-fourth of the pauper
insane are said to be illiterate, and as regards condition
as to marriage, the single are three times more numerous
than the married, the reverse, it is stated, to what is observ¬
able in England.

As the result of their calculations, the insane under treat¬
ment with suicidal tendencies, are about eight per cent., the
curable are said to number about thirty, the idiotic three,
and the epileptic five per cent. According to the Keport of
the English Commissioners for 1882, the proportion per cent,
of the number with suicidal propensity to the total number
admitted, amounted to 28*6, epileptics to 9*2 ;.and the number
suffering from congenital insanity, including idiocy, to 4-8.

The expenditure for the year 1881 (the last year au¬
dited), for the maintenance of district asylums, amounted to

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£206,324, being the whole sum, as the Inspectors point out,
chargeable for the support of these institutions, except what
is obtained through the Commissioners of Control for the
Erection and Establishment of Lunatic Asylums in Ireland.

The total number who were classed as lunatics, and were
under the supervision of the Inspectors in workhouses in
Ireland, amounted on Dec. 31, 1882, to 3,711. The condition
of the insane in these institutions was as follows : as a rule,
quiet and amenable, but incapable of working, the great
majority being composed of individuals advanced in years,
doting, epileptic, and imbecile, broken down by dissipation
and inebriety, and cases of chronic dementia sent from dis¬
trict asylums.

The question of the proper treatment of the insane in
workhouses, as the present accommodation for those afflicted
is confessedly imperfect, is here taken into consideration.
Two points are brought forward for solution; first, what is
best for the lunatics themselves, and secondly, how can this
be obtained consistently with efficient economy.

The Inspectors proceed to answer these questions, by ad¬
vising that to the large workhouses, “which are in some
institutions not only thronged with ordinary paupers but
much incommoded by lunatics,” the addition be made of suit¬
able detached buildings of simple character. The staff to be
attached to these buildings in addition to the present work-
house officials, to consist of a competent paid attendant to
every twenty-five patients, assisted by a couple of paupers.
The dietary to be more generous than that supplied to
common paupers, while, for exercise, a small portion of land
should be available.

It would appear, however, to be a doubtful sanitary
arrangement to add to these already admittedly overcrowded
workhouses, containing, as a general rule, over two thousand
inmates, and the question would also suggest itself how these
competent attendants are to be supervised. It cannot surely
be suggested that this can be done by the workhouse officials,
who must already have a larger share of supervision than
they can possibly do. If no supervision is required, we can
only say that the last state of these lunatics will be worse than
their first, as they will not only continue in their present
neglected state, but have to suffer in addition the cruelty of
the competent attendants.

On the other hand the proposition to add to the district
asylum, so as to afford accommodation for the insane at pre¬
sent in workhouses, is considered by the Inspectors to be

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injudicious for the following reasons :—1st, the amount of
land attached to asylums is too small; 2nd, the outlay for
a building consistent in character with asylum architecture
would be costly, whilst a third-rate class of edifice would be
inharmonious; 3rd, the mixture of idiots, epileptics, and
senile dements with the curable occupants of an hospital,
would be deleterious to the latter; 4th, the rate in aid might
be abused; 5th, it might appear unfair if all were not treated
alike.

In answer to all these objections we can only suggest to
the Inspectors to visit the annexes lately erected in addition
to the Lancashire County Asylums and see how these diffi¬
culties have been overcome, whilst the inmates are retained
under the supervision of the staff of these institutions.

A prospective view is next taken of the requirements for
the support of the insane in Ireland. It is supposed that a
normal accommodation of 9,600 beds in district asylums will
be ample for the present and coming generation (the number
at present in these institutions amounting to 9,271) ; for this
number the rate in aid is calculated at £96,000, the support
of Dundrum will amount to £7,400, while office and super¬
vision charges might raise the total Government cost to
£108,000 as a maximum.

Next as to local taxation, the amount computed for the
support of the inmates of district asylums would be
£134,400, and for 4,000 mentally affected in poor-houses
£56,000. This total sum of £190,400 is stated to be about
twopence-halfpenny in the pound on the rateable property of
Ireland.

With reference to “ lunatics at large ” the Inspectors
state that no less than 3,446 are supposed to be without
supervision. To these returns, which are allowed to be in¬
definite, the Inspectors state there are no parallel enquiries
either in England or Scotland. We must, however, refer
the Inspectors to the English Commissioners’ Report, which
gives a return of 6,255 out-door paupers, and to the Scotch
Commissioners’ Blue-Book, which gives a return of 1,693
patients in private dwellings, so that these would include
the larger number of the lunatics not in asylums or work-
houses in these countries.

From a return made to them by the constabulary the In¬
spectors find that the pauper lunatics in Connaught did not
constitute a fourth in regard to population of those in the
other provinces. “ Hence the evident deduction that lunacy

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is far less prevalent in the rural than the urban districts of
this county.”

An interesting comparison of the insane in the three
countries is next given. According to this England has
one insane person in 414 of its inhabitants ; Scotland one
in 362, and Ireland one in 369. From the circumstance that
in Scotland the rate in aid is given to lunatics not resident
in asylums, it is but fair to suppose that all who are really
insane receive the benefit of the Government grant in that
country. Hence from the Celtic descent of the two countries,
and their similarity in geographic formation, it is inferred
that the numbers of the bond fide insane must be closely
approximate. It does not seem, however, quite evident
how this follows, especially as the Inspectors admit that by
the last census nearly six thousand insane are reported to be
at large in Ireland, so that instead of one to 362 as in Scot¬
land there would be one in 260 in that country.

A retrospective history is next given of the treatment
of the insane in Ireland from the middle of the last cen¬
tury. The first institution for the treatment of mental
disease was founded in 1745 by the celebrated Dean
Swift for the reception of 100 insane persons, if among
idiots and maniacs so many could be found, otherwise
ordinary patients should pro tempore be admitted. This
institution is said to have been constructed, as it now
stands, with a due appreciation of the requirements of the
insane, and to have had distinct rules laid down that a
system of kindness was to be carried out, and every liberty
extended to the insane consistent with their safety.

For seventy years little further interest was taken till 1815
when the Eichmond Asylum for 240 was erected by Govern¬
ment, for the general benefit of the country. Since 1843,
when the present Lunacy Board was formed, a wondrous
change has taken place. When the population of Ireland
was 8,175,000, fully three millions over the existing number,
the accommodation for the insane poor amounted to 2,100
beds as against 9,000 at present for 5,100,000.

The report of the Eesident Physician of Dundrum is given
as usual in detail. He reports that there has been in the last
couple of years a grave increase in the number of cases of
chest affection, principally phthisis, resulting in an increased
death rate. He advocates a system of rewards to induce
the patients to employ themselves. In other institutions,
and especially at Broadmoor, he states that the system of

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rewards is largely brought into operation with good results.
The Inspectors, however, object to this, stating that they
are adverse to a greater liberality to criminal lunatics than
is shown to the unoffending inmates of district asylums.

Under the provisions of 5th and 6th Viet., cap. 123 there are
sixteen houses in Ireland licensed for the reception of private
patients. Besident in them at the close of last year were 271
inmates.

Independent of these there are institutions of a mixed
character, partly on a charitable foundation, viz.. Swifts, The
Betreat, belonging to the Society of Friends, Palmerston
House, founded as the Stewart Institute, containing im¬
becile children in one portion of the building and ordinary
lunatics in the other, and St. Vincent’s, the property of a
religious community for the reception of insane ladies. Of
the 808 private patients under treatment, 47 were discharged
cured, 32 inproved. These returns are stated to contrast
favourably with public asylums, whilst the mortality is 3£
under the average. During the year no deed of violence, no
suicide, no permanent escape, or untoward occurrence was
reported as happening in any of these private institutions.

The Inspectors close their report by pointing to the Ap¬
pendices as an evidence of the continuous and successful
administration of the Lunacy Department during the year
under review. [The profit from the farms was large; the con¬
tract prices were fair, evincing the judgment and discretion
of Boards of Governors; the dietary was liberal; and the
quantities of food consumed properly calculated; whilst
ample proof is given of the industrial aptitude of the patients
by the amount of work done by them.

Enquiries into Human Faculty and its Development . By

Francis Galton, F.B.S. Macmillan and Co. 1883.

We may say at once that this is a remarkable book, and
though almost all the essays it contains have already ap¬
peared under other forms, we are glad to have the whole
subject to which they refer comprised in a single volume.
The questions discussed are calculated to excite in the
strongest manner, the interest of Medical Psychologists.

The author informs the reader that his general object has
been “to take note of the varied hereditary faculties of
different men and of the great differences in different
families and races, to learn how far history may have shown

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the practicability of supplanting inefficient human stock by
better strains, and to consider whether it might not be our
duty to do so by such efforts as may be reasonable, thus
exerting ourselves to further the ends of evolution more
rapidly and with less distress than if events were left to
their own course.” However, so complex is the question
that all Mr. Galton hopes at present to effect is to fix the
position of several cardinal points. What these are we
shall shortly see. Meanwhile let us refer to some of the
investigations in which Mr. Galton has been so actively
engaged, Take first the remarkable differences in human
features, the sum of innumerable minute details. This is
a fascinating subject alike for artist and psychologist, be¬
tween whom there must ever be a common bond of union;
for the artist has much to learn from the psychology of expres¬
sion, and the psychologist is greatly assisted in his researches
by the art representing the expression of psychical states.
How laborious, and in a corresponding degree, how
valuable is the work of an artist, is well illustrated by the
fact that Mr. Galton in endeavouring to estimate the number
of strokes made by an able artist in painting a portrait—
every stroke being thoughtfully given—found that “ during
fifteen sittings of three working hours each, that is to say
during forty-five hours or two thousand four hundred
minutes, he worked at the average rate of ten strokes of the
brush per minute. There were therefore twenty-four
thousand separate traits in the completed portrait, and in
his opinion some, I do not say equal, but comparably large
number of units of resemblance with the original ” (p. 5).
No doubt, as Mr. Galton observes, English physiognomy has
differed greatly at different periods, after making allowance
for fashion in portrait painting. He has traced in his ex¬
amination of large collections of national portraits, the signs
of one predominant facial type succeeding to another. Thus
the men painted by Holbein are generally characterised by
high cheek bones, long upper lips, thin eyebrows, and lank,
dark hair. It would be impossible, Mr. Galton thinks, for
the majority of modem Englishmen t6 resemble the
majority of Holbein’s portraits by dress and arrangement of
hair. They are now a fair and reddish race.

As is well known Mr. Galton has endeavoured to obtain*
really representative faces by his ingenious method of com¬
posite portraiture, the effect of which is “ to bring into evi¬
dence all traits in which there is agreement, and to leave but
a ghost of a trace of individual peculiarities,” and the re-

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markable thing is that this composite picture made from so
many components is not a blurr. Of these pictures there are
given in this volume many interesting specimens, containing,
for example, numerous cases of tubercular disease in one
portrait, and of a hundred non-consumptive cases in another;
also of criminal types, and members of the same family. We
may mention that Mr. Gal ton has made a number of admir¬
able photographs of patients at Bethlem Hospital, but that
he has not succeeded in obtaining composite portraitures,
which would properly depict any typical form of insanity.
Of the portraits of convicts Mr. Galton has obtained fairly
distinct types. Some criminal composites possess a negative
rather than a positive interest.

They produce faces of a mean description with no villainy written
on them. The individual faces are villainous enough, but they are
villainous in different ways, and when they are combined the indi¬
vidual peculiarities disappear and the common humanity of a low type
is all that is left (p. 15).

Of the positively criminal type the author observes that
he had not adequately appreciated the utter degradation of
their physiognomy ; at last the sense of it took firm hold of
him, and he says he “ cannot now handle the portraits with¬
out overcoming by an effort the aversion they suggest.” Of
distinctively criminal facial convolutions, so to speak, Mr.
Galton speaks as strongly as Benedikt does of those of the
cerebrum in the same class. Concurrently with such
physical marks Galton portrays the criminal in colours
desperately black indeed, but we fear not overdrawn. His
conscience is almost absent; his instincts are vicious, his
power of self-control very weak, due partly to ungovernable
temper and passion, and partly to imbecility ; hypocrisy is
common, truthfulness and remorse are equally rare.

The criminal class is, of course, perpetuated by heredity,
and it may be properly urged in favour of long terms of im¬
prisonment that their progeny is lessened. Unfortunately
this class is continually increased by the addition of persons

who, without having strongly marked criminal natures do neverthe¬
less belong to a type of humanity that is exceedingly ill-suited to play
a respectable part in our modern civilization. . . They are apt to go
to the bad ; their daughters consort with criminals and become the
parents of criminals.

The Jukes family, in America, is a terrible example.

Mr. Galton’s remarks on madness are few, but are to the

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point as regards epilepsy and criminality. They refer to
facts familiar to our readers and need not detain us.

We pass on to the chapter on Mental Imagery. Early
in his inquiry Mr. Galton found, to his astonishment, that
the great majority of men of science to whom he applied,
were sublimely ignorant of any such thing, and regarded in¬
quiries into it as fantastic.

They had no more notion of its true nature than a colour-blind
man, who has not discerned his defect has of the nature of colour.
They had a mental deficiency of which they were unaware, and
naturally enough supposed that those who affirmed they themselves
possessed it, were romancing (p. 85).

In general society, however, Mr. Galton found a very
different opinion prevailing. What savants and members of
the French Institute could not see, ordinary men and
women, boys and girls, saw with perfect distinctness. Mr.
Galton is convinced that it is a much easier matter than he
had hoped to obtain satisfactory answers to psychological
questions. To artists the visualising faculty must be of in¬
estimable value. Mr. Galton has, however, known some
destitute of the gift who have managed to become Royal
Academicians. This, however, may or may not constitute
an exception to the rule, in view of the common observation
that the worst as well as the best pictures exhibited at the
Academy are by members of this guild. Examples are given
by the author of the association of colours with different
subjects, as the months, days, &c. An artist informs us that
he has done so ever since he can remember, and his associa¬
tions are as follows:— Jan. Dull orange. Feb. Light brown.
March. Neutral black. April. Grey. May. Neutral tint.
June. Yellow neutral. July. More orange than last. August.
Golden grey. Sept. Yellowish. Oct. Rather grey. Nov.
Almost black. Dec. Rather grey. The days of the week
are coloured thus. Sunday. Golden reddish yellow. Mon.
Neutral. Tues. Lighter red than Thursday. Wed. Blue.
Thurs. Reddish. Friday. Brownish black. Sat. Yellow.
Many of the letters of the alphabet have also corresponding
colours. ^

It need hardly be said that Mr. Galton’s researches on
mental imagery bear closely upon the relations between
ideation and sensation, the question of the seat of recalled
sensory images, and the hallucinations of the insane. After
all that has been written on the last subject much remains
to be accurately observed in regard to their character, in-

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tensity, unilateralness, the degree in which the terminal
sense organ can be shown to be involved, and the relation
of the hallucination of one sense to that of another.
Some patients have auditory hallucinations as distinct as
sounds heard by the outward ear ; others, and the majority,
hear voices in much more subjective fashion. The differ¬
ence would appear to be due to the degree of extension
of the current from the sensory centre in the cortex to
the peripheral termination, rather than to the degree of
intensity of the belief in the hallucination, according to
which a patient might be supposed to refer his subjective
sensations to a completely external stimulus. We have ob¬
served as intense and dangerous beliefs associated with
hallucinations of slight as of vivid objectivity. Whatever
may be the true explanation, there can be no doubt that
hallucinations may in some instances have their sole seat in
the sensory centres, and in others extend to the sense organs
themselves. Again, some patients as they read a book hear
every word distinctly uttered; just as some persons distinctly
perceive the words which they hear. Further, some lunatics
labouring under hallucinations of hearing, hear these sub¬
jective sounds only on one side. And are there not cases in
which colours accompany auditory hallucinations? At any
rate, with some patients, there may with a clash of bells be
a flash of light. We refer to these interesting points in
the briefest manner only to show how many questions of
importance remain unanswered or suggest further inquiry,
and it is to be hoped that those who are familiar with the
insane will work to the same good purpose that Mr. Galton
has done in regard to the sane.

Of “ Number Forms/’ Mr. Galton gives some remarkable
illustrations. Some persons in health visualise numerals so
distinctly that they amount to (sane) hallucinations, and can
define the direction in which they appear, and their distance.
Thus, if looking at an object on the horizon at the moment
a figure presents itself to their mental eye, the latter would
appear to the left or right of the object, and above or
below the horizon. It is also noteworthy that many ob¬
serve the image of the same figure in invariably the same
direction and at the same distance. And just as with the
insane, others are not conscious of the same degree of objec¬
tivity ; the image is more dreamlike and subjective.

These forms of figures in the sane are found to have
existed as long as the latter can remember, and are quite
independent of the will; they sometimes appear along a

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line or are arranged in rows or in a singular framework;
they are sometimes curved to the left, oftener to the right,
and run more frequently upward than downward; they
often have fantastic twists and curves.

The months of the year often appear as ovals, and appear
in the opposite direction to those of the figures on a clock,
as often as in the same direction. Mr. Galton truly
observes of forms of numerals in pupils in schools that
they are “ the most remarkable existing instances of what
is called topical memory, the essence of which appears to lie
in the establishment of a more exact system of division of
labour in the different parts of the brain than is usually
carried on.” Hence it is that topical aids to memory are
of the greatest service to many persons. No doubt, as the
author observes, “ those who feel the advantage of these aids
most strongly are the most likely to cultivate the use of
numerical forms.” But is it quite fair in competitive
examinations that such should be allowed to gain prizes
when they have in fact carried a book of answers to ques¬
tions in their visualizing centres instead of in their pockets?
Indeed we have known a prize-man confess that he owed his
success solely to reading his notes of lectures visually when
answering his examination papers !

But our space obliges us to leave this fascinating subject
and proceed to say a few words on “ Visionaries.” Mr.
Galton was surprised to find how many apparently healthy
persons were subject to what they themselves described as
visions, of which he regards the number-forms already
described as the lowest order of examples. Mr. Galton has
received many touching accounts of childish experiences of
visions. Such persons supposed that all the world saw
visions like themselves. They, however, soon excited as¬
tonishment in others, and surprise in themselves, by in¬
cidentally mentioning their experiences. Then followed
“ ridicule and a sharp scolding for their silliness, so that the
poor little things shrank back into themselves and never
ventured again to allude to their inner world” (page 156).
One of these victims of sensory-hypersesthesia after attend¬
ing a lecture by Mr. Galton wrote to him thus : “At your
lecture the other night, though I am now over twenty-nine,
the memory of my childish misery, the dread of being
peculiar came over me so strongly that I felt I must
thank you for proving that in this particular at any rate
my case is most common.” Another form of vision is the
instant flash of colour which, with some individuals accom-

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panies sound, and which is of the highest interest. The
vowel sounds chiefly call forth colours. The subjects of these
coloured visions minutely describe their precise tint and hue.
Rarely do two persons agree as to the associated colour.
This interesting tendency is very hereditary. A third form
of vision is that of visualised pictures with words. Here is
Mrs. Haweis’s experience:

When I think of the word Beast it has a face something like a
gurgoyle. The word Green has also a gurgoyle face, with the addi¬
tion of big teeth. The word Blue blinks and looks silly and turns to
the right. The word Attention has the eyes greatly turned to the
left. . . Of course these faces are endless as words are, and it makes
my head ache to retain them long enough to draw.

Mr. GaltonVown experience in observing his field of view
in perfect darkness is interesting. After straining to
examine it, he observed a '

kaleidoscopic change of patterns and forms continually going
on, but too fugitive and elaborate for me to draw with any
approach to truth. I am astonished at their variety, and can¬
not guess in the remotest degree the cause of them. They dis¬
appear out of sight and memory the instant I begin to* think
about anything, and it is curious to me that they should often
be so certainly present and yet be so habitually overlooked. If they
were more vivid, the case would be very different, and it is most easily
conceivable that some very slight physiological change, short of a
really morbid character, would enhance their vividness (p. 159).

The Rev. George Henslow’s visions are described as being
much more vivid.

When he shuts his eyes and waits he is sure in a short time to see
before him the clear image of some object or other, but usually not
quite natural in its shape. It then begins to change from one form to
another, in his case also, for as long a time as he cares to watch it.
Mr. Henslow has zealously made repeated experiments on himself, and
has drawn what he sees. He has also tried how far he is able to
mould the visions according to his will. In one case after much effort
he contrived to bring the imagery back to its starting point, and thereby
form what he terms a visual cycle (l.c.).

Of these a very curious illustration is given in one of Mr.
Galton’s plates.

We have no doubt Mr. Galton is right in holding that
hallucinations, especially in the form of visions, are much
more frequent among the sane than is generally supposed.
There are, no doubt, two ways of regarding this fact: the
one that there are a good many people at large in the world
who are, scientifically speaking, insane; the other that

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there are many whose senses are excited from within,
instead of, or as well as, from without, whom it would be
preposterous to regard as insane.

The important practical bearing of the latter fact is that
alienists ought to be more careful than they often are in
assigning, as a proof of insanity, the presence of hallucina¬
tions divorced from their relation to conduct and belief.

Mr. Galton relates the following:—

A near relative of my own, saw phantasmagoria very frequently.
She was eminently sane, and of such good constitution that her
faculties were hardly impaired until near her death, at ninety. She
frequently described them to me. It gave her amusement during an
idle hour to watch theses faces, for their expression was always
pleasing, though never strikingly beautiful. No two faces were ever
alike, and no face ever resembled that of any acquaintance.

What is very important, she never mistook them for
reality, although they sometimes came almost suffocatingly
close to her. Mr. Galton mentions also a distinguished
authoress who “ once saw the principal character of one of
her novels glide through the door straight up to her. It
was about the size of a large doll, and it disappeared as
suddenly as it came.” The daughter of an eminent
musician is mentioned who often seems to hear her father
playing when he is not. If it be admitted that this is
abnormal, it is certainly not an insanity. The tendency to
see visions is hereditary, as among the second-sight seers
of Scotland, whom no one regards as more lunatic than their
fellow-countrymen.

By means of ingenious psychometric experiments Mr.
Galton has shown how mental operations which have passed
out of the ordinary range of consciousness, can not only be
recalled, but recorded in a statistical form, and he has shown
measurably the rate at which associations spring up, the
date of their formation, their tendency to recur, and their
relative precedence. These experiments show—what, indeed
for some years, has been more and more perceived by
psychologists, the enormous number of operations of which
the mind is unconscious, thus indicating a depth of mental
action entirely “ below the level of consciousness, which may
account for such mental phenomena as cannot otherwise be
explained. We gain an insight by these experiments into
the marvellous number and nimbleness of our mental asso¬
ciation, and we learn also that they are very far indeed
xxix. 39

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from being infinite in their variety.” Our space does not
allow a detailed description of these experiments; we can
only briefly refer to them. In his first experiments Mr.
Galton walked slowly along Pall Mall (450 yards) and
scrutinised every object (about 300), and allowed his atten¬
tion to rest on them until one or two thoughts had arisen
through direct association with the object, never allowing
his mind to ramble. He found that although it was im¬
possible to recall clearly the numerous ideas which had
passed through his mind, samples of his whole life came
before him, including many byegone incidents never suspected
to have formed part of his mental furniture. He was
perfectly amazed at the unexpected extent of every day
mentality. In a few days he repeated his walk, and was
struck as before by the number of events to which his ideas
referred, and about which he had never consciously occupied
himself for years. He, however, found that there was a
great deal of repetition of thought, and that the same actors
appeared again and again upon the stage. In order to secure
these fleeting thoughts, and submit them to statistical
analysis, he selected a list of suitable words and wrote them
on small sheets of paper—

Taking care to dismiss them from my thoughts when not engaged
upon them, and allowing some days to elapse before I began to use
them, I laid one of these sheets with all due precautions under a book,
but not wholly covered by it, so that when I leaned forward I could see
one of the words, being previously quite ignorant of what the word
would be. Also I held a small chronograph, which I started by pressing
a spring the moment the word caught my eye, and which stopped of
itself the instant I released the spring ; and this I did so soon as
about a couple of ideas in direct association with the word had arisen
in my mind. I found that I could not manage to recollect more
than two ideas with the needed precision, at least not in a general
way ; but sometimes several ideas occurred so nearly together that
I was able to record three or even four of them, while sometimes I
only managed one. The second ideas were never derived from the
first, but always direct from the word itself, for I kept my attention
firmly fixed on the word, and the associated ideas were seen only
by a half glance. When the two ideas had occurred I stopped the
chronograph and wrote them down, and the time they occupied. It
was a most repugnant and laborious work, and it was only by strong
self-control that I went through my schedule according to pro¬
gramme. The list of words I finally secured was 75 in number,
though I began with more.

Mr. Galton found it took 660 seconds to form 505 ideas,
being at the rate of 50 in a minute. His list of 75 words gone

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over four times gave rise to 505 ideas, and 13 cases of puzzle
in which nothing sufficiently definite to note occurred within
the brief maximum period of about four seconds, that he
allowed himself in any such trial. Of these 505 only 289
were different. Out of every 100 words, 23 gave rise to
exactly the same association in every one of the four trials ;
21 to the same association in three out of the four, and so on.
For the tables prepared by Mr. Galton we must refer the
reader to the work itself, and we hope that others will be
stimulated to pursue similar experiments on themselves, and
record the results in this Journal.

Mr. Galton’s observations on what he calls the ante¬
chamber of consciousness are much to the point. When
trying to think anything out, the ideas that lie at any
moment within the full consciousness seem to him to attract
of their own accord the most appropriate out of a number of
other ideas lying close at hand, but imperfectly within the
range of consciousness.

A sort of presence-chamber where full consciousness holds court,
and where two or three ideas are at the same time in audience, and
an ante-chamber full of more or less allied ideas, which is situated
just beyond the full ken of consciousness. Out of this ante-chamber
the ideas most nearly allied to those in the presence-chamber appear
to be summoned in a mechanically logical way and to have their turn
of audience.

Mr. Galton describes the progress of thought here as
depending first, on a large attendance in the ante-chamber;
second, on the presence of ideas only germane to the subject;
and, thirdly, on the justness of the above-mentioned sum-
moning-mechanism. The flow of ideas in the ante-chamber
is involuntary—they cannot be created. The exclusion of
ideas foreign to the subject is accompanied by a sense of
effort and will, whenever the subject is unattractive; “ other¬
wise it proceeds automatically, for if an intruding idea finds
nothing to cling to, it is unable to hold its place in the ante¬
chamber, and slides back again.” We must not, however,
proceed further with this interesting description, or we
should be in danger of transferring the whole chapter to our
pages.

Briefly to summarise Mr. Galton's conclusions : The first
point is the vast variety of natural faculty in the same race,
and still more when regard is had to the whole human family,
all which tends to be transmitted.

The second point is that the faculties of men generally
are not equal to the claims of modern civilization, in conse-

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quence of our ancestors having till recently lived under con¬
ditions far from civilized, and the somewhat -capricious
distribution of inherited powers, affording in this way
immunity, more or less, from the ordinary agencies of selec¬
tion. Mr. Galton has proved the greatly preponderating
influence of nature over nurture, by pursuing the life-history
of twins, a subject to which, as is well known, he has devoted
so much laborious and intelligent investigation. He has
shown, indeed, that no improvement in mere education can
compensate for a retrograde condition of the gifts of nature.

It may be stated axiomatically that upon race depends the
root and flower of human faculty; that humanity conse¬
quently is variable, and that, therefore, we are obliged to
inquire into the true place and function of man in the
Universe. The author confesses that the solution of the
problem remains doubtful. In common with an increasing
number of inquirers, he is sensible that it is not so trans¬
parently clear as is often imagined. One result is the
conviction that man is a member of a system of enormous
range, resembling from one point of view u a cosmic republic.”
Confessedly long indeed has the period of growth and
development been, under, to all appearance, a very definite
system of causative influences, with a splendid profusion of
means or instruments and of time, and a disregard of the
ignorance which has run counter to, and become the victim
of, these conditions.

In the recognition of the awful mysteries of life and of
that which Mr. Galton feels to be wholly inscrutable, anterior
to the earliest evolution, we find ourselves face to face with
intelligent man as its latest outcome. “ Man knows,” Mr.
Galton observes, “how petty he is, but he also perceives
that he stands here, on this particular earth, at this par¬
ticular time, as the heir of untold ages, and in the van of
circumstance.” Mr. Galton, therefore, thinks that he may
be too diffident as to the functions which he can, and ought
to perform in the great drama of life, and that he should
rise to the consciousness of the power which he possesses of
shaping, to some extent at least, the future course of his
race. That which Mr. Galton speaks of as “the awful
mystery of conscious existence and the inscrutable back¬
ground of evolution” is referred to in the same spirit by the
Waynflete Professor of Physiology (Dr. Burdon Sanderson) in
his recent lecture “ On the Study of Physiology ” at Oxford,
when he observes—“ Towards the problem of the nature of
the psychical concomitants of the excitatory process in the

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brain we can contribute nothing, simply because they are
not things which we can compare with any standards we
possess. All that we can do about them is to localize them,
but in accomplishing this, we are well aware that our
researches neither help nor hinder us in the endeavour to
penetrate the mystery of our own existence. All this is so
plain that it would appear superfluous to state it, were there
not persons who need to be informed on the subject, persons
who imagine that because our method is founded on the
assumption that every material process is the product of
material influences, every measurable effect the product of
measurable causes, we extend that method to things beyond
our province, namely, to things which cannot be measured.
A physiologist may be a philosopher if he has the gift for it,
but from the moment that he enters the field of philosophy
he leaves his tools behind him. . . . We are checked, not
by the complexity of the phenomena, but by the encounter
with something else which as physiologists we have no
means of grasping.”

The question, of course, arises, how can Man best promote
this end ? The reply is, by acting in harmony with and
advancing in all possible ways the course of development
hitherto in operation. He must discover by his intelligence,
and expedite by his energy, those changes which the adapta¬
tion of circumstance to race, and race to circumstance,
demand. The history of the past clearly shows that his
influence has been great in the same direction, to secure
such ends as conquest or emigration. It is to the unused
means of his influence, however, to which Mr. Galton more
especially refers. By showing how largely the balance of
population may be affected by early marriages, and how
endowments have checked the marriages of monks and
scholars, he indicates how much greater and better an
influence might be exerted by promoting early marriages
in classes which it is desirable to favour. He endeavours
also to show, though with less success, that “a public
recognition in early life of the probability of future per¬
formance, as based on the past performance of the ancestors
of the child ” would exert a powerful influence on progress.
For repression of those stocks which it is undesirable to per¬
petuate, Mr. Galton has no more definite form of Malthu¬
sianism to propose than the voluntary celibacy of those who
are convinced that their progeny would be unfitted to make
good citizens, and for such patriotic bachelors and spinsters
he accords in advance the thanks of a grateful country.

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Alas for the future of our race and the evolutions of a higher
humanity, if these are in ever so small a degree to depend
upon such self-denying lovers of their kind ! Past develop¬
ment owes its impulse to very different influences and
motives than those which the author proposes, and we may
reasonably suppose that the development of the future will
be on the same lines.

In conclusion we may say that it is always a pleasure to
read what Mr. Galton writes. If the results of his investi¬
gations are not always a solid gain to our knowledge, and
admit only of very limited application to the progress of the
race, he at any rate originates a host of suggestions. He
has brought to our own branch a mass of fresh ideas, and it
is our own fault if we do not utilize and extend them. We
confess it is little to the credit of us, medical psychologists,
that we have not hitherto pursued the same line of inquiry
with like zeal and fertility of experiment.

Die Alcoholischen Geistesbrarikheiten in Basler Irrenhause. Vom

damaligen Assistenzarzte Wilhelm von Speyr, 1882.

( Concluded from p. 284.)

In our previous notice of Dr. W. von Speyr’s sketch of
the various forms of mental disturbance induced by alcoholic
excess, we cited some of his cases and commentaries on (1)
Alcoholismus Acutus, (2) Alcoholic Insanity of the Acute
Variety. The remaining varieties, (3) Chronic Alcoholic
Insanity, (4) Delirium Tremens, and (5) Chronic Alcoholism
are sketched with much discrimination and lucidity, but our
space will not allow of our doing justice to the descriptions,
and we shall only briefly pass them in review.

Of the cases given under chronic alcoholic insanity, we
would refer to that in which there was marked exaltation of
ideas, seeing that some difference of opinion exists on the
subject. It is the only instance met with by Dr. von Speyr.

W. J. J., a merchant, married. His father was a drunkard. The
son squinted from youth, was delicate and nervous, and when a lad of
eight had a vision after taking a moderate amount of wine. He
masturbated. When older he drank to excess, and took absinthe.
The consequence was, after being married three years, he was sepa¬
rated from his wife and was dismissed from his place. Two years
after, he was admitted into the Basle Asylum suffering from “ delirium
potatorum,” with delusion, of persecution. In 1867 he was admitted
for the second time, labouring under “ chronic delusions of persecu-

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tion,” and remained in the asylum till 1875, when he was discharged
on trial. In 1877 he was re-admitted, having slept badly for several
weeks, heard voices for four months, and seen a vision. He attributed
the causd to over-exertion, not to drink. On admission he looked
fairly stout, but had a bloated appearance. The left half of the face
betrayed loss of power, tongue very tremulous, spasmodic action of
the facial muscles, especially the forehead. Tremor of whole body.
Right leg at first somewhat weaker than left. Speech stuttering.
Writing slow but very fair. Appetite good, at first diarrhoea. Sleep
normal, sometimes headache, also vertigo, much vaso-motor disturb¬
ance, blushing on speaking, &c. Subjective sense of well-being; the
patient behaved himself in an orderly manner. Intelligence and
memory not apparently weakened. At first amiably disposed and
attached; afterwards excitable, imperious, and egotistic. He over¬
estimated, with indomitable assurance, his person, capacity, and pros¬
pects; was also very vain. He lived in an atmosphere of ideas of
persecution. People oppressed him, and withheld from him great sums
of money. In mental work he was dull, and if he desired he could
not do much on account of dizziness. Unconscious of being ill.

The patient went out on trial in an improved condition in June.
He proved himself again quite unequal to the slightest work, as he
became ill every time he attempted it. In December he was re¬
admitted in consequence of threatening, under the influence of hal¬
lucinations, to bring an action against some imaginary impostors. On
re-admission there was marked emaciation, and an unhealthy, yellow
complexion, with contorted face, and tremors. In spite of this, patient
maintained he was quite well; only, occasionally he related that he
sometimes heard voices, that he was attacked by dizziness, or was
nearly suffocated from a weight on the chest. When so affected some¬
one had once threatened to stab him. He had a small goitre, sweated
much, and was more sensitive to cold than before. He had hypo¬
chondriacal delusions about having a fatty heart and liver. If you
gave him pure milk he maintained that you wanted to fatten him to
death. Grandiose and suspicious delusions were stronger than ever.
Now the doctors were his enemies also. The mental humour he is in
changes periodically. The affections were more blunted, the memory
still weak, as shown in completely misrepresenting matters of fact.
He considers that he has foreseen everything. Still in the asylum.

This chronic alcoholic insanity may be called the drunk¬
ard’s monomania of persecution; and as Nasse, quoted by
the author, has observed, it is characterised by hallucinations,
especially those of hearing and sight, by weakening of the
intellect and emotions, insane jealousy, frequently exaggerated
egoism to the extent of changing the personal identity, with
religious exaltation and abatement of the depression, besides
athetosis, and the appearance of facial paralysis, and lastly
chronic incurable insanity.

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Then follow observations on delirium-tremens, based on 65
cases, some of which are detailed. Dr. von Speyr justly
observes that before we can appreciate such cases, we must
distinguish between those induced by giving up the
customary drink, as in prison, for example, and those
arising in drunkards suffering from pneumonia and severe
injuries, the distinction having reference rather to duration
and result than to form of disorder. The one is simple, the
other complicated with a severe illness. Referring to the
division of the uncomplicated into the two varieties of
Magnan—the feverish and the non-feverish—the latter being
the “ delire alcoolique ” of this alienist, the author does not
think he is justified in making so fundamental a difference,
but holds that the feverish form is only a higher and more
dangerous degree of the non-feverish. Rather would he
differentiate between (a) simple delirium-tremens; (6)
delirium-tremens following upon an. an epileptic attack;
(c) delirium-tremens complicated with feverish disorders or
injuries.

We had translated many passages in this portion of the
treatise as worthy of being transferred to our pages, but we
find it necessary to omit them and to pass on to the next
division, “Chronic Alcoholism, 55 which is essentially char¬
acterised by weakness. Hallucinations are the exceptions;
delusions may be quite wanting, but there are always defects
in the patients’ moral character. He is an egotist. As in all
other attempts at classification, it is difficult to distinguish
the exact point at which chronic alcoholism can be said
properly to commence, especially so when we first see the
patient when intoxicated, or seedy after a debauch, or with
the added complication of delirium-tremens. The writer
opposes the view that the latter is only an expression or
outbreak of the former. Though it may agree generally
with the facts of the case, there are exceptions. Chronic
alcoholism may, at any rate, be diagnosed when we find that
from such and such a period the patient has been rarely seen
sober, or that for a year he has been drinking freely. Such
incorrigible intemperance is, truly, a sure sign of chronic
alcoholism. It may be noted that the effects of drinking
spirits (schnapps) to excess was disastrously increased by the
patient having worked in lead; in other cases the system
had been weakened by pneumonia and by typhoid.

The well-known physical symptoms of chronic alcoholism
were well marked in Dr. von Speyr’s patients; puffy and
fat appearance, anaemia, premature age, loss of power, bald-

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ness, depressed aspect, tremors of tongue and lips, speech
thick, greasy and discoloured skin, or congestion of nose and
cheeks, atheromatous vessels, hyperidrosis after slight exer¬
tion, chronic gastritis, pain at the epigastrium, vomiting,
frequent diarrhoea, albuminuria, jaundice, bronchitis and
emphysema, and oedema of the limbs. It is all important
to remember that in this condition very slight injuries cause
bruises, and that their range is unusually extensive, for
unjust blame may be attached to attendants under these
circumstances at a coroner’s inquest. The face was very
frequently drawn to one side and the tongue deviated.
After death no case of apoplexy was observed, but on careful
dissection small apoplectic cicatrices were frequently dis¬
covered. In many instances the relatives had died of
apoplexy.

The value of Dr. von Speyr’s memoir is increased by the
fact that he has only made use of cases of a purely alcoholic
nature, i.e ., disorders of which abuse of alcohol was the
principal or exclusive cause. . He has rejected every case of
acute mania in which onanism or epilepsy could be supposed
to come into play in the aetiology. As carefully has he taken
into account the forms of alcoholism complicated with dis¬
turbances of a hysterical or traumatic nature, and similarly
he has disregarded those cases in which there was a tran¬
sition of alcoholic disorders into progressive paralysis. We
have omitted many, and, indeed, some important points,
which are well brought out in this thesis; but we have said
enough to indicate that the author has made a careful study
of alcoholic insanities, and possesses excellent qualifications
for an accurate and intelligent clinical observer. We shall
look for more papers from him in respect to other forms of
mental disease.

A Treatise on Insanity in its Medical Relations. By William
A. Hammond, M.D. London : H. K. Lewis. 1883.

We have been long expecting a work on insanity from the
American medical press. We have had from time to time
valuable contributions to psychological medicine from men
in the States to mental disorders. Long ago, but not by any
means obsolete, there appeared a classic work on the dis¬
orders of the mind, written by the celebrated Dr. Rush.
There is in recent times the excellent work of the distin¬
guished Isaac Ray on the Medical Jurisprudence of In¬
sanity, a Work which will always mark an era in psycholo-

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gical literature; and there is the volume of miscellaneous
contributions to medical psychology from the active pen and
intelligent brain of the same lamented author, of whom
alienists in America are justly proud, and to whose ser¬
vices to the insane, and especially the criminal insane, we
gladly bear our testimony. To the esteemed Superintendent
of the Pennsylvania Hospital for the Insane, Dr. Kirkbride,
we are indebted for highly important and most practical
publications on the construction of asylums, and for annual
reports of the working of his own institution, which of them¬
selves constitute admirable essays on the treatment of insane
persons, and on the duties of society and the legislature to¬
wards them—essays which must have materially affected the
condition of the insane in the United States. Dr. Pliny Earle,
again, has laid the profession of medical psychology under
great obligation by his frequent contributions to this
branch of medicine, of which he has so long been an
eminent authority. Dr. Gray, of Utica, also has during
a long course of years occupied a prominent position, and
exerted by his writings and asylum work no inconsiderable
influence upon psychological medicine.

But from none of these, however, or other men in America,
whom we might mention, has there appeared any large work
professing to travel over so large an area as is implied
by the title at the head of this article, “A Treatise on
Insanity in its Medical Relations; ” more especially as the
term “ insanity ” is employed by the author in a very wide
sense, for Dr. Hammond begins with the statement that as
all normal mental phenomena are the result of the action of
healthy brain and all abnormal mental manifestations result
from the “ functionation ” (an atrocious term) of diseased
brain, the latter ought to be included under the designa¬
tion of “ insanity,” as the former are under “ sanity.” For
him there is no middle ground between “ sanity ” and “ in¬
sanity.”

Dr. Hammond’s work includes the consideration of the
general principles of the physiology of the human mind ;
the nature and seat of instinct; sleep and dreams ; and,
lastly, the description and treatment of insanity. Out of the
718 pages to which this book extends we have to pass
through 234 before we arrive at what constitutes for us
the most important section of the treatise.

Dr. Hammond commences with the definition and descrip¬
tion of insanity, and after citing the definitions usually
given by standard authorities, proceeds to give his own

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as follows:—“ A manifestation of disease of the brain,
characterized by a general or partial derangement of one
or more faculties of the mind, and in which, while conscious¬
ness is not abolished, mental freedom is weakened, perverted,
or destroyed.”

Subsequently Dr. Hammond wavers, however,' and then
adopts in preference the definition given by Dr. Cruse,
“Insanity is a psychic manifestation of brain disease,”
with the addition of the words, “unattended by loss of
consciousness.”

It is very remarkable that 4 Dr. Hammond, after insisting
upon the unlimited view of the nature of insanity, with
which he sets out, and after contending that there is no
middle ground between a healthy and an unhealthy condition
of the brain—that the one is the equivalent of sanity and the
other of insanity—should, immediately he attempts a prac¬
tical definition, make a distinction between different un¬
healthy cerebro-mental states of the most radical kind. A
man whose psychic manifestations are affected by cerebral
haemorrhage to the extent of unconsciousness, has confessedly
passed into an unhealthy condition of brain, and yet Dr.
Hammond is driven to admit that “ he certainly is not
insane.” Again the somnambulist has passed into an un¬
healthy condition of brain and mind, and ought to be regarded
as insane according to the author’s first stand-point, but as
he is unconscious of his surroundings he cannot be so re¬
garded according to the definition he finally adopts. It is
peculiarly unfortunate to make so much hinge upon this
subsidiary and epiphenomenal factor, when, as all modern re¬
searches in mental physiology show, so large a range of
abnormal psychical phenomena occur independently of con¬
sciousness. The automatic acts performed by the epileptic,
and of which he has no remembrance, must not, according
to this definition, be regarded as insane $ and if there is to
be no middle ground between sanity and insanity they are
clearly sane. What again of mental stupor so profound as
to leave a complete blank behind it when the patient re¬
covers ? Such cases must be excluded from Dr. Hammond’s
definition of insanity. It is noteworthy that the author in
abandoning his own definition for that of Dr. Cruse, appears
no longer to regard the weakening of mental freedom as an
element in the definition of insanity. So complete a change
on a point of fundamental importance arrests our attention,
and we look for some explanation. None, however, is vouch¬
safed us, and in another chapter (p. 681) Dr. Hammond re-

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adopts his discarded definition and holds that “ mental free¬
dom is weakened, perverted, or destroyed” in all cases of
insanity. The value of this part of the definition appears,
however, to he of no practical value, for the weakening of
mental freedom bears no relation to the loss of responsibility,
for the author holds that many of the insane are not only in
part, but even wholly accountable for their acts, and ought to
be regarded as fully responsible for any crime he or she may
commit. Dr. Hammond sees no difficulty in maintaining an
unyielding line between legal sanity and legal insanity, and
holds that “ no better one than that based upon a know¬
ledge of the nature and consequences of an act, and that it
is or is not a violation of the law, can be devised” (p. 681).
Shade of Ray ! What must be your mournful regret to see
this legal dogma perpetuated after all the pains you took to
explode it, and after you had lived to see at least two intel¬
ligent Judges adopt your views of responsibility. Had Dr.
Hammond explained this test away till it only meant what
Sir James Stephen assures us it does mean, we could have
understood, though we should not have agreed with him.
But to accept the dogma in its barest form without para¬
phrase or modification, is indeed a disappointing retrogres¬
sion, but one which we are glad to think scarcely any
Superintendent of an American Asylum will be prepared
to endorse. If this work does not faithfully represent the
opinions of transatlantic alienists, they ought to let it be
clearly known; for on so essential, so vital a question, there
ought to be no misunderstanding as to the teaching of the
American school of medical psychology, the trusted repre¬
sentative of which we have always regarded as Dr. Ray,
whose opinions and whose whole tone towards the law in
relation to criminal responsibility strikingly contrast with
the sentiment expressed in the work under review.

Dr. Hammond's classification of mental disorders may be
said to be neither better nor worse than most of those which
have preceded it. It is impossible to regard it as an advance.
The difficulty, however, of framing one which is altogether
satisfactory is inherent in the subject so long as the physi¬
ology of the brain and mental pathology are so far from
having advanced to the stage in which we can speak with
precision of the parts affected in different forms of insanity
and of the nature of the morbid changes which take place.

Dr. Hammond’s groups of insanities are psychological in
character, although he is obliged to admit that the psycho¬
logical method cannot be exclusively followed in the way he

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had previously attempted in his “ Treatise on the Diseases
of the Nervous System/ 5 There are in the present volume
seven divisions presented to the reader, namely, Perceptional,
Intellectual, Emotional, Volitional, Compound, and Consti¬
tutional Insanities, and, lastly, Arrest of Mental Develop¬
ment. The obvious objection to the first as a distinct
division is that unless the intellect, or reasoning faculties,
are themselves involved there is no insanity, understood in
the practical sense in which it has to be regarded; for it is
all important to know whether a person labours under a
simple optical illusion, for example, or under visual illusions
which he credits, and is, therefore, insane, not only according
to received doctrines but the definition of Dr. Hammond
himself, when he speaks of the weakening of mental freedom
as a necessary element of insanity. To conclude that
there is an insanity in cases where the state of the optic
nerve, or track, gives rise to an illusion of sight, seems to us
totally unwarrantable in theory and a mischievous confusion
in practice. The second and third divisions are only open
to the criticism which the author himself recognizes, that
they necessarily overlap one another, but this is unavoidable
in the best psychological classification. It is no doubt of
the highest importance to recognize those forms of insanity
which are mainly and distinctively emotional, though they
may involve more or less of intellectual disorder.

In regard to the volitional group, a grave difficulty pre¬
sents itself, for in truth the greater number of the forms of
mental disease are, in a very true sense, the result of the
loss or weakening of the supreme centres, by which the
impulses and the thoughts are no longer under control, but
are driven wildly along, escaped from the guiding hand of
the master. A volitional class is, therefore, too small in its
area as given by Dr. Hammond, and is too large for syste¬
matic use, seeing that if logically adopted it would comprise
nearly all phases of mental disorder. At the same time, a
number of interesting cases are introduced under this head;
actual paralysis of will (aboulomania), to which Billod has
attached great importance, being a very marked condition of
insanity, and well worthy of more careful study.

It is to the sub-division, “ Volitional morbid influences,”
that the observation above made of the difficulty of distin¬
guishing between morbid will and impulses no longer
inhibited by the will, and therefore morbid, applies. It
seems rather anomalous that we have to pass through the
four grand divisions of the insanities of Hammond before

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[Jan.,

we reach, under the term ct compound insanities,” such im¬
portant forms as “ acute mania ” and “ dementia,” and we
have to proceed further still before we arrive at “ epileptic ”
and other striking forms of mental disorder. The last
division, “ arrest of mental development,” is a natural one,
and includes “ idiocy ” and “ cretinism.” Dr. Hammond’s
treatise is, however, characterised by the omission of any
description of these mental conditions, and is so far 4

necessarily incomplete. We do not propose to follow the |

author through his description of the sub-divisions of the 1,

classes to which we have briefly alluded. We may remark,
however, that " katatonia ” receives considerable attention.

There can be no doubt that there is some hesitation in the
British School of Medical Psychology to attach one name to
the succession of mental symptoms to which Kahlbaum has
given this designation. It is not that anyone disputes the
well-marked cataleptoid condition which often occurs in
mental stupor, nor doubts that this is frequently preceded and
followed by melancholia or by excitement and exaltation.

That intense excitement should be the cause of stupor in
some instances is only what might be expected, and that
after the stupor the previous excitement should return is
not remarkable. Whether, however, our present terms do
not sufficiently describe all that is necessary, whether the
series of phenomena referred to are so united together by a
common pathology that they can be regarded as constituting
a typical form by itself, are questions still legitimately open to
debate. Whatever the decision may ultimately be, it is very
desirable to continue the work so well begun by Kahlbaum
and Kiernan and expanded by Hammond, of collecting
together as many cases as possible which show not only
that (as in many other forms of insanity) very different
symptoms may arise in the course of the disorder—one phase
being the well-recognised state of mental stupor with
catalepsy—but that such symptoms are so uniform in their
character and succession, and so knit together by the same
bond, that the whole form one type of insanity, distin¬
guished by so abnormal a condition of the mind and muscles
as to be adequately expressed by one word, and that word
katatonia.

Dr. Hammond quotes a case from the “ Sketches of
Bedlam,” which he has no hesitation in regarding as one of
katatonia. We confess that if the symptoms there given
suffice to constitute it, we do not see what is gained by the
use of the term, or that the symptoms tally with the defi-

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585

1884.] Review 8.

nition which Dr. Hammond adopts from Kahlbaum. Thus
a young man had paroxysms of mental stupor and cataleptic
rigidity, in which the whole body was stiff, and the eyes were
fixed, staring open, and insensitive to touch. His breathing
was very feeble. His body was as stiff as a plank, and he
might have been carried about like a ladder. When this
unconscious condition passed away he had no recollection
whatever of anything that had happened, but said he had
had dreams and visions. Afterwards he was dejected and
feeble—anything but a state of tension (katatonia).

While we have not hesitated to criticise this work, and
while we think it falls short of what a treatise on insanity
ought to be at the present day, nay, further, while we deem
Dr. Hammond's teaching in relation to criminal responsi¬
bility, on the occasion when he refers to it, absolutely mis¬
chievous and retrogressive, we consider that he has done
his best to arrange and digest in a lucid and attractive
manner a large amount of information relative to the
manifold forms of mental aberration, and that he has advo¬
cated some views and practices in the moral treatment of
the insane, which will, we hope, be of service wherever the
latter are subjected to the cruelties he asserts to be still
practised in some asylums in his own country.

A Treatise on Diseases of the Nervous System . By James
Ross, M.D., LL.D., F.R.C.P. Lond., Senior Assist.
Phys. to the Manchester Royal Infirmary, &c. (Illus¬
trated with Lithographs , Photographs , and Three Hundred
and Thirty Woodcuts.) 2nd edit. Revised and enlarged.
Two vols. London : Churchill. 1883.

The first edition of this treatise appeared in 1881. The
fact that, notwithstanding the size and price of the work, a
second edition has been called for so soon shows that the
profession are not slow to welcome a really good book when
they see it.

The present edition bears the marks of careful revision
throughout. One of the most noteworthy features is the
insertion of copious references as foot-notes. The text also
is enriched by further researches, by additional illustrative
cases, and in several cases by fuller descriptions. A large
number of new woodcuts have also 'been added to this
edition.

So short a time has elapsed since we reviewed the first

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586

Reviews .

[Jan.,

edition, when the main features of the work were pointed
out, that we will not now go over the ground afresh. Suffice
it to say that the work is now what it was when first pub¬
lished—the best treatise on diseases of the nervous system
that has as yet appeared in any language.

W. E. H.

PART III.—PSYCHOLOGICAL RETROSPECT.

1. Italian Psychological Literature, By J. R. Gasqukt, M.B.

The accumulated numbers of the Archivio contain several very
interesting papers, read before the “ Society Freniatrica,” of which
Society that journal is the official organ. The following are those
most likely to interest our readers.

Dr. Grilli gives a very careful account of Moral Insanity , his main
conclusions being—first, that most cases of moral insanity are merely
ordinary insanity affecting the character rather than the understand¬
ing. If any form of true moral insanity exists it is in cases of con¬
genital degeneration, where the moral criteria are absent, or the
instincts are depraved.

Dr. Yerga s account of the Aetiology of Insanity in Italy is carefully
compiled from the returns. Pellagra is one of the most frequently
assigned causes, in 7‘22 per cent, of males and 10*75 of females.
Idiocy and cretinism account for 7*77 per cent.; epilepsy for
7*73 per cent, of males, 5*51 of females ; 3*93 per cent, are ascribed
to alcoholism, and 3*73 males, 1*16 females to sexual excess; while
6*93 per cent, of female cases are set down to uterine and puerperal
disease.

Prof. Morselli’s elaborate paper on the Geographical Distribution of
Insanity is vitiated by this fallacy, that it is based upon the number
of exemptions from the conscription. At that age insanity is rare,
and epilepsy is in some parts of Italy alleged to exist and received
as a cause of exemption, where it does not exist. His statistics, there¬
fore, are only of value in so far as they relate to idiocy (including
cretinism). This is most frequent in the Alpine and Sub-alpine
provinces, next most frequent in the valley of the Po, and rarest in
the Latin and Neapolitan provinces, save where the Appennine chain
rises to a considerable height in the Abruzzi.

Dr. Riva gave an account of the Temperature in General Paralysis ,
based upon eighteen cases closely observed at Reggio, the temperature
being taken between six and eight each morning and evening in the
rectum. His conclusions are that in typical cases the temperature is
always slightly, though irregularly, above the normal ; that periods of
excitement are always preceded by increase of temperature, although
this also may go before stupor or epileptiform attacks.

Dr. Seppilli has examined 170 inmates of the same asylum for

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1884.] Psychological Retrospect. 587

tendon-reflex. It appears to be usually more distinct in conditions of
excitement, particularly in general paralysis, than in other forms of
insanity. It is worth noting that he has observed ankle-clonus to
come on in a few hours after an attack of hemiplegia.

Dr. Tamassia’s account of Mania Transiloria is interesting. He
mainly devotes himself to pointing out the differences between such
cases and those dependent on epilepsy. The attack, he observes, is
usually instantaneous ; the symptoms point to hyperaemia rather than
anaemia ; the delirium is not always violent, and need not be hostile
(as in epileptics); there is no exhaustion, stupor, or tendency to sleep
when the attack is past. In the discussion on this paper some strik¬
ing cases were related by various speakers.

Transfusion of blood in anaemic insane patients has been tried to
some extent in various Italian asylums, and usually with benefit. The
plan adopted has been to inject defibrinated blood into the peritoneal
cavity. This method appears to cause no suffering or other incon¬
venience. In the discussion on this subject, Dr. Fo& stated that
many experiments on dogs had led him to believe this to be the best
way to introduce blood into the system. The blood passes mainly
through the spleen and retro-peritoneal lymphatic glands, but also in
part through the lymphatics in the diaphragm, and stimulates all
the blood-making organs to increased activity.

It is greatly to be regretted that the multiplication of journals
devoted to our specialty in Italy should have materially diminished
the number of original contributions to this, the oldest of them, but
such is certainly the case.

The Archivio di Psichiatria , Scienze Penali ed Antropologia
Criminate contains much interesting matter, mostly bearing, however,
on Professor Lombroso’s opinions as to the connection between in¬
sanity and crime, and as to pellagra. Probably the most striking
paper is one by the Professor himself, On the Sexual Passion ( Vamort )
in the Insane . He believes disappointed love is a very rare cause, and
successful love a still rarer cause of insanity. It would appear that,
in Italy at any rate, unrequited affection does not so often produce
insanity as some other varieties of nerve-exhaustion, which are rapidly
fatal. He narrates some singular examples of “ mute ” erotomania ;
but still more remarkable are those which he has collected of the
sexual passion being complicated with various kinds of cruelty or
violence. He also relates instances of perverted sexual instinct (in¬
verse or merely paradoxical) as well as of satyriasis and nympho¬
mania. All these are instructively compared with the part which
these conditions have played in the world outside asylums, and in
persons not reputed to be lunatics.

He has another article on the proposed establishment of Criminal
Lunatic Asylums in Italy. His main objection is to the suggestion
that persons should be committed for a definite time to such asylums
on the authority of the Court trying the case. He prefers the Eng-

xxix. 40

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588 Psychological Retrospect. [Jan.,

lish committal “during her Majesty’s pleasure,” whereby dangerous
lunatics can be confined for life.

Dr. Salvioli gives an account of Hypnotism , mainly interesting for
the contrast he draws between it and natural sleep. He considers
that in the former the brain is hyperaemic, and that it cannot be looked
upon as a condition of rest, but of peculiar excitement of the nerve-
centres which are set free from the influence of external impressions
and the guiding power of consciousness and will.

The Rivista Sperimentale continues to hold the high place it has
occupied, both for original work and for analysis of the progress of
science in insanity and medical jurisprudence.

The following are the most important original papers coming from
the school of Reggio.

Hyoscyamine has been tried in thirteen cases ; and Drs. Seppilli
and Riva report that it has been found useful as a sedative and hyp¬
notic, but with no special advantages, in most forms of insanity, over
better known and more manageable drugs. It was most successful in
recurrent mania and epilepsy; they also suggest that it would pro¬
bably find its chief employment when'it is necessary to remove very
excited and violent patients to an asylum.

Dr. Buccola has measured the time required for psychical acts in
the insane. His conclusions, which are based on a series of most
careful experiments which cannot be condensed, are as follows :—The
average and the mimimum periods after which a sensation is registered
are increased in dementia, idiocy, and in chronic insanity generally.
On the other hand in mania, in some cases of simple melancholia, and
of epilepsy without mental affection, the average period is lengthened,
the minimum remaining the same as in health. The former condition
(as Obersteiner pointed out) corresponds to organic degeneration of
the cortical cells; the latter to diminished power of attention.

Prof. Tamburini and Seppilli have studied the phenomena of
Hypnotism in an hysterical patient under care at Reggio. The chief
point which seems to have been elicited is the rapidity with which neuro¬
muscular excitability is produced when this patient is hypnotized, so
that the various agents usually employed to cause this (pressure, heat,
mustard-leaf, &c.) do so much more readily than usual. This leads
them to suggest that in hypnotism there is some molecular change in
the nervous system; a similar suggestion (it may be remembered by
readers of the last Retrospect) having been made by Schiff, to explain
the phenomena of u metalloscopy.” They distinguish three stages in
hypnotism. In the first, the Lethargic , muscular contractility and
tendon-reflex are exaggerated; there is hyperaesthesia of hearing and
of the ovary ; respiration is deep and frequent ; the peripheral vessels
are dilated. In the Cataleptic stage tendon-reflex is lessened or
abolished, the limbs are in a condition of passive flexibility; there is
complete anaesthesia of all the organs of sense and of the ovary; respi¬
ration is infrequent and shallow ; the vessels of the surface are con-

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1884.] Psychological Retrospect. 589

tracted. The stage of Somnambulism is characterized by general and
lasting muscular contraction.

These stages may be produced by only increasing the duration and
intensity of the stimuli employed. Their muscular phenomena are
evidences, only differing in degree, of an increased excitability of the
motor centres. There is a corresponding excitability of the sensory
centres, shown by the ready production of hallucinations by sugges¬
tion.

Morselli gives a very minute account of the Specific Gravity of the
Brain in insanity. It is only possible to note here the general results
at which he has arrived. He finds that insanity, on the whole,
increases the specific gravity of both grey and white matter, especially
in adult life. This tendency is rather more marked in the female
than in the male, so as to cause the two sexes to be more nearly
equal in this respect than they are in health. The highest specific
gravity is in alcoholism ; epilepsy was also very high, but our author
examined only one epileptic’s brain. Then follow, in order, the
chronic degenerative, forms of insanity and acute mania; while those
forms accompanied with atrophy of the cerebral substance are lowest
in the scale, and most nearly approach the physiological average. The
specific gravity is very high in cases of compression by tumour, and
high in softening and oedema ; it is, on the other hand, low in
sclerosis.

Dr. Amadei gives an equally careful investigation of the Capacity of
the Cranium in the insane. This is based upon the examination of
175 male and 280 female skulls, which are carefully compared with
a large collection of skulls of sane persons. The averages are—

1. In the sane.

Males .... 1474 cubic centimetres.

Females ... 1376 „ „

2. In the insane.

Males . . . . 1544 cubic centimetres.

Females . . . 1341 „ „

The general result thus obtained—that the insane cranial capacity
is greater than the sane—is in agreement with what had been pre¬
viously stated by Meynert, Sommer, and Peli.

But the different forms of insanity contribute in very varying
degrees to this result. Thus in idiocy (as might have been ex¬
pected) we have the smallest capacity, save where some hydrocephalic
skull would raise the average if it were reckoned, as our author has
not done. In epileptics the capacity is almost normal in the male,
and only slightly higher in the v female. It is in this series that the
greatest number of anomalies occur. In mania the capacity reaches
about the average above given for the insane. Finally, in melan¬
cholia, the highest averages are reached, viz., 1632 c.c. for males, and
1544 for females, though these figures represent cases of hereditary
insanity. The author suggests, to account for this remarkable fact,

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590 Psychological Retrospect . [Jan.,

that increased capacity of the skull is one evidence of degeneration,
development in size being in inverse ratio to development in struc¬
ture. In general paralysis the skulls examined (of males) were a
little above the healthy average. This Dr. Amadei ascribes to the
patients having been of a higher class in life, a source of fallacy which
is not to be forgotten.

Dr. Buccola has been measuring the Rapidity of Dilatation of the Iris
after puncturing one hand or arm, employing an apparatus to register
the moment at which the pupil is found to dilate. He thus ex¬
amined 15 cases of general paralysis (13 males and 2 females) ; in
seven the pupils were found not to act at all, while in the remainder
the movement was considerably delayed. This appears not to be the
case in ordinary insanity, where the period of re-action was found to
be the same as in health.

The longest and most elaborate paper in the Rivista is one by Prof.
Golgi, on The Minute Anatomy of the Nerve-Centres . His object is to
discover an anatomical basis for some of the data of physiology,
selecting particularly the following problems :—1. The connection
between the nerve-fibres and the ganglionic cells. 2. The relation
between the different forms of ganglionic cells and the functions of
the parts where they are found. 3. The arrangement and relations
of the elements in the several parts of the nerve-centres. 4. The
course of the nerve-fibres and their relation to the groups of gang¬
lionic cells. Space only allows of my extracting a few of the most
notable points dealt with in this remarkable essay. He defines nerve-
cells to be those only which are provided with a single prolongation,
continuous with the fibres. The “ protoplasmatic prolongations ” of
Deiters are not connected with the nerve-fibres, as may be most clearly
seen in the fascia dentata. Golgi suggests that they are probably the
means by which nutrition is kept up in the cells.

The nerve-prolongation sends off at tolerably regular intervals
lateral filaments, which in turn divide and subdivide into an ex¬
tremely complicated network through all the grey matter. Similar
filaments seem to be given off from the ordinary nerve-fibres. There
seem, therefore, to be two different ways in which the fibres and cells
are connected ; either directly by a prolongation from a nerve-cell
becoming the cylinder-axis of a fibre, or indirectly by the filaments
given off from the prolongations and fibres, which are closely inter¬
laced in the grey matter. Taking the case of the spinal cord, the
direct connection seems to prevail especially in the anterior cornua;
the indirect connection in the posterior cornua: the former being
therefore prevalent in the motor centres, the latter in the sensory.

For the most part each nerve-fibre is connected with separate groups
of ganglionic cells ; and each ganglionic cell in turn, with nerve-fibres,
going in different directions.

His examination of the cortical grey matter leads him to differ from
Meynert, and to divide it into the following layers, which gradually
shade into each other:—1. An outer layer, composed principally of

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1884.] Psychological Retrospect . 591

rather small pyramidal cells. 2. A middle layer of larger cells, also
pyramidal. 3. The inner layer, the cells in which are mostly fusi¬
form, but also polygonal, globose, or irregular in the anterior convolu¬
tions, but containing many small cells in the deepest part of this layer
in the occipital convolutions. This is the only histological distinction
noted by our author in different parts of the convolutions.

We have received the Archives Italiennes de Biologic for 1882, a
periodical published at Turin, and intended to supply abstracts in
French of all the more notable biological papers published in Italy.
The only paper bearing on our subject, which has not been already
noticed in these Retrospects, is one by Dr. Marcacci, on the Cortical
Motor Centres . He is led by a careful analysis of 27 cases to conclude
that there is no pathological evidence of the existence of localized
motor centres in man.

2. French Retrospect .

By Dr. T. W. McDowall.

Les Annales Medico-P sychologigues . Sept., 1880, to Jan., 1881.

The Treatment of Delirium Tremens and of Acute Delirium hy Cold
Baths and Bromide of Potassium . By Dr. Rosseau.

This short paper essentially consists in the record of two cases of
acute delirium.

In the first, the patient was admitted in a state of extreme excite¬
ment, the face red, the eyes bright, the temperature increased, the
pulse very rapid, full, regular. He had hallucinations, and the de¬
lusions usually found in such cases. He was immediately ordered 10
grammes of bromide of potassium, but the excitement and delirium
continued during the day and the following night.

Next day the bromide was continued; but in addition, the patient
was kept in a cool bath for seven hours, and from time to time cold
compresses were applied to the forehead. During this process
the excitement and violence disappeared, though his sanity was
not completely restored. He had an excellent night, and slept till
morning.

On 21st July he was reported to be free from excitement, and quite
rational. The baths were discontinued, but the bromide was continued
until the 23rd as a precautionary measure. In five days he consumed
50 grammes of that drug. He was discharged on the 29th, quite
well.

The second case was admitted on the 18th November, 1879. He
suffered from acute delirium, such as is so frequently seen in the be¬
ginning of general paralysis. He was 32 years of age, had always
been sober in his habits, and there was no history of insanity in his
family. He had experienced reverses in business, had led a sedentary
life, and was of an exceedingly sanguine temperament.

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592

[Jan.,

Psychological Retrospect.

The night after admission he was very restless in spite of a draught
containing 10 grammes of bromide. The face was congested, the
skin burning, the pulse strong and rapid, the excitement and restless¬
ness extreme.

On the 19th November the bromide was continued, and he was put
in a cool bath from 10 a.m. till 5 p.m. Cold irrigations of the head
were constantly renewed, as the temperature of that part of the body
was excessive. Some hours after the beginning of this treatment, the
agitation diminished, and some flashes of intelligence appeared. He
recognised an attendant, talked of his wife, and asked to write a letter
to her. During the remainder of the day and during the night he
was quite quiet, and his hallucinations did not appear.

On the 20th November he was still free from excitement, but his
intelligence was somewhat clouded. The baths were stopped, and
during the next five days he was purged by means of pills of calomel
and aloes. No further treatment was necessary as the patient was
quite well in every respect.

These results of Dr. Rousseau confirm those of Dr. F6r4ol. This
form of treatment has never become popular in England. Some very
sad cases have been recorded, in which rapid and fatal syncope
occurred, and it is possible that these casualties have deterred
physicians from using a most powerful and successful form of treat¬
ment in certain cases.

Hypochondriacal Delirium in a Severe Form of Anxious Melancholia.

By Dr. Jules Cotard.

The subject of this paper has been under observation for several
years. She states that she has no brain, no nerves, no chest, no
stomach, no bowels ; that there is nothing left of her but the skin and
bones. Neither has she a soul; God no longer exists; neither does
the devil. Mile. X., being thus nothing but a disorganised body,
has no necessity to eat, she cannot die a natural death, she will live
for ever unless she is burnt, fire being her only possible end. Her
condition need not be further described, as it is a typical one of melan¬
cholia with dominance of religious and hypochondriacal delusions.
Sensibility to pain is diminished over the greater portion of the body.
Ordinary sensation and the other senses appear normal.

Dr. Cotard has collected a few similar cases from the writings of
Esquirol, Leuret, Petit, and others. In all these patients the hypo¬
chondriacal delirium presents very similar characters ; they declare
that they have no brain, stomach, heart, blood, soul; sometimes even
they have no body.

The author points out that such a condition is very different from
that which precedes or accompanies the delirium of persecution.

Another common delusion in such cases is the belief that they can¬
not die, because their bodies are not in the ordinary conditions of
organisation, as, if they could die, they would have been dead long ago.

Dr. Cotard remarks, as specially interesting, that all the patients

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1884.] Psychological Retrospect. 598

who laboured under hypochondriacal delirium with the delusion of
immortality, believed they were eternally lost, were possessed by the
devil, in short, presented all the characters of demonomania or religious
insanity.

Somewhat similar cases are referred to as illustrating the one under
consideration, but they are not of special interest. Neither indeed is
the one recorded by Dr. Cotard, and we cannot understand why he
should suggest a special name for such, and give six special char¬
acteristics by which they may be recognised. The fact is that among
the educated classes there is no end to the elaboration of delusions,
especially in women of a religious and hysterical temperament.

On Brain-disease Due to Lead in its Relations to General Paralysis .

By Dr. Emmanuel Regis.

The amount of observation on the relation of the two diseases is
limited to about twelve cases, yet there are three distinct opinions
regarding them :—

1st. That of Dr. Devouge, who first attracted attention to the sub¬
ject so long ago as 1852, and who believes that there is a genuine
general paralysis of saturnine origin, closely resembling the ordinary
disease.

2nd. The original opinion of M. Delasiauve, who in 1851 stated
that certain forms of saturnine brain-disease could resemble general
paralysis so closely as to simulate it; hence the name “pseudo-paralysie
gdnerale saturnine ” which he gave to these forms of poisoning. Un¬
fortunately he afterwards changed his opinion, and admitted the exist¬
ence of a general paralysis due to lead poisoning ; and he even tried
to sketch some of the distinctive characteristics.

Yoisin supports Delasiauve’s first idea, and denies the existence of
a genuine saturnine general paralysis.

3rd. M. Falret’s opinion is a mixed one. He admits the exist*
ence of a genuine saturnine general paralysis, but adds that it pre¬
sents notable differences from the ordinary disease, differences unfor¬
tunately little understood.

Such variety of opinion can be easily understood when it is remem¬
bered that the cases described are under a dozen, and besides that
we are too ready to admit the etiological influence of lead in paralytics
exposed to its influence in their trade. Although a painter or white-
lead worker has had attacks of lead colic, and ultimately becomes a
general paralytic, it is obvious that the latter disease is not necessarily
the result of the action of lead. The relation may be a simple co¬
incidence.

The present paper by Dr. Regis is only introductory to a more
elaborate one in preparation, still it is interesting to know his opinions,
based as they are on the careful examination of four cases.

1. Symptomatic differences .—When we compare a pseudo-general
paralytic from lead and a genuine general paralytic, the first thing to
attract attention is that the former presents symptoms of lead poison-

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594 Psychological Retrospect. [Jan.,

ing in addition to the ordinary symptoms of meningo-encephalitis,
which are common to both. These signs, which clearly distinguish
between the two cases are—physical: 1, blue line on the gums, earthy
colour of the skin; 2, heaviness in head, headache, giddiness; 3,
cramps, formication, neuralgic pains, partial anesthise or hyperaesthesia,
disease of the joints, paralyses ; 3, epileptic or convulsive symptoms
of various intensity. Intellectual: 1, insomnia, dreams, nightmare;
2, hallucinations of sight, causeless terror ; 3, delusions of persecution,
poisoning, &c. All these symptoms are not present in every case,
but the most constant are the blue line on the gums, the earthy colour
of the skin, nightmare, hallucinations of sight, imaginary fears and
confused delusions of persecution. From their enumeration it is
evident how much the mental symptoms produced by lead are like
those due to alcohol. This remarkable similarity has been productive
of numerous mistakes.

There are other minor differences. In the disease due to lead the
inequality of the pupils is sometimes absent; the muscular tremor is
more intermittent, more marked, and more spasmodic, and the speech
is sometimes so affected as to be unintelligible. The patients are often
dirty and completely paralysed when admitted. In addition to the
mental symptoms already mentioned, and which are quite transitory,
the patients present a type of mental enfeeblement quite distinct from
that seen in ordinary general paralysis. Whilst in ordinary paralytics,
the mental enfeeblement, at first but slightly marked, becomes
gradually worse and ends in the most profound dementia, in the
other class of cases the dementia, which shows itself from the first
in its greatest intensity, is more apparent than real. On their admis¬
sion the patients appear to be completely demented, and can scarcely
say their own names. Yet in a very short time the intelligence re¬
turns, and we are surprised to see patients rapidly emerging from what
was believed to be an incurable and fatal illness. Excluding excep¬
tional cases the ordinary paralytic may be described as a gentle, kind
creature, ready to bestow his enormous wealth on the first comer. The
lead-paralytic, when not completely demented, is of an entirely
different disposition. He is irritable, suspicious, rude, selfish.

The diseases are entirely different in their progress.

Ordinary general paralysis goes from bad to worse as a rule. Its
invasion is slow, its beginning very insidious. At first the symptoms
are scarcely appreciable, and are limited to a few very slight physical
or mental symptoms. Gradually these symptoms increase in severity,
mind and body become feeble, dementia and paralysis occur, and after
a more or less rapid decline in all the vital functions, the patients pass
into a state called paralytic marasmus which speedily ends in death.

Saturnine general paralysis pursues an absolutely opposite course.
It breaks out suddenly, and at once reaches its worst. The majority
of the patients, when they are admitted, are in a state of violent ex¬
citement, but this excitement, which is accompanied by nightmare,
hallucinations, &c., is only an epiphenomenon of the disease, analo-

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1884.] Psychological Retrospect. 595

gous to the acute symptoms of chronic alcoholism. When this essen¬
tially transitory crisis is past the pseudo-general paralysis appears
fully developed. When the system is profoundly affected by the
poison, as it usually is, the patients are plunged in the most pro¬
found cachectic marasmus from the first day. They are dirty,
paralysed, demented, incapable of movement, or of uttering a word, so
that they appear as if about to die. In a few months these patients
leave the asylum, completely recovered. They first cease to be dirty,
by degrees their sphincters gradually regain their power; their in¬
telligence returns, and all symptoms of paralysis disappear. When
the action of the poison has been less violent, the symptoms are less
severe, but their progress is the same, and they disappear with
the greater rapidity that they were originally less marked.

Counter-lifting. By Dr. Lunier.

This paper is largely composed of the detailed histories of fourteen
cases of theft committed by persons more or less insane. Four were
weak-minded ; three epileptic ; one hysterical ; three demented from
old age ; two demented after other attacks of insanity ; and one was
a case of morphia-intoxication.

During a thirty years’ experience in public asylums Dr. Lunier met
with but two genuine cases of kleptomania. He details their history,
but there is no reason for reproducing them.

In the few remarks with which Dr. Lunier concludes his paper
there is nothing of interest or novelty.

The Clinical Study of Mental Diseases and Psychology . By Dr.

Prosper Despine.

It has always appeared to the author that alienist physicians are not
sufficiently interested in psychological studies, and he has already
pointed out the evil results of this neglect. In this paper he re¬
turns to the subject and endeavours to show that it is impossible
to prosecute clinical investigations in mental diseases without the aid
of psychology, and to exhibit the benefit which the physician might
obtain from this science.

This is a subject so thoroughly thrashed out that it is quite unne¬
cessary to give an abstract of the paper. Dr. Despine has nothing
new to say about it; indeed it would be surprising if he had.

The Employment of Metals in a Case of Hysteria and Insanity . By

Dr. Cullerre.

Since Dr. Burq first published his results a very large number
of cases have been published, supporting more or less his conclu¬
sions as to the power of metals placed upon the skin to alter the
nervous and vascular action and areas varying much in size.

The case published by Dr. Cullerre is a typical example of the kind
with which students of nervous diseases have of late become so
familiar.

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596 Psychological Retrospect . [Jan.,

He submitted the patient to the influence of three metals, gold,
copper, zinc. Gold had but little effect, copper had more, but the
result of zinc was most marked. His results correspond generally
with those reported to the Biological Society by Charcot and others,
by a Committee specially appointed to enquire into the subject. Every
precaution was taken to avoid error and deception. The application
of zinc always restored the capillary circulation as well as sensibility
to pain, whilst thermic sensibility was perverted, so that the contact
of a warm body gave rise to a sensation of cold, and inversely. Never¬
theless he never observed the phenomenon of transfer, as happens in
cases of anaesthesia which are not dependent on an organic lesion of
the nervous centres.

The internal administration of oxide of zinc was followed by the best
results. It was given at first in doses amounting to a decigramme per
diem. Every five or six days it was increased by the same amount
till the quantity taken daily equalled a gramme and a half.

Medico-legal Case. Attempted Murder of Three Persons. Reported

by Dr, Dufour.

Although the facts are recorded with great minuteness, there is
really nothing special in the case. A man laboured for several years
under delusions of persecution, poisoning, <fcc. In order to escape
from the tormentors he resolved to go to America, but he must first
procure money for the necessary expenses. He resolved to take the
money from a former employer who he knew kept considerable
sums in his house, and whom he believed guilty, with the other
members of his family, of repeated attempts to poison him. There
is one special feature of interest; the gradual development, during
several years, of the defined delusions. It is surprising that such de¬
lusions remained so long without tragic consequences ; for there can
be no doubt that delusions of suspicion are in their consequences more
dreadful than any other form of insanity, except, perhaps, melancholia.

Medico-legal Case. Violence Towards a Superior Officer. Reported
by Dr. E. Dufour.

There are several features of interest and importance in this case*
The patient was a soldier. On being found fault with by his corporal*
he became frantic with anger and made several attempts to murder him*
A military court sent him to an asylum for observation. It was ascer¬
tained that he had a hereditary tendency to insanity ; that he received
a severe*injury to the head when a boy, that he was epileptic for a few
years, but that he had been free from all symptoms of mental or
nervous disease for years, until, indeed, he entered the army. In en¬
listing he appears to have discovered that he made a mistake, and he
confessed that he began to simulate insanity so that he might obtain
his discharge. Amongst his comrades he passed as a fool with a
wretched temper, though it was observed* that the appearance of a
superior officer stopped his violence at once. Whilst in prison and

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in the asylum he behaved on the contrary just as he thought would
suit his purpose best; but he was so simple as to confess his roguery,
else his condition might have been one of great difficulty to those
commissioned to report on it.

Dr. Dufour is inclined to the opinion that there existed slight
mental weakness. In this he is, perhaps, right. The man was weak
enough to be a scoundrel, but had sense enough to try to escape the
consequences of his wickedness. Such cases are full of difficulty,
and each must be judged on its own merits. The line between crime
and insanity is sometimes a very fine one, especially in a very con¬
siderable percentage of the inmates of our prisons.

Dr. Dufour concluded that his patient was only partially responsible
for his acts. In spite of this decision, the Army authorities sent him
back to his regiment.

Non-Restraint.

It would have been imagined that this was a subject done to death,
yet we find that our worthy French colleagues devoted the better part
of three meetings to its discussion. We have no intention of repro¬
ducing, even in the briefest way, what was said, for it would profit
nothing. English asylums came in for high compliments and severe
condemnation, just as the speaker approved or disapproved of the
system. The discussion seemed to convince nobody, but was most
successful in exciting a good deal of warmth—a most unfortunate
result.

Increase of Fibrine in the Blood in a Case of Pericerebntis (General
Paralysis). By Dr. Daniel Brunet.

In 30 cases of general paralysis the amount of fibrine was measured
by Dr. Brunet, whilst resident at Charenton. He employed the
method followed by Andral and Gavarret. Its weight ranged between
1*8 and 5 # 9 grammes per 1,000, and was in proportion to the in¬
tensity of the inflammatory symptoms.

The minimum quantities, 1*3 and 1*86, were obtained from persons
affected with general paralysis, slow in its progress and characterised
by dementia. At the end of the second stage they were bled for
transient symptoms of cerebral congestion.

The amount of fibrine in twenty-four cases varied from 2 gr. to
3*32 gr. The mean quantity for these twenty-four cases was 2*6.

In four cases it exceeded 4 gr. in amount. In these some details
are given as to the progress and character of the disease. There
were marked symptoms of cerebral congestion, and microscopic ex¬
amination showed distinct inflammatory changes in the convolutions.

Dr. Brunet's conclusions are that: 1. General Paralysis, like
every other chronic inflammation, does not increase the fibrine in the
blood when it progresses slowly and regularly. 2. The increase
occurs when the inflammatory symptoms become very intense and
acute. The fibrine may then reach 5*9 gr. per 1,000.

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598 Psychological Retrospect . [Jan.,

Contribution to the Study of Folie a Deux. By Dr. E. Marendon de

Monty el.

This is an interesting paper, and would be valuable did it contain
nothing more than the histories of the patients whose lot it has been
to furnish examples of conditions not often observed. It is only very
rarely that two persons, e.g., husband and wife, become insane at
the same times, but such coincidences have attracted the attention of
some French writers, notably MM. Las&gue and Falret, and more
recently Dr. Regis.

Want of space compels us to be brief, and to reproduce only Dr. de
Montyel's conclusions, but we would recommend the whole paper to the
attention of our readers. In these days of careless, and often useless
writing, it is pleasant to read cases so carefully and elegantly described.

The ideas on which the whole paper is based may be summarised as
follows :—

I. Folie d deux includes three perfectly-distinct orders of cases.

(a.) Folie imposee , in which a lunatic imposes his delusions on a

person intellectually and morally weaker than himself, always except¬
ing certain conditions already indicated in MM. Las^gue and
Falret’s paper.

(b.) Simultaneous insanity , in which two persons, hereditarily pre¬
disposed, contract at the same time the same form of insanity, always
excepting certain conditions already indicated in M. Regis’s paper.

(c.) Communicated insanity , in which a lunatic communicates his
hallucinations and delusions to one hereditarily predisposed to insanity.

II. The union of three conditions appears to be necessary for the
production of communicated insanity.

(a.) A well-marked hereditary predisposition in the person to
whom the insanity is to be communicated.

(b.) At all times, an exceedingly intimate association and com¬
panionship between the two future co-lunatics.

(c.) An incessant action by the lunatic upon his sane companion so
as to induce him to share his hallucinations and delusions.

III. From a medico-legal point of view, in imposed insanity , the
passive person is feeble-minded, an imbecile ; but even when he co¬
operates in insane acts with the active person, he should not be con¬
sidered lunatic; on the contrary, in simultaneous insanity and in
communicated insanity , both co-deliriants are lunatic.

IV. From a medico-legal point of view, in folie imposee , the proba¬
bility of the delusion is relative, and the expert must thoroughly un¬
derstand the previous mental condition of the passive agent before
drawing any conclusions.

V. Simultaneous insanity and communicated insanity are only two
very good examples of the general influence of surroundings upon the
forms assumed by mental disease.

VI. It is also by the general influence of surroundings that we
must explain the singular fact that all examples of folie a deux
present delusions of persecution, the insanity of the 19th century.

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599

PART IV.—NOTES AND NEWS.

THE MEDICO-PSYCHOLOGICAL ASSOCIATION.

The Quarterly Meeting of the Medioo-Psychological Association was held at
Bethlem Hospital, on Friday, the 26th October, 1883, Dr. Manley, the Presi¬
dent-Elect presiding, in the unavoidable absence of the President, Dr. Orange.

Dr. Manley said that before proceeding with the business on the Agenda, he
had to propose for adoption the following Resolution in reference to the late
fatal fire at Southall Park, at which Dr. Boyd had lost his life:—

“ That this Association, meeting for the first time since the event referred
to in the Resolution, desires to record its profound sorrow and regret that one
of its oldest and most estimable members, Dr. Boyd, has been removed by a
lamentable accident, and to express its sense of the services which Dr. Boyd
had throughout his life rendered to the insane poor and to psychological
medicine—more particularly the pathology of insanity. This Meeting desires
at the same time to convey to the sorrowing members of Dr. Boyd’s family its
deep sympathy in their bereavement, rendered still more distressing by the
circumstances under which it occurred.”

Dr. Boyd had been his (Dr. Manley’s) oldest friend, and it was under Dr.
Boyd that he had begun his work. He had seen Dr. Boyd a very short time
before his death, and had seen a letter which had been sent to Dr. Boyd by
Lord Carlingford, thanking him for suggestions he had made in regard to the
insane poor, and promising attention to them. One of Dr. Boyd’s suggestions
was as to sending patients to asylums without waiting for an order from the
Justice; probably the same clause as that in the Scotch Bill.

Dr. Hack Tuke said that he had much pleasure in seconding this resolution.
He had known Dr. Boyd for many years, more or less intimately, and had
learnt to appreciate his sterling character, his worth, his sincerity, and his
kindliness of heart. In their own department Dr. Boyd had, during a long
period, done very good work. Those who referred to the earlier numbers of the
Journal would find papers of Dr. Boyd’s on subjects of great importance to
their own department of medicine, especially in regard to what the resolution
mentioned—cerebral pathology. Dr. Boyd was one of the earliest in the field,
pursuing his researches in the post-mortem room with unwearied energy, and
in recent times also he always expressed the greatest interest in the subject.
His papers on General Paralysis were marked by original observation and
retain their value. Within the last two or three years, Dr. Boyd had con¬
tributed a useful practical paper in regard to the proper provision for the
insane poor, and in one of the weekly journals —the “Medical Times and
Gazette,” he had recently written a paper on the “ Relative Weight of the
Heart in Sane and Insane Persons,” showing how much he had retained his
interest in subjects which had engaged his attention in his younger years. In
an evening which he (Dr. Tuke) had pleasantly spent with him not long before
the lamentable fire at Southall Park, Dr. Boyd had referred with great interest
and zeal to several subjects connected with medico-psychology, and altogether
Dr. Boyd’s career had been an example for them all in regard to retaining in
advanced life a warm interest in the subjects which ought to occupy their
attention. A tribute had already been paid to Dr. Boyd’s memory in the
Journal, and he should be repeating what appeared there if he said more. He
cordially seconded the resolution.

The resolution was then carried unanimously.

The following gentlemen were elected members of the Association, viz : —

P. W. Macdonald, M.B., C.M. Abd., Asst. Medl. Officer, Dorset County
Asylum, near Dorchester; R. Brayn, L.R.C.P. Lond., Med. Off. H.M. Invalid
Convict Prison, Woking, Surrey ; E. L. Rowe, L.R.C.P. Edin., Asst. Med. Off.,

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Gloucester County Asylum; C. E. Bran ton, B.A., M.B., Asst. Med. Off., Colney
Hatch Asylum.

Dr. Bayner brought under the notice of the Association two cases whioh
were of interest from a therapeutical point of view, in whioh patients had
attempted to swallow large foreign substances, these lodging in the oesophagus
just below the larynx. One case was that of a stone; the other a potato. In
the first case Dr. Bayner was afraid to use any force, as he did not know
whether the stone might have angles, and there was so much retching going
on that extraction by the forceps would have been difficult. He injected
into the rectum half an ounce of bromide of potassium with a few drops of
opium. Very soon after the injection the throat became completely
anaesthesia, retching oeased, and the stone passed away into the stomach.
In the potato case, using the same treatment, the retohing did not cease
altogether, but the potato was expelled. Probably in both cases the removal
of the foreign body was due to the anaesthesia produced in the oesophagus.
The reflex irritation of the foreign body in the ©sophagus would set up
such an amount of irregular contraction that the expulsion of the substance
would be impossible. These two cases were interesting as showing that by
the treatment adopted, a great deal of trouble was saved by not having to
force these foreign bodies down or get them up.

Dr. Savage said he should like to know whether chloroform had been tried
in cases of this sort. Of course that would be much more rapid, but whether
one dared to administer it to a man appearing to be struggling for his breath
was questionable. Then, too, were Dr. Bayner’s cases both general paralytics ?

Dr. Bayner —No.

Dr. Savage —Because his experience was that where patients had tried to
destroy themselves, or, like the ostrich, had eaten all kinds of rubbish they had
frequently, from the time of subsequent illness due to the swallowing, again to
recover. He had published a case of a woman who swallowed a lot of screws,
bottle corks, &c. She was seized^with a most terrible pain across the abdomen. In
this case he profited by the advice of Dr. Murchison, who had said—“ give ten
grains of calomel—if that does not do give more.’* This woman only required 10
grains of calomel. She passed a huge stool. Sometime afterwards she came
to him and said she had seen the report of her case, and she was pleased to find
that he had given a good prognosis. But the whole thing was whether such
cases were benefited by the severe shock—and that led up to this, viz :—whether
other members of the specialty were reverting to the old lines, as he felt
most distinctly that he was doing. He would like to shave many more heads
and apply many more counter-irritants than he did. There was a general
feeling against it, and it did not look ornamental, but there were a few cases
of intractable mania which he thought would be improved greatly by counter^
irritation. Cases had been most markedly palliated by it.

Dr. Bayner said that he might mention one point in regard to the stone case,
which was, that the stone which was swallowed was passed very'rapidly. Although
it was a large stone, it was passed by the bowel within twenty-four hours, and
it had occurred to him whether the rapid passing through the pylorus might
not have been produced by the anmsthesic effect of the bromide on the mucous
membrane of the stomach. If so, in cases of patients who had swallowed large
substances it might be worth while to try the effect of a large dose of bromide,
with the view of enabling them to pass the pylorus rapidly. He had been
using blistering very extensively for the last year or two, with very satisfactory
results, particularly in cases of stupor.

Dr. Hack Tuke thought it would be a great pity if Dr. Savage, from the
idea of there being a general feeling against shaving patients 7 heads, should
be deterred from applying so excellent a remedy as a blister or some form of
counter irritation. The cases which improved after a long period of insanity,
often owed their recovery to counter irritation induced either by man or
nature.

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Notes and News.

601

Dr. Manley said that with regard to foreign bodies he might refer to a paper
in which an emetic was recommended. He remembered seeing a patient who
had swallowed in the airing ground four ounces and a half of flint stones, and
they were all passed after a dose of castor oil, and without the least difficulty.
He had the stones in his possession at the present time. This statement, bear¬
ing upon fish-bones, would be a very useful thing if it were a fact that fish¬
bones were ejected after an emetic, because now that fish dinners were used it
was possible that patients might be choked. In regard to choking, he thought
that in the case of a simple idiot they would very often find recovery directly
after the body impacted had been removed, but it was very different with
general paralytics, because they suffered so from the shock that they often died
directly afterwards, although the body had been removed from the larynx.

Dr. Mickle read a paper “ On Rectal Feeding and Medication.*’ *

Dr. Fletcher Beach said that for three or four years past he had
been in the habit of using rectal feeding in the case of imbecile children.
Some years ago he was called to see a child in the status epilepticus, and injected
twenty grains of bromide of potassium, and in twenty minutes the retohing
ceased. Since then he had been in the habit of using it in all cases in which
it had been impossible to administer by the mouth, more especially in two
cases which he had reported. In some cases he had had to administer food by
the rectum even as long as a week. The only thing he had found it necessary to
observe was this, the less stimulant given the better. A child would retain milk or
beef tea, but, if brandy were given, it seemed to act as an irritant. He had not
yet used Carnrick’s Peptonoids, which were very extensively used in America.

Dr. Hy. Lewis mentioned a case in which peptonized food had been adminis¬
tered per anum for a whole month, at the end of which time the patient on being
weighed, was found to have gained one pound in weight. He also referred to
a case which had occurred in the Convalescent Home at Folkestone, in which
a patient with organic disease of the bowels was treated in the same way for
six weeks. During that time she gained strength and flesh, and the medical
officer found that when the peptonized food was only retained for mi hour it
was returned in the form of chyme, which would be found in the upper part
of the intestines.

Dr. Manley said that he hhd used rectal feeding a great deal, but not
peptonized food. He used a preparation of arrowroot made with the strongest
beef tea, and used two ounces. He had found it useful in cases of out-throat,
and during the coma of epilepsy.

The Secretary stated that the paper promised by Dr. Bonville Fox was not
forthcoming, Dr. Fox himself being ill and unable to attend.

Dr. Savage said that the members would perhaps like to hear that during
the last two or three days the electric light had been on trial at Bethlem
Hospital. It was only an experiment, and if those who could not then stop to
see the lighting-up, would care to see it another time, he should be very
pleased if they would look in any evening during the next five or six weeks to
see it and say what they thought of it. A certain company had undertaken for
a certain sum of money, to make use of the engines at Bethlem and illuminate
for a certain time. At present there was no accumulator, and the engines were
not suited to the work, so that the light was not absolutely steady. The com¬
pany said that the fitting-up of the whole apparatus, including the putting
down an engine, &c., for the whole place would be £900, and that then there
would be a saving of £300 a year in the gas bill. If that were true—if they
could thus recover themselves in three years and have a thoroughly good light
it would be a great success. But there were other points to be considered at
Bethlem. With the large number of gas jets in each gallery, they were
dependent to a very large extent on gas for heating. There was a great
amount of heat given by gas in comparison with electricity. He could not at
present speak definitely as to the amount of the difference. Up to the present

* This Paper will appear in the next Number of the Journal

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Notes cmd News .

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time the temperature in the wards had been about the same sinoe the electric
light was introduced as when gas was used, but that might be to a very great
extent owing to the recent warm weather.

METROPOLITAN COUNTIES BRANCH: SOUTH LONDON DISTRICT.

The first meeting of the session was held at St. Thomas’s Hospital, on Oct.
24th : Dr. C. J. Hare, President of the Metropolitan Counties Branch, in the
chair.

Dr. Bristowe read a paper on Masked Cerebral Tuberculosis.

Dr. G. H. Savage read a paper on the case of Gouldstone, and on the Evi¬
dence of Insanity in Criminal Cases.

In the debate to which it gave rise, Drs. R. Fowler, Hack Tuke, Nioolson,
and Bucknill, and Mr. S. Benton took part.

Dr. NlCOLSON described the present condition of Gouldstone, who is now
in Broadmoor, and confirmed the opinion formed by the writer of the paper. No
doubt he was insane.

Dr. Hack Tuke said that he hoped some practical good would result from the
paper, and the discussion, and to this end he should conclude with moving a
resolution. Nothing oould more clearly prove the necessity of some reform
in the mode of examining prisoners in regard to whom the question of insanity
arose. What could be more absurd and unsatisfactory than that the examina¬
tion of the murderer should have been made by the principal medical wit¬
ness at the eleventh hour, and for only twenty minutes. What had been done
after the trial should have been done before. He had brought this subject
under the notice of the Medico-Psychological Association several years ago,
and made a proposal in accordance with this view, which was warmly sup¬
ported, but nothing had yet been practically done to remedy the evil. At the
last annual meeting, however, in August, the President, Dr. Orange, had re¬
vived the question, and a resolution had been unanimously passed advocating
a change. He should now propose a resolution almost identical with it, and he
hoped to obtain the support of this branch of the British Medical Association.
It was as follows :—“ That persons charged with crime, respecting whom there
is any suspicion of insanity, shall be examined at the expense of the Treasury,
by three medical men—namely, the prison surgeon, the superintendent of the
asylum in the neighbourhood, and a medical man of repute practising in the
vicinity, and that their joint report shall be handed to the counsel for the pro-
secution. ,,

Mr. 8. BENTON seconded it, and it was supported by other speakers.

Dr. Bucknill was not able to support the resolution. He thought that the
course pursued in the United States was preferable. With regard to the case
of Gouldstone, he sympathized with Dr. Savage, in having to give an opinion
after such limited opportunities of observation. He demurred to making use
of the fact that he had insane ancestors or relatives, as an argument in favour
of his insanity. If that was a cause, all his brothers and sisters ought to have
been insane. The question is not, are a man’s parents insane, but is the man
himself insane ? He (Dr. Bucknill) had hoped to hear from Dr. Nicholson
more than a confirmation of Dr. Savage’s opinion, for he had not mentioned
any facts which proved him to be insane at the present time. He should very
much like to see Dr. Orange’s report. It was due to the public that these
reports should be published.

Dr. SAVAGE, in briefly replying, said he was quite satisfied with the discus¬
sion his remarks had elicited. He would support Dr. Tuke’s resolution. The
present state of things was most anomalous. With regard to what Dr. Buck¬
nill had said on insane inheritance, he would reply that if a man had webbed
fingers and had a family, although only one child had webbed fingers he should
consider the two facts stood in causal relation and not coincidentally. He

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603

1884.]

thanked the members for the attention with which they had listened to his
paper.

The Resolution was then put by the President, and was carried.

WILLIAM GOULDSTONE.

CENTRAL CRIMINAL COURT, SEPT. 14, 1883.

(Before Mr. Justice Day.)

[Times, Sept. 15, 1883.]

William Gouldstone, 26, blacksmith, was placed npon his trial upon an indict,
ment charging him with the wilful murder of his five children—Charles,
Herbert, and IVederick Gouldstone, and two male infants, on August 8.

The prisoner pleaded “ Not Guilty.*’

Mr. Poland and Mr. Montagu Williams conducted the prosecution for the
Crown; Mr. Grain and Mr. Elliot were counsel for the defence.

The prisoner was first tried upon the indictment charging him with the
wilful murder of his eldest child, Charles Gouldstone.

Mr. Poland, in opening the case, said the prisoner, William Gouldstone,
was charged in this indictment with the wilful murder of Charles Gouldstone,
his son. The prisoner had been for five years in the service of a firm in Lower
Thames street. He had been living for ten weeks at Walthamstow with his
wife and three children—the eldest, the subject of the indictment, Charles,
being three-and-a-half years, Herbert two-and-a-half years, and Frederick 16
months old. On the 1st August his wife, at the place where they were then
living, was confined of twins. The prisoner was by all accounts a sober,
hard-working man, and had been maintaining his wife and children by his daily
labour. There was no doubt, receiving as he did about 25s. per week, that he
regretted that his wife was confined of twins so as to add so seriously, as he
thought, to the number of his children. Up to that time, the learned counsel
repeated, the prisoner had been sober and industrious. On the day of the
confinement and on the following night the landlady, for the first time, saw
that he was somewhat the worse for drink. As he (Mr. Poland) gathered from
the evidence, the prisoner continued at his work until the Friday before Bank
Holiday, Monday, August 6th. On the Monday following—Bank Holiday—the
prisoner was, of course, not at work, neither did he go to his employment on
Tuesday, 7th, or Wednesday, 8th August, although he did not remain at home on
those days. On the 8th August he came home at half-past 5 in the evening, his
usual time for returning being half-past 7. When he came home, the two eldest
children were playing in the kitchen, and in the bedroom on the same floor
was his wife, the third child Frederick, and the two babies, which were being
suckled by the mother. Mrs. Hamilton, a lodger who had kindly attended
Mrs. Gouldstone during her confinement, was also in the room washing the
children. The jury would have evidence that the prisoner, who was then
apparently sober, took from the bedroom into the kitchen the child Frederick,
and they would find that after going backwards and forwards into the room,
he went into the kitchen, moved the perambulator, and placed a chair near the
cistern. It would be proved beyond all question that the prisoner drowned
the three eldest children in the cistern, and a piece of cord was subsequently
found tied round the neck of one. Having thus destroyed the lives of these
three children, the prisoner went into the bedroom where his wife was. Mrs.
Hamilton, thinking he wanted to speak privately to his wife, left the room,
leaving him alone with his wife and the two babies. The prisoner locked the
door, and Mrs. Hamilton then heard screams of “ murder ” coming from Mrs.
Gouldstone, who called out that the prisoner was murdering her children.
Mrs. Hamilton, in company with the landlady of the house, endeavoured to

xxix. 41

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Notes and News.

[Jan.,

force the room door open, bnt they were unable to do so. The prisoner soon
afterwards opened the door and said, “ I have killed the children, and I am
happy now,” and then he said to his wife 44 Your other three children are in the
cistern.” Mrs. Hamilton found that, although the two babies were not dead,
there had been inflicted upon them very serious injuries with a hammer which
was found lying in the room. The infants’ skulls had been fractured, and on
the following night they both died. Upon the prisoner making this statement
Mrs. Hamilton went into the kitchen, and there she found lying dead upon
the floor the three elder children, the bodies being saturated with water; and
evidently their death had been caused by drowning in the cistern. The act
must have been done with great deliberation, as only 14 inches of water was
in the cistern at the time. The prisoner said further to his wife, “ All the
children are dead now. I Bhall be hung, and you will be single. You wished
them dead, and now they are.” The police were sent for, and the wife, know¬
ing that he was to be taken away, kissed him, and asked him what money he
had about him. He gave her what he had, and he was then taken to the
police station. When the police came they found him with his coat off and
with his shirt sleeves tucked up. The prisoner said, 44 Good evening, policeman.
I have done it. Now I am happy, and ready for the rope.” He repeated the
statement to his wife that he had killed the children and that he should be
hanged. While on the way to the police station he said to the officer who had
him in charge, 44 When I took my money last week (referring to the previous
Friday when he was paid) I thought of buying a revolver to do it with, but I
altered my mind, as I thought it would make too much noise. I had a bard
job with the two biggest, but the other little - I soon settled him. I

thought it was getting too hot with five kidB within three-and-a-half years,
and I thought it was time to put a stop to it.” When charged, the prisoner
replied, “ That is right j I am happy now. I did it like a man.” After he had
been placed in the cell, the prisoner spoke to the constable who was placed in
charge of him, and said, 44 1 had an extra drop of drink to-day to accomplish
the job. Five of them have gone to glory, and a good job too.” He added
that he was sorry for his wife, but the children would be better off in heaven,
if there was such a place, than leaving them to the mercy of the world. The
prisoner further stated that he wished he had killed the little ones out of the
way; he did not know whether he hit them once or twice ; and he had had it
preying on his mind for some time previously. Up to the time of the occui>
rence the prisoner was pursuing his ordinary calling, and whether he had been
drinking at the time the prosecution were not able to prove, but there was his
own statement to that effect. The learned counsel pointed out that the prisoner,
according to his own statement, had considered the matter beforehand, and
whether he should buy a revolver to commit the act, and he seemed at length
to have come to the terrible determination to take the lives of his children,
thinking that, instead of having the burden of maintaining them and leaving
them to struggle in the world, he would take their lives. He preferred to take
that course, knowing thoroughly well what he was about, and that, by the law
of England, it was a crime to take human life, for he said, 44 I shall be
hung, and I am ready for the rope.” This expression indicated that he was
conscious at the time that he was committing a crime against the law of the
land. If he knew the nature and quality of the act he was committing, and
that it was a crime, he was responsible to the law for that act.

Mr. Grain, in opening the case for the defence, submitted that the prisoner,
according to the evidence of the prosecution alone, was not in a state of mind
to know the nature of the act he was committing, for it otherwise would have
been impossible that the kind and affectionate father, the good husband, the
well-conducted and meritorious man, in the short space of time alleged, should
have murdered in so barbarous a manner his five children, three of whom had
been playing at his knee, the two infants being suckled at their mother’s
breast. He (Mr. Grain) should call before them witness after witness, who
would prove that in both branches of the prisoner’s family there was un-

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doubtedly hereditary insanity. The accused’s mother at the present time was
a lunatic, and although she was not confined in an asylum, yet she was
undoubtedly insane, and at the time of his birth she was not in her right
mind. His aunt on his mother’s side was also not in a right state of mind.
The insanity was not confined to the maternal side alone. He should be able
to prove that on the paternal side there was also insanity in the family. His
second cousin on his father’s side died a lunatic, and other members of the
family on the same side had been of unsound mind. He should call Dr. Savage,
the principal physician at Bethlem Hospital, and he would say that having
examined the prisoner, and heard the evidence of insanity in both branches of
the family, he was of opinion that he had had a hereditary tendency to a weak
mind. He submitted that the prisoner's mind became unhinged before he
committed the act, and that unless it had become so it would have been impos¬
sible for him to have committed a deed of so awful a character.

A number of witnesses were then called in support of the defence.

Thomas Gouldstone, examined by Mr. Grain for the defence, said—I am
the father of the prisoner at the bar. His mother is alive, and is very bad in
her mind now, and has been for many years. A woman has to be employed to
look after her. Once she attempted to strangle herself, and once I took a knife
away from her. About eight weeks ago she threatened to take her life. When
the prisoner was born she was in a bad state of mind. My wife’s sister is also
not in her right mind. William Gouldstone, a second cousin of mine, died in a
madhouse, and my father’s sister wore a strait jacket for some years.

Cross-examined by Mr. Poland.—All my children have been quite right
except the prisoner. My wife has never been in an asylum. She is a sober
woman. When 1 saw my son about eight weeks ago he seemed queer.

Robert Gouldstone, the eldest son of the last witness, proved that his mother
had threatened to make an end of herself, and the family had had to look after
her and keep knives out of her way. The prisoner was ruptured some six or
seven years ago, and about this time frequently complained of pains in his
head.

Emily Gouldstone, sister of the prisoner, deposed that through troubles in
business her mother had several times attempted to commit suicide. She last
saw the prisoner about two months since at her sister’s house.

William Graves, foreman at the Falkirk Ironworks, Thames street, where
the prisoner was employed, deposed that he had known him since childhood.
He had always known him to live happily with his wife and family. On the
2nd of August, after his wife’s confinement, witness noticed a change in his
manner, and spoke to him about it. The accused complained of pains in the
head. Witness paid him his wages the next day, and gave him a customary
present of 10s.

A number of fellow workmen also gave evidence on the prisoner’s behalf.
On several occasions the prisoner told a man named Cakebread that he would
throw himself under a train if he thought he would be killed instantaneously
and without pain, and at another time he said that he would throw himself
down the lift if he could do so without torture. He also stated to other men
that he wished he was dead, and he complained of pains in his head arising
from the rupture. He also expressed a wish that someone would knock him
on the head. He bore the character of a quiet and steady man, and if any¬
thing was rather morose.

Mr. Kennard, one of the prisoner’s employers, stated that he knew nothing
of him personally, but the general feeling among his fellow workmen was that
he was insane.

Charles Gouldstone, a cousin of the prisoner’s father, deposed that his son
(the prisoner’s second cousin) had been confined in a lunatic asylum for ltf
months from 1880.

Dr. Sunderland, a medical man practising at Thaxted, in Essex, spoke to
having attended the prisoner’s mother, who was of unsound mind, for eight
years. The form of insanity she was suffering from was despondency. He

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[Jan.,

also attended Mrs. Andrews, her sister, who suffered from the same malady.
Replying to Mr. Poland, witness said that neither the mother nor her sister
had been certified as insane.

Dr. Savage, the principal physician of the Bethlem Hospital, deposed that
he had examined the prisoner, and from the examination alone he considered
him rather weak in his mind, as was evidenced by slowness of appreciation of
questions concerning the crime of which he was accused. When speaking
about it he seemed not to appreciate in any way the gravity of the charge.
Beyond that, from his personal examination, witness could say nothing. He
Vinrl heard the evidence of the prisoner being a fond husband and father and a
quiet steady workman, and details of the case, and he should think that his
mind was unsound at the time the act was committed. He had heard his
fellow workmen describe his wishing to be dead, and of his wanting to fall
down the lift, and witness was of opinion that such symptoms were frequently
present with persons of unsound mind.

The witness was about to be asked what conclusion he arrived at after
hearing the evidence of insanity on both the paternal and maternal side of the
family, when

Mr. Justice Day said it seemed to him that that was the question the jury
had to decide. A doctor was entitled to give his medical evidence, but not
to draw a conclusion which the jury had to draw.

Dr. Savage, in answer to further questions, said the insanity on the mother’s
side being proved, he thought there would be a great tendency for the prisoner
to become insane, and that if insanity, even in a remote degree, was proved on
the male side the liability to insanity in the offspring would be increased to a
considerable extent. At Bethlem the last patient who died without being
removed to Broadmoor, was a woman who had killed her whole family.

Replying to Mr. Poland, witness said he examined the prisoner on Thursday
for between a quarter and half an hour. He was then called by the prisoner’s
solicitor, and he knew he had to examine him as to the state of his mind.
From his conversation alone there was nothing to show that he was otherwise
than a sane man. From what witness saw of him yesterday he would not
certify the prisoner to be a lunatic, and he would say that he was not
actively suffering from any form of mental disease that he knew of. He could
not, therefore, certify that he was a lunatic. His conversation with witness
was that of a rational man, and he should say the prisoner knew that the
penalty awarded by law for the crime of murder was death. When he said
he thought the prisoner was of unsound mind at the time of the commission
of the act he formed the opinion from what he heard in court and from his
examination of him. He thought he knew the penalty of what he was doing
at the time, and that he had killed the children knowing that the penalty was
death.

This concluded the evidence for the defence.

Mr. Justice Day then proceeded to sum up on the whole case. The prisoner,
he said, was indicted for the wilful murder of his five children, and that he
killed them was beyond all question. The question for the jury to determine
was whether he killed them in such circumstances as would amount to the
crime of wilful murder. The killing of a human being was presumptive
murder; but the circumstances in which it took place might show that it did
not amount to that crime, but that it amounted merely to manslaughter,
justifiable homicide, or homicide by misadventure, or the act of a not reason¬
able being. The only question for the jury was whether this was the act of
a reasonable being in the sense he would explain to them. The matter of law
was one unquestionably for him, and the jury were bound to take his instruc¬
tions with regard to the law, in doing which they would be incurring no
responsibility upon themselves. He told them, as a matter of law, that if the
prisoner at the time he killed the children knew the nature and quality of
the act he was committing and knew that he was doing wrong, then he was
guilty of wilful murder. The nature and quality of the act meant that the

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607

man knew what it was that he was doing—that was to say, that he knew he
was killing a fellow creature. He repeated that if a man killed a fellow
creature knowing at the time that he was doing wrong then he was guilty
of wilful murder. The only question, therefore, for them to determine was
whether the prisoner knew the nature and quality of the act he was com¬
mitting, and whether he knew it was wrong. The jury were bound to give
their verdict according to the evidence, and to administer justice according
to law. The circumstances were very sad, and a painful duty rested on the
jury and all concerned in the trial. However painful that duty was they
must not shrink from the performance of their duties. The only defence, and
the one which had been set up on behalf of the prisoner with the utmost skill,
discreetness, and ability by his learned counsel, Mr. Grain, was that the
accused at the time he committed the act was of unsound mind, and therefore
not responsible for his actions. His Lordship then carefully reviewed the
evidence which had been given on the part of the defence in order to prove
insanity, and remarked that previous to the 8th of August no one would have
said the prisoner was of unsound mind, and referring to the statement made
by the accused, he observed that it was difficult to say that at the time he did
the deed he did not know what he was doing. He had had handed to him by
the learned counsel for the prosecution, an Act of Parliament passed towards
the end of last month—of the existence of which he was not previously aware,
as no notice had been given to him—which might affect the form of their
verdict. The former and logical law was Bimply this:—Wilful murder involved
malice aforethought, and a person of unsound mind was incapable of forming
an intention or malice aforethought, and therefore incapable of murder. In
such circumstances a jury found a person “ Not Guilty on the ground of
insanity.” The law, however, had been altered, and if the jury found that
the prisoner was insane at the time he committed the act they would have
to return a special verdict that he committed the act, but was insane at the
time. If, on the other hand, they found that he knew the nature and quality
of the act when he killed his children, and that he was not of unsound mind,
they must find him guilty, and the new Act would not affect that verdict.

The jury retired to consider their verdict, and, after an absence of about a
quarter of an hour, returned into Court, finding the prisoner Quilty.

Being asked in the usual course whether he had anything to say why sentence
of death should not be passed upon him, the prisoner replied in the negative.

Silence was then formally proclaimed, and

Mr. Justice Day, having assumed the black cap, proceeded to pass sentence
of death.

The prisoner, who had preserved a calm and undisturbed demeanour
throughout the trial, was then removed.

to the editor op The Times .

Sir, —I feel it my duty to write shortly about the case of William Gould-
Btone, the murderer of his five children. Justice demands further investiga¬
tion of the case. The facts are plain. A young man of 26, who had been a
well-behaved and industrious man, odd in some of his ways, is seized with
fear of impending ruin to himself and family, and kills them to send them
to heaven. The act is an insane one, and I think little more should have been
needed to prove it to be such, but it was proved that his mother and aunt
both suffered from precisely similar fears of ruin, and though the Judge
ridiculed the importance of a second cousin on his father’s side being insane,
I would repeat emphatically that there being an insane taint which could have
been shown to exist in several second cousins and others on the father’s side,
was of great importance. A great deal was made of my statement that I
could not certify to his insanity from my personal interview of 16 to 30
minutes. It does not follow that the man may not have been insane at the
time the act was committed.

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ftotes and Ifews.

[Jan.,

There is the feeling abroad that a man if insane and irresponsible is always
so, whereas the most insane people often are collected enough during the
greater part of their lives. The poor man Gouldstone is, to my mind, a typical
case of insanity associated with insane parentage. He had done his work,
which was purely mechanical, well, but he had no power to resist, and the act
he perpetrated depended on an insane feeling of misery. I have no doubt ho
would have sooner or later developed delusions.

The medical officer to the House of Detention told me he considered him
to be suffering from melancholia.

I trust this prisoner will not be allowed to be hanged. I may say that I
am not one who is in the habit of defending criminals on the plea of insanity.

I am, yours truly,

Geo. H. Savage, M.D.,

Physician Bethlem Hospital.

September 15, 1883.

to the editor of The Daily Telegraph.

Sept. 18,1883.

Sir, — I feel bound to take notice of the letters written to you by “ One
of the Jury ” in this case, as there seems to be great danger that the prisoner
will suffer through misunderstanding of my opinion. The skilful cross-
examination of Mr. Poland gave me no opportunity of representing my own
opinion on the man’s sanity. I was forced to own that in a short interview,
from the facts seen by myself, I could not have signed a certificate of insanity.
I doubt not but that if I had expressed a willingness to sign one that the
haste of the proceeding would have been used as an argument against its
value.

I did say, however, that, taking my examination with the history of the
man and the crime, I had no doubt that he was of unsound mind. The Judge
opposed strongly attempts to get my opinion, believing the common sense of
a jury to be the best judge of sanity. This is all very well if the facts are
explained by one understanding their value, and not otherwise. That the
patient knew he had killed his children, and that he knew he might be
hanged, I could not deny, but knowledge of this kind does not exclude
insanity.

I have patients of the most insanely dangerous class here who have said
the same things which Gouldstone said, and who know as much as he does.
Yet they are mad. William Gouldstone ought not to suffer without a careful
independent investigation of his history and the history of his crime, one not
confined to an examination of twenty minutes or half an hour.

I am, yours truly,

Geo. H. Savage.

Bethlem Hospital, Sept. 17.

LETTER FROM GOULDSTONE’S WIFE.

(; Standard , Sept. 20.)

“ During our five years’ married life I frequently noticed that my husband
was absent-minded and given to brooding. If he were asked a question he
Would not, no matter how simple it was, or however easy to answer, reply at
once. He would think over it, and sometimes say something not concerning
the question. We commenced housekeeping on 21s. a-week, and latterly he
had 25s. It was sometimes difficult to make ends meet when the children came
bo rapidly, and this weighed on his mind, I fear, although he never spoke of it
to me—except in the way of saying how sorry he was that my hands were so
full, and that we could not go out together as we used to do. That was the
only way in which he ever spoke of the burden of the family. Before we had

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Notes and Nens.

609

the first child, and right on till the birth of the second, we regularly went to
church. The second child was weakly, and the first was still only a baby, so
that we could not leave the house together. For all his occasional absent ways
he was very lively, and as I had all to do with the spending of the money, and
did not let him know if there was any trouble about payments when there was
a confinement or sickness in the house, I always found it very easy to turn his
attention to something brighter. He was very kindly with me and the
children, handy and willing if they were ailing, and he constantly helped me
in household duties. He was a man who had few acquaintances except his
own relatives and his fellow-workmen, and he was nearly always at home
when not at work, except on the Sunday morning, when he occasionally took a
walk alone. But for hours together he would keep the children going with his
concertina, which he was very fond of playing, while I was engaged in house¬
hold duties. The children were very fond of him, and were never tired of listen¬
ing to the concertina. If he seemed worried, amusing the children—at which
he was very good—or a remark from me would at once change his mood. He
was painfully aware of how easy it was for him to get worried, and he has
often said to me that it was a good job he had not much to think of, as if he
had he believed it would turn his brain. Nothing that ever he said or did
before the loss of the little ones gave me the least fear that he would take his
own life or that of anyone else. But shortly before my last babies were born
he Baid to me that he believed he had not many weeks to live, which was a
strange remark that I have often thought of since. He never complained,
except that he did not know how I should manage with my hands already so
full, an$ soon to be even fuller. But then lots of people manage on less, and
we did very well, and when I put this before him he ceased to be moody and
absent. I never knew till very lately that there was any insanity in the
family. Knowing that now, and looking back on all that has happened, I am
certain he was insane, and that the times when I found him sitting thinking
lately- he was distressing himself about our growing family. You see the
eldest was 3J, bright and healthy, but the next, 2£, was sickly and could not
walk, and the third being only 16 months, I had practically two babies to mind
when the twins were born. But for all this there was no change in his kindly
ways to me and the children. He got up early in the morning of the day when
the twins were born, and got me a cup of tea, as he often did before, and did
every morning from their birth till their death. The thing that struck me most
was that during all this time he never took any notice of the babies. They
were born about half-past ten, and he immediately went out of the house, and
did not return till after twelve. He then came into the room to me, but did
not speak. His appearance seemed changed, and his eyes were strange and
wandering. He came home early on the day he attacked the poor things, and
I asked him if he had told his foreman about the twins, as he had lived with
him once, and we looked upon him as one of our own family, but he said he
had not. Since the occurrence I have seen my husband three times at the
House of Detention, once at the Old Bailey, and yesterday (Tuesday) in the
prison at Chelmsford. On each occasion he has been as happy as a child at
play. At Chelmsford he said he had seen several relatives whom he had not
met for a long time, but neither he nor I made any reference to the fate of the
children. His sister and aunt accompanied me yesterday. He asked me to
take care of myself, and, turning to his relatives, said, ‘ You will take care of
her, won’t you ? * Then he said, ‘ I have broken God’s commandment, and I
must expect to suffer, but He will forgive me for what I have done.* He
realises his position in so far as he believes he will die, but he seems to have
no notion of the enormity of killing the children. In a letter I had from him
he spoke of them as being in heaven, where he hopes soon to join them. Hero
is a letter I have had from him, dated the 15th, in the same strain :—

“ ‘ My Dear Wife,—I feel it is a Pleasure to Write a few lines to you and
trusting to God that it will find you as well as Can Be Expected after the

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[Jan.,

Dreadfull news but I am thankfull to God that I feel Happey as I may Expect
and I Hope yon will Look to God to Help you and He Will Comfort you as
Well as myselfe Dearest Wife I Hope yon will Receive this Letter this Even¬
ing and then I Hope yon wont fret mnch about me as what God Doest is for
the Best and I Hope yon will Be able to Come and See Me Over a Short Time
and I Hope Aunt and all at Home are quite Well and all Cousins and Rember
me to all that know me, and Let Cousin Gouldstone in Mash-street know How
I am and I am going to Send a few Lines to Mr. G. Sampford and I Hope all
Will forgive me for I am thinking about you all. But I Hope you all Will Pray
to God to Comfort One and all of you and Bear that in mind that God Will
forgive all Dear Wife do not fret about what I Have to Live Upon Because I
Can Have What I wish for in my Liveing from the Prison and you may Belive
that the Chappelling will Give me all I Require and I thank God that I Have
Been Preparing for the Other World and which I shell do more so now and Live
in Hopes to meet you all in Heaven. So Good By God Bless you

“‘William Gouldstonb,

“ * Her Majesty’s Prison, Chelmsford, Essex,

“Sept. 15, 1883.’”

to the editor of The Daily Telegraph.

Sib,— 1 am very happy to see that the true issue of this case is slowly but surely
being placed before the public. As the employer of William Gouldstone, I am
as sure as are his foreman and shopmates that he was insane when he com¬
mitted the act. The ruling of the Judge, although, doubtless, a proper exposi¬
tion of the law, precluded the jury from bringing in any other verdict than
that of wilful murder. Had I myself been on the jury I should have felt com¬
pelled to return that verdict. That the man knew what would be the
consequences of his act there can be no possible doubt.

Sir William Harcourt will have the whole matter carefully and fully laid be¬
fore him, and it is satisfactory to know that his decision will not be based
upon the dry letter of the law alone. This appears, indeed, to be a case in
which law and common-sense are at variance.

Yours truly,

H. J. Kennard.

67, Upper Thames street, Sept. 18.

TO the editor of The Daily Telegraph.

SIR,—The Judge presiding at the Gouldstone trial told us (the jury) that the
law regarding insanity was this, “ That if a person was proved to be of sound
mind up to the time of committing a certain deed ; if he knew the nature of
that deed and the penalty it involved , and if after this he still appeared of
sound mind, we were bound according to this law to say such a person was not
insane.” What was the evidence ? For five years he had worked at the Fal¬
kirk Iron Works, and had always done bis work satisfactorily like a sane man.
The seven witnesses who were called from these works admitted this, and they
also stated that at intervals he had said he wished he was dead, that he would
like to throw himself in front of a train or down the lift hole if he were sure of
killing himself without any pain. He suffered from a rupture, and these re¬
marks were often made when it pained him. When the great addition to his
family came, he appeared somewhat upset, but did not mention the fact to any
of his fellow-workmen. He then resolved to rid himself of his children, and
intended at first to do it with a revolver, but thought that would make too
much noise, so he planned it the other way, going out first, as he said, to have
an extra drop of drink to nerve him to the job. When it was over he said,
“ Now I shall have the rope.” The constable who took him, and the officer to
whom he was handed in prison, stated that he seemed perfectly aware of what

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Notes and News.

611

he had done, and quite sane. We did not misunderstand Dr. Savage, who said
he would not certify him as insane, though he had examined him, but he “ con¬
sidered he Was of weak mind, owing to his slowness of appreciation of
questions concerning the crime of which he was accused.” The father and a
sister stated that his mother and an aunt were at times of unsound mind and
required looking after, but neither of them had ever been confined as lunatics.
There was, however, a cousin of his father’s on the male side who had been a
soldier, and died in a lunatic asylum. These were the salient points of the
evidence, and upon this the jury were quite agreed that the case of insanity
was not made out, and therefore were compelled to return a verdict of guilty.

Yours obediently,

The Foreman or the Jury.

to the editor of The Times .

* « * * * *

Sir,— -Yhere is one department of the law, that affecting homicidal crime,
where a peculiar obscurity, or rather conflict, exists, at least in many instances;
where the letter of the law, though plain, is in clear collision with the con¬
sensus of the best scientific medical observation also, and therefore, with
equity and justice. The case of the Walthamstow murderer, now under
sentence of death, affords an illustration. It was unmistakable, from the
evidence at the trial, and, indeed, from the prisoner’s own admission, that he
well knew the nature of the act he was committing. Hence, too, that act is,
plainly and legally, “ wilful murder.” But, from the testimony of the physician
of Bethlem Hospital and others, it is similarly obvious that, notwithstanding
this, the condition of the man’s mind was, to say the least of it, very ab¬
normal and doubtful.

And in so far as this may be the case, it is appropriate to bear in mind the
very important resolution unanimously adopted at the annual meeting of
the Association of Medical Officers of Asylums and Hospitals for the Insane,
held at the Royal College of Physicians, London, on July 14, 1864, as
follows :—

“That so much of the legal test of the mental condition of an alleged
criminal lunatic as renders him a responsible agent, because he knows the
difference between right and wrong, is inconsistent with the fact, well-known
to every member of this meeting, that the power of distinguishing between
right and wrong exists very frequently among those who are undoubtedly in¬
sane and is often associated with dangerous and uncontrollable delusions.”

Such a resolution as the above by such a body is a virtual condemnation of
the law by the responsible official exponents of modern medical science. And
this, taken in connection with a series of Home Office precedents for interposition,
constitutes a valid reason for expecting the Home Secretary, in such a case as
the present one, to seriously reconsider the sentence.

* * * 4c * *

Yours truly,

William Tallack.

Howard Association, London, Sept. 17.

to the editor or The Times,

Sir, —It is a difficult thing to bring the public mind to think that a man who
deliberately kills his five children ought not to be hanged as an example to deter
others from doing the same thing. In the case of the convict Gouldstone
there is reason to believe that what he wanted was to compass his own death,
and he adopted an irrational method to accomplish what he desired. In any
other case than murder an irrational act is accepted as ground at least for
suspicion that the mind of the perpetrator is disordered; but in cases of
murder no account is taken of the unreason of the act. The fact that a man

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of good character, under the influence of a cause, or causes, held to be utterly
inadequate by persons of sound mind, suddenly commits an act inconsistent
with all his previous history, is in any other event than the perpetration of
murder regarded as a very serious symptom arousing the most anxious fears
on the part of his friends, especially if he has insane relations ; but the law
ignores all this, and asserts that a man is responsible for his actions if he
knows the nature and quality of the act he commits, and that it is forbidden
by law. This standard of responsibility is directly opposed to the established
judgment of every person who has had any experience of the disordered mind.
I sympathize with Dr. Savage as to his sense of duty as a recognized
authority in such a matter, impelling him to make a public appeal for some
further investigation of the circumstances. I agree with him that the act of
William Gouldstone, taking into account the whole history, was an insane act,
and none the less so because on every other subject his conduct and con versa*
tion was rational.

I am, Sir, your obedient servant,

W. Wood, M.D.,

Physician to St. Luke’s Hospital.

No. 99, Harley street, Sept. 17.

JAMES COLE.

CENTRAL CRIMINAL COURT, OCT. 18.

(.Before Mr. Justice Denman.)

James Cole, 37, labourer, was indicted for the wilful murder of Thomas Cole.

In August he was living with his wife at Croydon. Their two children,
Richard, aged 14, and Thomas, three years eight months, also lived with them.
Prisoner had been out of work for some time. On the evening of the 18th he
took the child Thomas by the legs and knocked its head against the floor and
walls. As the prisoner ran away he said to a man he met—“ I have murdered
my child.”

It was elicited from the boy Richard that upon the night in question, the
prisoner complained that his wife had hidden people under the floor and in the
cupboard to try to poison him. He was jealous of his wife, but no ground for
this suspicion appeared.

The plea of insanity was set up.

The surgeon and chief warder of Clerkenwell House of Detention gave evi¬
dence that the prisoner had displayed no symptoms of insanity, but had con¬
ducted himself in accordance with the prison regulations. On one occasion he
became violent, but it was stated that it did not arise from unsoundness of
mind.

For the defence, a brother of the prisoner was examined, and stated that
some members of the family had been subject to fits.

Dr. Jackson, an alderman of Croydon, said he was quite certain that he was
a typical lunatic, with dangerous delusions. In cross-examination, witness
said the prisoner seemed to understand the questions put to him, and gave per¬
fectly rational answers. He told him that he thought he was being poisoned,
that his wife had set men on to him, that he used to shriek out and wake up at
night thinking that people were murdering him. The prisoner acknowledged
that he drank occasionally, and that he had been many times in prison for violence.
The prisoner said he found a little drink made him lose his senses. The prisoner
knew perfectly well that he was on his trial for murder. When asked how he
could have treated his child so cruelly, he made no answer. In re-examination,
Dr. Jackson said he believed the prisoner was in such a state of mind that no
parish doctor ought to allow him to be at large, as he was dangerous.

Mr. Geoghegan, in defence, argued that there had been no motive for the
commission of the crime, but that there were strong antecedent probabilities

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Notes and News.

613

1884.]

that the prisoner was so unsound in his mind at the time that he did not know
the nature and quality of the act he was committing.

Mr. Poland said that the prisoner’s belief that attempts had been made to
poison him would not be sufficient for any medical man to certify that he was
insane, and thus necessitate his confinement in an asylum. It was for the jury
to say whether the prisoner was a violent drunken man or an insane person fit
for Broadmoor.

Mr. Justice Denman said it was an appalling case. As to the plea of insanity,
the law as laid down by the House of Lords was, that every man was supposed
to be responsible for his acts until the contrary was proved, and it must be
shown that he was suffering from such a state of mental disease as not to know
the nature and quality of the act he was committing, or that it was wrong. The
Judge referred to the new Act regarding the treatment of persons alleged to be
insane, and said that he observed that last session a learned colleague expressed
dissatisfaction with the new enactment, in which, however, he was not inclined
to disagree, the new Act not altering the law as to insanity as it previously
stood, but only making a difference as to the formal verdict.

The jury found the prisoner Guilty.

The Judge, in sentencing the prisoner to death, said the learned counsel had
attempted to make out that he was not responsible. The attempt had failed,
and he must express his opinion that, according to the law of England, it had
rightly failed. “Although it was, I think, established in evidence that you had
been suffering from delusions, I cannot entertain a doubt that on the occasion
on which you violently caused the death of your child, you know you were doing
wrong, and knew that you acted contrary to the law of this country, and that
you did it under the influence of passion, which had got possession of your
mind from want of sufficient control, the result being that the poor child came
by a sudden and savage death.”

Fortunately, Sir William Harcourt ordered a medical examination of Cole to
be made by Dr. Orange and Dr. Glover, with the result that he was found to be
unquestionably insane, and he was reprieved. (See Occasional Notes of the
Quarter.)

Side by side with the foregoing practical opinion, it may be well to place on
permanent record the theoretical rhapsodies of lay writers of leading articles
in leading newspapers. The day after the trial of Cole the following dis¬
creditable article appeared in the Times :—

. . . There was the usual defence of insanity. It was urged that the prisoner had been so
violent when in prison that he had to be put in a padded cell; that he had used, as was very
probable, threats to his wife, and that he had frequently been in prison for crimes of violence.
These not uncommon symptoms of lawlessness and ruffianism satisfied one doctor that Cole
was “ a typical lunatic with dangerous delusions.” But the jury were not convinced by the
familiar argument that a man who does anything particularly wicked must be insane, and
they found the prisoner guilty of murder. For years the plain men who sit in jury boxes
have been assailed by medical theorists who seek to discredit all the homespun ideas as to
responsibility. A <?ua.n-scientific terminology or jargon, very advantageous for everyone
who happens to be self-indulgent and passionate has been invented. Theories destructive
of society’s right to punish some of its most dangerous foes—which would save from the
gallows all but those who showed in their evil deeds some scruple and compunction—have
been promulgated in books and in the witness-box. The legal doctrine as to insanity has
been cried down as unscientific. Juries have often been frankly invited to find a person of
unsound mind just because he had committed a particularly monstrous crime. But with
rare exceptions they decline to be convinced by this sophistry, and have clung to the legal,
which in this matter is the common-sense view, and have held answerable for their actions
men whom so-called experts would consign to Broadmoor Lunatic Asylum. It seems to
have been proved that Cole entertained some delusions. But it was not shown that they
at all affected his conduct towards his child; and there cannot be a doubt as to the righte¬
ousness of the verdict. This, however, may not conclude the matter. A case, the circum¬
stances of which are not yet forgotten, has shown that a jury may come to the opinion
that the evidence offered to substantiate a defence of insanity is quite insufficient, and act
upon their view ; and that the Home Office may nevertheless put their verdict aside. At
the last sitting of the Central Criminal Court, G-ouldstone, a blacksmith at Walthamstow,
who had deliberately killed his five children, was convicted of murder; the jury, declining
to be guided by the vague evidence as to his mental weakness. But for reasons satisfactory
to the Home Secretary and his advisers, the jury were overruled, and Gouldstone was sent
to Broadmoor. Who are to be punished if the hideousness of a crime is taken to be indi*

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614

Notes and News.

[Jan.,

cative of Insanity? Who are to be responsible if a jury must not convict unless they see
that the prisoner had some really adequate motive for what he did ? .... It is need*

less to say that it would be incumbent upon “ mad doctors ” to expound in the witness-box
their views with great caution, even if they were all at one with regard to essentials. It is
no light matter to shock the conscience of a community and to perplex people’s sense of
justice, as must be the case when the very magnitude of a criminal’s wickedness seems to
be a claim to immunity. Society has good reason to dread the effects of the spectacle of
moral monsters being treated as irresponsible. But no such agreement exists. The books
written by experts show that they are at variance as to the terminology of their so-called
science; that scarcely two accept the same classifications of mental diseases; and that the
tests of their existence are altogether uncertain and debatable. It is well from time to time
to remind those who dogmatize from the witness-box about insanity of the provisional
character of their conclusions. In the last resort, the Home Secretary is the final Court of
Appeal as to these questions ; and no doubt he takes pains to obtain the best medical advice
before making up his mind. But this tribunal is far from being so satisfactory as could be
wished. Its decisions are in the main determined by the reports of experts who are some¬
times tempted to apply much too refined tests, leading to parodoxical results. For the
present, and .’until the mystery of mental diseases—for example, the effect on conduct of
collateral delusions and the extent to which certain dangerous tendencies are hereditary—
are cleared up, much more than is now the case, it will be well at the Home Office and else¬
where to rate cheaply theorists who gauge the extent of a criminal’s insanity by the magni¬
tude of his crime, who would spare a Troppman and hang a half-hearted imitator.

CONTEMPLATED LUNACY LEGISLATION IN FRANCE.

In a former number of the Journal we stated that the propriety of revising
the French Lunacy Laws was under consideration, and we referred to several
of the more important proposals contained in the Projet de Lot portant revision
de la loi du 30 Juin, 1838, sur les Alienas, presented to the Senate by the
Minister of the Interior, M. A. Failli&res.

The Commission appointed by the Senate to prepare this Bill decided before
separating to investigate the laws affecting the insane in other countries—
Belgium, Holland, England, and Scotland. For this purpose they delegated
the following: Dr. Dupre, Professor of the Faculty of Medicine, Montpellier,
President, Dr. Th6ophile Roussel, M. Delsol, formerly Professor of Law, M.
Tenaille-Saligny, Dr. Frezoul, Dr. Brugerolle, Secretary. Dr. Achille Foville,
Inspector General of the Administrative Service, was appointed by the
Minister of the Interior to accompany the Commission and aid them, as he was
so peculiarly well qualified to do, in their difficult task.

This Senatorial Commission visited England and Scotland last October, and
it afforded their English confreres much pleasure to afford them every facility
within their power to pursue their enquiry. Among the institutions they
visited were Bethlem Hospital, Broadmoor, Brookwood, the Woking Prison,
Caterham, and the York Retreat. They attended by appointment at the offices
of the Lunacy Commissioners and the Lord Chancellor’s Visitors, and obtained
much valuable information bearing on the object in view. In Edinburgh the
Commissioners in Lunacy assisted the delegates in every way likely to further
the investigation, and the latter visited the Royal Edinburgh Asylum, the
Lenzie and Gartnavel Asylums at Glasgow, the Fife and Kinross Asylum, and
acquired all the information they were able respecting the working of the
boarding-out system at Kenoway, &c.—the main object of their visit.

We are glad to know that the Commission are gratified with the attention
paid them in Britain, and feel themselves repaid for their labours by the
welcome accorded them and the information they were able to collect. We on
our part must express our sincere pleasure in the visit of the Commission to our
shores, our sympathy with their laudable object, and our desire that their
endeavours may bear fruit in the amendment, so far as amendment is needed,
of the lunacy law of 1838, which, notwithstanding its shortcomings at the
present day, was a monument of legislative wisdom at that period. On the
return of the Commission to France, the following appeared in the Telegraphe
(Paris), 25th October, 1883 :—

“ Ce voyage vient de se terminer; les s^nateurs sont rentres a Paris hiey.

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1884.]

Notes and News.

615

Partont ils ont bt6 aooueillis non settlement aveo le pins grand empressement
mais aveo nne r6elle distinction.

“ Lea ambassadenrs de France aupr&s desqnels ils dtaient accreditee, les
ministres des diverses puissances avec lesquels ils ont ete mis en rapport, les
ali6nistes les plus eminents des pays parcourus ont facilite leur tAche avec la
plus extreme courtoisie.

“ Les etablissements dignes de quelque interet general, special ou historique,
ont ete visits ; les portes de tons les asiles, celles des prisons pour les ali6n6s
criminels leur ont ete largement ouvertes; des conferences nombreuses et
prolong^es aveo les ad ministrateurs les plus 41eves du service n’ont laissA dans
l’ombre aucun detail important.

“La delegation rapporte un nombre considerable de documents precieuxj
sa tache en sera facilitee et tout permet d’espArer que la session de 1884
ne se terminera pas sans que le projet de loi du gouvernement soit discute
et vote aveo certaines modifications deja pressenties et dont l’etude et la
reflexion preciseront la nature et l’importance.’’

DALRYMPLE HOME FOR INEBRIATES.

With a view to giving a really fair trial to the Habitual Drunkards Act of
1879 a new establishment, under the above name, was opened yesterday at
Rickmansworth. It is prettily situated on the banks of the Colne, and will
accommodate sixteen patients. The plan of management has been worked out
by Dr. Norman Kerr, F.L.S., and an influential committee, aided in the first
instance by a gift of £1,000 by Mrs. Dalrymple, widow of Dr. Dalrymple,
who took great interest in the reclamation of inebriates. Patients will be
admitted either under the provisions of the Act, binding them to remain
twelve months, or by voluntary and private engagement, on payment ranging
from a guinea and a half per week upwards. The home is under the manage¬
ment of Dr. J. Smith, late honorary surgeon to the Royal Surrey County
Hospital, in whose experience, skill, and judgment the greatest confidence is
placed. Six applications have already been received and accepted—three
under the Act, with the stringent provision that the dipsomaniac himself and
two witnesses shall make formal deposition before a magistrate, and three by
private stipulation. It is understood that, in order to avoid an evil that has
crept in at similar and more secluded establishments, the use of alcohol shall
be permitted only by special medical order. Hopes are entertained that
sufficient contributions and donations may be received to enable the Com¬
mittee, which is presided over by the Earl of Shaftesbury, to open a home for
women suffering from the effects of habitual inebriety. On the invitation of
the Committee, a party of about eighty ladies and gentlemen went from
Euston yesterday to see the new home. The company included Canon
Duckworth, Lord Claud Hamilton, Dr. Norman Kerr and Mrs. Kerr, Sir
Martin Tapper, ex-Prime Minister of Nova Scotia; Sir Spencer Wells, ex-
President of the Royal College of Surgeons j Dr. Hare, President of the
Metropolitan Branch of the British Medical Association; Dr. Hack Tuke;
Mr. John Taylor, President of the National Temperance League; the Very
Rev. Dr. Diokeson, Dean of the Chapel Royal, Dublin, and Chairman of the
Church of Ireland Temperance Society ; Mr J. H. Raper and Mr. F. Hilton,
United Kingdom Alliance ; Mr. R. Roe, National Temperance League; Dr.
George Eastes and Mrs. Eastes, Mr and Mrs. Axel Eustafson, the Hon.
Reginald Capel, Mr. Gilliatt, Prof. Sydney Thompson, Mr. F. S. Alford, and
Dr. Bridgewater. The home is a well-furnished house, containing dining¬
room, drawing-room, billiard-room, and fairly good-sized bedrooms, overlooking
a garden and a tennis-lawn, and a wide stretch of verdant country beyond.
The situation and comparative seclusion are, indeed, all that could be desired.
The sanitary arrangements have been adequately carried out under the direo-

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616

Notes and News.

tion of Mr. H. H. Collins, F.R.I.B.A. At a meeting in the billiard-room, presided
over by Canon Dookworth, speeches in support of the object in view were
made by several of those present. It was strongly urged by the medioal
men and other gentlemen competent to form an opinion that the habitual
drunkard is, by the continual use of stimulants, deprived of all will-power to
resist the fatal fascination, until the natural tone of the system is recovered
by a sufficiently long period of total abstinence .—Daily News , Oct. 30.

Appointments,

Burke, Hubebt, W., L.R.C.S., L.R.C.P.Ed., L.S.A.Lond., to be Resident
Medioal Officer to St. George’s Retreat, Burgess Hill, Sussex.

Bush, J. D., F.R.C.S., to be Clinical Assistant to the Birmingham Borough
Asylum.

Cocks, Horace, M.B., C.M.Ed., to be Assistant Medical Officer to the Rubery
Hill Lunatic Asylum, Bromsgrove, Worcestershire.

Drapes, Thomas, M.B., to be Resident Medical Superintendent to the Ennis-
corthy Lunatic Asylum.

Glendinning, James, M.D., F.R.C.S., to be Medical Superintendent of the
Joint Counties Asylum, Abergavenny.

Hill, Hugh Gardner, M.R.C.S., to be Assistant Medical Officer to the Cane
Hill Asylum.

Nelis, William F., L.R.C.P.Ed., to be Senior Assistant Medical Officer to the
Joint Counties Asylum, Abergavenny.

Rowe, Edmund L., L.R.C.P., and L.R.C.S.Ed., to be Second Assistant Medical
Officer to the County Asylum, Gloucester.

Richardson, William, M.B., C.M.Edin., Senior Assistant Physician, Crich¬
ton Royal Institution, Dumfries, has been appointed Medical Superintendent of
the Isle of Man General Lunatic Asylum, Douglas.

Thompson, D. G., M.D.Ed., to be Senior Assistant Medical Officer to the Cane
Hill Asylum.

ASYLUM REPORTS.

The Editors will be obliged to the Superintendents of Asylums to send them
their Annual Reports, addressed to Messrs. Churchill. Very few reach them
at present.

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STATISTICAL TABLES

or THE

llt£&jjC0-|)sgtfwlogkal lUsoriatiotr.

ADOPTED 1883.

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[ 2 ]

TABLE I.

Showing the Admissions, Re-admissions, Discharges and Deaths during the Year
ending 31s* December , 18

In the Asylum, January 1st, 18

Gases admitted—

First admissions

Not first admissions.

Total Cases admitted during the year ...

Total cases under care during the year...

Cases discharged—

Recovered .

Relieved.

Not improved.

Died.

Total cases discharged and died during )
the year . i

Remaining in the Asylum 31st Dec., 18

Average number resident during the year

Persons * under care during the yeart...

Persons admitted „ »

Persons recovered „ »

Transferred J to this asylum .

„ from this asylum.

* Persons, t.e., separate persons in contradistinction to “ cases ” which may include the
same individual more than once. L _ _ . ..

t Total cases, minus re-admissions of patients discharged during the current year.

X Patients transferred from one asylum, &c., to another, even when re-certified, are to be
regarded as transfers,

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[ 3 ]

TABLE Ia.

Showing (1) the Previous Attacks among Persons Admitted during the Year 188 ,
and (2) the Number of Times they had Previously Recovered in this or any Asylum .

(1) Number of Previous Attacks.

Persons.

Male.

Female.

Total.

Have had 1 Attack

„ 2 Attacks

»» 3 „

»» 4 ,,

(2) Number of Times Patients
Recovered.

In this Asylum.

Once.

Twice .

8 times .

4 .

5 „ .

6 „ .

F. | T.

In any Asylum.

M. F.

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Google

[ 4 ]

TABLE II.

Showing the Admissions , Re-admissions , Discharges and Deaths , /rom tfa opening of
the Asylum to the 31 st December , 18

Persons admitted during the period of

— years .

Re-admissions .

Total cases admitted .

Discharged cases —

Recovered .

Relieved .

Not improved.

Died.

Total cases discharged and died since
the opening of the asylum

Remaining 31st December, 18 ...

Average number resident during the

— years.

Transferred to this asylum

„ from this asylum ...

N.B.—If not practicable to obtain these figures from the opening of the asylum, it is
hoped that the information will be carried back as far as possible.

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[ 5 ]

TABLE IIa.

Showing the Admissions and Recoveries of Persons* from to

the present date, 31sf December , 18 •

( years.)

History of Recoveries of Persons.

The same, only omit¬
ting all Persons
Transferred from
other Asylums, &c.

Persons admitted during the years

5S8

513

1051

340

322

662

Of whom were discharged recovered,')
during the same period, being 21*9 >■
per cent, of persons admitted ... )

115

114

329

108

107

215

(32-4)

Of whom were re-admitted relapsedt ...

Leaving recovered persons who have’)
not relapsed . ... )

170

156

Relapsed persons discharged recovered^

Net |J recovered persons, being 191 per")
cent, of persons admitted ... 5

101

200

186

(t8.1)

N.B.—If not practicable to obtain these figures from the opening of the asylum, the
information should be carried back as far as possible.

* Persons, i.e., separate persons in contradistinction to cases which may include the same
individual more than once.

Re-admission applies only to re-admission into this asylum,
t i.e., Persons who have relapsed one or more times,
t i.e.. After last re-admission, if relapsed more than once.

|| i.e.. Recovered persons sane at the present time so far as the asylum statistics show.

The figures in this table are merely given as illustrations.

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TABLE III. (Unchanged.)

Showing the Admissions, Discharges, and Deaths, with the mean Annual Mortality and proportion of Recoveries per Cent, of the
Admissions , for each Year since the opening of the Asylum , ,18

[ 6 ]

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£ *

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£ $

apjuxa^

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« ; o : m

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ass*!

si 0-2 I

TABLE V.

Showing the Causes of Death during the Year 18 , together with the Ages at Death .

[ 8 ]

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a I 1

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ifs

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Cause of Death.

The Committee
recommend that
the nomencla¬
ture of Diseases
of the College of
Physicians be
adhered to, as
far as possible.

| Total .

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Ascertained by post mortem examinations . Males ; Females.

TABLE VI.

Showing the Length of Residence in those Discharged Recovered , and in those who
have Died , during the Year 18

Length of Residence.

Recovered.

Died.

Under 1 month .

1 month and under 3 months.

3 months and under 6 months

6 months and under 9 months

9 months and under 12 months

1 year and under 2 years .

2 years and under 3 years .

3 years and under 5 years .

5 years and under 7 years .

7 years and under 10 years .

10 years and under 12 years .

12 years and under 15 years .

15 years and under 20 years .

20 years and under 25 years .

25 years and under 30 years .

30 years and under 35 years .

35 years and under 40 years .

40 years .

Total .

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Showing the Duration of the Disorder on Admission in the Admissions , Discharges , and Deaths , during the Year 18

[ 10 ]

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Total

TABLE VIIJ.

Showing in Quinquennial Periods the Ages of those Admitted, Recovered, and Died, during the Year 18 , and of those remaining

on 31s* December, 18 . v

[ ii J

Patients Resident
31st December, 18 .

Total.

Female.

■3

The Deaths.

Total.

Female.

Male.

Recovered.

Total.

Female.

Male.

The Admissions.

Total

■

Female.

■

Ages.

5 years and under 10 years .

10 years and under 15 years .

15 years and under 20 years .

20 years and under 25 years .

25 years and under 30 years .

30 years and under 35 years .

35 years and under 40 years .

40 years and under 45 years .

45 years and under 50 years .

50 years and under 55 years .

55 years and under 60 years .

60 years and under 65 years .

65 years and under 70 years .

70 years and under 75 years .

75 years and under 80 years

80 years and under 85 years .

85 years and under 90 years .

Unknown .

Total .

Mean Age .

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TABLE IX.

Showing the Condition as to Marriage , in the Admissions , Recoveries , and Deaths , during the Year 18 , end of

Patients Resident December 31sf, 18

[ 12 ]

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Total

Showing the probable Causes of Insanity in the Patients Admitted during the Year 18

t 13 ]

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Note. —* With reference to the distinction between “ predisposing ” and “exciting” causes, it must be understood that no single cause is enumerated
as both predisposing and exciting in the case of any individual patient,
t The figures in the Total column represent the entire number of instances in which the several causes (either alone or in combination with
others) were stated to have produced the mental disorder. The excess of the aggregate of such causes over the number of patients
admitted is owing to combinations of causes.

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* The subclasses are optional; other classes as Delusional or Moral Insanity may be inserted. Congenital, Epileptic, General Paralytic, and
Puerperal Oases, &c., are not to be repeated under other headings,
t Including cases which, while not acute in the sense of “ active, are recent.

[ 15 ]

TABLE XII.

Showing the Station or Occupation of Patients admitted during the Year 18

MALES.

Accountants .

Artist .

Architect.

At School .

Army Pensioner ... ..

Agent .. .

Bakers .

Barristers.

Blacksmith.

Boot and Shoe-makers.

Brick-maker .

Brass Finisher .

Bookbinder.

Butcher .

Coach-builders .

Clerks .

Coachmen..

Cork-cutter .

Carmen .

Cabinet-maker .

Carpenters.

Compositors .

Cabmen .

Chair-maker .

Cheesemonger .

Carpet Printer .

Drapers .

Drover .

Engine Fitter .

Engineers.

Farrier .

Farmers .

Fireman .

Fishmonger .

Carried forward.

The Occupations mentioned in this

Brought forward.

House Painters .

Horse-keepers and Stablemen ...

Hawkers .

Hair-dresser .

Iceman .. ...

Labourers.

Lamp-maker .

Money-taker .

Musician .

Miner .

Oilshop-keeper .

Paper-maker .

Police Pensioner.

Professors of Languages

Plasterer .

Porters .

Pianoforte Stringer .

Surgeon .

Servants ... .

Stoker .

Soldiers

Silk-weaver .

Sailor .

Sawyer .

Tailors .

Travellers ... ..

Waiter .

Upholsterer .

&c.

No Occupation .

Not ascertained.

Total.

Table are merely given as examples.

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[ 16 ]

TABLE XII.— Continued.

Showing the Station or Occupation of Patients admitted during the Year 18

FEMALES.

Brought forward.

Artist .

Boatwoman .

Barmaid .

Box-maker.

Charwomen .

Cooks .

Dressmakers .

Feather Curler .

Governesses .

Housekeepers .

Ironers .

Laundry Women.

Lodging-house Keeper ...

Milliners .

Map Colourer .

Nurses .

Needlewomen .

Prostitute.

Servants .

Shopwoman .

Shop-keeper .

Tailoress .

Teacher of Music.

Widow of—

Carter .

Cabman .

Valet .

Daughter of—

Accountant.

Bronze Powder Manufacturer
Cabinet-maker
Engine Driver

Farmer .

Newsagent
Wheelwright

Carried forward

Wife of—

Bricklayer’s Labourer ..

Bricklayer.

Boot-maker.

Brewer’s Servant.

Carman .

Cabinet-maker .

Constable.

Commercial Traveller

Collector.

Carpenter.

Cook.

Coachman.

Glazier .

Haybinder.

Labourer.

Metal Polisher .

Plumber .

Porter .

Publican .

Roadman.

Stone Mason .

Stationer’s Assistant

Sign Writer .

Seedsman ...

Ship’s Steward .

Tailor .

Undertaker.

Warehouseman .

&c.

No Occupation ...

Not ascertained.

Total ...

The Occupations mentioned in this Table are merely given as examples.

]

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INDEX TO VOL. XXIX.

Acute delirium, treatment by cold baths, etc., 591
Adam, Dr. J., cases of self-mutilation by the insane, 213

„ „ „ case of melancholy with stupor and catalepsy, 508

.ffisthesiometer, a new instrument for measuring sensitiveness of skin, 119
44 After-Care " Association. Annual Meeting for 1883, 455
Alcoholic excess and lead poisoning causing insanity, 394
Alcoholisohen Geisteskrankheiten in Basler Irrenhause, eto., 278, 576
Alienism, the data of, 31

Alterations in the nervous centres from ergotism, 426
Alternative (the) : a study in psychology. (Rev.), 271
Animal heat, effect of caffeine and alcohol on, 167
Ante-chamber of consciousness, 573
Apes and man, the first bridging gyrus in, 117
Aphasia, sensorial or word deafness, 431
Apoplexy, mental symptoms precursors of an attack, 90
Appointments, 146, 328, 458, 616

„ recent lunacy, 401, 456

Artificial feeding in cases of refusal of food, 312
Asylum benefit club, 454
„ beer dietary, 248
„ fire in, 402

„ large and small, value of, 1, 205, 309
„ management, some minor matters of, 373
„ recovery of, as influenced by size, etc., 4
„ relative cost of large and small, 1
„ reports, 284, 432

Attendants, difficulty in getting suitable, 286, 292, 302
„ special training of, 459, 293
Auditory centre, the, 120

Bacon, Dr., death of, 137
Baths, prolonged, treatment of insanity by, 287
Beer dietary in asylums, 248, 290
Boarding-out system, 308
Bone-degeneration in the insane, 452
Boyd, Dr., death of, 402, 599
Brain, auditory centre of, 120
„ disease due to lead, etc., 593
„ first bridging gyrus in man and apes, 117
„ results of removal of parts, 118
„ specific gravity of, 589
„ symmetrical tumour at base of, 246
„ visual centre, 119

British Medical Association Meeting, Sec. G., 451

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618

INDEX.

Caffeine, in relation to animal heat, 167

Camnheli *?£ ^ T' hyo8cyamin “ a Primitive agent, 138

t ‘ n ■’ ? ln0r ma “ ers of management in asylums, 373
Campbell Clark, Dr. A., special training of asylum attendants, 459
»> »» a » phthisical insanity, 391

Capacity of the cranium in“e a, °° h0li8m ‘“S’ 89 <

Cappie, Dr., on the causation of sleep. (Rev.) 108
Cases, Notes on Special— ’

Acute loss of memory, 65
Cole (Medico-legal), 539, 612
Exophthalmic goitre with mania, 521
Feigned insanity, 81

General paralysis in a young woman, 241, 530

~ ( doubtful ) with pachymeningitis, 512. 519

Gouldstone (Medico-legal), 534 6 ’ *

Impulsive insanity, 387
Insanity of twins, 400

„ following alcholic excess and lead poisoning, 394
Melancholy with stupor and catalepsy, 608
Mental symptoms precursors of apoplexy 90
Monasterio case, 253
Murder during temporary insanity, 382
Phthisical insanity, 391
Rapid death with maniacal symptoms 245
Self-mutilation by the insane, 213
Senile insanity with remarks, 231
Tubercular meningitis in insane adults, 219
Unilateral sweating, 396
Causation of sleep. (Rev.), 108
Causes of insanity, 546

„ and prevention. (Rev.), 412
Cerebral localization of mental disease, 452
Chapman, Dr. T. A., recovery and death rates of asylums, 4
Character and hallucinations of Joan of Arc, 18
Children, disorders and deficiencies of speech in, 122
„ souls of, 114

Civilization and liability to insanity, 413
Clark, Dr. A. Campbell, clinical abstracts, 391
Classification of mental disorders, difficulty of 582
Cleland, Prof. J., on the seat of consciousness, 147
«’! . ” ” an answer to by Dr. Mercier, 498

Clinical study of mental diseases and psychology, 595
Clogs, use of in asylum, 381 J

‘‘Closed asylums are but gilded prisons,” 310

Clouston, Dr. T. S., female education from a medical point of view, 100
” ■’ t lGtfcer 0n recent lun acy appointment, 444

Commissioners in Lunacy, reports, England 544, Scotland 552, Ireland 558
Comparative size of crania of townspeople and villagers 117

Consciousness, basis of, 498 6 9 *

» seat of, 147
Correspondence—

Between Parliamentary and Pensions Committee and Mr. Gladstone, 128
„ Medico-Psychological Association and the Commissioners, 132
” jgg tf ” »» and Chancellor of Exchequer,

Proposed reprint of Scott’s “ Discoverie of Witohoraft,” 135
xlyoscyamine as a means of punishment, 138

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Google

INDEX.

619

Correspondence—

New statistical tables, 324
Miliary sclerosis, 325
Recent lunacy appointment, 444
Shakespeare, examination of remains, 457
Cost of large and small asylums, relative, 1

„ maintenance in county and borough asylums, 551
Costelloe, Dr. B. F. C., retrospect of mental philosophy, 111
County Board bill and pensions of medical officers, 97
Counter-lifting, 595

Cowan, Dr. F. M., lunacy legislation in Ireland, 158
„ „ „ general paralysis in a woman, 530

Crania, comparative size of, 117
Crime and madness, 258

Criminal law of England, history of. (Rev.), 258, 329
Criminal lunatics, 330, 408, 444
„ types, 566

Dalrymple home for inebriates, 615
Danish medico-psychological literature, 305
Data of alienism, 31

Death-rates influenced by size, etc., of asylum, 4
Definitions of insanity, 475, 580

Delirium tremens and acute delirium, treatment of, 591
„ hypochondriacal, 592
Delusional insanity, 196
Dementia, 198

„ acute, pathology of, 355

Diarrhoea, severe, in an asylum, 302
Diathesis, 45
Dietary in asylums, 380
Dress of patients, hints as to, 381
Drunkards, disease of spinal cord in, 428

Educated imbeciles, 453

Education, female, from a medical point of view. (Rev.), 100
„ excessive, cause of insanity, 413

Electricity in treatment of insanity, 318, 415
Electric light in asylum, 601
Eleotro-diagnosis in nervous diseases, 106
Empirical theory of vision, 118

Employment of the insane as a curative agent, 95, 286, 303, 375, 433, 451
English psychological retrospect, 284, 432
Enquiries into human faculty and its development. (Rev.), 564
Epileptic and suicidal class, special care of, 549
„ fits, loss of weight after, 430
Ergotism, effects of on nervous system, 426
Exophthalmic goitre with mania, case of, 521

Fallacy in the knee phenomenon, 429
Farms, asylum, value of, etc., 375
Feigned insanity, case of, 81
Female education, 100
Fire in an asylum, 289, 402

Fibrine in blood, excess of, in general paralysis, 597

Folie k Deux, study of, 598

Food, refusal of, 178,312

Fox, Dr. Francis Ker, death of, 136

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620

INDEX,

France, contemplated lunacy legislation in, 614
French psychological retrospect, 591

Galton, Mr. Francis, enquiries into human faculty, eto. (Rev.), 564
Gasquet, Dr., Italian retrospect, 586
General paralysis, 241, 453, 512-
In a young woman, 241
Pathology of, 453, 512
Case resembling, 519
In a woman, 530
Temperature, in, 586
Due to lead poisoning, 593
Increase of fibrine in blood, in, 597
German psychological retrospect, 117, 425
Gill, Joseph, sentence on—attempts murder, 319
Gill, Mr. Henry Clifford, death of, 136
Gouldstone, case of, murder, 634,602, 603
Grant, 4s., effect of, 290

Greene, Dr. Richard, case of impulsive insanity, 387

Green, Prof. T. H., death of, 111

Gyrus, first bridging, in man and apes, 117

Hallucinations of Joan of Arc, 18

Hammond, Dr. W., insanity in its medical relations. (Rev.), 579
Heating asylum, 295
Hegelism, criticism on, 112

Hdr6dit6 psychologique, par Th. Ribot. (Rev.), 98

History of the Criminal Law of England. (Rev.), 268

Holland, lunacy legislation in, 158

Homicide, cases of, 319, 382,387

Homicidal impulse, 433, 596

Huggard, Dr. W. R., definitions of insanity, 475

Hughes-Bennet, Dr., electro-diagnosis in disease of the nervous system.
(Rev.), 106

Human faculty, enquiries into. (Rev.), 564
Hyoscyamine as a means of punishment, 138
„ „ medicine, 588

Hypnotism, mental condition in, 55,124, 688

„ use of, in cases of refusal of food, 315
Hypochondriacal delirium, 692
Hysteria, effects of marriage in, 50
,, employment of metals in, 695

Hyst&riques, 6tat physique et etat mental. (Rev.), 408

Ideas, rapidity of, measured, 571

Idiots, education of, association with other lunatics, 301
„ legal responsibility in, 467
Imbeciles, educated, responsibility of, 467,463
Impulsive insanity, 387, 433, 696
Increase of insanity discussed, 544
Index Medico-psychologicus, 139, 326
Inebriates, Dalrymple home for, 615
Insane, punishment of, 93, 138
„ employment of, 95

Insanity, causes and prevention of. (Rev.), 412
„ definitions of, 476
„ delusional, 196
„ feigned, 81

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INDEX.

621

Insanity, following alcoholio exoess and lead poisoning, 394
„ gestational, 202

„ homicidal, 319, 382, 387, 433, 596

„ hysterical, 204

„ impulsive, 200, 387, 433, 596

„ in its medical relations. (Rev.), 579

„ of lactations, 204

„ of pubescence, 201

„ of twins, 400

„ puerperal, 202

„ prognosis in, 188

„ phthisical, 391

„ relation to diseases of women, 425

„ senile, 231

„ treatment of by electricity, 415

„ „ „ hyo8cyamine, 138, 538

Intentional actions are in greater part unoptional, 275
Ireland, asylums in, report of, 558
Ireland, Dr., Joan of Arc, 18

„ „ German retrospect, 117

„ „ on Shakespeare’s remains, 457

Italian psychological literature, 586

Joan of Arc, character and hallucinations of, 18
Johnstone, Dr. J. C., exophthalmic goitre with mania, 521

Kesteven, Dr., letter on “ Miliary Sclerosis,” 325
Knee-jerk phenomena, source of fallacy in, 429

Laekgue, M., death of, 321
Lavatories, 382

Lead poisoning with insanity, 394

Legal procedure in ascertaining mental state of prisoners, 539
„ responsibility in insanity, 435, 467
Lewis, Dr. Bevan, oaffeine in relation to animal heat, etc., 167
Lunacy Commissioner, appointment of, 444, 456
Locomotor ataxia, 430
Loss of weight after epileptio fits, 430
Lunacy board, changes, 456
„ legislation in France, 614
„ „ „ Holland, 158

McDowall, Dr. T. W., French retrospect, 305, 591
Mania, mental exaltation, 188
„ pathology of, 485
„ transitoria, 587

Manley, Dr., case resembling general paralysis, 519
Marriage in neurotic subjects, 49,126
McDowall, Dr., Danish retrospeot, 305
„ „ French retrospeot, 591

Medical offioers of asylums, pensions of, 97
Medico-legal cases, 382, 534, 539, 596, 602, 603, 612
Medico-psychological association meetings—

At Bethlem Hospital, 21st Feb., 1883,124
„ „ „ J 8th May, 1883,311

„ Glasgow, 18th April, 1883, 317

„ Royal College of Physioians, London, annual meeting, 27th July, 1883,
435

„ Bethlem Hospital, London, 26th October, 1883, 599
Presidential address, 329

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622

INDEX,

Melancholia, puerperal, 204
„ senile, 239

„ attonita, pathology of, 355

Melancholy with stupor and catalepsy, 508
Memory, acute loss of, 85
Meningitis, resembling general paralysis, 519
Mental condition in Hypnotism, 55, 124

Cerebral circulation, 59 Galvanic reaotion, 62

Muscular sense, 63 Muscles, action of, 60

Bespiration and circulation, 59 Sensations, 63

Special senses, 63 State of pupils, 58

Susceptibility to suggestions, 71 Volition, 69

Mental philosophy, retrospect of, 111
Mental symptoms precursors of an attack of apoplexy, 90
Mercier, Dr., the data of alienism, 31

„ „ the basis of consciousness, 498

Metah, employment of, in hysteria, 595
Metropolitan counties branch, South London district, 602
Mickle, Dr. A. F., twins in similar states of imbeoility, 400
Mickle, Dr. J., tubercular meningitis in insane adults, 219
„ „ „ unilateral sweating, 396

„ „ „ visceral and other syphilitic lesions in insane patients

„ „ „ without cerebral syphilitic lesions, 492

Miliary sclerosis, 27, 325
Milk as a drink instead of beer, 290, 293
Miller, Geo., case of murder, 382
“ Mind.” (Bev.), Ill

Minor matters of management in asylum, 373
Monasterio case, 253
Munk’s visual centre, 119
Murder, cases of, 382, 389, 534

„ during temporary insanity induced by drink, 382

Nerve-cells, state of, in case of melancholia attonita., 355
Nervous centres, state of, from ergotism, 426
„ „ minute anatomy of, 590

„ system, electro-diagnosis in diseases of, 106
„ „ treatise on diseases of, 585

Neurotic subjects, marriage in, 49, 126

Nicholson, Dr. B., proposed reprint of Scott’s u Discoverie of Witchcraft,” 135
Nitrous-oxide gas intoxication experiences, 112
Non-restraint, 597

Note on a case of impulsive insanity, 387
Obituary notices—

Bacon, Dr. G. M., 137 Everts, Dr. B. H., 456

Gill, Mr. H. C., 136 Fox, Dr., F. K., 136

Tuke, Mr. W. S., 323 Las&gue, M., 321

Boyd, Dr. B., 456 Wilbur, Dr. F. B., 322

Open-door system, 291, 304, 311, 378, 456
>f „ „ risk of prosecution, 456

Orange, Dr. W., presidential address, 329,444
Original articles—

Alienism, data of, 31

Apoplexy, mental symptoms precursors of an attack, 90
Alcoholic insanity and lead poisoning, 394
Asylum attendants, special training of, 459
„ management, minor matters in, 373

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INDEX.

623

Original articles- -

Beer dietary in asylums, 248

Caffeine in its relation to animal heat, 167

Cole, case of, and the legal procedure in ascertaining the mental condition
of prisoners, 539
Consciousness, seat of, 147
„ basis of, 498

Criminal lunatics, presidential address, 329
Dementia acute, state of nerve cells in, 355
Definitions of insanity, 475
Exophthalmic goitre with mania, 521
Feigned insanity, 81
Food, refusal of, prognosis in, 178
General paralysis in a young woman, 241
„ „ doubtful cases of, 512

„ „ cases resembling, 519

„ ,, woman, 530

Gouldstone, case of, 534
Hypnotism, mental condition in, 55
Holland, lunacy legislation in, 158
Impulsive insanity, 387

Joan of Arc, character and hallucinations of, 18

Large and small asylums, 205

Legal responsibility in educated imbeciles, 467

Mania, pathology of, 485

Marriage in neurotic subjects, 49

Melancholy with stupor and catalepsy, 508

Memory, acute loss of, 85

Melancholia attonita, 355

Miliary sclerosis, 27

Monasterio case, 253

Murder during temporary insanity, 382

Pachymeningitis, cases of, 512

Phthisical insanity, 391 *

Presidential address, 329

Prognosis in insanity, 188

Bapid death with maniacal symptoms, 245

Becent lunacy appointment, 401

Beoovery and death rates of asylums as influenced by size, etc., 4
Belative cost of large and small asylums, 1
Self-mutilation by the insane, 213
Senile insanity, 231
Southall park, catastrophe at, 402
Sweating, unilateral, 396
Symmetrical tumours at base of brain, 246
Syphilitic lesions in insane patients, 492
Tubercular meningitis in insane adults, 219
Twins, insanity of, 400
Overcrowding asylums, evils of, 433
Overtasking of pupils at school, 121

Pachymeningitis, 612

Parliamentary and pensions committee, correspondence, 128
Pathology of mania, 485

„ of certain cases of melancholia attonita, 355
Pensions of medical officers of asylums, 97, 128
Perioerebritis (general paralysis), 597
Persistence, survival and reversion, 45

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624

INDEX.

Phthisical insanity, 891
Plaxton, Dr. J. W., miliary sclerosis, 27
Poliomyelitis potatorum, 428
Porencephaly, 122

Presidential address, criminal lunacy, 329, 436, 444
Private asylums v. publio institutions, 300
Prize essay, 443

Prognosis in cases of refusal of food, 178, 312
„ „ insanity, 188

Psyohomotor region, 411
Psychometric experiments, 571
Puerperal diseases in relation to insanity, 425
„ melancholia, 204

Punishment of the insane, 93

. >> >» » by hyoscyamine, 138

Pupil dilatation of rapidity, 690

Pace and nationality in connection with insanity, 32
Rayner, Dr. H., relative cost of large and small asylums, 1
Recent lunacy appointment, 401
Recoveries from insanity, remarkable, 298

Reoovery and death rates of asylums as influenced by size, eto., 4
„ from insanity of seven years’ standing, 318
Rectal feeding and medication, 601
Regi&o psychomotry, 411
Relative cost of large and small asylums, 1
Relation of pauper lunacy to density of population, 655
Relapsed cases, remarks on, 304
Reports of commissioners in lunacy for England, 544
a ft „ Scotland, 552

„ inspectors „ Ireland, 558

Responsibility of criminal lunatics, 261, 349,444

„ legal, is it acquired by educated imbeciles, 467
Retrospect, psychological—Danish, 305

tt tt English, 284, 432

tt tt French, 691

ft ^ German, 117,425

it a Italian, 586

tt a Mental philosophy. 111

Ribs, fractures of, 289, 295
Robertson, Dr. A., case of feigned insanity, 81

a tt recovery from insanity of seven years’ standing, 318

„ Dr. 0. L., letter to the First Lord of Treasury on pensions, etc.|

128

Savage, Dr. G. H., acute loss of memory, 85

„ „ marriage in neurotic subjects, 49

tt tt mental symptoms, precursors of an attack of apoplexy, 90

it tt two cases of general paralysis and one doubtful, pachy¬

meningitis in all, 512

„ „ two cases of rapid death with maniacal symptoms, 246

„ „ case of senile insanity, with remarks, 231

School, song of the, 103

„ overtasking pupils at, 121

Scotland, 25th annual report of commissioners in lunacy for, 552
Scot’s “ Discoverie of Witchcraft,” proposed reprint, 135
Self-mutilation by the insane, 213

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INDEX.

625

Senile insanity, with remarks, 231
, f melancholia, 239
Sexual passion in the insane, 587
Shakespeare’s remains, proposed exhumation, 457
Shaw, Dr. T. Clay, on large and small asylums, 205
„ „ „ the new statistical tables, 324

Shuttleworth, Dr. G. E., is legal responsibility acquired by educated imbeciles,
467

Sleep, causation of. (Bev.), 108
Souls of children, study of, 114
Southall park asylum, fire at, 402

Southey, Dr. B., appointment as commissioner in lunacy, 444, 458
Speech in children, disorders and deficiences of, 122
Spine and spinal cord, injuries of, etc. (Key.), 270
Statistical tables, after p. 616
„ „ letter on, 324

Stephen, Sir James, history of criminal law of England. (Bey.), 258, 348, 445

Strahan, Dr., symmetrical tumours at base of brain, 246

Suicide of discharged patients, sad cases, 306, 290

Sutherland, Dr., prognosis in cases of refusal of food, 178, 312

Swallowing of large foreign substances by insane, 600

Sweating, unilateral, 396

Symmetrical tumours of brain, 246

Syphilitic tabes dorsalis, 430

Spyhilis and locomotor ataxia, 430

Syphilitic lesions in insane patients, 492

Tabes dorsalis, syphilitic, 430
Tell-tale clocks, use of, 549
Temperament, 35

Tendon-reflex, examination of patients for, 587
Thomson, Dr. D. G., prognosis in insanity, 188
Transfusion of blood in anaemic insane patients, 587
Training of asylum attendants, special, 459
Tubercular meningitis in insane adults, 219
Tuke, Dr. D. H., mental condition in hypnotism, 55, 124
„ „ comments on the case of Cole, 539

,, Mr. W. S., death of, 323
Twins, insanity of, 400

Unilateral sweating, 396

Visceral and other syphilitic lesions in insane, 492

“ Visionaries,” 569

Vision, empirical theory of, 118

Visual centre, Hunk’s, 119

Volitional morbid influences, 583

Voluntary admission to asylum, 288

Water closets in asylums, 381

Wiglesworth, Dr. J., general paralysis in a young woman, 241
,, „ pathology of melanoholia attonita, 355

„ „ „ mania, 485

Wilbur, Dr. H. B., death of, 322
“ Will," 276

Women, diseases of, in relation to insanity, 425
Wood, Dr., on hypnotism, 124

Digitized by ^.ooQie

626

JNDEX.

Word deafness, 431

Workhouses and asylums for insane, 296

Yellowlees, Dr. D., murder during temporary insanity iaduoed by drinking, 382

ILLUSTRATIONS.

Symmetrical tumours at base of the brain, illustrating Dr. Strahan’s paper,
p. 248

Nerve-cells in cases of melancholia attonita, illustrating Dr. Wiglesworth’s
paper, 355

Pachymeningitis in general paralysis, illustrating Dr. Savage’s cases, 519

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Full text of "The Journal Of Mental Science. 29.1883 84 Minnesota"

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